►
From YouTube: Health and Wellbeing Board, 6 January 2021
Description
AGENDA
1. Declarations of Interest 00:00:39
2. Minutes 00:00:54
3. Public Participation 00:01:08
4. Review of Terms of Reference for York's Health and Wellbeing Board 00:06:19
5. Report of the Independent Chair of the York Health and Wellbeing Board's Mental Health Partnership 00:09:29
6. Building a Health System in York based on Population Health Need 00:29:27
7. Update on Covid-19 01:11:25
8. Better Care Fund Update 02:04:18
9. Healthwatch York Report - Listening to BAME people about Health and Social Care Services in York 02:12:33
For full agenda, attendance details and supporting documents visit:
https://democracy.york.gov.uk/ieListDocuments.aspx?CId=763&MId=12570
A
A
C
A
C
C
I'd
like
to
ask
what
progress
the
city
council
has
made
towards
developing
a
dementia
strategy
for
york
and
when
it's
likely
to
emerge
in
your
own
strategy
document
covering
the
period
2017-2020
to
2022,
you
do
mention
dementia
and
there
was,
as
you
may
recall,
a
presentation
to
the
mental
health
partnership
about
this
by
the
relevant
officer
in
april
2019,
since
when
responsibility
for
dementia
has
passed
to
the
aging.
Well,
partnership
we'd
really
like
to
know
what
progress
has
been
made
and
when
we
might
expect
to
see
at
least
a
consultation
draft
of
the
strategy.
C
D
Yes,
I
mean,
as
steven
mentioned,
the
the
dementia
strategy
was
moved
to
the
aging
well
meeting,
but
I
do
share
his
concern
that
it's
vitally
important
that
we
have
a
a
joined
up
strategy,
which
is
also
heavily
consulted
on.
I
think
it's
an
area
that
is
a
pressing
concern
in
the
if
you're
taking
the
wider
mental
health
concerns
of
the
city
and
what
that
means
for
people
in
in
that
in
that
group.
D
So
I'm
more
than
happy
as
chair
of
the
mental
health
partnership
to
to
work
with
the
aging
well
group
or
meeting,
but-
and
I
will
contribute
to
that
because
I
think
we
have
a.
We
have
a
clear
agenda
to
make
the
environment
and
the
whole
city
dementia
friendly.
But
I
I
I
share
his
concern.
It's
really
important
that
people
with
dementia
and
those
caring
for
those
with
dementia
have
a
say
clearly
in
the
in
the
upcoming
document
that
we
would
expect
to
see.
E
A
A
F
Thank
you
chair.
We've
brought
these
back
to
you
today
with
just
a
few
minor
amendments.
We've
made
some
slight
changes
to
how
we
appoint
to
the
committee
and
also
just
updated
the
membership
to
reflect
it
as
it
currently
is.
So
we're
asking
you
to
confirm
the
changes
annex
one
and
to
confirm
that
you're
happy
for
these
to
be
ratified
at
full
council.
We
will,
of
course,
bring
them
back
if
there
are
any
further
changes.
A
G
So
I
think
there
are
two
opposition
representatives
listed
as
part
of
the
membership
on
page
15,
and
it's
just
that
at
the
moment
we
have
got
three
executive
members
who
sit
on
the
committee
in
one
opposition
representative
in
me.
So
I
don't
know
if
they
need
reflecting
and
changing
to
sort
of
reflect
the
membership
of
the
committee
or
not.
H
A
D
Good
afternoon
chair,
thank
you
for
considering
my
report.
I
will
make
the
timely
assumption
that
most
people
have
actually
had
a
chance
to
go
through
the
report,
but
I
would
I'll
highlight
certain
points,
then
I'll
pause
and
I
will
make
some
comments
at
the
end.
In
relation
to
my
some
of
my
concerns
in
relation
to
the
result
of
the
pandemic
and
what
that
is,
the
consequences
that's
had
for
mental
health
and
the
partners
who
report
back
to
the
the
partnership
group.
Just
that.
D
How?
I
think
we
view
the
the
needs
of
those
individuals
who
are
living
with
multiple
complex
needs
and
how
we
can
how
we
can
start
to
change
the
services
and
how
they
can
access
service
and
listen
to
their
voice.
So
I
just
it's
really,
I'm
grateful
to
those
people.
Who've
been
involved
and
the
ongoing
work
by
lan
kelly
chase
who've
supported
that
right,
the
way
through
the
last
couple
of
years.
I
will
touch
on
the
the
issues
in
relation
to
covid
at
the
end
of
my
report.
D
It
will
eventually
take
to
a
whole
city-wide
approach,
but
we
decided
in
the
last
couple
of
years
that
we
could
work
with
a
whole
group
group
of
community
assets,
community
organizations
supported
by
virtually
everyone
within
the
the
health
agenda.
I
have
to
say,
and
despite
what
people
have
experienced
in
the
last
nine
months,
10
months,
we've
continued
to
make
progress,
which
I'm
I'm
very
grateful
for
doesn't
mean
there
haven't
been
some
challenges
and
their
ongoing
challenges
and
some
frustrations.
D
I
don't
think,
and
we
lost
some
of
the
essence,
but
we
have
received
a
lot
of
positive
recognition
for
the
principles
that
we've
been
embedding
over
the
last
18
months
two
years
and
with
a
heavy
emphasis
on
the
this
will
be
a
three-year
piece
of
work.
The
the
the
community
mental
health
transformation
fund
will
fund
three
years
worth
of
work
with
increasing
funding
each
year
as
we
speak
today.
I
don't
know
what
funding
york
will
receive,
but
we
will
receive
funding
and
it
will
increase
each
year
of
the
three
year
period.
D
We
are,
there
are
certain
elements
within
the,
I
suppose,
not
rules,
but
guidance
that
we
have
to.
We
have
to
include
certain
areas
and
we-
and
we
certainly
will
do
that
again.
They
all
fit
within
the
the
principles
we've
been
working
with,
and
I
would
just
like
to
pay
particular
credit
to
individuals
such
as
officers
chris
weeks,
who's
been
a
driving
force
behind
much
of
that
work
and
some
of
the
the
individuals
working
at
the
laks
at
the
local
area
level.
Who've
really
pushed
forward
on
engaging
with
their
community.
D
D
What
we're
looking
for
is
that
big
conversation
to
be
translated
into
actually
reflecting
the
comments
and
needs
of
service
users,
carers
and
and
other
people
in
the
city
have
contributed,
and
I
know
it's
been
a
regional
approach,
but
I
know
an
awful
lot
of
people
in
new
york
have
made
that
time
to
contribute
and
get
involved
just
working
through
that.
I
think,
there's
there's
a
real
importance
as
we
go
through
the
next
year
that
everybody
who's
represented.
D
The
health
and
wellbeing
board
understands
what
we're
trying
to
achieve,
because
I
fear
that
the
mental
health
challenges
over
the
next
few
years
in
the
city
are
going
to
grow
and
grow
and
that's
backed
up
by
some
of
the
tube
research
work,
and
we
know
the
pressures
that
gps
are
under.
We
know
what's
happening
in
relation
to
issues
in
relation
to
self-harm.
D
D
I
won't
and
there's
a
bit
at
the
end
of
my
report
around
terms
of
reference,
which
I
think
yeah
people
can
note.
What
I
would
like
to
say
in
conclusion,
chair
is
that
I
think
we
are
facing.
I
know
the
covet
has
has
received
huge
coverage,
but
I
think
we
are
facing
a
mental
health
challenge,
which
is
is
huge.
D
I
know
that's
really
difficult
when
people
work
phenomenal
hours
to
respond
to
the
covert
issues,
but,
as
I
say
I
would,
I
would
stress,
the
importance
of
continuing
to
support
the
smaller
partnerships,
the
the
charities
and
cvs
in
general,
because
I
think
they
will
sustain
us
in
the
future
when
there's
some,
which
are
really
close
to
not
being
able
to
sustain
themselves.
So
there's
issues
there
for
that.
D
We
are
committed
to
a
future
of
co-production
we
will
and
in
to
that
end
sean
from
healthwatch
colleagues
from
cvs
and
goes
right
across
the
receiving
service
and
carers
are
going
to
be
involved
in
trying
to
shape
what
our
service
will
look
like
over
the
next
couple
of
years.
But
I
just
would
like
to
pay
credit
to
those
people.
D
A
J
You
caught
me
by
surprise,
though
carol
I
didn't
actually
have
anything
burning
to
say,
but
wow
no,
but
I
will
always
have
something
to
say
so.
Tim
mentioned
about
the
multiple
complex
needs
network
and
I
was
going
to
suggest
that
we
have
them
back
to
do
another
update
because
they've
done
quite
a
lot
of
work
around
cultural
values
and
if
we're
looking
at
co-production
and
different
ways
of
working,
I
think
it's
important
that
we
look
at
some
of
the
work.
J
D
A
H
H
I
think
the
northern
quarter
work
is
very
good
and
I'm
afraid,
I'm
sorry
that
I
I
wasn't
able
in
the
end
to
come
to
that
recent
event
in
in
december.
It
does
include
my
ward,
which
of
course,
I'm
very
pleased
about.
I
just
had
two
questions,
maybe
a
comment
as
well
in
terms
of
the
terms
of
reference
and
and
and
the
board
membership.
H
I
just
wondered
whether,
in
in
the
spirit
of
co-production,
you
would
think
about
including
a
couple
of
places
for
service
users
on
the
board,
and
perhaps
perhaps
your
mental
health
peer
support
group,
maybe
might
might
be
involved
or
into
and
or
individuals.
I
think
it
would
be
good
to
get
that
that
element
at
the
top
level
in
on
the
board
might
might
be
a
good
idea.
Absolutely.
D
H
D
Yes,
yes,
we
do,
and
we're
required
to,
I
think,
there's
two
things
there.
We
always
we
always
thought
that
we'd
start
with
one
section
of
the
city
and
then
spread
it
across
the
whole
city
will
be
required
in
years,
two
and
three
of
the
cmht
funding
to
be
a
city-wide
approach.
So
what
we'll
do
is-
and
I
think
I
said
last
last
time-
I
was
speaking
at
the
board-
any
items
that
come
up
that
can
be
immediately
implemented
across
the
city,
but
in
in
a
in
a
way.
D
D
G
Thank
you,
chair
actually
had
very
similar
questions
to
denise's
about
and
whether
there
could
be
any
kind
of
representation
from
people
with
lived
experience
as
part
of
the
terms
of
reference.
So
I'm
glad
that's
been
addressed
and
also
I
was
going
to
ask
about
sort
of
how
fast
the
northern
quarter
is
going
to
go
out.
City-Wide.
Because
again,
I'm
I'm
always
concerned
when
it's
not
very
asset-based
that
it's
not
addressing
the
need,
and
I
suppose
I'd
be
interested
to
know
how
you
sort
of
square
that
off
with
the
a
gender
item.
G
That's
coming
up
later
about
sort
of
population
based
health
approach
and
how
we
sort
of
need
to
move
from
it
being
sort
of
just
place
based
to
sort
of
altering
it
so
that
we're
meeting
need,
rather
than
sort
of
just
giving
people
services
where
they
already
sort
of
exist.
Because
I
think
that's
always
been
my
nervousness
around
the
northern
quarter
project
that
we're
using
the
assets
which
are
brilliant
and
you
know,
they're
really
stepping
up
in
a
time
of
great
need
for
the
city.
G
D
Yeah
I
wish
I
yeah,
I
suppose
I
I
wish
it
was
easy,
but
I
know
she
said
easiest.
I
think
the
the
I
think
the
point
was
we.
We
thought
we
should
actually
start
to
progress
in
a
way
where
we
thought
we
you
know
we
can.
We
can
learn
quickly
from
certain
issues,
but
I
do
I
I
I
do
hear
what
you're
saying
to
me
about
the
issue
about
we
yeah
it
shouldn't
just
be
place
based
place
based.
It
underpins
much
of
what
the
cmht
proposal
will
have
in
it,
but
it
won't
be.
D
It
won't
be
unique
to
the
north
quarter
and
you're
right.
Often,
services
need
to
be
shaped
in
a
different
way
and
I'd
argue
that's
part
of
the
system,
change
that
needs
to
happen
as
well.
I
think
sometimes
expecting
people
who
are
really
finding
it
difficult
to
get
through
a
day,
let
alone
anything
else
to
to
trail
across
the
city
to
one
side,
for
something
may
not
be
the
answer.
Sometimes
it's
about
taking
services
to
them.
So
I
think
that
there
is
an
awful
lot
of
cultural
change.
D
That's
required,
yes,
there'll
always
be
specialist
assets
and
we're
lucky
to
have
some
very
positive
specialist
assets
in
the
city.
But
I
think
I
would
echo
your
concerns
if
we
were
in
that
position
in
in
one
of
years,
one
year
or
two
years
time,
I
would
expect
it
to
be
a
far
wider
spread
of
services,
and
ideally
I
would
share
your
hope
that
it's
it's
it's
structured
around
the
service
use
and
not
round
bricks
and
mortar
and
other
things.
A
K
D
Absolutely
nigel,
yes,
I
do
believe
it.
It
does
need
to
be
trying
to
find
the
right
balance
because,
of
course,
as
you're
well
aware,
squeezing
time
out
for
yeah
it's
not
because
they
don't
think
it's
important,
but
then
they're
under
huge
pressure,
particularly
when
some
of
the
meetings
are
scheduled.
D
For
so
I
do
think
we
need
to
strengthen
the
the
primary
care
representation,
because
when
we
saw
the
the
national
pilots
they
well
certainly
the
ones
we
saw
one
from
london,
one
from
the
midlands
had
really
strong
primary
care
involvement,
and
I
think
it
possibly
when
I
reflect
on
one
of
the
weaknesses
we've
you
know,
we've
had
as
part
of
the
the
program
is
trying
to
get
the
right
messaging
and
information
into
primary
care.
Because
that's
what
and
I
think
this
so
I
think
it's
a
two-way
street.
Really.
D
Yes,
we
need
the
you
know.
We
need
the
representation
of
the
time,
because
clearly
you
have
such
a
huge
part
to
play
in
this
massive.
But
secondly,
we
need
to
try
and
get
more
information
out
there
in
a
timely
way
and
see
because
you
know
they're
some
of
the
experts
at
primary
level
who
need
to
be
saying.
Oh,
this
is
this
is
this
is
what
the
situation
is.
D
I've
certainly
had
more
positive,
not
more
positive,
because
it
wasn't
negative
in
the
first
place,
but
more
calls
in
the
last
four
weeks
in
relation
to
that
and
and
looking
at
how
they
can
be
involved.
I
say
the
tension
will
be
in
the
immediate
future
time
really,
but
I'd
appreciate
any
help
and
support
you
can
give
to.
You
know
to
increasing
the
involvement
of
primary
care.
Thank.
L
Yes,
yes,
I
don't
want
to
jump
the
gun,
but
I
did
wonder
whether
the
cmht
work,
if
that
is
sitting
under
the
mental
health
partnership,
if
that's,
where
we
kind
of
watch
what's
happening
and
just
have
the
sort
of
the
place-based
discussions,
whether
that
will
help
with
primary
care
representation
as
well,
because
it'll
be
vital
that
they're
involved
in
the
community
mental
health
transformation
work
so
there's
an
additional
reason
for
being
involved
in
the
partnership
that
makes
it
all
come
together.
So
I
suppose
that
was
just
a
thought
in
my
brain
yeah.
M
Wholly
agree,
sean
the
the
con.
The
conversations
we've
had
from
a
place
based
perspective,
meaning
york,
is
that
the
mental
health
partnership
board
would
be
the
the
center
of
that.
The
coordination
of
what
we
bid
for
for
york,
but
also
how
it's
coordinated
and
therefore
primary
care
networks
need
to
be
absolutely
and
they
are
involved.
A
D
Yeah
I
mean
they,
they
are,
and
I
think
it's
it's
in
the
early
days.
It
was
one
of
the
the
obvious
gaps
that
we
were
struggling
to
fill.
I
think,
since
the
cmht
funding
proposal
has
been
there,
there
is
now
it'll,
never
be
enough.
Money
chair,
but
it'll
be
some
money
which
will
get
us
to
a
position
where
we
can
start
to
see
changes.
D
J
A
A
A
N
N
N
We've
previously
discussed-
or
rather
the
board,
has
previously
discussed
that
and
looked
at
some
of
the
data
that
we
knew
about
last
summer,
and
since
then
I
think
we
know
even
more
about
the
way
the
pandemic
has
affected
communities
as
exacerbated
inequalities
has
led
to
people's
health
being
impacted
in
a
real
multitude
of
ways.
That
is
the
first
context.
I
guess
to
any
presentation
that
talks
about
what
our
need
is
as
a
city,
but
the
the
second
two
are
specific.
N
That,
obviously
doesn't
just
extend
to
the
nhs's
care,
but
would
include
social
care
and
other
ways
in
which
we
are
supporting
the
health
and
well-being
of
the
population
and
the
third
one
is
a
document
which
recently
came
out.
The
manages
england
called
integrating
care-
and
this
is
a
policy
document,
but
it's
about
to
enter
into
the
parliamentary
time
scale
to
to
enact
some
legislative
change.
N
That
york
will
become
a
place
in
the
new
nhs
architecture
and
that
will
probably
have
some
repercussions
which
at
the
moment
are
a
little
unclear
for
some
of
the
structures
around
the
nhs
in
the
city
of
york
and
the
purpose
of
presentation
isn't
to
go
into
the
structural
bit.
But
it
is
a
bit
of
context
for
what
we're
about
to
talk
about
the
paper
talks
about
two
things
and
I
wanted
to
make
sure
I
was
really
clear
on
them,
so
I've
done
a
little
diagram.
I
hope
this
does
make
it
clear.
N
It
talks
about
population,
health,
so
the
big
circle,
what
we
do
to
improve
the
health
of
our
whole
population
for
the
city
of
york-
and
this
is
delivered
by
so
many
different
people.
It
comes
out
of
the
third
sector
and
community
and
voluntary
groups.
It
comes
through
statutory
services
from
the
council,
the
nhs
and
and
and
different
bodies,
the
police,
fire
and
rescue
pharmacy
general
practice.
N
How
do
we
use
them?
And
how
do
we
really
sort
of
maximize
their
impact
and
we're
not
starting
from
scratch
and
want
to
acknowledge
that
this
this
board
and
the
work
of
the
board?
The
health
and
well-being
strategy
is
based
on
the
joint
strategic
needs
assessment,
which
has
used
data
for
a
good
number
of
years
now
very
effectively
and-
and
we
take
that
and
we
build
on
it
as
an
asset.
We've
done
specific
work
around
covid
to
understand
health
impact.
N
We've
we've
got
a
couple
of
collaborations
which
to
draw
attention
to
for
north
yorkshire
and
york,
around
population
health
data
trying
to
get
better
access
to
data
and
to
use
data
better,
and
at
the
moment
we
are
being
supported
by
nhs,
england
and
an
organization
called
optum,
specifically
around
population
health
management.
That
is
a
national
program
that
is
being
rolled
out
in
waves
and
humber
coast
of
vale
are
part
of
that
wave
and
york
is
participating
in
that.
N
N
How
many
people
live
in
the
city
of
york
in
the
different
age
bands?
Is
that
number
going
up
or
is
it
going
down,
and
how
do
we
plan
services
to
accommodate
any
additional
people
that
are
coming
in
and
this
would
also
extend
to
those
not
only
who
are
being
born,
but
those
who
are
migrating
into
york
either
from
other
parts
of
england
or
or
the
united
kingdom?
Also
from
overseas
and
migration?
And
things
like
that?
So
will
we
use
regular
data
like
this
to
inform
the
choices
we're
making?
N
The
the
top
six
here
which
are
in
the
most
deprived
20
in
the
country,
and
we
often
look
at
these
areas
to
say
what
can
we
do
to
try
and
improve
the
health
of
these
people
the
fastest
living?
Here
we
might
talk
about
life
expectancy
and
we
monitor
at
this
regularly
and
for
those
who
who
who
have
read
the
marmot
reports
we're
now
on
the
third
one
marmot.
N
My
commandment,
professor
michael
marmot,
from
ucl,
delivered
a
groundbreaking
report
in
2010,
updated
10
years
on,
but
recently
with
a
third
update,
taking
into
account
covid
showing
that
really
2020s,
so
that
the
2010s
was
a
lost
decade
for
life
expectancy
and
in
many
ways
for
improvement
in
health,
and
we
can
see
that
that
is
most
evident,
not
only
in
the
fact
that
overall,
our
life
expectancy
didn't
improve
very
much,
but
actually
for
our
most
poorest
and
for
females
who
are
the
most
poor.
That
was
a
notable
trend.
N
N
So,
where
does
york
not
look
too
healthy
compared
to
other
cities
we
might
compare
ourselves
to
and
we
could
think
about
areas
like
suicide
or
self-harm,
diabetes,
diagnosis,
alcohol
emissions,
smoking
and
pregnancy,
excess
winter
deaths,
areas
which,
I
guess
you
would
say,
yorkis
has
a
red
flag
on.
We
don't
do
as
well
as
other
areas,
but
then
we
also
need
to
think
about
absolute
need.
N
N
Since
then.
So,
essentially,
over
the
last
decade,
the
extra
number
of
people
with
those
conditions,
as
you
can
see
for
a
lot
of
these
long-term
conditions,
we've
added
a
huge
amount
of
chronic
disease.
So
we've
been
looking
at
this
data.
It's
obviously
worrying.
It
drives
a
lot
of
healthcare
use
and
we
took
diabetes
as
a
key
example
and
there's
a
lot
of
numbers
on
this
slide
which
I
won't
go
through.
But
we
started
to
look
at
things
like
risk
factors
for
diabetes,
about
people
who
are
on
the
cusp
of
diabetes.
N
N
So
we
took
this
data,
we
used
the
radar
dashboard
lots
of
figures
on
this,
which
I
won't
go
through
again,
but
this
can
I
mean,
for
instance,
this
could
tell
us
of
the
people
with
diabetes.
Where
are
they
in
which
gp
practice
are
they
in
and
how
many
of
them
had
a
medication
review
in
the
last
12
months,
which
would
be
good
practice?
So
we
can
see
that
actually
there's
a
good
number
that
haven't
and
then
we
can
start
to
identify
who
those
patients
are.
N
We
can
write
out
to
them
and
we
can
say:
can
we
invite
you
in?
We
can
try
and
explore
the
barriers
with
those
patients.
Why
wouldn't
necessarily
they
they
find
coming
to
a
medication
review
to
be
something
they'd
be
up
for
doing?
Can
we
try
and
address
some
of
those
barriers?
Can
we
try
and
walk
through
them
the
journey
that
they're
on
as
a
patient
with
diabetes
and
help
them
to
to
to
manage
their
condition
a
little
bit
better?
N
We
can
then
use
the
data
that
nhs
england
can
help
us
with
to
identify
who
they
are
in
each
gp
practice,
and
then
we
can
start
thinking.
Well,
what
can
we
do
to
address
some
of
the
issues
that
they're
facing
and
try
to
prevent
a
second
condition
rearing
its
head?
Try
and
prevent
that
or
at
least
delay
the
point
at
which
it
comes,
and
we
used
nhs
england
supported
us
to
to
write
a
logic
model,
so
we
think
about
things
like
well,
who
are
the
participants
in
the
city
that
would
help?
N
This
is
a
very
small
on
the
screen
I
had.
I
do
appreciate
that,
but
the
participants
that
we
identified
are
people
working
in
the
voluntary
sector,
move
the
masses
and
good
gym
organizations
like
that
who
may
be
able
to
help
with
this
sort
of
thing:
social
prescribing
local
area
coordination,
but
then
obviously
people
working
in
healthcare,
diabetes,
nurses,
practice,
nurses,
we
think
about.
Well.
N
What
activities
could
we
schedule
in
for
the
cohort
that
we
identify
generally
starting
with
a
conversation
with
the
individual
to
say
what
are
the
barriers
to
help
you
maybe
measuring
their
activation?
So
essentially
how
motivated
they
are
to
change
their
lifestyle
and
maybe
to
change
their
management,
their
condition
and
try
and
say
well
what
what
would
it
take
to
help
you
move
forward
in
that
process?
N
And
then
you
look
to
set
some
outcomes
for
the
program.
You
look
to
say
actually
at
the
end,
can
we
measure
patient
activation
again,
and
can
we
see
that
people
have
actually
moved
forward
and
feel
more
able
to
manage
the
condition
that
they're
in
and
also
they're
enabled
to
so
not
just
about
their
own
ability?
But
it's
are
the
conditions
right
for
you
to
manage.
What
can
we
do
to
help
you
if
it's
finance,
that
is
stopping
you
or
if
it's
quitting
smoking,
which
is
the
key
concern
for
you?
N
Sometimes
this
work
has
been
done
and
it's
actually
made
affluent
people
healthier
and
actually
exacerbated
inequalities.
We
want
to
really
steer
away
from
doing
that.
How
do
we
do
that
and
then?
Thirdly,
how
can
we
bring
a
co-production
approach
into
this
work?
Obviously,
anything
that
works
with
patients
will
try
to
put
them
at
the
center,
but
even
thinking
about
the
work
in
general,
how
do
we
make
sure
that
it
reflects
what
patients
feel
they
need?
N
How
do
we
make
sure
it
doesn't
tread
on
any
difficulties
when
it
comes
to
dealing
with
patient
data
and
we
stay
very
safe
in
the
way
that
we're
identifying
patients
and
contacting
them?
So
we
do
everything
in
a
very
sort
of
robust
manner.
So
so
those
would
be
the
three
questions
chair.
I
wanted
to
leave
the
ball
with,
but
I'm
sure
there
are
plenty
of
others
so
I'll,
just
open
it
up
and
hand
that
to
you
chair
for
comments.
A
Thank
you
very
much
peter.
That's!
That's
really
useful.
Just
to
remind
everybody,
we're
asked
to
do
two
things.
We're
certainly
asked
to
comment,
and
that
is
what
we'll
be
doing
next
and
then
we're
asked
to
endorse
the
approach.
So
can
I
just
have
comments?
First
of
all,
please
or
any
particular
responses
to
the
questions
that
peter
put
up
on
the.
G
I'll
kick
us
off
them
just
by
asking
them.
I
suppose
a
little
bit
more
about
what
everybody's
thoughts
are
on
inequalities,
because
we
know
that
sort
of
poor
health
does
go
hand
in
hand
with
your
economic
situation.
So
I
suppose
it's
what
the
partners
think
we
could
be
doing
and
what
data
do
we
hold
across
the
city
that
could
be
brought
to
bear
sort
of
with
this
project?
G
And
I
suppose,
following
on
from
my
question
previously
about
the
northern
quarter
project
and
the
sort
of
difference
between
asset
based,
I
don't
know
if
this
is
just
me
sort
of
misunderstanding-
the
sort
of
title
of
the
paper,
but
building
a
place
based
health
and
care
system
based
on
population
health
need.
Is
there
any
sort
of
tension
between
those
two
things,
because
how
we've
sort
of
mentioned
place
based
in
the
past,
I
think,
has
been
on
a
sort
of
more
local
level,
and
I
realized
that
it
has
moved
to
it.
G
Being
york
is
the
place
based
now,
but
does
that
alter
sort
of
how
we
think
and
talk
about
it
in
other
sort
of
strategic
documents?
Because
I
know
place-based
approaches
have
been
mentioned
and
my
sort
of
argument
against
that
has
always
been,
but
we
need
to
target
need,
which
is
why
I'm
really
excited
about
this
population
of
need-based
approach
coming
in
now.
So
I
suppose
it's.
How
do
we
sort
of
square
that
circle
and
yeah?
It
might
just
be
that
I've
yeah,
I'm
still
stuck
in
the
old
place-based
sort
of
definition.
G
N
Yeah
happy
to
comment
on
that
as
a
parent.
I
I
think
it
is.
There
is
sometimes
a
little
bit
of
a
tension
between
the
universal
and
the
targeted.
Isn't
there
and
and
getting
a
balance
between
both,
I,
I
think
is
what
we've
ought
to
do
and
I'm
mindful
that
that
york
is
a
a
different
population
to
other
other
cities
even
of
a
similar
size,
in
that
those
who
are
often
struggling,
the
most
in
york
are
in
small
pockets
around
the
city.
N
There's
not
one
side
of
the
city
that
we
would
point
to
and
and
are
often
the
way
that
we've
drawn
our
boundaries
are
often
hidden,
and
I
I've
apologized
to
comment.
Colleagues
have
heard
me
say
this
before,
but
hugh
with
is
a
real
good
case
in
point
of
of
of
the
way
that
a
very
sort
of
quite
an
affluent
area
next
door
to
quite
a
deprived
area.
N
P
Then
you
can
do
in
in
relation
to
some
of
the
more
social
aspects
of
this
and
that
sometimes,
if
you
don't
do
that
in
the
right
way-
and
it's
not
nuanced
correctly-
you
lose
out
on
that
kind
of
the
assets
of
a
local
place
and
the
assets
of
a
community,
and
so
so
to
answer
your
question
around.
How
do
you
use
this
to
prevent
children
coming
into
care?
There
is
some
data
around
you.
Inequality
is
the
thing
that
leads
to
children
being
in
in
care,
and
we
know
that.
P
N
Absolutely
do
amanda
an
example
from
from
more
from
my
world
is,
is
for
a
number
of
years
we
used
to
try
and
predict
hospital
emissions
using
a
tool
which,
actually,
when
we
went
back
and
evaluated
it
turned
out
to
be
really
quite
bad
at
predicting
who
in
the
population,
was
likely
to
access
a
hospital.
It
was
something
like
it
was
a
it
was.
N
If
we
don't
intervene
now,
I'm
trying
to
put
the
intervention
now
rather
than
later,
because
it's
less
costly,
but
also
better
for
them,
and
those
are
the
things
I
think
I'm
more
interested
in.
I
totally
agree
with
you.
The
algorithm
bit
of
it
can
be
misused
and
has
been
a
lot
with
you
know,
sort
of
targeting
of
welfare
benefits
that
sort
of
thing
it's
it's
been
actually
misused
quite
poorly.
In
some
circumstances,
hasn't
it.
A
A
G
H
I'm
not
sure
what
the
right
word
is
corroborating,
that
data
vindicating
getting
feedback
having
it.
You
know
that
from
the
grassroots,
from
on
the
ground
from
the
kind
of
things
amanda
was
talking
about
from
the
local
area
teams
from
from
all
the
networks
that
we're
trying
to
pull
together.
So
if
we
can
bring
those
two
aspects
of
it
together,
we
can
perhaps
have
a
an
approach-
that's
very
powerful,
but
it
seems
to
me
it's
about
balancing
it
is.
H
That
is
that,
would
that
be
fair
to
say
and
I
think
in
terms
of
the
inequality
as
as
anna
said,
I
think.
Obviously,
all
inequalities
are
important,
but
income
inequality
is
obviously
particularly
increasingly
important
at
the
moment.
So
that
would
just
be
my
feedback
as
well,
and
I
suppose
also
just
it
seems
if,
if
this
approaches
is
going
to
progress
well,
we
need
to
make
sure,
from
the
council
perspective,
that
we
reach
all
the
parts
of
the
council
that
could
really
link
into
it
and
and
make
use
of
it.
Perhaps
housing.
H
From
my
perspective
and
just
final
point
that
I
think
applies
to
everything
almost
on
this
agenda
is
that
by
telling
stories,
by
giving
examples,
I
think
it
makes
all
of
this
a
lot
more
accessible
for
people
to
see
how
how
useful
this
is,
because
it's
quite
theoretical,
isn't
it
some
of
it.
But
if
you
can
give
good
examples
of
how
it
works,
that's
really
useful.
A
E
E
E
We've
known
this
for
a
number
of
years,
and
we've
had
discussions
previously
at
this
board
and
had
these
conversations-
and
I
suppose,
I'm
really
interested
to
have
people's
views.
Perhaps
you
know
nigel's
and
simon's
views
about
how
what
so?
What
are
we
going
to
do
with
this?
Then?
What
what's
the
next
step
and
there's
lots
of
discussion
at
the
moment?
Isn't
there
about?
L
Thank
you
chair.
I
mean,
I
think,
for
me
the
big
challenges
around.
How
do
we
even
decide
what
it
is
we're
going
to
do,
because
every
single
one
of
us
could
name
half
a
dozen
priorities
on
our
list
right
now
that
we
don't
actually
have
the
capacity
to
fully
tackle
all
of
them
a
hundred
percent?
So
I
mean
I
could
sit
here
and
say.
I
think
dementia
is
a
massive
issue
at
the
moment.
I
think
learning
difficulties
and
support
for
people
is
a
massive
issue.
L
I
think
support
for
families
of
children
with
special
educational
needs
has
been
picked
up.
I
know
carer's
support
is
massive
poverty,
mental
health
we've
heard
about
the
surge
stuff,
so
I
think
all
of
this
data
is
fascinating,
but
it's
how
we
make
sure
we
don't
just
use
it
as
a
sort
of
a
rabbit
hole
that
we
disappeared
down,
but
we
actually
make
some
decisions
about
what
we
want
to
do.
I
think,
in
terms
of
co-production
we
all
have
contact
with
people.
There
isn't
sort
of
a
magic
wand.
L
So
I
think
it's
up
to
all
of
us
to
be
part
of
that
to
commit
to
it
every
single
day
in
everything
that
we
do
and
I
think
there's
something
very
difficult
for
me.
Around
population
messages
and
health
messages,
and
particularly
at
the
moment
when
we're
saying
don't
not
go
to
the
gp
but
don't
go
to
the
gp,
and
I
think
there's
something
about
how
we
engage
our
population
and
what
it
is
they
need
to
know
about
when
they
should
be
accessing
services
about
when
they
should
be
seeking
help.
L
And
I'm
very
aware
of
the
fact
I'm
one
of
those
people
who
is
more
likely
to
go
and
access
help,
because
that's
what
I've
been
brought
up
to
do
but
there's
a
whole
issue
around
culture,
around
understanding
of
the
population,
health
and
it's
it's
it's
a
massive
topic
in
terms
of
how
we
get
those
people
who
most
need
to
seek
help
to
seek
help.
And
I
sometimes
think
that
the
challenges
around
making
those
messages
right.
L
So
that
they
don't
land
with
people
like
me,
who
immediately
go
well,
there's
half
a
dozen
things
I
can
go
and
talk
to
my
gp
about,
but
how
we
collectively
get
the
right
messages,
the
right
information
to
the
right
people
to
make
sure
the
right
things
happen.
That's
that's
a
whole
discussion
topic
as
well,
so
I
don't
know
if
I've
actually
asked
a
question
or
just
said
a
lot
of
stuff,
but
that's
kind
of
where
I'm
at
with
this.
A
You've
asked
a
lot
a
lot
of
questions
sean
and
for
me
before
I
go
to
pipper,
and
also
I'm
going
to
ask
nigel
to
comment.
One
of
the
big
difficulties
is
where
people
get
their
information
from
and
whether
that
information
is
accurate
and
you've
only
got
to
say
the
word.
Vaccine
and
you'll
probably
know
exactly
what
I
mean
right.
Pippa.
You
wanted
to
make
a
comment.
Thank.
I
You
yeah
just
just
a
couple
of
brief
comments.
Thank
you.
I
really
welcome
this
and
I
I
think
it's
been
an
exciting
development
for
us,
because
it
as
charlatans
it
builds
on
a
lot
of
things
we
already
know,
but
I
think
it
shapes
and
leads
us
in
a
good
direction.
I
think
to
use
the
cliche,
it's
really
helpful
to
have
something
that
says:
prevention
is
better
than
cure
and
to
continue
focusing
on
tackling
inequalities.
I
I
think
for
me
in
my
work
around
commissioning
and
the
report
that
we've
got
later
on
better
care
fund.
I
will
really
want
to
be
able
to
draw
on
this
to
help
shape
decision,
making
to
make
sure
that
we're
targeting
the
resources
we
have
to
where
it
will
make
the
both
the
most
difference
and
what
I've
enjoyed
about
the
involvement
I've
had
in
this
work.
I
So
far,
I've
been
part
of
a
multi-agency,
quite
an
inclusive
group,
and
that's
been
looking
at
this
and
trying
to
understand
the
intelligence
that
peter's
describing
and
thinking
about
to
answer
sean's
question:
where
shall
we
start?
Let's
start
somewhere
where
we
can
definitely
have
an
impact
that
will
make
a
difference.
So
that
people
can
have
confidence
in
it
as
well
and
feel
that
we've
achieved
something.
So
to
me,
it's
very,
very
positive,
but
it's
the
beginning.
I
K
Yes,
thank
you.
Thank
you
peter.
I
I
welcome
this
and
this
approach
and
I
think
sharon
is
that
that's
a
really
good
challenge
to
us
all,
but
this
this
approach
uncovers
hidden,
hidden
bits
that
we
don't
see
and
those
in
books
drive
inequity
through
into
further
generations,
and
if
we
don't
act
now,
this
is
going
to
be
a
legacy
piece
that
we
that
last
so
we
need
to
get
onto
it.
K
I
think
we
need
to
something
like
this
will
create
momentum,
and
we
need
to
sort
of
tell
stories
about
it
and
publicize
why
we
would
do
it
and
the
benefits
and
also
be
clear
about
what
good
looks
like
and
and
the
things
that
we
can
do
and
are
doing
and
and
show
people
that.
So
those
would
be
my
sort
of
initial
comments,
but
I
do
take
sharon's
comments
on
board,
but
we
do
really
need
to
get
on
with
this
and
not
come
again.
A
Q
Q
Q
So
I
absolutely
welcome
it.
I'm
and
I'm
you
know
I
absolutely
recognize
as
well
the
challenge
that
sharon
sets
is
we
we
have
to
rise
to
that
and
I
think,
at
a
future
health
and
well-being
board.
Perhaps
you
know
we
do
need
to
spend
a
bit
of
time
talking
through
just
what
we
think,
certainly
from
an
nhs
perspective,
but
what
what?
What
the
opportunities
are
for?
All
of
us,
with
with
the
integrating
care
documenting
the
changes
that
are
about
to
be
about
to
be
made.
A
Thank
you,
simon,
I
think
peter
you
will
be
brought
in
in
a
minute.
I
think
one
of
the
things
we
might
think
of
doing
as
a
health
and
well-being
board
is
having
a
workshop
on
this.
I
think
there's
so
much
in
this
paper.
That
needs
a
a
discussion
rather
than
an
agenda
formal
meeting,
and
maybe
we
can
organize
a
workshop
at
some
point,
even
with
the
technicalities
of
zoom
and
breakout
rooms,
I'm
sure
we
could
do
that
anyway,
peter
I'll
at
last.
Let
you
speak.
N
Thanks
yeah,
I
get
the
last
word,
which
is
always
dangerous
thing.
I
really
appreciate
comments
that
have
been
today,
some
some
great
points
being
made
and
we'll
try
and
reflect
as
much
as
possible
in
at
least
the
work
I'm
involved
in
just
a
few
things.
I
think
this
will
be
the
most.
It
will
only
really
be
powerful
and
and
be
effective.
N
We
want
to
focus
on,
but
we
haven't
yet
got
in
a
way
to
the
the
key
bit
which
is
actually.
How
do
we
do
some
really
simple
things
to
to
improve
the
health
of
those
people
and
evaluate
if
it
worked,
and
that's
the
key
bit
if
we
don't
get
to
that
bit?
So
it's.
I
guess
it's
a
method
as
much
as
it
is
talking
about
data
and
there's
some
really
really
quick
opportunities
there
that
in
a
way,
that's
almost
a
bit
of
a
moral
sort
of
imperative
that
we
get
right
for
our
population.
N
I
mean,
for
instance,
if
in
primary
care
we
get
certain
people
with
certain
conditions
medicated
on
the
right
medicine.
We
will
prevent
stroke,
we
will
prevent
diabetes
and-
and
we
already
know,
we
already
have
a
a
really
good
understanding
of
the
number
of
strokes
we
could
prevent
per
year.
The
number
of
heart
attacks
we
could
prevent
per
year
through
those
things
through
primary
care
prescribing
that's
right
through
secondary
care.
That's
delivered
correctly
and
through
the
public
health
core
things
around
stopping
smoking,
maintaining
a
healthy
weight
that
sort
of
thing.
N
I
I
personally
think
diabetes
is
not
the
only
one,
but
it
is
a
good
place
to
start
it
affects
so
many
of
the
population,
but
it's
also
very
preventative
to
start
there,
because,
as
I
was
saying,
it's
oft
is
the
most
common
first
condition
and
for
our
people
that
are
living
with
lots
of
long-term
conditions.
Seeing
numerous
you
know,
health
consultations
every
week
really
struggling
under
the
burden
of
managing
all
their
medicine
every
week-
and
you
know
multiple
pills
they've
got
to
take.
N
It
started
20
years
ago,
often
with
having
a
little
bit
too
much
excess
weight
and
having
their
blood
sugar
tip
over
into
becoming
diabetic
and
and
if
we
can
do
something
about
something
like
that,
we
can
really
improve
health
and
there
are
lots
of
other
popular
priorities
that
we
could
focus
on
and
that
won't
be
the
only
one.
But
but
that
is
a
good
example
of
of
how
this
data
to
identify
who
those
people
are,
because
we
know
in
general
practice
they're
often
picked
up,
then
we
can
work
on
that.
N
A
Yeah
that'd
be
very
good
peter.
Thank
you
very
much.
I
needed
that.
I
think
this
needs
to
come
back
to
the
board
at
some
point,
but
we'll
try
and
build
in
a
workshop
first,
so
we've
actually
got
something
tangible
to
talk
about,
and
not
just
talking
about
the
same
things
that
we
were
talking
about
today,
which
is
always
the
danger
with
something
like
this.
I
think.
Are
there
any
final
comments
from
anyone?
A
A
E
My
apologies
to
any
colleagues
who
have
been
on
earlier
conversations
today
about
covet
and
lawrence.
I
think
you're
going
to
help
me
with
the
technical
bits
of
the
presentation.
That's
lovely!
Thank
you!
So
you
go
on
to
the
next
page,
please!
So
I'm
going
to
go
through
or
or
try
and
go
through
the
data
as
quickly
as
possible
and
I'm
conscious
of
of
time.
E
E
E
So
if
we
go
on
to
the
next
slide,
that
graph,
I
think,
shows
quite
starkly
how
york's
position
has
changed.
So
if
we
were
looking
at
this
just
kind
of
three
three
and
a
half
weeks
ago,
york
would
have
been
at
the
bottom
there,
with
the
lowest
rate
of
cases
and
the
fact
that
we've
gone
so
quickly
within
just
a
few
weeks
really
to
having
the
highest
rate
of
cases
and
that
that
kind
of
gives
you
quite
a
good
illustration.
E
E
That
line
is
almost
vertical
there,
which
again
reflects
how
quickly
the
case
numbers
are
increasing
and
more
than
doubling
every
week,
as
as
I
said
on
to
the
next
slide,
please
so
this
shows
what's
happening
with
our
positivity
rate.
So
this
is
the
number
of
people
who
are
being
tested
through
the
pillar
two
program.
So
this
isn't
people
who
are
being
tested
in
hospital
or
nhs
staff.
E
These
are
people
that
are
being
tested
through
the
walk-in
or
drive-through
center,
and
and
now
we're
able
to
separate
the
number
of
people
that
are
testing
positive
and
three
pcr
testing,
which
is
the
lab-based
testing
and
the
number
of
people
who
are
testing
positive
through
lateral
flow,
which
are
the
rapid
tests
that
we
now
have
available.
In
in
york,
so
when
you
look
at
the
positivity
rate
for
pcr
tests,
that's
now
above
19
and
when
we
were
at
the
peak
of
cases
in
october,
our
positivity
rate
was
around
18
at
that
time.
E
So
on
to
the
next
slide,
please
we
don't
just
look
at
case
positivity
data
or
when
we're
looking
at
what's
happening
and
with
the
pandemic
in
york,
we
triangulate
that
information
with
other
data
sources.
So,
on
the
top
graph,
there
we've
got
the
picture
of
what's
happening
with
people
contacting
nhs,
111
and
and
again
you
can
see
that
we
had
the
peak
earlier
in
the
year
that
came
right
down.
E
E
So
on
to
the
next
slide.
I'm
not
going
to
say
very
much
about
this
because
simon
is
here
to
talk
about
it,
but
what
this
tries
to
illustrate
is
what
the
picture
looks
like
at
york,
hospital
and
one
of
the
challenges
with
this
data
in
the
way
that
it's
presented
is
there's,
always
a
time
lag,
and
so
I
think
this
picture
has
worsened
since
this
slide
was
developed,
but
simon
will
be
able
to
update
us
on
that.
So
going
on
to
the
next
slide,
please.
E
So
we've
seen
fewer
fewer
deaths
from
seasonal
flu
this
year
and
we've
seen
lower
rates
of
norovirus
and
so
it's
possible
and
that
we
reach
the
end
of
the
year
with
no
excess
deaths.
But
obviously
we
still
have
the
winter
period
to
get
through.
So
we
won't
be
able
to
say
with
any
confidence,
what's
happened
around
excess
deaths
and
until
we're
reviewing
the
data
up
until
and
the
end
of
march
on
to
the
next
slide,
then
please,
this
show
us
shows
really
what's
happening
across
age
bands.
E
So,
as
you
can
see,
there's
been
a
rapid
increase
in
covid
across
all
age
groups
and
the
largest
infection
rate
is
in
the
35
to
49
age
group
and
the
then
the
50
to
64
age
group.
But,
as
you
can
see,
we've
seen
increases
in
children
and
in
the
over
65s
as
as
well
so
the
increase
isn't
isn't
contained
within
one
particular
age
group,
which
is
a
little
different
to
what
we
saw
earlier
in
the
year
when
we
had
that
massive
peak
there.
E
That
was
in
the
15
to
34
age
group,
which,
as
we've
discussed
the
student
population,
featured
quite
highly
there
in
in
earlier
in
the
year.
So
moving
on
to
the
next
slide,
then
just
to
give
you
an
overview
of
what's
happening
in
care
homes
in
schools.
So
again,
there's
a
bit
of
a
time
lag
with
this
data.
I
understand
today
there
are
13
care
homes
in
the
cyc
area
and
with
confirmed
infection
and
and
then
we've
had
a
a
a
recent
outbreaks
in
two
homes
as
well.
E
Nevertheless,
it
shows
an
increasing
picture,
and-
and
so
we
are
stepping
up
the
support
that
we've
been
doing
to
care
homes
throughout
the
pandemic
and
particularly
around
ensuring
that
care
home
staff
have
access
to
the
correct
ppe
and
and
that
we're
working
alongside
care
home
staff
where
there
have
been
outbreaks
to
to
understand.
If
there's
any
additional
infection
control
measures,
I
would
just
like
to
thank
and
all
of
the
care
home
staff.
E
They
have
been
incredible
throughout
the
pandemic
and
worked
very
very
hard
with
us
to
ensure
that
care
homes
are
safe
places
to
be,
but
obviously
that
work
continues
we're
seeing
a
very
different
picture
in
york
now
with
schools.
So
up
until
just
before
christmas,
we
were
seeing
very
low
rates
of
infection
of
school-age
children
and
that
has
increased
more
recently.
E
The
work
that
we've
done
to
extend
the
offer
of
lateral
flow
testing
to
staff
and
students
in
school
will
continue
so
on
to
the
next
slide.
Please.
This
just
shows
where
different
parts
of
the
city
really
this
is
data
based
on
medium
super
output,
areas
and,
and
it
shows
the
areas
of
the
city
where
we
have
higher
rates
of
infection.
E
This
is
changing
quite
quickly.
So
if
we
were
looking
at
this
slide
yesterday,
we
would
have
just
seen
bishop
thorpe
and
ask
him
richard
on
this
slide.
They,
those
rates,
are
not
in
the
highest
now
and
we've
got
wood,
thorpe
and
aiken
park
there,
and
we
have
responded
with
putting
increased
testing
in
place.
E
So
bishop
thorpe
has
had
a
mobile
testing
unit
this
week
and
from
today,
there's
also
a
mobile
testing
unit
that
is
increasing
access
to
residents
living
in
the
wood,
thorpe,
drink
houses
and
aiken
park
area,
and
we
will
be.
We
continue
to
monitor
this
data
very
carefully
and
will
respond
to
community
outbreaks
and,
as
has
been
agreed
in
our
outbreak
control
plan,
so
on
to
the
next
slide,
please.
E
This
shows
a
little
bit
about
what's
happening
with
local
contact
tracing
the
numbers
of
people
being
referred
into.
The
service
now
from
nhs
test
and
trace
have
been
increasing,
and
obviously,
if
we're
seeing
a
180
new
positive
cases
a
day.
Now
that
kind
of
gives
you
some
indication
of
the
how
busy
the
contact
tracing
services
and
we're
recruiting
more
staff
to
boost
capacity
within
that
service
at
the
moment.
E
E
A
Q
Thank
you.
Thank
you
carol.
I
I
I
I
mean
sharon
to
some
extent
covered
it.
What
what
sharon
presented
in
terms
of
the
graphs
is
very
much
being
reflected
in
in
the
hospital.
So
while
sharon
was
speaking,
I
was
having
a
quick
look
at
our
live
dashboard
and-
and
this
number
does
fluctuate
in
an
hourly
basis
as
patients
are
admitted
and
discharged.
But
it's
currently
it's
currently
at
130
35,
but
that's
for
the
trust
as
a
whole.
So
that
would
include
scarborough
as
well.
Q
Q
The
second
wave
there
was
very
clearly
a
bigger
impact
on
on
the
scarborough
on
the
scarborough
site,
so
in
terms
of
our
we've
been
sort
of
moving
through
the
gears
in
our
surge
plan,
really
over
over
the
last
few
over
the
last
few
days
and
and
conversation
taking
place
today
about
how
we
can
step
up
and
make
available
more
beds.
So
the
minute
we
have
around
150
cobit
beds
available.
Q
Q
Yet
and
that's,
I
think
true
across
the
most
of
humber
coastal
valley
and
yorkshire,
number
we've
only
got
six
in
york
and
three
and
three
in
in
in
scarborough
anecdotally
and
there's
any
there's
a
moot
point
around
the
the
the
number
of
the
the
new
number
of
patients
that
we
have
with
the
new
variant.
But
anecdotally
clinicians
are
saying
that
patients
are
younger
and
and
and
and
and
and
sicker
in
terms
of
the
the
cohort
that
we've
got
within
the
hospital
at
the
minute.
Q
So
I
I
think
we
can
expect
to
to
to
basically
see
a
tough
tough
few
weeks
for
us
within
the
month
of
of
of
january.
Hopefully,
hopefully,
the
lockdown
sharon
was
saying
within
sort
of
seven
seven
to
ten
days
or
so.
We
would
expect
to
see
the
impact
of
the
lockdown
kick
in
and
then
shortly
after
that,
hopefully
we
would
then
start
to
see
a
fall
in
the
numbers
within
the
hospital.
Our
overall
sickness
rates
are
still
relatively
good
compared
to
others.
Q
I
think,
looking
at
the
numbers
we're
from
yesterday
we're
at
around
five
and
a
half
percent,
30
percent
of
those
numbers
are
covered
related.
Obviously,
the
lockdown
has
an
impact
as
well
with
shielders,
obviously
no
longer
no
longer
no
longer
working
with
us
and
and
there's
the
impact
of
child
care,
and
you
know
you
know,
obviously
a
plea
to
schools
to
make
sure
that
they
support
key
workers
and
make
sure
that
those
staff
who
need
to
work
can
get
can
get
to
to
work
on
the
upside
we
have
started.
Q
We
started
yesterday,
the
the
the
staff
vaccination
program,
so
we
we
will
be
looking
to
vaccinate
around
15
and
a
half
thousand
staff
over
the
next
three
to
four
weeks.
So
it's
effectively
all
of
our
staff,
but
we're
also
vaccinating
staff
that
work
within
the
north
yorkshire
within
secondary
care,
largely
within
the
north
yorkshire
area.
Q
The
pcns
are
handling
primary
care
stuff,
so
yorkshire,
ambulance
service,
the
mental
health
trust
humber,
humber,
humber,
ft
york,
medical
school
students,
nursing
students
from
the
university
encompass
university
as
well
so
whole
swathe
of
organization,
the
hospices
as
well.
We
will
be
vaccinating
their
staff
that
has
started
and
and
our
vaccination
centers
on
the
york
site
in
the
scarborough
site
are
open.
Q
Seven
days
a
week,
eight
to
eight
till
eight,
the
only
rate
limiting
factor
for
us
there
will
be
the
supply
of
the
vaccine
nationally,
and
so
we
we
are
effectively
at
their
mercy
on
on
on
that
in
terms
of
maintaining
supply.
But
if
we
do
manage
to
maintain
supply,
we're
confident
that
we
will
be
able
to
to
vaccinate
staff
within
that
within
that
time
frame,
so
I'll
leave
it
there,
a
very
challenging
few
weeks,
a
few
weeks
ahead
and
a
big
thank
you
to
I
mean
system
partners
are
working.
Q
I
mean
we
obviously
what's
important.
You
know
that's
what
I
was
saying
by
looking
at
my
live
dashboard.
It
changes
on
an
hourly
basis,
making
sure
we
maintain
flow
and
keep
getting
patients
out
of
hospital
is
absolutely
fundamental.
The
the
worst
thing
that
can
happen
to
us
is
to
stop
that
flow
and
and
just
see
that
the
kind
of
numbers
that
we've
seen
since
new
year's
day
continue
to
come
through
the
front
door.
Q
A
K
K
K
The
hackspree
site
is
an
nhs
site,
so
that's
a
wave
one
site,
so
that
was
approved
first
and
then
the
ask
and
bar
site
away
for
free
site
which
took
a
little
bit
longer
to
approve
because
it's
it's
not
an
nhs
site
and
all
the
sites
then
didn't
receive
some
small
quantities
of
the
fisa
bionic
vaccine
just
before
christmas-
and
this
will
continue
this
week
together
with
the
astrazeneca
vaccine
coming
out.
But
just
as
simon
says
that
the
forward
rollout
is
limited
by
the
short
notice
that
we
get
for
vaccine
delivery.
K
So
that's
the
the
issue
that
that
we've
got
alongside
simon,
so
so
the
the
infrastructure
is
there
and
and
though
it's
the
wish
to
do
it
and
and
it's
just
getting
those
supply
lines
coming
through,
but
I'm
sure
that
will
start
to
settle
down
over
the
next
few
days
and
weeks.
Primary
care.
Colleagues
vaccinating,
of
course,
alongside
the
joint
committee
on
vaccine
immunization
guidelines.
So
that's
about
the
priority
cohorts
and
and
that
that's
really
what
was
what
they're
doing
at
the
minute.
K
So
you
will
be
patients
and
residents
will
be
called
when
when
they,
when
that,
when
they're
available
and
when
they
are
able
to
come
and
then
longer
term,
I
suppose
it's
about
allocating
more
sites
and
that's
going
to
something
that
people
are
looking
at
nationally,
more
community
settings
and
community
pharmacies.
But
I
just
think
we'll
we'll
understand
a
bit
more
of
that
over
the
next
five
to
seven
days.
So,
hopefully,
that's
maybe
just
a
bit
of
a
a
snapshot
where
we
are
with
vaccinations
in
the
primary
care
role.
R
R
P
So
some
of
our
schools
are
full
just
on
critical
workers
and
key
workers,
and
obviously
staff
in
those
schools
are
raising
concerns
about
well.
If
it's
not
safe
for
schools
to
be
open,
then
how
can
it
be
safe
for
them
to
be
full
just
with
children
of
a
particular
definition,
but
we're
really
committed
as
a
system
to
making
sure
that
we've
provided
places
for
key
workers?
Children,
because,
obviously
that's
what
we
need
to
do,
because
if
we
don't,
then
the
system
starts
to
fall
apart?
P
Doesn't
it
and
it's
in
all
of
our
interests
that
critical
workers
are
able
to
carry
on
doing
what
it
is
that
they
need
to
do
so?
We've
got
daily
meetings
and
we're
looking
at.
How
can
we
share
resources?
How
can
we
share
space?
How
can
we
organize
ourselves
slightly
differently
so
that
we
can
manage
enough
spaces
for
vulnerable
children?
Enough
spaces
for
key
worker
children
and
and
also
the
the
requirement
for
online
learning.
P
P
P
I
can
obviously
pick
that
up
and
reflect
that
in
those
those
conversations,
we've
also
raised
it
with
dfe
today
in
relation
to
the
need
to
have
much
clearer
guidance
in
in
a
number
of
these
areas,
so
they've
we've
been
in
a
call
with
them
and
they've
taken
that
away
children's
social
care
is
doing.
Okay,
I
think
there's
there's
a
recognition
that
we've
been
here
before
you
know:
we've
been
in
knockdown
before
we've
got
some
good
systems
and
processes
in
place,
we're
not
seeing,
thankfully,
an
impact
on
staff
staff
sickness
levels.
P
We
did
have
a
bit
of
a
blip,
but
but
that
seems
to
be
better
now,
so
you
know,
children
that
that
are
in
need
are
still
being
visited.
Children
who
need
a
protection
will
still
be
also
be
supported.
Our
children,
who,
who
we're
the
corporate
parents
of
will,
will
still
get
our
full
support,
so
those
systems
are
still
working
and
I
think
it's
really
important
for
anybody
watching
this.
If
anybody
is
concerned
about
the
safety
of
a
child,
then
services
are
still
open.
So
please
do
report
that
and
don't
wait
until
it's
critical.
P
If
people
feel
the
need
for
help,
then
ask
for
early
help
and
ask
for
support.
Don't
wait
until
it's
a
crisis,
because
in
the
last
lockdown,
what
we
didn't
see
was
a
massive
spiking
need
for
children.
Social
care,
like
a
number
of
authorities,
did
what
we
did
see
a
big
rise
in
support
offered
from
our
early
health
services,
and
that's
really
really
important.
So
please
do
please
do
pass
that
through
adult
social
care.
Pip
is
also
on
the
call
so
we'll
reflect
it's
really
difficult.
P
You
know
they're
very
busy,
because
obviously
they're
part
of
the
same
system
that
works
with
with
health
colleagues
and
we've
we've
heard
about
about
what
that's
like.
We
are
bringing
in
additional
resources
particularly
to
the
hospital
teams,
to
to
make
sure
that
we
can
continue
that
flow
and
continue
to
offer
that
support
and
and
also
looking
in
within
our
mental
health
services
around
how
we
can
make
sure
we've
got
enough
people
there
because
again,
they're
very
busy
at
the
moment.
P
You
know
people
are
tired.
People
are
struggling
with
with
you
know,
managing
their
lives
and
lockdown,
as
well
as
as
well
as
doing
this
like
everybody
is,
but
they
keep
doing
it
and-
and
that's
been
really
incredible,
so
I
think
you
know
it's
really
important
to
thank
everybody
for
doing
what
they're
doing
and
and
to
just
to
kind
of
keep
going,
because
you
know
spring
is
on
the
way
the
vaccine's
been
rolled
out.
We've
heard
about
that.
We
just
have
to
get
through
this
next
bit.
A
M
Yes,
thank
you
chair
just
a
brief
one,
then
from
mental
health.
As
far
as
carved,
we
currently
have
no
positive
patience
right
across
north
yorkshire
and
the
city
of
york,
which
is
really
good.
However,
a
number
of
staff
unfortunately
have
have
positive
results
and
that's
impacted
on
a
few
of
the
services
we
have.
So
it's
close
one
of
two
admissions
one
of
our
awards
at
foss
park.
M
Last
time
or
earlier
on
in
the
year,
we
did
see
a
significant
increase
in
referrals
to
it,
particularly
to
inpatients
of
people
that
we
were
previously
unknown
to
mental
health
services
and
that
the
level
of
acuity
was
particularly
high
and
and
referrals
have
started
to
escalate
again
so
we're,
but
we
are
prepared
and
just
to
reflect
on
what
amanda
said
is
we
you
know?
A
lot
of
the
learning
we
had
earlier
has
led
to
a
much
more
positive
approach.
This
time
you
know,
we
know
how
to
access
the
equipment
we
need.
M
We
we've
got
better
communication
and
relationships
with
our
partners
across
the
city,
which
you
know
really
will
work.
We
know
we're
in
this
together
and
working
well.
Operational
teams
are
currently
working
as
normal,
so
the
services
are
working
as
normal.
However,
we
we
are
starting
to
have
the
conversations
about
you
know.
What
do
we
start
to
slow
down?
What
do
we
pause
et
cetera,
just
to
make
sure
we
can
maximize
the
the
capacity
of
the
front
line?
M
J
Yeah
so
I'll
talk
about
york
cvs
first,
so
we've
ramped
up
what
we
did
before.
So
the
the
gp
help
lines
up
on
running
through
our
social
prescribers,
so
people
call
the
gp
if
they
don't
need
a
gp.
We
need
a
social
solution
that
comes
through
to
our
social
prescribers.
That's
starting
to
go
through
the
roof
again
this
week,
we're
doing
the
monitoring
hub
again.
So
we
monitor
people
who
have
symptoms
of
covid.
Again,
that's
gone
through
the
roof.
J
J
J
We
are
doing
some
intelligence
gatherings,
so
fortnightly
we're
contacting
the
sector
to
find
out
what
are
the
issues
that
they're
seeing
and
hearing
about,
and
then
we
can
feed
that
through
to
whoever
I
mean
at
the
moment.
There's
nothing
different
to
before
mental
health
is
a
big
one,
and
prescriptions
is
another
big
one.
At
the
moment
that
we're
coming
across.
S
Thank
you
chair,
as
others
have
mentioned,
a
really
big.
Thank
you
for
the
fantastic
partnership
working
across
the
city
for
the
entire
year.
I
have
to
say
since
march
last
year
that
has
gone
from
strength
to
strength
through
the
local
resilience
forum
and
and
people
on
this
call.
So
thank
you
very
much
for
that.
S
And
now
we
are
looking
at
at
what
point
we
can
vaccinate
our
staff
and
officers
that
have
that
direct
contact
with
the
public,
because
it's
not
always
easy
to
self
to
distance
from
some
of
the
people
that
we
deal
with.
In
some
of
those
circumstances,
or
have
the
time
to
put
your
ppe
on
before,
we
have
to
lay
hands
on
in
some
of
those
difficult
circumstances
that
we
deal
with
in
the
community,
but
also
looking
at
the
opportunities
for
doing
asymptomatic
testing
on
people
that
have
been
told
to
isolate.
S
If
we
can't
deliver
the
service
that
we'd
like
to
deliver
externally
or
out
there
in
our
communities
with
the
public,
our
echo
mental
health
cases,
we
saw
an
increase
in
mental
health
episodes,
and
I
think
we've
got
a
fear
that
that
will
go
up
more
so
in
this
lockdown.
Just
because
of
the
circumstances
of
the
weather
conditions
where,
in
the
summer
months,
people
could
get
out,
it
was
light.
People
could
get
out
there
and
get
some
fresh
air
and,
of
course,
the
regulations.
S
This
time
around
were
operating
in
in
the
winter
months
and,
of
course,
a
lot
of
the
legal,
legitimate
reasons
for
being
outside
your
home
address
have
been
reduced.
So
previously
you
could
go
out
for
recreational
reasons
you
can't
now,
and
the
biggest
challenge
for
us
is
communication
from
health
partners.
Really
there
are
already
people
contacting
us
in
their
droves
trying
to
work
their
way
around
how
far
they
can
stretch
the
regulations.
So
we've
had
people
contacting
us
saying.
I
know
I
can
go
out
to
exercise
we're
off
work.
S
Our
children
are
off
school.
Can
we
go
to
the
north
york
malls
for
our
one
period
of
exercise
for
the
whole
day,
and
local
really
does
mean
local
in
terms
of
the
government
website
suggests
that
local
means
within
your
own
city,
town
or
village,
and
the
public
are
trying
already
to
to
look
at
ways
in
which
they
can
stretch
and
those
definitions
just
to
urge
really
the
key
messages.
This
is
not
about
trying
to
get
around
police
legislation
or
regulations.
It's
about
protecting
the
health
of
your
family
and
friends.
So
that's
our
biggest
challenge.
S
Really.
We
will
continue
to
deliver
a
full
policing
service.
We've
still
got
good
levels
of
attendance
here
in
north
yorkshire
and
the
city
of
york
in
terms
of
our
policing
capacity.
So
we
will
be
out
there
at
community
policing.
I
have
to
say
in
the
usual
community
style
that
our
communities
are
used
to.
We
want
to
work
with
you
and
we
will
operate
what's
called
the
four
e's,
so
we
will
engage
with
people,
explain
the
regulations
to
them,
invite
them
and
encourage
them
to
abide
by
those
regulations.
A
Thank
you
lisa.
I
think
that
gives
the
health
and
wellbeing
board
a
very
thorough
overview
of
what's
going
on
in
the
city,
and
I
have
to
say
it's
an
enormous
amount
of
work
from
all
the
organizations
that
are
represented
here
and
an
awful
lot
of
other
organizations
that
aren't-
and
we
need
to
put
our
thanks
on
record
to
absolutely
everybody
involved,
because
everybody
has
really
pulled
their
weight.
Anybody
that
hasn't
had
a
chance
to
speak.
Who
would
like
to
speak
or
anybody
who
would
like
to
ask
any
questions.
A
L
So
could
I
just
say
a
massive
thank
you
to
city
of
york
council
as
one
of
the
voluntary
organizations
that
are
commissioned
through
you
in
terms
of
your
flexibility
and
understanding
that
we
can't
currently
do
what
we
normally
do,
but
we're
busy
trying
to
do
things
that
are
more
helpful,
and
I
know
we
have
been
working
within
the
wider
cvs
team
to
help
with
some
of
the
work
they're
doing
so
without
your
willingness
to.
Let
us
do
what
we
think
is
best
for
the
community,
the
needs
that
are
facing
us.
L
We
wouldn't
be
able
to
be
as
useful
and
helpful
and
effective
as
we
are,
and
I
know
that
other
partners
are
engaging
around
that
around
making
sure
that
we
we
do
the
responses
that
are
necessary,
but
I
think
it's
really
important
to
acknowledge
that
you,
as
our
commissioner,
have
been
really
flexible
and
understanding
in
terms
of
you
want
us
to
do
the
right
things,
not
the
things
that
you
originally
paid
us
to
do.
If
that
makes
sense,.
G
Thank
you
chair.
Could
I
just
sort
of
ask
whether
we're
having
any
issues
reporting
through
about
vaccinations
for
people
who
are
being
invited,
because
I've
had
a
couple
of
different
residents
from
different
practices
that
have
been
in
touch
with
me
and
just
sort
of
raised
concerns
about
how
they
were
approached,
whether
it
was
sort
of
asking
them
to
go
online
to
book
links
and
they
didn't
have
internet
access,
and
it
seems
like
it's
a
little
bit
different
how
each
of
the
different
practices
are
sort
of
managing
that
process?
G
And
I
understand
that,
obviously
it's
very
difficult
when
you
don't
know
how
many
vaccines
you're
going
to
get
into
plan
very
far
ahead
and
sort
of
set
up
these
surgeries,
but
is
the
best
practice
being
shared
now
across
the
network
in
new
york,
so
that
different
practices
sort
of
learn
from
what's
working
here
there
and
everywhere,
because
it'd
just
be
a
shame.
If
some
people
are,
you
know,
sort
of
one.
G
A
K
Yeah,
I'm
happy
to
take
that
comment
back
and
look
into
that
a
bit
further
for
you
you'll
understand
that
this
week,
of
course,
there
was
a
there
was
a
change
to
the
to
the
national
rollout
from
the
the
two
dose
vaccination
schedule
to
the
one
dose
and
so
for
this
week
and
into
next
week
there
will
be
some
communications
that
might
be
coming
through
in
different
ways
about
postponing
the
second
doses,
but
I
will
take.
I
will
take
that
back
and
look
into
that
for
you.
E
Just
quickly
on
the
vaccination
issue,
nigel,
if
the
council
can
help
in
any
way
and
with
communications,
and
just
just
let
us
know-
and
we
can
look
to
see
whether
we
can
help
get
some
of
those
messages
out
through
our
networks
and
I've.
Just
jotted
a
couple
of
things
down
really
to
quickly
wrap
up.
E
A
A
I
Yes,
thank
you
chair,
so
I
don't
think
at
this
stage.
The
board
needs
a
lengthy
discussion
about
this.
In
the
context
of
all
of
the
discussion
we've
had
this
evening.
The
better
care
fund
is
a
piece
in
the
background
about
how
we
plan
and
work
together
in
partnership
to
deliver,
deliver
those
preventative
schemes
and
and
to
integrate
services
as
far
as
possible.
I
Yes,
I
just
want
to
draw
attention
to
a
couple
of
things
we
have
had
on
the
3rd
of
december.
A
formal
publication
from
the
government
confirming
that
the
better
care
fund
and
improve
better
care
fund
will
continue
into
the
2021
2022
financial
year.
So
that's
been
in
the
balance
during
the
autumn
and
now
we
know
that
that
will
definitely
continue,
which
is
good
news
and
it
gives
us
some
stability
and
we
will
get
some
further
detail
about
the
specific
financial
allocations
around
that
and
paragraph
13
in
the
report.
I
I
just
have
referred
to
the
fact
that
those
financial
assumptions
are
rolling
forward
and
we
want
to
review
the
current
plan
to
make
sure
that
we
continue
to
deliver
the
best
impact
possible
on
the
outcomes
that
that
we're
looking
to
achieve
and
we're
going
to
be
doing
that
very
rapidly,
and
a
lot
of
that
will
draw
on
the
existing
intelligence
and
evaluation
material.
We
have
from
our
performance
framework,
but
it's
meant
that
we
didn't
confirm
a
full
year
to
people
as
soon
as
the
announcement
was
made.
I
I
A
Yes,
thank
you
pippa.
I
think
the
information
that
it's
going
on
in
20,
21
22
is
is
very
welcome
not
only
for
the
schemes
that
are
funded
by
the
bcf,
but
also
the
bcf
pays
for
some
people's
employment,
for
example,
the
local
area
coordinators
and
anybody
that's
employed
with
bcf
funding
needs
some
security,
especially
in
the
present
circumstances.
So
that's
very,
very
welcome.
Denise
has
a
question.
H
I
was
on
the
health
and
well-being
board
before,
as
you
know,
and
the
best
care
fund
always
seemed
to
be
a
bit
shrouded
in
mystery
and
I
think
that's
become
less
so
and-
and
I
think
this
is
you
know,
it's
really
positive-
that
this
is
a
it's-
become
an
example
of
good
partnership
working
and
working
together,
and
I
suppose,
I'm
again
just
coming
back
to
the
question
about
telling
the
story
of
what
it's
actually
doing
you've
got.
I
mean.
Maybe
this
is
reported
to
the
board
in
another
paper
and
I've.
H
H
A
I
Yeah
so
you're
absolutely
right
and
councillor
craic
island,
because
I'm
conscious
that
it
is
a
bit
of
a
bureaucratic
rabbit
hole.
I
always
try
and
bring
somebody
with
me
who
can
tell
the
story
of
some
of
the
schemes,
so
we've
had
jennifer
allen
from
age
uk.
Back
in
october,
talking
about
the
home
from
hospital
scheme,
we've
had
the
social
prescribing
team
come
and
other
colleagues
being
similar,
which,
which
is
always
much
more
engaging
and
interesting
for
anybody.
I
Listening
in
paragraph
three,
I
did
refer
to
the
fact
that
we
had
the
annual
report
on
the
better
care
fund
in
the
october
meeting.
I
think
it
was
october
anyway,
so
if
people
want
to
go
back,
it's
all
there
and
I
thought
I
had
included
a
link
to
those
papers
in
this,
but
in
any
case
I'm
very
able
to
forward
those
on
to
people
so
that
that
has
a
lot
of
written
information
about
the
schemes.
I
A
A
A
Is
anybody
dissenting
from
those
recommendations
which
case
you
can
assume
they're
all
agreed?
Thank
you
very
much
pippa.
Thank
you
for
that
and
then
our
final
report
is
from
sean,
who
has
also
been
very
patient
and
it's
a
very
interesting
report
from
healthwatch.
So
sean
would
you
like
to
introduce.
L
L
This
report
for
us
is
not
a
full
stop.
It's
an
opening
question.
I'm
delighted
that,
as
part
of
this
work,
we've
developed
better
relationships
with
york.
Racial
equality
network
with
a
newly
emerging
speak
up
diversity
group
with
york,
travelers
trust
we've
also
been
working
after
we've
completed
this
report
with
bianca
and
the
minority
group
in
york.
Looking
at
the
impact
for
for
migrants
in
york,
so
for
me
this
is
about.
We've
started
the
conversation
it's
begun.
L
A
Thank
you,
sean.
It's
very
interesting,
the
the
groups
that
you
contacted.
I
can't
find
the
right
page
at
the
moment.
I
remember
the
travelers
trust
were
very
pleased
that
you
contacted
them
and
of
course
they
are
an
ethic
minority
group
which
often
are
not
recognized
as
such.
So
it's
good
that
you're
saying
it's
the
beginning
of
some
work,
because
it's
work
that
certainly
needs
doing
and
we'll
all
be
able
to
learn
from
it.
So
we
might
be
needing
an
update
at
some
point
when
you've
gone
a
little
further
along
the
road.
A
If
not,
if
anybody
has
any
further
information,
they
could
feed
into
sean
or
any
particular
questions
that
they
would
like
asked.
If
you
could
email,
tracy
and
tracy
will
hand
them
on
to
sean.
That
would
be
extremely
useful
right.
I
think
we've
got
to
the
end
of
the
agenda.
I
haven't
been
notified
of
any
urgent
business.
A
I
All
right,
I
was
a
bit
slow
on
the
uptake.
Wasn't
I
it
was
just
to
say
thank
you
to
sean
and
to
healthwatch
york,
because
this
is
really
good
timing
and
to
say
that
the
humber
coast
and
vale
integrated
care
system
has
been
promoting
some
work
around
inequalities
on
this
issue
and
I
think,
there's
a
good
opportunity
to
join
this
up
with
that
and
some
other
colleagues
around
the
table
will
be
aware
of
that.
So
I'll
take
it
as
a
task
for
me
to
make
that
connection.
A
Thank
you
pippa.
That's
very
helpful
right.
I
think
that's
everybody
now.
So
thank
you
all
very
much
at
the
start
of
2021.
Let's
wish
everybody
every
resident
a
good
year
a
better
year
an
improving
year
and
do
your
best
to
keep
healthy
hands
face.
Space
and
fresh
air
is
my
fourth
one.
I
know
it
doesn't
quite
work
with
the
other
three,
but
I
think
it's
really
important.