►
From YouTube: Health and Wellbeing Board, 11 September 2019
Description
AGENDA
1. Declarations of Interest 00:03:12
2. Minutes 00:05:46
3. Public Participation 00:05:58
4. Healthwatch York Annual Report and 2019/2020 Workplan 00:11:26
5. Annual Report of the York Mental Health Partnership 2018/19 00:29:38
6. Better Care Fund Update 01:04:22
7. York Carers Strategy 2019 - 2024 01:20:04
8. Primary Care Home and Networks Presentation 01:32:40
9. Health and Wellbeing Board Briefing Paper: Humber, Coast and Vale Partnership Long Term Plan 01:50:12
For full agenda, attendance details and supporting documents visit:
https://democracy.york.gov.uk/ieListDocuments.aspx?CId=763&MId=11336
A
I'm
Council
Carol
run
summer
I'm
very
pleased
to
see
everybody
here
and
I'm
particularly
pleased
to
see
all
the
people
in
the
what
might
loosely
be
called
the
audience,
not
just
the
officers,
but
the
real
people
as
a
couple.
You're
extremely
welcome
and
I
hope
you
first
of
all
can
hear
which
in
this
room
is
extremely
difficult
and
secondly,
that
you'll
find
it
interesting
in
a
minute.
Anybody
that
has
a
hearing
aid
can
turn
it
onto
the
loop
and
then
you
will
find
as
I
do
that
you
can
hear
everything,
even
when
other
people
can't.
A
A
N
A
Thanks
very
much
everybody
we're
missing,
Simon
Moret
who's,
the
new
chief
exec
of
the
hospital,
it's
all
quite
possible,
he'll,
be
delayed
or
not
even
be
able
to
come,
so
he's
the
only
person,
that's
missing
when
she's
good.
So
that's
appreciated
right,
I'd
like
to
sign
the
minutes
of
the
previous
meeting.
If
everybody
that
was
there
is
happy
with
them.
Yes,
thank
you.
A
O
Okay,
are
you
ready,
mm-hmm,
yes,
I'm
amber
and
I'm
a
social
researcher
and
I
live
and
work
in
York,
but
I'm
really
here
to
talk
about
and
more
of
a
national
campaign
that
I'm
helping
to
lead
on
and
which
is
called
our
minds,
our
future
and,
in
short,
it
basically
aims
to
highlight
and
tackle
this
very
the
disparity
we
see
between
young
people's
needs
and
access
to
mental
health
support,
and
we
take
a
rights-based
approach.
So
we
basically
use
human
rights
to
stand
for
better
mental
health
services,
support
treatment.
O
So,
in
terms
of
campaign
aims,
we
show
that
failures
within
the
mental
health
system.
Don't
only
let
young
people
down
but
actually
breaches
our
human
rights
as
well,
because
in
the
in
this
country
we
have
signed
up
to
various
international
agreements
and
three
of
which
work
to
support
mental
health
rights.
O
But
we
kind
of
see
in
a
postcode
lottery
of
support,
inconsistencies
with
referrals
and
thresholds,
and
it
means
that
people
are
kind
of
getting
different
levels
of
care
which
breeches
are
human
rights
so
and
as
as
rights
of
protected
by
law.
It
means
the
people
at
government
level,
local
level,
decision
makers
and
we've
kind
of
agreed
to
and
uphold
this
right
across
the
country
and
so
as
a
campaign.
O
What
we
are
looking
at
is
a
better
kind
of
appropriate
services,
so
not
just
young
people,
services
and
older,
older
age
services
and
we're
looking
for
to
reduce
the
long
waiting
list
and
also
to
focus
on
community
support
and
and
yeah
local
provision,
and
also
youth
participation,
so
trying
to
kind
of
build
young
people
power
and
and
where
it's
appropriate,
to
invite
young
people
to
talk
about
their
priorities
where
the
gaps
are
and
what
they
really
want
and
appreciate
in
terms
of
their
treatment
going
forward.
And
so
it
works
as
an
at
a
national
level.
O
Sorry,
but
it
really
depends
on
kind
of
young
local
advocates
and
local
decision-makers,
some
of
which
are
in
this
room
to
work
together
to
make
any
change
and
I'm
really
fortunate,
because
I'm
in
a
city,
that's
the
first
and
only
human
right
city
in
the
UK.
And
that
means
that
individuals
and
organizations
have
already
said
that
human
rights
are
important
to
them.
And
I
already
know
from
various
documents.
For
this
group
that
that
the
rights
based
approach
has
already
been
implemented.
And
so
I
kind
of
wanted
to
come.
O
A
H
A
A
But
yes,
okay,
for
it
to
be
we'll
make
sure
we
put
them
in
the
minutes.
Then
we've
got
the
idea
of
what
you
do
and
what
you're
campaigning
for,
which
is
really
helpful.
But
if
people
want
to
contact
you
separately,
that
would
be
really
good
yeah
and
we
do
appreciate
your
coming.
Thank
you
very
much.
Andy.
Oh
sorry,
there's
a
question
for
him:
counselor!
That's
better
chair.
F
D
A
That's
ugly,
that's
a
good
start
to
the
meeting.
Thank
you.
So
if
I
now
can
just
warn
everybody
that
we
are
being
webcast
and
all
the
thousands
of
people
that
watch
her
so
wet
watching
a
girly
and
it's
usually
about
200,
which
is
much
higher
than
anybody
else's
committee,
because
ours
is
clearly
the
most
interesting.
So
that
means
you
must
have
your
little
green
light
on
when
you
speak
and
turn
it
off
when
you're
finished
and
I
want
to
reassure
the
people
in
the
audience
that
they
are
not
being
webcast.
A
D
Okay,
thank
you,
chair,
I.
Think,
as
hopefully
most
of
you
are
aware
already
we
have
to
produce
an
annual
report
every
year
and
share
it
with
people,
and
the
health
and
well-being
board
are
some
of
those
people
that
we
have
to
share
it
with
I
hope.
You
find
it
interesting
as
as
you've
probably
noticed
it
is
in
a
different
format
this
year,
because
people
missed
our
summer
magazine.
D
So
we've
done
our
summer
magazine
and
included
an
annual
report
supplement
as
it
were
within
it,
so
we'd
be
very
grateful
for
any
feedback
on
whether
people
liked
the
new
style.
Whether
it's
kind
of
interesting,
informative
makes.
You
read
it,
but
I
think
what
we
also
wanted
to
share
at
this
point
was
our
work
plan
for
the
year,
so
you'll
have
seen
that
I'm
assuming
everybody's
read
it,
but
I
think
it
is
just
worth
pulling
out
a
couple
of
things
that
we
talked
about,
which
is
within
the
work
plan.
D
We
as
HealthWatch
York,
have
made
commitments
to
join
the
steering
group
for
the
time
to
change
project
and
we've
also
made
a
commitment
to
support
a
City
of
York
Council
around
the
no
permanent
placements
home
first
approach.
Following
a
workshop,
so
within
the
sort
of
the
formal
bit
of
the
papers,
we've
presented
a
couple
of
options
that
we'd
like
the
board
to
consider
and
some
recommendations
that
we
think
would
be
helpful
for
us
as
a
city.
D
It
might
seem
a
bit
cheeky
why
a
HealthWatch
York,
suggesting
these
things,
but
I
think
somebody
ought
to,
and
if
we
are
committed
to
mental
health
as
our
top
priority,
then
actually
as
employers
of
individuals
as
key
organizations
in
the
city.
We
should
be
leading
that
approach.
We
should
be
time
to
change
employers
who
are
thinking
about
how
we
enable
our
staff,
our
workforce,
to
work
in
a
mental
health
friendly
workplace,
and
we
should
be
demonstrating
the
power
of
that
work
to
other
employers
in
the
city
to
enable
them
to
follow
our
lead.
D
I
am
making
an
assumption
that
most
people
around
the
table
will
be
familiar
with
time
to
change,
so
I'm
not
going
to
dwell
hugely
on
what
that
is,
but
I
have
brought
along
posters.
So
you
can
all
have
a
quick,
read.
There's
a
few
quick
messages
on
there
and
the
key
thing
is:
we
shouldn't
feel
ashamed
if
we've
got
a
cold
to
tell
people
we're
not
feeling
very
well,
we
shouldn't
be
ashamed.
If
we
break
our
leg
to
tell
people,
we've
broken
our
leg.
D
So
why
should
anyone
feeling
shame
to
say
they
are
experiencing
mental
ill-health?
Keep
passing
keep
passing
around
all
around
and
in
terms
of
the
no
permanent
placements
approach
again,
one
of
the
things
we
know
is
hospital
is
a
really
good
place
to
be
if
you
are
acutely
unwell
and
need
to
be
treated.
D
But
there
comes
a
point
where,
actually
you
no
longer
need
treatment
in
hospital,
you
shouldn't
be
in
a
hospital
bed,
it
stops
being
a
good
place
to
be
I.
Don't
want
to
preach
the
converted.
I
know,
there's
many
of
you
around
the
table.
Who
could
give
me
chapter
and
verse
on
deconditioning
but
I?
Think
sort
of
the
headline
is,
if
you're
in
bed
in
hospital
for
ten
days
at
a
certain
point
in
your
life
that
can
be
the
equivalent
of
10
years
of
muscle
mass
loss.
That's
a
really
bad
thing
to
happen.
D
So
the
point
of
no
permanent
placements
in
the
home
first
approach
is
to
remember
that
every
single
person
who
goes
into
hospital
already
has
a
home
it's
where
they
came
to
hospital
from,
and
we
should
be
as
a
system
working
towards
getting
them
out
of
that
hospital
and
back
to
their
home.
People
shouldn't
be
placed
from
a
hospital
into
a
care
home
bed
as
a
permanent
situation.
I
know.
Sometimes
that
does
happen.
So
again.
D
You
know
I
know,
there's
people
around
the
table
who
could
go
on
much
more
about
no
permanent
placements,
but
I
just
wanted
to
bring
your
attention
to
the
recommendations
that
we've
made
around
that,
because
I
think
we
want
to
play
our
part
in
helping
people
in
York
to
understand
both
time
to
change
and
the
importance
of
it
and
no
permanent
placements
in
home.
First
and
I.
Think
we're
just
asking
that
everyone
around
this
table
shares
that
commitment
makes
that
commitment
publicly
today.
A
Thank
you,
Shawn
I
think
I
just
need
to
mention
that,
for
somebody
that's
involved
in
fostering
like
I
am
no
permanent
placement
is
sounds
completely.
Contrariwise,
because
actually
we
too
want
children
that
are
adopted
to
have
a
permanent
placement,
but
I
think
what
you're
saying
is
you
don't
want
them
to
stay
in
hospital
forever
and
that
I
found
when
I
read
it
I
found
that
actually
quite
confusing,
so
I
think
we
need
to
reassure
people
that
it's
not
about
adoption
and
fostering.
This
is
about
people
in
hospital.
Okay,
about
any
questions.
G
And
I
think
it's
really
good.
Thank
you
very
much.
I
was
just
picking
up
on
page
32.
The
emerging
issue
to
with
access
to
GP
services
and
I
was
just
wanting
to
Russia.
That
will
work
very
closely
with
you
around
that
this
is
a
national
issue,
not
a
local
issue,
and
it's
an
emerging
issue
that
we're
having
more
and
more
precious
so
more
than
happy
to
work
with
you
with
that
from
the
CCG.
F
Custard
yeah
Thank
You,
chair
and
I'm,
just
looking
at
the
foot
of
page
32
and
finding
suitable
care
for
people
with
challenging
behavior
in
the
very
bottom
box
there
and
I'm
just
wondering
if
you've
got
any
connections
with
the
the
young
people's
are
because
their
team
wouldn't
by
the
City
Council
and
if
that
might
be
of
any
use
to
you
to
to
get
involved.
Because
I
would
imagine
this
some
kind
of
crossover
and.
D
I
think
this
issue
came
to
us
through
conversations
with
particularly
older
people
looking
for
places
for
people
with
advanced
dementia,
who
were
exhibiting
behaviors,
that
other
people
find
challenging,
I.
Think
there's
a
lot
of
conversation
goes
on
about
whether
challenging
behaviors
is
an
appropriate
label
for
anybody,
and
when
we
had
a
meeting
with
York
advocacy,
they
also
confirmed
that
they'd
had
a
number
of
people
speaking
to
them
about
the
challenges,
particularly
around
things
like
continuing
health
care,
finding
suitable
packages
of
care.
D
It's
been
on
our
radar
for
a
little
while
and
we
have
been
asked
to
look
into
where
places
are
available
for
people,
because
there
are
basically
virtually
no
places
in
York
itself
and
the
places
where
they
think
there
is.
They
are
outside
of
York.
They
are
often
quite
inaccessible
by
public
transport.
F
Thank
you
chair
and
thank
you,
a
child
for
that
and
I
was
thinking
of
the
words
challenging
behavior
with
my
executive
member
hat
on,
and
but
are
you
aware
of
the
dementia
forward
team
in
Haxby
I,
just
wonder
if
they
might
have
any
views
on
how
to
engage
people
who
are
perhaps
in
the
early
stages
of
dementia,
or
maybe
moving
forward
into
a
more
advanced
condition
before
personality
changes
set
in
I'm
venturing
into
territory?
At
the
time
there
little
about
so
dr.
wells,
Bonjour
and
dr.
Lee
will
forgive
me
for
that.
D
We
haven't
had
a
conversation
specifically
about
this,
because
it's
sort
of
an
emerging
issue
and
we're
still
trying
to
figure
out
how
we
might
approach
it
and
I
think
our
colleagues
from
the
independent
care
group
would
also
be
a
very
useful
source
of
reaching
people
and
understanding
what's
out
there.
So
I
think
it
would
have
to
be
something
we'd,
we'd
kind
of
explore
with
partners,
and
definitely
dementia
forward
would
be
on
that
list.
Okay,.
I
You,
chair
I
just
want
to
go
back
sorry
to
the
point
that
dr.
wells
brought
up
and
asked
Sean
and
dr.
wells,
perhaps
about
the
access
to
GP
services,
whether
you're
aware
that
it's
actually
a
very
personal
issue.
In
my
ward
in
Michael
gated,
the
my
many
many
many
residents
are
collecting
evidence
about
the
effect.
The
lack
of
well
all
the
the
almost
complete
would
complete
disappearance
of
GP
appointments
at
a
local
clinic
in
my
ward
I.
D
And
we
haven't
picked
that
up,
and
one
of
the
things
I
would
say,
is
it's
great
to
meet
some
of
the
new
counselors
around
the
table?
If
you
are
picking
up
issues
like
that,
please
do
share
them
with
us,
because
the
more
we
know
about
each
specific
area,
the
more
we
can
put
together
a
complete
picture
of
where
the
gaps
are.
D
What's
going
on,
what
isn't
going
on
the
thing
around
access
to
GP
services
that
we
have
picked
up
is
when
we
consulted
around
the
long
term
plan
and
the
York
results
for
that
are
now
available
via
our
website
and
there's
a
link
within
these
papers.
The
main
issue
for
people
was
around
being
able
to
access
a
GP.
We
previously
did
a
report
about
access
to
GP
services
as
well,
and
we
frequently
hear
the
whole
thing
about
phoning
up
trying
to
get
an
appointment
finding
out.
D
G
It
is
an
issue
both
nationally
and
locally
access
to
GP
services
and
you'll.
Hear
later
on
that
there
are
national
initiatives
around
primary
care
networks,
which
is
could
stand
to
look
at
scale
of
how
we
can
work
better
together,
and
the
main
thing
is
to
get
the
right
person
to
the
right
place
at
the
right
time
and
Shaun
kindly
says
about
the
NHS
app
and
she
was
on
their
radio
last
week
about
it
about
getting
those
people
that
can
access
that
to
access
that
to
allow
those
people
with
mobility
issues
the
access
that
they
need.
G
The
other
thing
I
think
that
I
would
like
to
point
out
which,
which
goes
with
your
point
as
well,
was
probably
as
a
community.
We
need
to
get
better
at
talking
about
advanced
care
planning,
both
physical
and
mental
health,
about
what
we
want
where
we
would
want
ourselves
to
be
cared
for
or
not
cared
for
and
start
to
have
from
discussions
about
about
that
really,
and
maybe
our
culture
isn't
isn't
geared
up
to
that
of
the
minutes.
G
But
one
of
the
things
that
we
need
to
do
is
look
forward
and
and
be
upfront
and
honest
with
ourselves
and
with
our
carers
and
our
family
about
what
we
need
so
that
when
we
do
go
to
hospital,
there
is
maybe
an
understanding
when
people
come
to
talk
about
going
home
or
where
we
want
to
go
that.
We
know
where
we
want
to
be
cared
for.
L
Just
wanted
to
respond
to
Shannon
the
content
really
of
the
HealthWatch
report,
obviously
welcome
the
emphasis
on
the
time
to
change
and
I
think
we
can
work
more
effectively
to
support
employers
as
well.
That
would
be
a
key
role
and
also
interested
in
how
the
work
will
develop
around
the
home
first
principle
in
terms
of
what
would
how
do
we
measure
that
success
and
what
are
the
cultural
changes?
We
needs
that
sit
behind
that
and
with
the
mental
health
focus
on
patient's
with
dimensions
and
the
challenge
and
behaviors
for
want
of
a
better
phrase.
L
A
Right
we've
got
on
page
10,
we've
got
options,
I
don't
usually
have
options
from
HealthWatch.
We
have
this
time
and
I'm
always
a
bit
worried
about
signing
anything
on
behalf
of
the
whole
board
when
I
haven't
asked
all
the
individual
members
of
the
board
if
they
agree-
and
they
haven't
checked
with
their
organisations
that
they
do
agree.
A
K
Thank
you,
I
think.
You
probably
know
that
many
of
the
organizations
sitting
around
the
table
have
already,
as
organisations
signed
the
time
to
change
pledge
so
certainly
from
the
local
authority
perspective
I,
think
we're
there
and
so
I,
don't
know
how
repeating
that
in
this
forum
would
be
particularly
helpful.
It
may
be
that
we
want
to
look
at
of
those
of
us
and
it
probably
everybody
that
has
signed
it.
What
does
that
mean
in
reality,
and
what
are
we
going
to
do
collectively
about
it?.
A
D
Think
the
only
the
only
thing
is
that
we
were
having
a
conversation
about
this
at
a
time
to
change
event,
and
there
were
people
who
worked
for
some
of
the
organizations
around
this
board
who
didn't
know
that
their
employer
was
a
time
to
change,
employer
and
I.
Think
part
of
the
reason
for
me
bringing
this
here
is:
we
are
the
health
and
well-being
board.
D
We
want
people
to
know
what
we
do
collectively,
as
a
group
of
organisations
working
together
as
a
system
I
think
there
is
capital
in
us
working
together
to
share
some
of
the
stories
about
what
we've
learnt,
by
being
time,
to
change
employers
as
a
health
and
well-being
board,
to
kind
of
demonstrate,
a
system
commitment
to
really
making
your
conne
mental
health
friendly
city
and
addressing
and
tackling
the
stigma
around
mental
health.
So
I
don't
know
whether
I'm
again
kind
of
overstepping
but
I,
think
we've
said
it
is
one
of
our
key
priorities.
A
Far
as
I'm
concerned,
it's
not
just
signing
anything
is
making
something
happen,
I'm
going
to
ask
for
it
that
record
that
option
both
those
options
to
come
back
next
time
and
I'm
going
to
ask
Tracy
to
find
out
not
only
if
people
have
signed
up
to
it
already,
but
what's
happened
because
of
it
and
I.
Think
Tim,
who
is
sitting
terribly
quietly
at
the
back,
will
very
much
want
to
know
that
some
action,
because
we've
just
been
talking
to
each
other
about
something
else
and
my
my
question
would
always
be
so.
A
What
I
just
don't
want
a
piece
of
paper.
I
want
something
to
happen.
I
want
something
to
change,
so
we
won't
take
a
decision
on
that
at
the
moment.
But
can
we
support
8b?
Is
everybody
happy
with
a
B
yeah,
and
is
everybody
happy
to
respond
to
Tracy
when
she
writes
them
about
time
to
change
and
what
does
change
because
of
it
there's
a
sudden
silence
but
I'm
sure
they
will?
Yes,
it's
starting!
Thank
you
very
much.
A
Thank
You
Shawn.
It's
a
very,
very
interesting
report.
It's
actually
packed
with
information
and
I
hope
that
everybody's
been
able
to
read
it
and
take
it
in
now.
We
go
on
to
the
next
item,
which
is
very
closely
aligned
to
that
and
Tim
magic.
We've
agreed
a
strategy
here
to
speak
for
about
two
hours
and
then
you
can
ask
questions.
Alternatively,
he
will
show
you
a
bit
of
a
video
and
then
speak
for
four
minutes.
I
think
that's
one
we'll
go
with
so
Tim
when
you're
ready.
P
Start
again,
yes,
thank
you
chair.
The
summary,
as
you
see
at
page
35,
tells
part
of
the
story,
but
I'm
interested.
It's
really
interesting
to
listen
to
the
first
30
minutes
of
this
meeting.
The
scene
keeps
coming
back
around
mental
health,
whether
it
was
from
amber
in
the
first
place,
whether
it
subsequently
from
Shawn
in
relation
to
HealthWatch
and
the
priorities
there
I
believe
passionately
that
if
I
made
the
time
to
change
as
you
is
the
clearly,
we
all
agree.
It's
the
right
thing
to
do.
P
There
was
12
months
ago
about
where
we,
where
we
need
to
go
and
what
we
were
about
to
do
so
in
terms
of
the
background,
the
board
can
see
clearly
where
the
priorities
are
in
relation
to
that
strategy.
It
does
sit
squarely
with
you
know.
What's
what's
been
put
out
nationally
in
relation
to
the
focus
on
prevention,
recovery,
early
intervention,
certainly
from
and
and
when
we
talk
about
an
all
age
approach.
P
P
What
I
would
say
about
the
any
report
before
I?
Ask
you
to
listen,
there's
a
reason:
I'm
asking
the
board
to
listen
to
the
a
few
minutes
there
we
on
the
board
and
the
partnership
story,
a
slightly
slow,
slow,
slow,
sluggish
start
trying
to
understand
what
our
role
was
and
where
we
were
adding
value
as
a
partnership
to
replicate
a
series
of
people's
targets
and
then
quizzed
them
about
why
they
didn't
have
enough
resource
to
meet
that
target.
Wasn't
particularly
helpful.
P
I,
don't
think
what
we
committed
to,
and
it
thinks
about
to
Amber
Pine
is
common.
Is
that
we're
committed
to
every
single
resident
in
this
city
and
having
the
best
possible
emotional
and
well-being,
mental
health?
The
best
possible?
That's
a
hell
of
a
strong
statement
to
make,
but
that's
what
we're
committed
to
and
that's
what
we
should
be
striving
for.
P
I've
come
here
off
the
back
of
being
delighted
to
be
master
of
ceremonies
at
the
suicide
prevention
conference.
If
you
want
to
know
where
the
evidence
is
and
how
far
this
city
is
going,
you
sit
there
and
listen
to
that
approach
and
the
work
done
by
public
health
and
the
individuals
within
that
who
have
really
made
a
difference.
They're
not
claiming
statistically
yet
because
they
realized
the
folly
in
making
early
claims
around
those
things
what
they
have
said,
that
is
they've
start
to
change
people's
lives
and
they've
changed
them
markedly.
P
What
struck
me
before
I
get
into
the
body
of
the
report
yesterday
was
one
statement
by
a
GP.
There
was
a
GP
for
Bristol
University
and
she
was
a
compelling
individual.
If
you,
if
you
get
a
chance,
it
was
all
videoed.
Yesterday,
listen
to
Dominique
speak
for
45
minutes.
On
her
experience,
she
said
when
she
left
Bristol
University
one
in
two.
The
people
she
was
seeing
were
had
mental
health
issues
that
was
presenting
one
in
two
and
she
then
came
along
with
a
lot
of
statistical
background.
P
Why
that's
the
case
and
of
course,
some
people
said
well
you're,
not.
You
know
that
that
doesn't
taking
all
the
people
who
aren't
in
university.
She
was
just
indicating
that
for
young
people,
when
we
talk
about
the
demand
coming
over
our
shoulder,
that's
where
it
is
one
in
two
and
I
was
I
was
staggered
by
that
level.
Right
moving
chair
from
a
then
into
the
body
of
the
report
we
decided
some
time
ago
in
line
with
what
the
health
and
well-being
partnership
was.
P
A
challenge
just
to
do
is
that
we
had
to
embody
a
community
approach
to
mental
health
in
the
city.
We
had
to
access
the
talent
wherever
it
made,
where
it
lies
in
communities
and
in
partners
outside
the
what
I
would
call
the
traditional
and
that's
never
the
traditional
health
partners,
if
you
like,
and
to
that
end,
we
put
together
an
event
which
is
connecting
our
city
I'm
not
going
to
play
the
the
music
in
the
end,
exam
singing
and
I'm,
probably
the
worst
out
of
terms
thing.
P
You
can
have
so
I'm
going
to
cut
that
bit,
but
there's
nothing
significant
around
we
couldn't
have,
but
I
just
asked
you
to
listen.
Some
of
the
comments
we
gathered
and
some
of
you
were
there.
We
gathered
international
experts,
certainly
from
Trieste
who
we
plan
and
no
man
our
fortune
enough
to
go
there
earlier
in
the
summer.
The
people
who
could
help
this
city
achieve
what
the
health
and
well-being
board
wants
us
to
achieve.
R
P
The
so
what
factor
comes
into
that
splendid
confidence
really
good
day?
So
what?
Fortunately,
there
are
a
number
of
people
who
sent
us.
So
what
forms
back
in
and
challenge
say?
Okay:
where
is
this
going?
What
are
you
going
to
do
about
it?
It's
all
very
well
getting
some
very
enlightened
speakers,
and
just
for
the
record,
my
new
hero
has
been
replaced.
Jonny
Wilkinson
used
to
be
my
hero,
it's
now
Roberta
maizena,
so
there
we
are
the
shows
that
old,
I'm
getting
I
think.
P
But
it's
the
when
we
come
back
to
the
the
partnership
decided.
We
need
their
focus
around
a
limited
number
of
priorities.
I
think
we
clearly
have
based
at
the
heart
of
it:
a
community
approach
to
mental
health
and
a
pilot
program
that
we'd
like
to
establish
as
early
as
possible
in
the
northern
section.
P
P
We
will
bring
back
plans
through
the
respective
directors
and
others
to
do
to
get
that
off
the
ground
and
the
other
priorities
and
I
must.
It
would
be
noted
if
I
didn't
mention
the
next
couple
of
minutes
before
I
stop
for
questions.
Self-Harm
issues
have
been
a
really
high
priority.
We've
had
excellent
support
from
Sophie,
whereas
the
assistant
director
in
relations
trying
to
get
underneath
the
figures,
particularly
for
young
people,
but
actually,
as
you
start
to
zelma
yeah
across
the
of
course,
the
world
self-harm
and
people
presenting
it.
P
Your
teaching
hospital
with
those
issues
is
out
of
kilter
for
a
city
with
the
background
of
New
York.
As
you
can
imagine
the
more
you
start
to
work
around
that,
the
more
you
need
to
are
try
and
understand
why
that's
the
case,
but
this
and
there's
some
significant
concerns.
So
it's
not
just
young
people,
it's
an
itself
farm
is
a
normal
age
issue
and
there's
ongoing
work
and
I
will
not
let
that
go,
and
so
we
have
an
answer
in
relation
to
why
and
then
what
is
the?
P
Who's
done,
work
around
mental
health
and,
in
the
long
term,
realizes
the
critical
importance
of
housing,
appropriate
accommodation,
and
it's
quite
telling
when
you
listen
to
a
a
person
yesterday
at
the
conference
say
his
first
formal
accommodation
in
the
city
was
when
he
was
29,
Carl
yeah
and
he's
quite
happy
to
you.
Yeah
we'd
use
these
details
would
say
he
was
a
challenge.
He
was
a
challenging
to
policing.
Colleagues,
he
was
challenged
to
all
sorts
of
people,
but
he
felt
he
had
no
location.
P
He
who
call
a
house
until
he
was
29
much
work
has
gone
on
we're
on
the
cusp
I
think
of
securing
a
far
better
position,
but
it
will
continue
and
then
lastly,
the
priority
our
mental
complex
needs
and
we're
getting
great
support
from
HealthWatch
and
from
Kathryn
within
HealthWatch.
In
relation
to
that
and
Lang
Kelly
chase
again,
it's
a
it's
an
area
that
undoubtedly
causes
challenges,
I
think
the
the
issue
of
how
people
access
care
and
support
to
deal
with
addiction
issues
to
deal
with
their
mental
health
issues
and
in
what
order
those
are
tackled.
P
What
I
was
just
chair
is
that
I
do
think
underpinning
it.
The
alcohol
issue
is,
we
tend
to
jump
to
the
drugs
issue.
The
alcohol
issue
is
fundamental
and
how
people
access
that
and
get
some
control
of
their
lives
and,
as
the
counselors
have
mentioned
earlier,
how
people
continue
to
access
GP
service
and
others
can
are
challenging.
Their
behavior
is
difficult
to
manage
they're.
Not
this
there's
no
easy
answer
to
this,
but
to
drop
out
of
care
completely.
It's
not
an
answer
either
chair,
I
would
I
hope.
P
You
appreciate
that
I'm
passionate
that
we
see
some
steps
forward.
The
first
significant
step
forward
would
be
to
get
the
pilot
up
and
running
in
this
city
to
chest
out
what
is
best
practice
to
work
with
in
the
national
yeah
five-year
plan
to
try
and
access
support
and
the
fund
survey
and
STP,
which
is
the
and
then
say
it's
deeper
than
I.
P
Think
someone's
going
to
ask
me
exactly
what
it's
someone
in
the
round
the
table
tell
me
exactly
what
st
b
stands
for:
there's
a
big
conglomerate
of
areas
across
Humberside
and
bizarrely,
more
think
and
share
and
Yorkshire,
and
because
these
are
the
places
we
need
to
be
represented
at
to
get
support,
support
York,
because
I
feel
we
lose
out.
We
lose
out
because
other
other
places
have
increased
demands
and
I
think
we
have
our
demands.
Chair,
I'm
gonna
leave
my
report
at
that
and
then
I'll
open
up
quick.
P
Think
chaired
the
corridor
was,
after
our
first
view
of
trying
to
link
assets
that
were
already
in
place
and
positively.
We
discussed
it
in
some
detail
with
some
feedback
around
that
because
they
said
it's
it's.
It
feels
like
an
artificial
zone
we've
created
in
New
York.
Hence
why
we
widened
that
to
say:
look,
wouldn't
it
be
more
sense
to
link
into
structures
that
are
already
going
to
be
defined.
P
What
I
did
learn
from
doing
that,
and
perhaps
Shawn
already
knows
this,
but
I
didn't
was
the
amount
of
Sabourin
and
things
that
are
in
place
across
our
community
that
aren't
necessarily
linked
up
in
relation
to
mental
health
and
don't
get
me
wrong.
The
subs
tiny
pieces
of
work
being
done
some
in
isolation,
somebody
communities
all
over
the
place,
but
I
thought
the
potential
it's
phenomenal,
and
that
was
just
in
one
section,
the
city
so
chairman,
the
short
the
short
answer
is
we
saw
the
opportunity
with
a
new
hospital.
P
The
massive
opportunity
that
culturally
I
think
presents
I
think
the
opportunity
that
are
already
established
groups
and
also
I
have
to
be
remember.
The
approach
of
New,
York's
and
John
has
been
exemplary
as
a
unit
as
a
university
who
really
wants
to
care
about
its
place
in
the
community.
Not
just
the
students
and
I
say
not
just
the
students,
because
I
think
that's
about
8,000
of
them
says
they're,
not
it's
significant
in
their
own
right,
but
just
how
they
sit
within
the
community
of
that
part
of
York.
P
A
J
P
Sure
if
I
may
I
know
it
was
a
challenge,
but
it
was,
but
my
challenge
to
board
members
and
to
burn
the
North
Yorkshire
Police
would
be
I,
think,
there's
opportunities
to
be
creative
and
different
around
how
we
tackle
low-level
offending,
which
is
linked
primarily
to
people's
mental
health
and
I.
Think
we've
seen
for
years
and
years
diversion
schemes
around
cannabis
to
start
with
around
alcohol,
but
we've
yet
to
see
a
program
at
work
around
trying
to
divert
people
from
the
last
place.
C
You
ter,
and
just
on
that
I
just
encourage
you
to
research
a
bit
wider
because
we
we
have
had
and
I
know.
North
Yorkshire
was
one
of
the
places
that
had
an
excellent
mental
health
diversion
scheme
operating
in
the
courts
and
the
police
cells,
which
was
a
partnership
mainly
led
by
the
Probation
Service.
C
Unfortunately,
so
many
of
those
schemes
have
have
kind
of
fallen
by
the
wayside
because
of
various
reasons,
including
budget
cuts
and
the
privatization
of
the
Probation
Service.
But
I,
though
those
schemes
were
put
in
place
because
they
absolutely
worked
and
you're
absolutely
right.
There
is,
you
know
absolute
clear
evidence
that
offending
is
often
linked
to
mental
health
and
other
things
that
people
with
mental
health
issues
often
become
involved
with
and
those
diversion
schemes.
C
P
If
I'm
a
chair
and
that's
my
point
of
raising
it
really
I-
know,
they've
existed
in
the
past
and
I'm
acutely
aware
of
the
financial
position
that
partners
find
themselves
in
in
relation
to
how
their
budgets
get
ya
swallowed
up
by
increased
demand
and
I
would
argue,
there's
scope
within
the
pilot
to
have
an
element
where
we
could
make
that
happen.
I
think
it's
the
art
of
the
possible,
not
the
arts,
of
the
fact
that
it's
and
I'm
not
gonna,
get
into
any
judgement
about.
P
D
Mine
was
just
a
very
quick
point
to
say:
we
could
have
got
distracted
by
where
we
start
the
pilot
and
I
think
Tim
did
an
excellent
job
actually
in
wrangling
the
board
to
go
we're
going
to
start
somewhere
and
there's
a
lot
going
on
here.
So,
let's
start
here,
rather
than
letting
us
have
existential
debates
about
what
we
might
do
so
I
think
it
doesn't
matter
where
we
start
it's
that
we
actually
start.
That's
the
key,
but.
P
I
would
think
we
did
learn
a
lesson
and
the
lesson
is
we:
that's
why
the
the
representation
round
the
board
is
so
key
because
part
of
it
was
out
ignorant
in
terms
of
let's
start
somewhere,
cuz
I'm,
a
bit
of
an
activist.
As
you
know,
Shannon
would
have
liked
that,
but
also
it's
really
important
from
partners
perspectives
that
we
actually
think.
P
Okay,
what
would
make
most
sense
from
their
perspective
because
we
need
their
support
and
there
are
still
gaps
around
the
partnership
table
chair
that
we
haven't
filled
after
all
this
time
and
it's
critical,
we
do
we'd
feel
virtually
all
of
them,
but
there
are
still
partners.
We
need
to
get
around
that
table
when.
A
B
Just
to
pick
up
on
the
point
that
was
raised
in
the
video
in
relation
to
services
that
improve
mental
health
are
often
not
mental
health
services.
They
are
things
like
cultural
services,
arts
services
and
and
to
make
sure
that
we've
got
the
link
with
the
cultural
strategy.
That's
developing
for
the
city,
because
York
is
very
rich
in
its
cultural
resources
and
making
sure
that
we
link
that
on
to
this
agenda
is
really
important.
I.
A
Was
very
interested
in
the
Haiku
that
they're,
so
they're
they're
quite
difficult
to
write
because
they're
so
short
much
easy
to
write
to
sonic.
She
says
from
experience,
but
I
think
the
work
they're
doing
it's
and
Jon
with
the
arts
and
mental
health
is
absolutely
outstanding.
I
quite
agree
with
you
is
that
a.
P
New
chair
to
the
when
you've
witnessed
and
talked
to
people
who
you
know
their
lives
have
been
turned
around
through
connection
with
the
arts.
Through
programs
sue
yeah,
anything
okay,
they
didn't
yet
they
may
have
been
touching
the
the
medical
services
before
but
clearly
from
via
my
perception,
their
quality
of
life
and
where
they're
at
now,
as
a
result
of
that
is
significant
and
they're.
Saying
that
and
as
I
say,
some
of
those
hikers
were
very
interesting
to
read
because
they
actually
captured
where
that
person
was
and
that
where
they
were
feeling
and
I.
A
G
P
Think
those
are
the
the
the
prevention
agenda,
as
I
said,
I
think
it
has
to
start
pre-birth
I
think
we
are
talking
about
that
agenda.
I
think
we're
talking
about
a
whole
system,
integration
that
is
really
hard
to
grapple
with,
but
has
to
happen,
but
rather
some
services,
wolf,
yeah
yeah
really
really
struggle.
P
If
we
keep
asking
the
same
question,
they've
still
sort
through
the
same
pot
of
resources
and
I
think
the
eye
witness
professionally
thirty
years
ago,
a
family
and
cliff
in
in
York,
whose
three
children
all
ended
up
in
prison,
but
their
life
expectancy,
two
of
them
died
in
their
twenties
and
I
thought
eh.
What
a
waste
yeah
yeah
where's.
What
does
that
say
about
the
city
and
I?
Keep
coming
back
to
the
human
right
City?
What
does
that
say?
But
what
could
we
have
done
differently?
P
P
Ever
yeah,
a
specialist
group
of
people,
who've
gotten
far
more
professional
qualifications
than
I
have
but
I'm
convinced
that
we
need
to
link
in
those
services
that
were
already
in
place
in
an
effective
way,
and
we
understand
the
risks
and
we
understand
the
role
of
each
other
in
achieving
that
and
I
think
it's
not
a
panacea
to
everything,
but
it
would
certainly
move
us
into
a
different
place
and
it's
not
easy.
Believe
me.
It's
not
it's
not
easy,
but
I'm,
certainly
much
more
optimistic.
Now
that
it's
possible,
then
I
was
twelve
months
ago.
I'm.
A
M
You
Jerry,
it's
just
a
quick
reflection,
really
Tim.
This
is
a
really
timely
piece.
Well
done,
certainly
supportive
of
it.
I'm.
Also
mindful
that
we
ought
to
be
aware
of
the
considerable
strains
on
our
workforce
need
to
protect
our
workforce.
I
think
Phil,
you
alluded
to
that
with
the
policing
workforce.
I
can
certainly
speak
from
the
point
of
doctors.
M
Dr.
claire,
gerardo
from
the
Royal
College
of
General
Practitioners,
recently
quoted
Cystic
that
every
three
weeks
dr.
commits
suicide
and
paladin's
down
to
workload,
pressures
and
so
forth,
and
as
of
last
week,
I
was
visiting
GPS
at
unity,
the
university
services,
and
they
talked
about
the
emotional
strain
of
looking
after
young
people
who
are
self
harming
so
go
on
to
commit
suicide,
and
it's
something
about
how
do
we
as
a
society,
create
a
much
more
supportive
environment
and
that
respects
and
looks
after
our
frontline
professionals?
Thank
you.
That's.
I
Yeah
just
a
quick
question
on
the
note
about
prevention
and
how
it
should
start
pre-birth
and
therefore
throughout
childhood
and
education
as
well
on
your
list
of
people
in
your
partnership.
I,
don't
see
anyone
representing
education
and
I
just
wondered
if
that
could
be
thoughts
of
ours
or
if
it's
a
gap.
P
Carried
away
I
should
know
by
now
the
it's
a
good
point
that
we've
had
quite
a
representation
through
this
isn't
director
who
is
actually
being
present
their
workload,
so
it
it
is
there,
but
it's
we
need
to
make
sure
it.
It
carries
on
quite
frankly,
because
yeah
it's,
we
we're
not
trying
to
put
even
more
pressure
on
someone
to
attend
another
meeting,
but
when
that
subgroup
comes
to
an
end
as
it
will
do
in
terms
of
self-harm
at
some
point,
we
need
to
think
how
that's
represented
and
I
yeah
I
echo
your
comments.
P
L
But
now
we're
moving
to
and
I
was
just
speaking
to
Tim
before
the
meeting
we
are
moving
to
the
how
and
the
what
are
we
going
to
do.
This
will
require
us
to
and
I
think
the
well-being
corridors.
A
good
idea
in
the
sense
of
we
will
be
testing
concepts
that
are
actually
quite
challenging
in
terms
of
the
way
we
work
in
organisations.
We
do
separate
and
silo
teams
functions
the
bureaucracy
and
we'll
be
testing
removing
parts
of
those
underneath
that
and
in
recognition
of
the
impact
on
the
workforce.
L
P
Very
point
but
know
me
helpfully
provided
the
link
in
for
me:
it's
the
culture
within
organizations
in
the
city
to
actually
step
up
and
actually
the
ends
of
school.
We
can't
look
at
the
the
look
at
the
money,
we'll
come
up
with
a
series
of
knows:
it's
the
it's
the
culture
for
those
people
actually
involved
in
delivering
those
people
receiving
it.
P
And
actually
are
we
true
the
statements
we
make
a
human
right
city
which
looks
at
the
the
rights
of
every
individual,
not
those
ones
who
are
good
at
accessing
services,
not
those
people
who
are
can
either
pay
or
can
find
other
ways
of
doing
it.
It's
every
every
person
who
lives
in
this
city
and
that's
the
challenge
and
I
think
that's
what
we
should
retain.
Thank
you
for
listening,
Jim,
Jim.
A
A
That
was
fascinating
and,
of
course,
mental
health
is
our
top
priority
in
the
health
and
well-being
board,
and
we
it
will
go
on
being
our
top
priority.
Of
course,
we
now
come
to
report
which
I
found
absolutely
fascinating.
I
realize
not
everybody
does
what
find
the
BCI
fascinating,
but
I
read
it
with
great
interest
and
pippers
going
to
introduce
it
to
us
and
take
questions.
S
It
probably
won't
escape
your
notice
that
it's
a
bit
strange
to
have
planning
requirements
halfway
through
the
financial
year,
but
that's
the
way
it
works
on
a
national
basis.
So
we're
not
late
we're
on
time,
but
also
I
just
need
to
mention
that,
in
terms
of
the
timetable
for
planning
and
the
assurance
process,
I
am
asking
the
board
to
delegate
you
and
the
vice
chair
the
opportunity
to
sign
off
our
formal
plan
before
its
submission.
Because
of
the
way
that
the
meeting
dates
fall.
We
can't
bring
the
actual
plan
to
this
board.
S
So
this
was
the
same
piece
of
work
that
shone
referred
to
just
in
the
main
body.
The
report
then
just
a
reminder
that
the
planning
timetable
requires
us
to
submit
our
formal,
better
care
fund
plan
for
this
financial
year
by
the
27th
of
September,
and
that
goes
to
sort
of
regional
and
then
national
assurance
and
last
year,
that
process
was
completed
just
before
Christmas,
as
our
plan
had
been
in
escalation,
so
we
hope
to
get
through
without
going
to
nationalized
escalation.
This
year,
I've
just
explained
there
at
paragraph
10.
S
The
way
that
will
sign
that
off
will
need
to
be
outside
of
this
formal
board,
but
obviously,
once
it's
approved
the
plan
then
becomes
a
public
document
and
the
2017-19
plan
was
actually
an
included
and
narrative
document.
That
was
like
a
document
you
could
read
as
a
publication.
They
they've
changed
the
system.
So
now
the
plan
is
submitted
through
an
Excel
spreadsheet,
which
is
not
everybody's
cup
of
tea,
but
the
sort
of
strategic
narrative
part
amounts
to
about
four
and
a
half
thousand
words,
which
is
the
descriptive
part.
S
So
what
we
might
choose
to
do
is
sort
of
published
that
plus
the
list
of
schemes
and
you'll
see
in
that
the
review
from
this
year.
It
will
build
on
what
we've
already
done
so
just
going
on
to
the
annual
review
and
I.
Don't
propose
to
go
through
the
document
in
a
lot
of
detail,
because
I
hope
it's
self
explanatory.
S
S
S
S
If
anybody
wants
more
information
and
really
what
I'd
like
to
do,
is
just
to
pass
over
to
Christine,
who
is
going
to
talk
a
little
bit
about
how
social
prescribing
is
one
of
our
really
precious
better
care
fund
schemes
has
made
a
difference
in
the
lives
of
some
local
people,
and
people
can
read
some
of
the
other
information
about
all
the
different
schemes
there,
because
I
know
there's
not
really
time
to
go
into
detail.
I
think.
A
That's
right
and
in
fact
all
the
schemes
are
set
out
and
the
budget
is
set
out
the
expenditure
and
that
that
is
all
there
for
people
to
read
and
when
I
think
what
it
was
like
four
years
ago.
The
change
is
quite
remarkable,
so
we
wouldn't
get
anything
agreed
for.
Yes,
thank
you,
Pippa
right,
Christine,
your
slot.
Thank.
T
You
and
so
just
to
introduce
social
prescribing
a
little
bit
to
those
who
might
not
have
the
full
details
we
funded
through
the
better
care
fund.
We
are
in
3gpp
groups
across
the
city,
so
we
work
within
New
York,
Medical
Group
acts,
the
Medical,
Group
and
Priory
and
we're
a
small
team.
Three
part-time
staff
say:
there's
one
practitioner
in
each
of
the
medical
groups
and
the
kind
of
the
pure
model
that
we
work
to
is
trying
to
reduce
the
number
of
people
accessing
their
GP
for
a
non
clinical
reason.
T
T
Actually,
x,
y&z
really
isn't
working
now,
it's
time
for
me
to
go
and
see
my
doctor,
and
so
we
acknowledge
that
lots
of
things
impact
on
a
person's
physical
and
mental
well-being,
changes,
dynamic
changes
in
a
person's
life,
emotional,
health
and
well-being,
physical
health
and
things
like
income,
all
things
that
affect
somebody
and
not
something
that
there's
a
clinical
solution
for,
and
so
our
work
is
to
find
a
social
solution,
largely
based
within
a
person's
own
community.
So
something
that
already
exists.
T
We
don't
try
and
create
new
things,
but
we
work
with
across
the
boundary
and
community
organizations
to
find
things
that
fit
each
individual.
It's
a
bespoke
service,
so
every
single
person
gets
a
different
service
because
what
each
person
is
looking
for
and
what
what
their
outcomes
are
are
completely
different.
So
what
might
be
something
that
I
think
is
a
good
life
will
be
completely
different
for
Pipper
and
for
everyone
around
this
room.
So
we
don't
project
onto
other
people.
T
Any
connections
in
the
city
didn't
really
have
a
support
network
around
her
and
kind
of
their
whole
plan
of
what
their
life
was
going
to
look
like
was
completely
changed
for
them.
By
this
this
diagnosis,
basically,
since
treatment,
Karen
height,
had
quite
significant
side
effects.
It
affected
her
ability
to
verbally
communicate.
She
constantly
had
to
wipe
saliva
from
her
mouths,
and
this
knocked
her
confidence
as
I'm
sure
you
can
imagine
and
being
in
a
new
place
and
not
known
anybody.
T
She
became
increasingly
socially
isolated,
Karen's
goal,
so
not
our
goals,
Karen's
goals,
but
to
meet
new
people,
reduce
their
isolation,
and
so
initially
she
met
our
practitioners
within
the
clinic
because
that's
where
she
was
most
comfortable,
that's
where
most
of
our
clients
feel
safe,
GPS,
but
slowly
but
surely
we
got
her
out
into
the
community
and
accessing
more
things.
She
attended
a
sewing
group
that
was
organized
to
make
sanitary
ware
for
girls
living
in
poverty.
She
absolutely
loved.
T
It
had
no
idea
that
something
like
this
might
even
possibly
exist
across
the
city
and
continue
to
go
back
there
under
her
own
steam
without
support
from
us.
We
also
got
her
in
touch
with
Kyra
and
women's
project.
Again
we
supported
her
to
access
the
drop-in
and
again
she
was
just
couldn't
believe
the
group
existed
and
the
support
that
she
got
and
the
peer
support.
There
was
fantastic
and
again
she
she
continues
to
access
that
service.
So
Karen
reported
to
as
this
improvement
in
her
mental
health
and
her
well-being.
T
However,
I've
actually
got
Karen's
own
words
here
as
to
what
the
outcomes
were
for
her,
and
so
she
states
I
can't
thank
you
enough
for
the
health
and
support
that
you
have
given
me
three
ways
to
well-being.
As
you
know,
my
husband
and
I
lived
in
New
York
for
less
than
a
year
when
my
cancer
return
that
I
needed
a
major
operation.
Consequently,
I
had
little
time
to
make
new
acquaintances
before
my
operation
and
since
my
operation,
I'm
no
longer
able
to
speak
properly
or
to
swallow.
T
This
has
had
such
an
impact
on
my
quality
of
life,
although
not
clinically
depressed
my
mood
was
low
at
times
and
I
felt
lost.
My
sense
of
I
had
no
sense
of
purpose
and
was
isolated.
Meeting
you
at
my
GP
surgery
gave
me
hope,
thanks
to
your
listener
skills
and
knowledge
of
activities
and
social
groups
in
the
York
area,
attending
the
day
for
girls
workshop
at
York,
Minster
certainly
took
me
out
of
my
comfort
zone,
but
with
support
I
felt
proud
to
have
taken
part
in
such
an
important
event.
T
I'm
really
enjoying
spending
time
with
other
women
at
Kyra,
such
a
lovely
environment,
where
I
feel
comfortable
and
more
confident
I
would
not
have
known
such
a
place
existed
without
your
help.
Thanks
to
your
support
and
suggestions,
it's
becoming
easier
to
adapt
to
my
very
different
life
by
boosting
my
self-esteem
and
confidence
to
socialize
the
waste
well-being
services.
Wonderful
publishing
have
read
the
last
bit
that
I
did
to
say,
and
so
that's
just
a
really
lovely
example
of
there
is
a
clinical
need
there.
T
A
D
Shut
I
should
probably
have
declared
an
interest
at
the
start.
Obviously,
HealthWatch
York
sits
within
New,
York,
CVS
and
so
does
ways
to
well-being,
but
I
know
that
currently
you
only
work
across
a
number
of
practices,
but
part
of
the
plans,
particularly
with
primary
care,
home
and
primary
care
network,
are
around
the
expansion
of
social
prescribing
into
every
practice
in
York.
Is
that
progressing
because
I
know
we
are
being
asked
quite
frequently
now,
when
will
social
be
prescribing
be
available
everywhere?.
S
Thank
You
Sean
so
and
within
the
better
care
fund.
This
year
is
a
single
year
and
we're
still
waiting
for
government
announcements
about
how
the
better
care
fund
will
progress,
but
within
our
better
care
fund,
were
absolutely
committed
to
sustaining
and
maintaining
social
prescribing,
as
it
is
in
terms
of
the
NHS
long
term
plan
where
there
was
a
quite
an
in
significant
announcement
about
the
development
of
social
prescribing.
S
A
Think
that's
something.
I
would
really
like
to
see.
I
think
social
prescribing
is
incredibly
valuable
and
very
useful
service
and
I
hope
it
will
expand,
because
I
think
it
does
a
great
job
and
if
we
get
people
whose
problems
aren't
all
solved,
that
who
are
able
to
function
much
more
happily
in
their
communities
and
the
way
that
you've
described
Christine
I
think
that
was
absolutely
right.
E
Yes
can
I
just
add
a
slightly
different
perspective
on
social
prescribing,
Tim
and
others.
Tonight
have
been
talking
a
lot
about
connecting
and
I.
Think
I
came
to
your
four
years
ago
to
CBS
four
years
ago
and
in
terms
of
connecting
and
cooperation,
this
place
was
a
desert.
Actually,
in
my
my
views,
I
think
one
thing
that
social
prescribing
is
done
is
actually
allow
us
to
experiment.
We
took
a
punt
when
we
set
it
up,
but
it's
actually
allowed
a
lot
of
clever
collaboration
to
develop
sustainably.
E
It
gives
us
a
really
strong
foundation,
and
the
thing
it
does
is
shows
that
I
mean
I.
Just
love
Tim's
enthusiasm
that
we
can
do
it
and
when
we
started
on
social
prescribing,
we
went
what
wait
what
you're
talking
about,
and
it's
not
just
for
individuals,
but
it
also
has
benefits
of
the
fabric
I,
think
of
York,
but.
A
A
A
S
You
chair
so
I
feel
like
a
little
bit
of
an
impostor
here
this
evening,
because
the
Care
is
strategy
and
the
work
that
has
gone
into
developing.
It
has
been
done
by
a
group
that
I'm
not
actually
personally
a
member
of,
although
it's
it's
within
my
division,
it
would
have
been
one
of
my
team
members
Gary
here
this
evening,
but
I'm
presenting
it,
but
I
don't
want
to
claim
any
of
the
glory
and
I
hope
there
will
be
plenty
of
glorious
as
we
get
through
the
item.
S
As
the
report
says,
we're
asking
the
health
and
well-being
board
to
support
the
strategy
and
to
help
us
take
it
forward.
It's
been
developed
through
a
partnership
approach
which
I'm
going
to
hand
over
to
Carol
and
all
that
it's
Carol
sakovich
and
Sharon
Smith
from
the
carers
centre
who've
been
part
of
the
process.
All
the
way
through
this
board
knows
very,
very
well
the
absolutely
vital
role
played
by
family
carers.
Friendship,
carers
of
people
who
have
ongoing
care
and
support
needs
both
young
carers
and
older
carers,
whether
it's
partners,
siblings
sons,
parents
throughout
our
lifetime.
S
Many
of
us,
if
not
all
of
us,
will
become
carers
and
at
any
given
time
in
New
York.
There
is
the
better
part
of
20,000
people
who
are
taking
a
role
caring
for
somebody
else
in
a
voluntary
capacity,
and
the
report
includes
some
really
important
information
that
we've
gleaned
from
the
carers
survey,
which
has
some
stark
messages
for
us,
but
also
underpins
the
really
important
need
for
us
to
work
together
to
deliver
a
strategy.
S
H
Thank
you.
Some
of
you
will
know
that
Karis
Center
is
an
independent
charity.
It's
been
around
since
2009
when
I
arrived,
it
was
Francis
Perry
who
developed
the
carers
strategy
and
since
then,
we've
had
Adam
gray,
I
think
what
we
were
doing
was
waiting
for
the
national
strategy
to
come
forward,
but
never
happened
so
Adam
just
progressed
this
strategy
with
carries
through
York,
like
I,
know,
Adams
left,
but
I.
Think
we'd
really
like
to
thank
Adam
for
the
amount
of
work
that
he
put
into
the
consultation
with
carers.
H
We
have
a
carer
strategy
group
of
members
that
have
put
this
together
and
Mystere
would
have
liked
to
have
seen
the
members
names
or
the
organization's
they
represent
in
the
strategy.
I
think
that
gives
carers
and
powers
carers.
So
if
they
can
use
the
strategy
and
use
the
action
plan
where
they
go,
they
can
say:
hey
you
signed
up
to
this.
Therefore
you
know
and
I
think
Lee.
H
The
consultation
that
was
held
in
West
offices
was
with
the
carers
Action
Group,
which
Shallon
who's
our
lead
officer
for
adult
carers,
helped
us
establish
that
group
we've
been
meeting
for
quite
some
time
and
it
gives
the
voice
of
carers
enable
them
to
feed
into
the
strategy
group.
So
it's
not
just
council,
lead
or
or
officer
lead,
I.
H
Think
the
having
read
through
the
action
plan
and
the
strategy
that
there's
some
responses,
that
care
is
made
on
page
six
and
I
think
they're
very
much
alive
in
in
the
action
plan.
I.
Don't
if
you
want
to
add
2
to
that,
you
know
I,
think
there's
some
things
about
care
is
wanting
to
be
listened
to.
We
believe
that
they're
very
much
part
or
should
be
part
of
an
integrated
plan,
whatever
that
is
whether
it's
with
a
mental
health,
professional
or
or
another
health,
professional
or
statutory
services.
They
should
be
able
to
bring.
H
U
Yeah
in
in
part
of
the
consultation
adam
attended,
a
group
with
mental
health
care
errs
as
well.
He's
listened
to
different
groups
of
carers
across
substance
misuse
and
lots
of
different
areas,
dementia
carers
and
different
groups
of
carers,
and
I
think
it's
just
important
to
highlight
that
as
it
as
it's
written
in
the
action
plan.
Carers
are
everybody's
business
right
from
the
board.
D
Hi
I
guess
the
question
I'd
like
to
ask
is:
what
do
you
think
needs
to
happen
to
make
sure
that
the
needs
of
carers
are
properly
embedded
in
absolutely
everything
we
do
so
that
when
we're
talking
to
people
were
always
thinking,
is
there
a
carer
that
we
haven't
identified
in
this
picture?
Is
there
a
voice
that
we're
not
listening
to?
Is
there
someone
we're
leaving
out
of
this
conversation?
What
you
want
to
see
happen
so
that
we
actually
get
it
right
for
people.
H
I
think
that's
a
pretty
big
question,
sure
I
think
we're
already
working
by
delivering
training
to
professionals
and
the
Clinical
Commissioning
group
is
helping
to
implement
that
very,
very
well,
and
the
training
is
held
at
West
offices.
I
think
there's
been
some
200
professionals
that
have
attended
that
training.
What
it
does
is
help
them
to
identify
carers,
help
them
to
know
where
to
refer
care
is
to
help
them
to
understand
the
problems
that
they
face.
I
still
think
that
there's
an
awful
long
way
to
go,
particularly
in
identifying
perhaps
young,
adult
carers,
their
problems.
H
The
focus
is
on
the
person
with
the
health
problem
and
the
young
adult
care
at
home
is
ignored
and
they're
not
able
to
ask
for
help,
particularly
if
it's
something
to
do
with
mental
health,
addiction
or
substance
misuse.
Something
like
that
they're
afraid
to
ask
for
help
because
of
any
implications.
Do
it
so
I
think
more
needs
to
be
done
around
that
yeah.
U
I
mean
I
think
we
for
all
the
organizations
that
around
the
table
to
sign
up
to
the
strategy
and
attend
the
carers,
Strategy
Group
and
and
be
really
involved
and
feed
it
down
to
their
organizations
to
ground
level
right.
So
it's
it's
taken
on
board
and
really
embedded
into
every
area
of
practice,
really
that
that
carries
needs
to
be
identified,
listened
to
and
supported
and
referred
to.
N
Thank
You,
chair
I,
think
that's
a
very
big
question
and
I
think
that
very
nice
monster.
Thank
you.
What
are
the
things
I
wanted
to
ask
us
about
the
recent
focus
on
Kara
stress
and
how
actually
the
breakdown
of
that
caring
environment
can
often
come
to
really
sad
and
unintended
consequences
and
I
suppose
for
me,
is
in
our
city.
How
do
how
does
respite
work
for
carers?
Is
that
something
that
might
link
to
what
Sean
just
asked
you
around?
What
you'd
like
to
see.
R
H
H
You
know
the
training
that
we
provide
them
with,
for
instance,
going
through
rehabilitation
where
somebody
with
substance
misuse
is
going
through
rehabilitation.
Quite
often,
we
find
that
a
families
already
broken
down
by
the
time
it
gets
to
that
point.
So
you
know
it's
not
a
caring
role,
so
what
we
need
to
do
is
to
to
help
that
carer
understand
the
rehabilitation.
So
that
families
there,
when
that
cared
for
person,
comes
back,
that
sort
of
thing
that
you
would
say
we
do.
A
Right,
any
more
questions,
I
think
what
I've
been
acutely
aware
or
for
many
many
years
is
without
the
carers.
The
whole
health
system
would
fall
over
completely
and
the
professionals
would
be
completely
drowned
out
and
I've
been
aware
for
many
years
that
there
are
many
young
children
at
school
who
are
caring,
they
may
be
late
for
school.
They
may
not
be
able
to
do
their
homework
on
time.
A
I'm,
never
sure
that
the
schools
are
absolutely
clear
about
that,
but
I
hope
they
are
I'm
sure
that
both
Amanda
and
Dean
will
take
that
point
up
at
some
point
and
I'm
also
aware
that
there
are
older
carers,
where
the
partner
that
they're
caring
for
has
got
older
and
so
have
they,
and
that
creates
a
particular
difficulty,
particularly
with
things
like
lifting
and
handling
so
you're
doing
great
job,
and
thank
you
very
much.
Thank
you.
A
A
M
M
Okay,
that's
all
right.
I'll,
just
carry
on
the
Valleyfield
CCG
covers
a
fairly
large
patch.
As
you
will
see
it's
we
we
span
much
of
the
Vale
of
York.
We
go
as
far
north
as
Pickering
carry
more
side
up
in
the
north
as
far
south
to
Selby
and
Sherman
Tadcaster.
We've
got
around
26
practices
across
the
patch
of
which
twelve
are
in
the
city
view,
and
that
accounts
about
a
quarter
of
a
million
people
in
the
City
of
York.
So
a
fairly
big
patch.
M
M
General
practice
teams,
general
practice
teams
up
and
down
the
country
work
very
hard
and
certainly
in
the
City
of
York.
They
work
very
hard.
There's
demographic
change.
We've
got
an
aging
population
with
much
more
complex
health
needs.
There's
increasing
demands,
increasing
expectations
set
that
begins.
An
aging
workforce
set
that
against
the
fact
that
in
the
last
year,
we've
had
a
2%
reduction
in
the
number
of
permanent
full-time,
equivalent,
GPS
and
I
know
from
a
snapshot
survey
we've
done
at
practices
that
we
are
carrying
a
shortage
of
eight
GPS
and
at
least
for
practice.
M
Nurses
in
our
patch
I
also
know
from
our
discussions.
It
practices
that
a
common
complaint
is
workload
workload
workload
so
I
appreciate
when
patients
can't
get
in
to
see
the
GP
and
they
have
to
wait
two
weeks.
It
is
not
for
want
of
trying
and
part
of
the
client
practice.
We've
got
infrastructure
challenges.
We
are
moving
in
a
digital
age,
we're
needing
to
consider
whether
the
workforce
and
the
infrastructure,
the
buildings
are
right
for
now,
as
well
as
going
to
the
future,
and
we
also
mindful
of
general
practice
resilience.
M
We
know
GPS
under
a
lot
of
pressure.
Some
of
them
leave
the
area.
Some
of
them
leave
the
profession
altogether
because
workload
so
there's
a
sustainability
issue
going
forward.
But
this
is
not
a
new
problem.
This
has
been
going
on
for
some
time
and
the
government
and
the
British
Medical
Association
NHS
England
recognize
this
and
they
came
up
with
a
contract
reform
to
try
and
strengthen
general
practice
and
one
of
them.
M
One
of
the
initiatives
is
around
setting
up
of
primary
care
and
Edwards,
and
this
basically
is
a
grouping
of
practices
around
30
to
50
thousand
people
on
average
nationally
to
try
and
bring
together
services
to
make
them
more
seamless,
bring
the
services
closer
to
the
home,
try
to
break
down
those
barriers
between
primary
care,
secondary
care
and
mental
health,
and
to
try
and
adopt
a
much
more
play
space
neighborhood,
much
more
population
health
approach
to
it.
So
that's
the
wishlist
for
primary
care
networks
and
is
a
very
challenging
one
indeed
link
to
that.
M
Our
investments
in
primary
care
to
try
and
strengthen
the
workforce.
This
year,
you've
already
heard
that
there
is
funding
introduced
for
all
social
prescribers,
as
well
as
clinical
pharmacists
in
the
coming
years
and
will
include
physician,
Associates,
first
contact
physiotherapists
as
well
as
community
paramedics.
So
all
that's
in
the
pipeline
going
forward,
and
these
presents
new
opportunities
for
doing
general
practice
differently.
M
In
the
city
of
York,
we've
got
three
primary
care
networks.
The
first
is
York
City
Center
consisting,
if
you
are
with
delegate,
is
parade
unity,
health,
Dalton,
Terrace.
The
second
is
York
Medical
Group
and
the
last
is
Nimbus
healthcare,
which
is
a
very
large
primary
care
network
of
150,000
people
covering
Pocklington,
al
Vinton,
old
school
Front
Street,
my
health
Haxby
and
the
friary
Medical
Group,
but
they
have
challenges
they've
only
just
been
launched
on
the
1st
of
July.
M
They
are
very
much
at
the
setting
up
stage
at
this
point
and
they're
having
to
get
the
heads
around
how
they
develop
an
approach
to
delivering
a
sustainable
service,
how
they
strengthen,
expand
your
teams,
how
they
start
taking
advantage
of
new
opportunities,
such
as
around
digitally
enabled
working
they'll,
have
to
try
and
work
out
the
local
stakeholders,
local
partnerships
around
the
table,
including
with
the
local
council
and
the
third
sector
as
well,
and
changing
a
way
of
working
to
become
much
more
population.
Health
focus.
M
We've
got
some
challenges
locally,
because
the
geographical
boundaries
of
our
3pcs
receive
them.
The
next
three
figures
don't
quite
overlap.
Well,
sorry
they're,
not
quote
they're,
not
independent,
and
they
overlap,
and
this
therefore
means
they
have
to
work
in
a
slightly
different
way
to
primary
care
networks.
M
So
it's
about
moving
away
from
the
individual
patient
for
these
primary
care
networks
to
them,
adopting
a
much
more
population
health
approach
and
seeing
how
they
fit
in
with
all
the
other
partners.
So
I'm
quite
optimistic
about
primary
care
networks
going
forward,
as
I
said,
presents
a
new
way
of
working.
It
brings
in
much-needed
investment
into
primary
care,
which
they've
not
had
for
last
ten
years
or
so,
and
increasingly
they
will
become
the
building
block
for
NHS
primary
care
and
a
key
part
of
the
health
infrastructure
going
forward
and
that
basis.
A
F
Thank
You,
chair
and
I
realized
that
the
problem
is
complicated
by
overlapping
boundaries
between
author
effectively
separate
businesses.
So
it
seems
slightly
peculiar
to
me
that
it's
been
chosen
to
put
a
limited,
pretty
structure
above
these
groups
of
separate
businesses,
and
you
suggest
that
that's
going
to
improve
the
level
of
investment.
F
M
You
Council
cubberson,
that's
a
great
question,
a
little
bit
of
history.
If
you
go
back
ten
years
ago,
it
was
already
thinking
among
the
general
practice
practices
nationally
they're,
all
coalition
practices
that
they
saw,
the
future
of
general
practice
being
in
Federation's
or
GP
is
basically
working
together
to
try
and
improve
their
resilience,
and
a
lot
of
the
resilience
would
come
from
consolidation
of
backroom
functions,
for
example,
or
finding
ways
to
work
at
scale
with
the
PCN
model.
The
practices
are
allowed
to
to
form
these
alliances
in
different
ways.
M
Some
of
them
might
form,
as
you
described
a
subsidiary
company
of
sorts.
Some
of
them
are
more
loose
Federation's
where
there
might
be
a
lead
practice,
acting
as
the
lead
practice
on
behalf
of
the
group.
So
there
are
different
models
there
and
NHS
England
and
has
passed
funding
through
the
CCG
on
to
the
primary
care
networks
to
help
set
up.
So
certainly
in
the
first
year,
they've
received
an
initial
investment
amount
to
try
and
help
set
up
themselves
as
these
alliances.
A
F
You've
probably
addressed
about
12
and
a
half
percent
of
the
of
the
problem
domain
that
I'm
trying
to
think
to
inquire
about
and
I
think
it
will
be
better
if
we
had
a
separate
conversation
and
maybe
a
subsequent
report
to
the
board
to
amplify,
but
I.
Just
think
that,
forgive
me
it's
a
very
simple
concept:
you've
introduced
and
a
very
simple
explanation
and
I
suspect
the
reality
is
far
more
complex
and
that's
what
I
really
would
like
to
understand.
Thank
you.
Thank
you.
C
Thank
you,
Thank
You,
chair
I'm,
a
little
confused
because
when,
if
you
look
at
everything,
apart
from
the
description
of
what
the
network's
cover,
the
role
of
the
primary
care
networks
point
to
deliver
care
close
to
home
based
on
natural
geographies
and
population
distribution
and
need
rather
than
organizational
boundaries,
then,
if
you
fast-forward
to
the
actual
the
descriptions
of
the
York
networks,
they're,
almost
exactly
the
opposite
of
that
in
some
cases.
So
how?
M
We've
got
a
complexity
in
Europe,
which
requires
the
primary
care
networks
to
come
together
and
in
a
way,
try
and
work
differently
to
try
and
achieve
this
aspiration
of
not
having
those
boundaries.
We
very
much
are
at
the
early
stages
of
those
discussions,
basically,
and
hence
why
I
said
they've
got
a
challenge
here:
they've
got
a
challenger
to
try
and
find
a
way
of
working
that
gets
over
them.
I.
A
G
York
cities-
probably
unusual
for
cities
that
they've
got
three
of
the
biggest
groupings
of
practices.
You
see,
you
know,
you've
got
Haxby
group,
you've
got
York,
Medical,
Group
and
you've
got
Priory,
Medical,
Group
and
they're
all
big
practices
in
it.
If
you
went
elsewhere,
so
those
big
practices
will
cover
most
localities
within
the
city.
If
you
go
elsewhere,
that
doesn't
really
happen,
and
so
the
geographical
barrier
boundaries
that
Andrews
talking
about
sort
of
make
more
sense.
So
this
complex,
but
there
is
a
will
to
work
together
to
get
it
down
to
sort
of
locality
level.
C
C
So
when
we
talk
about
seeking
to
deliver
care
close
to
home,
we
need
to
think
about
what
close
to
home
means,
but
but
one
of
the
things
one
of
the
the
impacts
on
on
people
living
in
the
area
that
I
represent,
is
that
they
have
to
travel
to
go,
see
a
GP.
And
you
know
when
you
look
at
some
of
the
stats.
We
do
have
some
poor
outcomes,
health
outcomes
in
the
ward
and
it
there
must
be
a
link
there.
C
If
you
have
no
access
to
healthcare
provision
within
walking
distance
and
you
have
to
travel
to
to
go
and
seek
health
care,
then
there
must
be
an
impact
and,
and
so
I
was
I
was
really
enthusiastic
in
the
early
slides,
because
I
thought.
Yes,
that's
exactly
what
we
want
to
livering
Care
close
to
home,
making
taking
away
that
that
sort
of
boundary
between
primary
and
secondary
care,
all
of
those
things
marvelous
and
so
I
suppose
it
was
just
a
bit
of
a
surprise
then,
to
see
that
that's
not
gonna
be
achieved.
Okay,.
G
Care
and
what
we
mean
by
care
and
what
that
means
for
the
local
authority
and
health
together
and
what
what
we
build
in
the
future.
So
we're
talking
about
infrastructure
digital.
So
this
is
a
great
opportunity
for
for
people
to
understand
what
the
needs
are
and
what
we
need
to
do
and
networks
are
a
way
of
starting
to
build
those
relationships
around.
D
But
actually
we
keep
seeing
initiatives
to
bring
more
money
in
through
health
to
then
funnel
out
and
how
much
of
that
is
actually
likely
to
ever
reach
the
voluntary
and
community
sector
that
underpins
a
lot
of
the
thinking
about
meeting
need
better
closer
to
home
through
non
clinical
non-medical
processes
and
I
guess.
My
colleagues
from
Social
Care
would
probably
argue
that
there's
a
need
for
funding
in
that
and
in
mental
health
colleagues
would
argue,
doesn't
need
funding
in
that.
So
how?
D
Much
of
this
is
going
to
come
out
of
primary
care
to
support
the
wider
system?
And
if
it's
not
coming
through
this?
Where
is
that
coming
from?
Because
I
think
we
do
hear
that
there
isn't
a
lot
of
increase
in
funding
for
health,
but
there's
been
virtually
no
increase
for
the
voluntary
and
community
sector.
For
a
number
of
years
now,
so,
if
we
are
getting
more
referrals,
how
are
we
going
to
pick
those
up
without
additional
capacity?
D
A
A
I
think
that's
obviously
right
I
think
we're
going
to
need
an
update
on
this
one
when
it
gets
his
feet
under
the
table,
but
I
think
that
council
dermis
might
take
up
the
same.
Offerors
was
offered
to
councillor
Baker
and
to
just
have
a
private
conversation
about
the
provision
of
GPS,
in
particular
in
your
ward.
Thank
you.
A
Now,
we've
got
Lindsay
and
Chris
who've
been
waiting
terribly
patiently
for
hours
and
they're
going
to
talk
to
us
about
the
humbuckers
from
their
long-term
plan
is
called
and
now
for
something
slightly
different.
I
think
Lindsay
and
Chris
I'm
very
pleased
to
see
you
both
and
thank
you
very
much
for
taking
the
time
to
come.
V
Thank
you
for
the
invitation.
I
just
should
advise
that
Lindsay
myself
have
spent
two-and-a-half
hours
this
afternoon,
unbridled
joy
in
the
partnership
executive
meeting,
so
first
stop
talking
complete
gibberish.
Just
please
advise
me
what's
wrong
with
my
brain
is
up
to
this,
but
we'll
give
it
a
go.
So
thank
you
for
the
invitation
I've
been
working
in
health
care
planning
for
longer
than
I'd
care
to
remember
and
longer
that
I
prepare
to
admit
to
today.
V
So
being
asked
to
write
for
a
public
audience,
leading
us
to
write
for
a
professional
audience
being
asked
to
write
for
a
political
audience
and,
of
course,
we're
being
asked
to
write
for
the
Department
of
Health
and
the
Treasury,
because
the
department,
health
and
the
Treasury
want
commitments.
Promise
that
we
will
deliver
the
deliverables
that
are
described
in
the
long
term
plan
and
there
are
many
of
them.
So
that's
the
scale
of
what
we're
talking
about
here,
we're
trying
to
make
sense
of
that.
V
The
guidance
that
we
have
received
I,
think
the
initial
guidance
was
was
quite
helpful,
linked
back
to
the
the
objectives,
particularly
outcomes
based
objectives
of
the
long
term
plan
and
some
of
the
things
that
mean
everybody
around
the
table
would
regard
as
very
positive
within
the
long-term
plan.
But
some
of
the
subsequent
guidance
has
been
a
little
bit
can
I
say
in
public
company
less
helpful.
V
Some
of
it
is
being
quite
late,
and
some
of
it's
been
very
detailed
and
there
is
a
danger
that
some
of
the
very
positive
things
about
this
exercise
will
be
stifled
burdened
by
the
the
more
detailed
elements,
so
we're
trying
to
keep
that
that
balance
and
keep
that
separation.
So
when
we're
talking
about
what
we
want
to
put
into
the
plan,
we've
described
the
different
sections,
there's
actually
an
extra
section.
That's
been
added
in
so
we
talked
about
of
the
narrative
bit
and
I.
V
Think
the
the
narrative
section,
the
strategic
plan
section
is
probably
the
area
where
we
can
describe
effectively
what
it
want
to
achieve
and
that's
the
area
where
I
think
we
probably
can
produce
something
that
ultimately
will
be
of
interest
to
members
of
the
public
elected
members
and
our
stakeholders
and
members
of
staff.
The
technical
plan,
which
is
about
activity,
workforce
and
finance,
will
be
enormous
interest
to
the
regional
team
and
the
national
bodies.
Perhaps
less
so
locally.
V
We've
talked
about
the
engagement
process,
which
is
crucial
and
we've
Lindsay
I'll
talk
more
about
it
when
they
engage
when
exercise
that
we've
undertaken
and
the
scale
of
that
and
where
we've
got
to
do
with
it,
what
we've
learnt
from
it,
but
there's
another
section
as
well.
Just
in
case
we
didn't
think
it
was
burdened.
So
enough.
V
So
apparently,
according
to
the
guidance
they're
out
of
scope,
as
I
said
earlier
on,
I'm
not
going
to
test
that
that
theory
and
I
think
it
is
important
that
we
set
our
all
out.
You
know
those
things
because
they
are.
You
know,
amongst
other
things,
that
are
important
to
people
they're
important
to
patients
and
they're
important
to
our
regulatory
bodies
as
well.
So
we'll
cover
all
of
that.
So
really
in
terms
of
the
the
content
we've
broken
this
down
into
the
four
sections
that
are
that
are
highlighted
on.
V
We
haven't
got
page
numbers
for
lots
of
rather
confuse
me
under
our
priorities
to
try
to
capture
the
messages
in
a
nutshell,
there
are
two
really
really
important
sections
in
this
form.
All
that
will
be
one
is
the
the
section
about
how
as
a
group
of
organizations-
and
that
does
include
local
authorities,
because
local
authorities
are
part
of
the
humbuckers
and
baile
partnership,
how
we
will
jointly
help
people
to
look
after
themselves
and
stay
well.
That
is
central
part
of
a
long-term
plan.
Central
part
of
our
plan.
V
And
then
the
second
crucial
element
is
really
about
integration,
and
under
is
talked
about
the
role
of
primary
care
networks
in
integration
of
services
at
local
level,
and
this
is
really
where
the
crucial
benefits
will
be
achieved.
You
listen
to
people
like
Professor,
Don
Berwick.
He
talks
about
fragmentation,
costing
money
and
costing
and
compromising
quality.
So
if
we're
covering
services
together,
we
all
get
a
better
value
for
money.
V
So
that's
where
our
partnership
plan
will
will
focus,
and
it
is
about
the
six
places
to
use
that
not
across
the
Humber
coast
and
Vale
area
describing
what
they
want
to
achieve
within
those
localities
and
us
then
bringing
that
together
it
is
not
a
top-down
plan,
so
the
content
is
is
being
built
very
much
from
the
bottom
up.
There
will
be
statements
about
areas
that
are
of
significant
clinical
priority
cancer,
mental
health
primary
care,
but
they
will
be
strategic
statements
about
the
roll,
a
direction
of
travel
for
improving
service
quality
and
outcome
in
those
areas.
V
W
Mean
in
in
detail
and
the
paper
so
we'll
go
back
over
that
I'll
assume,
you've
read
it,
but
I
think
you
just
wanted
to
stress
and
maybe
take
some
questions
as
well
on
the
process
that
we've
gone
through
to
get
to
where
we
are
now.
The
plan
itself
is
various
stages
of
drafting,
but
I.
Think,
as
Chris
has
said,
this
is
being
built
from
the
bottom
up
rather
than
the
top
down.
W
So
the
very
first
piece
of
engagement
we
did
was
the
public
was
a
coordinated
effort
across
the
whole
patch,
with
the
six
local
HealthWatch
organizations
working
together
and
then
produced
a
very
comprehensive
report.
Specifically,
looking
at
the
NHS
long
term
plan
what
the
priorities
for
our
local
public
and
our
sex
places
and
how
that
was
reflected,
so
that
has
faded
and
through
the
report,
and
also
to
complement
that
we
did
another
extensive
piece
of
work
with
all
the
partners,
including
HealthWatch,
but
the
other
health
and
care
partners.
W
And
it's
a
map
how
all
of
the
things
that
we
already
know
that
people
are
telling
us
through
the
engagement
that
we
do
so
those
those
pieces
of
work
have
come
out
on
to
with
us.
As
we've
done.
Our
various
stakeholder
engagement
events
and
we've
been
able
to
talk
and
listen
to
lots
of
key
stakeholders
as
we've
begun
to
put
that
plan
together,
not.
J
J
This
is
there's
broader
opportunities
here
than
just
health
and
really
interests,
actually
we're
moving
to
look
at
how
we
invest
greater
in
prevention,
intervention
work
around
the
impact
on
crime
Exeter's,
maybe
accept
it
and
how
we
can
get
some
short-term
performance
gains,
but
also
some
generational
ones.
When
we
look
at
ACS
and
some
of
the
work
that
you
are
doing,
I'll
be
extremely
interested
to
hear
your
thoughts
on
how
you
think
the
house,
this
would
could
link
into
some
of
the
work
that
we
could
be
considering
in
policing,
I.
V
V
I
V
Of
healthy
communities
and
public
service,
voluntary
sector
organizations,
health
service
organizations
working
together
on
the
here
and
now
and
on
the
upstream
work,
it's
well
researched
in
the
evidence.
It's
not
well
implemented,
certainly
not
in
this
country,
and
you
have
to
scour
the
globe
really
to
find
examples
of
where
this
is
being
done
and
has
been
done
over
an
extended
period
of
time
and
delivered
benefit
and
improved
outcome
over
that
period
of
time.
V
I
think
we
should
aspire
to
replicate,
what's
been
achieved
in
some
of
those
global
exemplars
I
think
the
onus
is
on
the
partnership
to
secure
that
best
practice
guidance
and
to
give
advice
and
to
share
information.
But
the
true
responsibility
sits
a
place
level,
so
it's
organizations
a
place
level
who
have
to
find
their
way
on
that
yeah.
W
Think
I
think
that's
a
part
one
of
the
rules
of
this
board,
if
I
may
be
so
bold
as
to
saying
that
it
might,
you
know,
as
the
various
representatives
of
the
system,
leaders
in
York,
please
and
because
obviously
you've
got
a
role
to
be
able
to
develop
that
partnership.
In
terms
of
the
this
of
the
plan
that
sells
the
paperwork,
I
mean
it.
The
CCG
links
I,
sort
of
driving.
W
Some
of
that,
but
I
think
in
terms
of
the
feedback
that
you
mentioned,
I
mean
obviously
all
that
all
the
things
that
we
Kali
would
publish
the
reports
we
share
them.
I
think
it
would
just
be
useful
for
us
to
be
able
to,
as
you
say,
share
that
back
into
each
local
place.
If
we
can
disaggregate
and
and
yes,
I-
think
you've
already
looked
at
that
in
York,
and
if
we
could
share
that
learning
and
what
tends
to
happen
is
ten.
W
Just
going
to
say,
I
think
the
other
thing
to
stress
about
that
Carol
is
that,
but
actually
the
police
is
part
of
the
partnership,
so
we
shouldn't
see
Humber
course
and
bail
as
something
over
there,
but
separate
from
the
sum
of
all
the
parts
and
it's
sort
of
a
message
that
we
keep
trying
to
repeat
again
and
again
and
again
and
I
can
see
Nigel's.
Nor
doing
so
that's
good,
but
actually
it's
it's
not
about
Humber
course
and
being
separate
from
the
rest.
W
V
Reinforce
that
it's
it's
hugely
important.
It
is
an
issue
that
partner
organizations
who
meet
was
on
a
monthly
basis,
still
get
confused
by
and
we
still
try
to
because
we
love
the
idea
of
an
organization
in
the
NHS
and
we
often
associate
the
concept
of
of
the
park
or
use
the
partnership,
because
it
is
a
member
grouping.
It's
a
partnership
that
is
owned,
led
and
managed
by
the
partner
organizations.
It
isn't
a
group
of
organizations
that
are
in
hierarchical
relationship
in
the
strategic
Health
Authority,
but
we
like
to
think
of
it
like
that.
V
So
if
we
can
avoid
falling
into
that
truck
would
be
great.
The
other
thing
in
response
to
Shawn's
point
is
that
we
do
have
arrangements
at
a
place
level
across
the
six.
We
do
have
arrangements
at
what
we
describe
a
subsystem
level
across
York
and
scarborough
north
yorkshire
and
colonies
riding
and
noir
Lincolnshire,
and
we
have
some
arrangements
across
the
partnership
as
a
whole
because
of
the
the
scale
of
the
geography
and
the
the
large
group
of
organisations.
V
That
system
architecture
is
a
little
bit
more
complicated
in
some
of
the
other
partnerships
in
other
parts
of
the
world
where
the
geographies
tight
are.
The
number
of
organisation
is
smaller,
but
it
is
possible
to
make
sense
of
it,
but
it
is
absolutely
critically
dependent
upon
the
arrangements,
those
place
and
subsystem
levels
being
strong
and
effective
and
feeding
up,
because
as
soon
as
they
don't
feed
up,
you
go
into
default
mode,
which
is
to
push
back
down,
and
the
regional
team
is
not
forgiving.
A
I'm
going
to
stop
there
because
we've
gone
over
time
and,
as
you
all
know,
I
do
like
to
finish
on
time.
I'll
have
them
tonight,
I'm
going
to
ask
Lindsay
to
be
in
touch
with
Tracey
about
having
an
informal
session
where
we
can
talk
about
the
plan
and
nothing
else,
just
a
one
agenda
item
as
it
were,
and
hopefully
that
can
be
arranged
before
too
long
and
that
everybody
who
can
will
attend
because
it
is
very
important.
The
Health
Service
works
in
a
wonderful
way.
A
It's
wonders
to
perform
I
couldn't
they
want
to
say
that
was
tackle,
and
this
is
one
of
them,
so
we
do
need
to
be
involved
as
much
as
we
possibly
can,
but
I'm
very
grateful
to
you
for
coming
and
I
hope.
You'll
both
go
home
and
rest,
your
poor
brains
now
in
a
darkened
room
and
feel
better
soon.
Thank
you
very
much
everybody.
Unless
there's
anything
else,
I
think
we
can
now
conclude
the
meeting.