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From YouTube: Leeds City Council - Adults, Health and Active Lifestyles Scrutiny Board - 22nd November 2022
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A
Today's
meeting
Abigail
Marshall
cutting
is
my
name
and
one
of
the
counselors
in
Leeds
city,
council
and
I'm.
Also
the
chair
for
adult
health
and
active
lifestyle
scrutiny
board,
which
you're
all
here
for
today,
so
very
warm
welcome.
I
can
also
see
students
from
Leeds
Trinity,
University
and
their
lecturer.
So
thank
you
very
much
for
joining
us
at
the
undergraduates
of
postgraduate
students.
A
You've
got
you've
got
both
excellent.
Are
you
all
happy
there
yeah
good
stuff?
Okay,
so
just
to
let
you
all
know
that
this
meeting
has
been
webcast
on
the
council's
website,
so
that
any
interested
members
of
the
public
or
other
stakeholders
who
are
unable
to
join
or
observe
in
person
can
actually
observe
the
meeting
remotely.
The
meeting
recording
will
also
be
available
on
the
council's
website
after
today's
meeting.
So
first
of
all,
I
would
only
be
inviting
board
members
to
introduce
themselves.
A
A
M
You
chair
under
agenda
item
number
one.
There
are
no
appeals
against
the
refusal
of
inspection
of
documents
under
agenda
item
number.
Two:
there's
no
exempt
information
that
would
require
the
exclusion
of
the
press
or
the
public
under
agenda
item
number
three.
There
are
no
formal
late
items
noted
under
agenda
item
number.
Four
can
I
ask
members
to
declare
any
interest
they
may
have.
M
A
A
That's
all
in
your
agenda
pack,
any
issues
arising
from
that
anyone
can
we
adopt
and
accept
that
as
a
true
copy
and
all
the
information
on
there
is
correct.
Excellent
okay
right
agenda
item
number:
seven
you
can
tell
them
couldn't
wait
to
get
to
that.
We
have
been
waiting
for
a
while.
Now.
The
last
time
we
had
a
meeting
on
that
was
in
March
and
I
would
like
to
use
this
opportunity
to
say
huge.
Thank
you
to
our
principal
security
advisors
who
have
made
this
meeting
and
this
agenda
possible.
A
Steve
Stephen
Cockney,
even
though
he's
not
here,
I,
know
how
much
work
he
put
in
trying
to
liaise
with
lots
of
you
in
the
dental
industry
in
making
this
meeting
happen,
and
obviously
Angela
Brogden
as
well.
Who
has
you
know
seen
it
through,
and
all
of
you
are
here
today,
so
I
want
to
use
this
opportunity
to
say.
Thank
you
very
much
for
attending,
and
we
would
be
very,
very
keen
to
go
through
this
agenda
with
everything
inside
of
us
this
afternoon.
A
So
Dentistry
has
been
a
very
long-standing
area
of
interest
and
importance
to
this
particular
scrutiny
board.
Earlier
this
year
the
board
had
engaged
with
the
dental,
Commissioners
providers
and
patients
themselves
to
discuss
and
review
access
to
local
NHS
Dental
Services,
which
has
resulted
in
the
board
agreeing
a
number
of
recommended
recommended
recommended
actions
during
its
March
meeting
earlier
this
year.
A
A
summary
note
of
the
findings
and
recommendations
that
had
stemmed
from
the
board's
work
in
March
can
be
found
today
within
your
agenda
pack
and
that's
on
page
17,
huge
thanks
to
all
the
members
who
attended
that
meeting
in
March,
I
think
the
only
member
that's
not
here.
That's
still
not
on
this
board
at
this
moment
in
time
is
councilor
Dowson,
but
other
others
are
still
here.
So
thank
you
very
much
for
that.
A
The
board
is
aware
that
there
have
been
specific
issues
raised
regarding
access
to
orthodontic
services
for
children,
and
so
the
intention
is
to
allocate
time
during
this
meeting
to
have
a
more
focused
discussion
around
Orthodontics
at
today's
meeting.
We
are
very
pleased
to
welcome
a
wide
range
of
contributors
who
are
able
to
pres
represent
the
view
of
Commissioners
providers
and
patients
in
this
very
important
area
of
our
health
provision.
A
My
intention
is
to
firstly
invite
representatives
from
NHS
England
and
the
West
Yorkshire
ICB
to
introduce
themselves
and
to
briefly
introduce
their
briefing
paper,
which
starts
on
page
27
of
your
pack
of,
and
while
this
paper
does
pick
up,
the
issue
of
Orthodontics
I
would
ask
that
this
be
picked
up
a
bit
later
in
the
meeting.
As
indicated
earlier.
A
I
will
then
invite
the
chairs
of
the
Leeds
Dental
network
and
leads
Dental
committee
to
introduce
themselves
and
to
give
a
brief
overview
of
key
issues
being
raised
from
the
perspective
of
dental
practitioners.
I'm
sure
you
can
tell
that
there
are
just
so
many
different
parts
of
dental,
but
whatever
it
is
they're
all
Dental
okay.
So
we
will
deal
with
all
of
you
individually
today
and
looking
forward
to
hearing
from
you.
A
We
will
then
hear
from
representatives
of
healthwatch
leads
in
terms
of
understanding
issues
currently
being
raised
with
them
from
a
public
and
patient
perspective,
which
is
really
really
very
important
for
us,
reflecting
on
the
information
we
have
been
given
from
all
the
perspectives.
I
will
then
open
it
up
to
questions
from
board
members.
A
It
is
important
to
acknowledge
that
we
also
have
colleagues
here
from
public
health
who
will
be
briefing
the
board
on
the
current
position
in
relation
to
water
fluoridation,
and
there
will
be
time
allocated
towards
the
end
of
this
agenda
item
to
consider
this
specific
matter
as
well.
So
I
will
now
invite
Emma
and
Ian
to
introduce
themselves
and
briefly
introduce
their
briefing
paper
so
over
to
you.
N
N
So
if
I
could
just
talk
you
through
the
paper
that
we've
submitted,
which
I
hope
gives
you
an
update
where
we
are
in
relation
to
commissioning
of
services
and
the
challenges
that
we
have
faced
also
does
give
some
understanding
of
some
of
the
national
reforms
that
will
help
to
ease
the
challenges
of
access
to
dentistry
and
also
talks
about
those
things
that
we
have
done
locally
to
do.
The
same.
There
were
two
specific,
but
there
were
some
others,
but
specific
issues
that
were
picked
up
with
colleagues
in
March.
N
N
The
paper
gives
some
reference
to
some
of
the
national
reforms
that
will
be
happening
in
dentistry.
Some
of
the
challenges
that
we
face
in
dentistry
are
to
do
with
the
national
contract
and
the
limitations
of
payments
and
the
ability
to
deliver
services,
and
there
is
some
there's
one
work
which
will
help
to
address
some
of
those.
The
key
component
for
that
is
in
relation
to
information
for
patients.
It
is
currently
not
a
mandated
expectation
that
providers
will
or
the
dental
practices
will
keep
any
of
their
information
up
to
date.
N
That's
generally
websites,
Etc.
The
new
reforms
will
ask
them
to
do
so
and
expect
us
as
Commissioners
to
make
sure
that
that
does
happen
for
our
providers.
So
that's
something
that
came
into
fos
in
the
1st
of
October
and
we
are
working
with
our
providers
to
make
sure
that
the
information
is
updated
and
correct.
N
N
We
can
Target
our
resources
as
effectively
as
possible,
and
we've
outlined
some
of
the
findings
of
that
and
challenges
of
access
to
Dentistry
do
continue.
Many
of
those
challenges
are
to
do
with
Workforce
and
I
know.
My
colleagues
will
explain
some
of
the
challenges
of
being
able
to
recruit
Workforce,
but
that's
only
one
of
them.
D
Yes,
thanks
Council,
so,
as
I
mentioned,
the
expectation
is
that
the
West
Yorkshire
care
board
will
take
on
commissioning
responsibility
of
these
services
from
next
April.
This
is
consistent
with
the
direction
of
travel
of
the
Health
and
Social
Care
Act,
where
you
know,
the
intention
is
to
bring
together
budget
at
system
level
so
that
Partners
in
the
system
can
work
together
and
join
up
those
Services.
D
We
discussed
this
at
the
board
of
the
integrated
care
board
last
week,
so
the
papers
and
the
recording
of
that
are
available
online
I
think
there's
two
aspects
to
the
discussion
that
we
had
the
first
one
was:
are
we
doing
the
appropriate
due
diligence
work?
Are
we
confident
in
terms
of
safe
transfer
of
those
services
from
NHS
England
to
the
integrated
care
board,
and
then
the
second
aspect
of
it
was?
Are
we
do?
D
We
have
a
good
understanding
of
the
service
challenges,
the
service
pressures
and
have
a
plan
to
respond
to
those
service
challenges
and
service
pressures
in
terms
of
the
former
issue,
I
think
we've
identified
three
key
risks,
I
suppose
in
transferring
the
services
across
to
the
ICB.
The
first
one
is
around
Staffing
and
the
teams.
You
know.
D
The
second
one
is
some
specifics
around
how
complaints
functions
will
be
handled
in
the
future
and
Clarity
around
the
process.
For
that
and
then
the
third
one,
possibly
the
most
material
one,
is
around
transfer
of
funding
to
ensure
that
sufficient
funding
transfers
from
energy
to
England
to
the
ICB
store.
We
can
commission
a
service
to
a
level
that
we
are
satisfied
with.
D
D
Think
there's
a
wider
conversation
there
around
the
role
of
integrated
teams
to
take
a
more
proactive
and
preventative
approach
and
I
think
the
fourth
one
is
the
work
that
we
can
collectively
do
to
influence
upwards
I.
Think
as
icbs
taking
these
services
on
at
these
times,
we've
actually
got
quite
a
strong
voice
in
terms
of
what
we
think
we
need
different.
What
we
think
we
need
to
be
different
in
taking
on
these
services.
So
how
do
we
influence?
D
You
know
National
policy,
so
that
we
can
get
some
of
the
changes
that
we
know
are
needed
and
it'd
be
really
good
to
get
thoughts
and
views
from
around
the
table
on
that
today.
So
so
that
was
it
I
guess,
I!
Guess
the
sort
of
the
overarching
messages
that
you
know
things
aren't
going
to
change
massively
from
the
first
of
April.
D
These
are
a
little
set
of
long-standing
challenges,
but
as
an
ICB,
we're
really
committed
to
this
agenda
really
commit
to
understanding
what
we
can
do
and
really
exploring
the
art
of
the
possible
so
that
we
can
make
improvements
for
people
in
Leeds
in
West,
Yorkshire,
I,
guess
just
to
say.
Finally
that,
following
the
conversation
on
the
board
last
week,
we
agreed
so
three
tests
really
for
the
board
and
taking
on
these
Services.
D
D
Is
it
going
to
be
sufficient
money
coming
from
NHS
England
to
the
icbs,
to
be
able
to
commission
these
services
to
a
standard
that
we're
happy
with,
and
the
third
one
is
Clarity
around
flexibility,
the
contractual
flexibilities
that
we
might
need,
and
we
might
want
to
apply
so
that
we
can
tackle
some
of
the
issues
that
you've
heard
about
from
healthwatch
and
other
colleagues
sort
of
work
in
progress.
Like
I
say
we're
working
hard
to
be
prepared
for
next
April,
but
that's
a
bit
of
a
summary
of
Where
we've
got
to
in
our
conversations.
A
Thank
you
very
much
Ian
and
that's
great
to
know.
I'll
just
remind
members
that
any
questions
that
you
have
for
for
any
of
them,
if
you
just
write
them
down
and
write
down
who
you
would
need
to
be
asking
in
particular
that
would
be
very
helpful
when
we
get
to
members
input
you're
welcome,
councilor
Vena.
Thank
you
for
joining
us
great
to
see
you,
okay,
I
would
Now
call
on
Sam
to
speak
to
us.
O
Now,
thank
you,
I'm
some
prints
and
director
operations
at
Leeds,
Community,
Healthcare,
and
so
this
community
healthcare
offers
a
very
small
but
important
dental
service
and
that's
for
people
who
can't
access
General
dental
practice.
So
people
have
a
learning,
disability
or
a
physical
disability,
people
who
are
dental
phobic
and
we
also
provide
a
service
for
children
who
look
after
it's
very
small.
We
have
a
case
load
of
around
4,
000
patients
and
last
time
I
was
here.
O
O
A
P
Thank
you
councilor,
so
my
name
is
Richard
I'm
general
manager
for
the
Leeds
Dental
Institute,
which
is
part
of
Leeds
teaching,
hospitals,
trust
in
terms
of
the
position
at
the
Lee's
Dental
Institute.
So
from
the
meeting
held
in
February
till
now,
originally
we
were
focused
in
our
recovery,
but
that's
now
well
underway
in
terms
of
actually
reviewing
our
capacity.
P
We've
done
a
huge
amount
of
work
now
about
improving
our
utilization
so
focusing
on
the
really
the
basics
and
getting
them
right
so
making
sure
we're
making
best
use
of
the
capacity
that
we
have,
because
recognizing
there's
a
lot
of
patients
who've
been
waiting
a
very,
very
long
time
in
terms
of
our
long
waiters.
So
originally
we
were
reporting
on
those
waiting.
Over
two
years,
we've
now
been
able
to
clear
those
patients
now
so
they've
all
been
treated
in
good
time
by
the
end
of
March.
So
that's
how
it
happened.
P
We're
now
focusing
on
patients
waiting
a
year
and
a
half
for
their
procedures.
So,
with
those
we're
now
estimating
by
the
end
of
March
2023,
we
would
have
seen
all
our
patients
waiting
a
year
and
a
half
and
then
making
really
really
good
progress
onto
moving
towards
patients
wasting
a
year.
So
this
has
now
been
all
the
good
work.
P
But
it's
just
recognizing
that
I
think
something
differently
has
to
be
done,
but
within
the
dental
Institute
we
are
obviously
looking
at
what
else
we
can
do
to
help
support
those
members
of
staff
other
than
that
I've
always
said
the
messages
and
we
are
working
very
close
to
our
Community
Partners.
But
it's
about
making
sure
these
patients
are
treated
as
close
to
home
as
possible.
Recognizing
the
dental
Institute
can
be
quite
an
intimidating
atmosphere
for
lots
of
patients
who
are
coming
through
so
working
through
those
Pathways
working
with
our
Community
Partners
and
Commissioners
Etc.
P
A
Thank
you
very
much,
Richard
appreciate
it
and
I'm
sure
we
we're
we're
going
to
have
questions
for
yourselves
shortly.
Okay,
I
would
now
invite
Jane
Moore
to
introduce
herself
and
give
us
a
brief
overview
on
the
key
issues
being
raised
by
the
Leeds
Dental
Network
briefly
so
over
to
you
Jane.
Thank
you.
Q
Thank
you,
chair
Jane,
Moore
I'm,
the
West
Yorkshire
LDN
chair,
the
local
dental
network,
show
I
am
actually
a
practicing
dentist
as
well.
I
work
in
a
general
dental
practice
in
Leeds
I
work
for
NHS
England
I
work
as
part
of
the
commissioning
team
to
try
and
improve
services
for
patients
and
I
also
work
with
all
our
stakeholders,
so
I
work
with
Richard
at
the
ldi
I
work
with
Sam
and
her
colleagues,
part
of
the
CDs.
A
R
Okay
hi.
Thank
you,
chair
I'm,
on
Africa,
you
I'm,
the
chair
of
the
Leeds
LDC,
and
also
an
NHS
practitioner
with
my
own
practices
in
North
Leeds.
Now,
as
general
practitioners,
we're
facing
quite
a
few
problems
at
the
moment
regarding
our
existing
staff,
we've
got
still
a
lot
of
stuff
being
off
sick
and
patients
are
sick,
so
we're
having
difficulty
fully
Staffing
all
clinics.
Also
practices
are
having
extreme
difficulty,
recruiting
nurses
and
NHS
practitioners.
R
Some
of
this
is
because
in
Leeds,
I
think
generally
there's
a
lot
of
other
jobs
that
people
can
go
off
for
that
don't
have
as
much
stress
or
workload
as
working
in
an
NHS
practice
and
without
the
responsibilities
without
having
to
go,
get
qualification
and
to
be
GDC
registered.
So
a
lot
of
the
workforce
have
during
covid
left
and
got
easier
jobs
and
it's
harder
to
recruit
new
patients.
New
staff
to
come
into
the
profession
we've
at
the
moment
are
advertising.
R
We've
had
the
advert
out
for
four
weeks
and
we've
had
three
responses
out
of
which
no
one
was
a
suitable
candidate
for
a
dental
nurse,
and
until
we've
got
enough
Dental
nurses,
we
can't
expand
their
dentist
side,
so
we're
having
difficulty
recruiting
staff
at
the
moment
and
I'm,
not
sure.
If
the
colleges
could
do
more
to
encourage
the
patient,
Young
School
leaders
to
go
into
Dental
nursing.
It
would
help
there's
talk
about
the
changes
in
the
contract
that
are
coming
in
that
were
announced
in
July.
R
R
Some
of
these
changes
are
announced
in
July,
but
I
have
still
not
coming
to
place
and
I
think
they
may
be
coming
into
practice
before
the
end
of
the
month,
so
that
Dentists
get
remunerated
better
for
some
of
the
procedures
they
do.
You
could
see
a
patient
who
takes
10
minutes
surgery
time
and
you
do
a
simple
extraction
and
you
get
three
units
and
you
can
spend
the
same
amount
of
time
on
up.
R
You
could
spend
six
hours
of
surgery
time
on
a
different
patient
and
get
the
same
amount
of
credit
for
doing
that
work.
So
this
was
off
off-porting
for
practice
to
take
on
new
patients,
because
you
could
get
a
new
patient.
That
would
need
a
lot
of
work,
so
it
could
cause
a
lot
of
Demand
on
the
dentist
without
on
the
appointment
book,
without
actually
seeing
many
udas
delivered
for
that
treatment.
So
waiting
lists
are
growing
in
practice.
R
I
know
my
practice
is
open
on
the
NHS
website,
but
I've
got
three
to
five
hundred
patients
waiting
on
the
list
and
realistically
we
can
only
see
about
five
to
ten
new
patients
a
week,
so
we're
looking
at
over
six
months
to
nine
months
if
I
was
seeing
them
every
week,
but
then
some
some
weeks
you
see
new
patients,
don't
need
a
lot
of
work.
Doing
so,
they'll
take
more
time,
so
it
takes
longer
to
start
accepting
more
patients
off
your
list
practices
of
some
of
the
costs
that
we're
incurring.
R
R
So,
each
time
a
patient
brings
a
denture
to
the
practice
to
be
repured
and
out
of
pocket
by
10
pounds,
also
at
the
moment,
their
referrals
for
secondary
sentences
for
children
we're
finding
as
the
community
services
under
a
lot
of
pressure,
we're
finding
it
hard
to
get
patients
referred
into
either
the
community
or
the
dental
hospital,
and
the
same
with
their
Orthodontics.
We've
had
a
few
patients
on
the
waiting
list.
There
were
originally
the
baiting
lists
were
managed
in
practice
by
each
practice
themselves
and
written
referrals
were
sent
to
them.
R
The
new
elect
management
system
for
the
referrals
patients
develop
trying
to
validate
this
list,
and
some
patients
are
getting
letters
asking
if
they
want
to
stay
on
the
waiting
list
and
they
have
to
reply
by
a
certain
date
and
quite
often
the
date
that
they
need
to
reply
by
is
after
the
proceed
before
they've
even
received
the
letter.
So
they've
not
got
time
to
do
that,
so
people
are
responding,
but
they've
not
had
any
response.
So
I'll
be
getting
quite
a
lot
of
concerned.
R
Parents
contacting
practices
to
ask
whether
their
children
are
on
the
waiting
list
and
there's
nowhere
for
us
as
practitioners
to
find
this
out.
So
at
the
moment,
we
are
facing
quite
a
few
challenges
in
practices,
but
most
practices
are
we're
all
contracted
to
do
our
100
of
our
contracted
work.
But
this
is
where
I
think
the
commissions
of
the
hands
tie
since
2006.
The
new
contract
practices
cannot
expand,
naturally,
how
we
used
to
in
the
past.
So
it's
like
at
my
practice.
A
Thank
you.
Thank
you
very
much
Mona
for
your
openness
in
terms
of
the
challenges
that
you're
facing
and
I
believe
we
would
explore
that
further.
So
we
appreciate
that
okay,
I
would
Now
call
on
Stuart
to
introduce
himself
and
give
us
an
overview
on
the
issues
being
raised
with
healthwatch
leads
by
patients
and
also
the
public
and
our
beliefs
to
what
you're
bringing
in
Monday
as
well.
Is
that
correct
excellent
over
to
you.
S
S
But
I'll
tell
you
what
we've
been
hearing
since
the
last
meeting
and
again
it's
around
General
access,
we're
still
getting
calls
on
a
daily
basis
from
people
asking
for
help
to
find
an
NHS
dentist
and
we're
having
to
tell
them
that
there
are
none
or
there
are
long
waiting
lists.
I.
Think
six
months
is
great
compared
to
some
waiting
lists
that
are
out
there.
S
I
suppose
for
Trend
recently
has
been
the
number
of
calls
we've
had
from
pregnant.
Ladies
and
parents
trying
to
get
dentists
for
children.
That's
something
that's
kind
of
seems
to
be
creeping
in
a
little
bit
as
well.
The
other
thing
we
hear
a
lot
around
is
or
know
about
is
communication.
As
we've
heard
websites
not
being
kept
up
to
date,
certain
practices
on
the
website
saying
they're,
accepting
when
they're
not
or
they
don't
mention
the
waiting
times.
S
People
telling
us
they
get
more
information
on
options
that
are
available
from
us
than
they
did
from
NHS,
but
one
person
told
us
they
contacted
111
online
was
promised
a
response
within
24
hours
and
four
days
later
they
contacted
us
because
they
hadn't
had
a
response,
an
issue
around
BSL
or
British
sign
language.
Interpreting
and
deaf
people
have
told
us
that
there's
no
provision
for
BSL
interpreters
for
their
Dental
appointments,
often
relying
on
friends
or
families
to
interpret
some
local
dentists
have
told
us.
They
don't
know
where
and
how
to
book.
S
Bsl
interpreters
and
whether
NHS
England
has
a
contract
with
any
local
provider
for
this
service.
So
it'd
be
good.
If
we
could
clarify
the
position
on
interpreting
around
this
at
some
point
accessible
information
standard,
this
should
be,
you
know,
enforced
with
all
NHS
organizations.
So
there's
a
lot
of
people
with
sensory
impairments
and
learning
disabilities.
They
might
need
things
like
clear
explanations
of
the
treatment,
and
when
this
doesn't
happen
they
can
become
scared
or
don't
understand.
What's
going
on.
S
There
are
lots
of
work
we've
done
at
healthwatch
that
we
could
would
happily
advise
on
things
like
recording
people's
communication
needs,
offering
longer
appointments
ask
how
people
want
to
be
contacted,
offer
different
ways
to
make
appointments,
and
this
is
one
that's
quite
common.
Around
deaf
people
haven't
thrown
up
to
make
an
appointment.
It's
not
obviously
doesn't
work
and
I.
Think
inequalities
is
something
that
is
really
shining
through.
With
this.
S
Some
people
feeling
like
there
is
no
option
but
to
go
private,
which
isn't
an
option
for
a
large
number
of
people
who
had
a
recent
call
from
someone
who
has
an
abscess
and
a
broken
tooth
and
was
quoted
over
four
thousand
pounds.
Now,
that's
not
something
that
a
lot
of
people
have.
Obviously,
we've
also
had
examples
of
dentists,
saying
they'll
treat
a
child
on
the
NHS.
S
If
the
parent
goes
private,
I'm,
not
sure,
if
that's
strictly
legal,
also
it
it
appears
to
be
affecting
people
with
the
greatest
needs,
so
I
suppose
people
with
less
stable
lives,
people
with
mental
health
issues
or
maybe
Refugee
and
Asylum
Seekers,
not
knowing
the
system.
So
they
can't
attend
appointments
for
a
variety
of
of
reasons,
so
they're
going
to
remove
from
the
list
and
then
they're
in
the
cycle
again
Orthodontics
I
think
has
been
talked
about.
But
for
me
around
that
communication
was
a
big
issue.
S
S
So
we
hear
that
people
do
get
to
see
dentists
when
they're
in
urgent
need,
but
then
they
might
just
have
their
teeth,
removed
or
given
a
series
of
antibiotic
prescriptions
and
then
told
to
go
and
get
a
dentist
for
any
follow-up
care,
and
then
they
can't
get
that
follow-up
care
and
I.
Think
and
there's
confusion
about.
What's
actually
in
the
contract
as
well.
I
think
NHS
England
say
that
all
dentists
should
take
on
urgent
patients
and
in
fact
this
just
doesn't
actually
happen
all
the
time.
S
But
we've
also
heard
from
local
dentists
that
it's
not
in
their
contract
and
they
do
it
through
Goodwill,
so
I'm
not
sure
what
what
their?
What
is
in
the
contract-
and
one
thing
I
will
say,
though,
is
that
we
very
very
rarely
if
I
can't
remember
the
last
time
we
got
any
get
any
negative
feedback
from
people
once
they've
actually
received
Dental
Care.
S
So
that's
a
that's
a
positive
so
once
you're
in
there
it's
it's
great
I,
think,
but
for
me
we're
seeing
more
and
more
examples
of
the
negative
impacts.
The
lack
of
NHS
Dental
Care
is
having
on
people
with
mental
health.
Being
increasingly
infected
affected,
sorry
I've
got
a
couple
of
examples.
I
just
want
to
read
out
beforehand
over
to
Mandy
who's
got
some
of
her
own
experiences.
If
that's
okay
and
person
called
us
on
23
from
Leeds
I'm,
currently
on
disability
benefit
due
to
an
eating
disorder
in
mental
health.
S
I
have
tried
for
some
time
to
get
an
NHS
dentist
due
to
losing
my
spot
four
years
ago
from
missing
an
appointment,
I
was
mentally
unwell.
My
teeth
were
absolutely
shocking.
They've
snapped
it
all
at
the
front,
causing
pain
and
major
self-esteem
problems.
I
already
suffer
with
body
dysmorphia,
and
my
teeth
are
playing
a
huge
part.
I
try
to
keep
my
dental
hygiene.
The
best
I
can
but
I
throw
a
pass
it
a
lot.
S
This
causes
rotting
I'm
at
a
place
now,
where
I've
tried
to
get
dentists,
I've
rang
an
emailed,
almost
every
dentist
in
and
around
my
area,
and
had
no
luck.
It's
making
making
my
mental
health
deteriorate
and
I'm
feeling
very
vulnerable
because
of
bully
bullying.
I
can't
seem
to
get
help
actually
I'll
just
leave
it
there
and
let
Mandy
have
an
opportunity
I.
S
Just
wonder
if
I
know
they're
a
massive
kind
of
issues
and
we
all
know
them,
but
there
are
some
people
like
this
this
person
here
who
were
in
kind
of
real
need
of
that
treatment.
It
would
be
really
good
if
I
don't
know
somehow
those
in
most
needs
could
be
could
be
seen,
but
I
don't
know
how
we
how
we
work
that
out.
Okay,
so
I'll
just
hand
it
over
to
Mandy.
That's
what
Mandy
you're
going
to
show
your
own
experiences,
hello.
T
T
T
T
I
didn't
get
anything
back
and
then
I
got
a
letter
saying
don't
contact
us
for
another
for
five
weeks,
so
I
left
it
for
four
or
five
weeks.
Then
I
spoke
to
somebody
up
at
my
local
hospital
at
wharfdale
and
his
exact
words
were
well.
We
don't
know
where
to
put
yeah
I
said:
what
do
you
mean?
You
don't
know
where
to
put
my
he
says:
well,
you've
got
problems.
You've
got
TMJ.
You've
got
this.
You've
got
that.
So
we
don't
exactly
no
way
to
pleasure.
T
He
said
to
tell
you
what
go
see
GP
again
and
ask
him
to
write
another
letter.
So
I
went
back
my
GP,
he
was
a
bit.
Oh,
they
said
urgent
on
it
because
I'd
gone
for
an
abscess
and
he
didn't
even
know
he
could
treat
me
for
an
abscess,
because
at
one
point
you
couldn't
even
go
to
your
doctor
for
an
abscess
in
your
mouth
go
find
a
dentist,
so
I
phoned
I.
Guess
another
letter
ring
after
the
tenth,
which
were
ten
days
later,
10th
of
August.
T
T
What's
going
on,
I've
lost
nine
of
my
teeth
at
Christmas,
I'm
losing
other
teeth,
they're
just
snapping
off,
and
it's
all
because
they
have
me
wisdom,
teeth
removed
when
I
was
26
and
they
had
grown
straight
across
the
top,
the
top
four
of
my
teeth,
so
it
bent
Army
Roots
so
and
then
the
bone
never
grew
back,
which
often
happens
so
I
found
him
go
back
to
your
GP
and
get
another
letter.
So
it
goes
back
to
me.
Gp
says:
what's
going
on
so
then
he
gets
an
email
from
the
dental
Institute.
T
T
T
T
Stewart's
and
Gemma
helped
me
and
they
must
have
got
in
touch
with
Pals
for
me
and
I
got
a
phone
call
from
the
dental
Institute
and
from
yourselves.
Basically
brushing
me
up.
I
might
be
able
to
get
in
to
give
me
a
phone
number
at
the
point.
I
had
an
ulcers,
I
couldn't
have
been
trained
anywhere,
so
it
was
a
waste
of
time
me
going
to
see
you
you
may
or
may
not
be
seen.
T
T
They
thought
if
I
invest
this
money,
so
okay
I
mean
teeth,
done
it's
cheaper
than
I
mean
it
done
here,
but
it
never
came
up,
you're
still
not
buried
yet
by
the
way
his
mom's
on
injections,
because
she
came
up
there.
Rich
she's
lost
a
song
everyone's
distraught
you're,
the
friend
she's
Linda,
her
mom's
diabetic.
T
She
was
a
nursery
nurse
for
like
45
years.
She
kept
with
a
dentist,
but
she
had
a
stroke.
She's
got
severe
diabetes,
she's
got
leg
ulcers.
She
takes
warfarin
she's
had
two
strokes.
The
dentist
was
upstairs.
She
couldn't
get
upstairs
no
problem,
Linda
called
at
the
house
and
she'd
actually
pulled
it.
Her
own
teeth
out
with
a
pair
of
pliers.
T
Nobody
can
access
a
dentist
in
West
Yorkshire
unless
you
sent
30
40
miles
away,
which
to
be
fair.
If
you
got
to
catch
a
taxi
or
you
go
into
an
area,
you
don't
know,
you
get
a
taxi
which
costs
you
like
30
pounds,
40
pounds.
Nobody
can
afford
that
each
way
and
all
you
get
from
people
is
what
do
you
want
to
wear
English?
How
long
do
you
waiting
list?
It's
not
Lee!
It's
10
years,
10
years,
I,
look
at
myself
two
years
ago,
I
had
a
full
set
of
teeth.
T
I
got
nothing
now
at
the
top.
I've
got
this
one
I
look
like
a
drug
addict
people.
Look
down
on
me.
I'm
laughed
at
I'm,
gonna,
usually
wear
a
mask,
but
I'm
not
going
to
today,
because
you're
all
dentists
and
you're
all
saying
you're
doing
this,
and
you
try
to
do
that
and
you
try
to
do
this,
but
nobody's
actually
thinking
about
the
people
that
are
born
in
the
to
go
two
doors
away
from
me.
T
T
You
I
found
in
January
to
go
and
says
because
I
told
you
I
lost
nine
at
Christmas
I,
don't
know
why
that
is
the
medication
I
take
it's
actually
exploded,
my
teeth,
they've,
actually
exploded
and
the
the
teeth
are
actually
expanding,
so
they're
going
to
the
roof
of
my
mouth,
which
is
really
really
hard.
It's
hard
to
eat
it's
hard
to
swallow.
I
can't
be
killing
all
the
time
about
my
lip.
T
T
T
People
are
finding
out
it's
it's
having
an
effect
on
the
autoimmune
system,
so
people
are
getting
yeah
I
mean
the
cheese
be
done
properly.
They're
getting
arthritis
I've
done
a
lot
of
study
on
it.
Trust
me
because
I
went
like
a
dog
with
a
burn.
I
want
to
find
out.
What's
what
all
I
want
is
not
just
for
me.
E
T
April
on
the
Leeds
website,
A
diversity
in
otley
and
I
got
2
000
families.
Some
of
the
children
are
15
and
never
seen
a
dentist,
because
I
can't
find
one.
So
it's
been
going
a
lot
longer
than
people
think
and
paints
begging
to
see
a
dentist.
What
happened
to
the
school
dentist
we
are
just
when
I
went
to
school.
T
We
had
a
dentist
that
came
in
twice
a
year
inspected
the
teeth,
taught
the
kids,
how
to
use
the
tools
and
toothpaste
help
them
oral
hygiene
is
to
wear
to
stop
things
like
this
happening,
so
we
don't
end
up
with
problems,
but
dismissing
people
as
well.
When
you
get
to
a
point
of
concert
or
being
offered
or
if
you've
got
80
pounds
coming
tomorrow,
we'll
see
you
well
once
you
do
that
and
you
step
over
that
line.
You
can
never
go
back
on
NHS.
Once
you've
gone
private,
you
can't
go
back
to
NHS,
that's
it!
T
You've
done.
I
have
got
so
many
people
that
have
reached
out
to
me.
Then
I
did
delete
survey.
They
actually
took
it
down
after
two
hours
because
there
was
7
000
responses
of
people,
old
people,
young
people,
desperate
to
see
a
dentist,
not
everybody's
reached
that
just
Jokers.
They
don't
know
about
healthwatch
who
care
they
don't
know
about.
Hell's
watch
England
they're,
trying
111
and
they
sat
on
the
phone
for
like
three
hours.
T
They've
got
to
give
up
they
seeking
away
at
the
credit,
how
many
people
can
do
that
I
know,
there's
lots
and
lots
of
packages
on
your
phone,
but
to
sit
there
for
two
and
three
hours
not
being
able
to
move
just
in
case
the
answer.
Yeah
and,
like
you
said,
if
you
I,
will
look
here
to
get
a
response
back
in
48
hours,
not
24,
48
I
did
get
a
response,
but
they,
where
they
offered
me
to
go,
was
absolutely
insane.
T
T
T
To
be
to
be
fair,
I
I
think
the
full
Way
Forward,
if
you
want
my
opinion,
is
get
yourself.
Some
Vans,
like
you
do,
for
the
for
the
homeless.
Five
fans
packing
like
Softail
on
spill
Chocolat
in
hospital
Wakefield
one
day
moves
them
about
every
day,
get
five
pounds:
two
dentists
on
each
bone
and
move
around,
because
I'm
telling
you
've
fallen
into
doing
like
one
extraction
or
thing
and
then
the
afternoon
for
longer
appointments,
That's,
the
Way
Forward.
T
A
Thank
you
very
much
Mandy
for
that
very
heartbreaking
story
that
you've
shared
with
ourselves
and
I
just
want
to
assure
you
that
you
are
the
voice
of
so
many
in
this
city
and
what
you've
come
here
to
tell
us.
It
is
the
reason
why
we're
sat
around
this
table
and
we
have
not
just
invited
NHS
England
and
the
dental
Institute
to
just
come
and
talk
to
us.
A
O
Thank
you,
Mandy
I
just
want
to
apologize
for
the
way
that
you
have
been
spoken
to
in
our
service
and
not
been
able
to
get
the
access
that
you
needed,
and
it's
certainly
what
not.
What
I
would
expect
and
I
don't
want
to
take
up
too
much
time
here
and
but
I'm
very
happy
to
take
your
circumstances
away
and
come
back
to
you
and
see
what
happened
there
with
an
apology
from
the
service
as
well
as
myself,.
A
V
Thank
you
for
that
chair
and
Mandy.
That
was
really
heartbreaking.
Thank
you
for
sharing
I
I
guess
with
my
hat
on
as
a
counselor
representing
Gibson
Hare
Hills
a
couple
of
weeks
ago,
I
was
out
with
a
local
youth
service
and
I
just
tagged
along.
They
were
doing
house
visits
in
the
area
of
hair
Hills.
V
V
This
youth
service,
this
organization
helped
mum
and
dad
sort
of
navigate.
What
you
know
is
difficult
for
anybody,
but
particularly
with
parents
that
don't
have
English
as
their
first
language
in
terms
of
finding
a
dentist,
and
they
said
this
was
back
in
October
that
he
could
have
an
appointment,
I
think
in
February.
V
The
problem
we've
got
is,
you
know,
he's
not
going
to
school
because
he's
in
so
much
pain,
so
I
think
the
impact
of
what
this
means
for
some
of
those
kids
in
not
being
have
being
able
to
have
access
to
dental
Services
is
actually
they
could
miss
on
their
education
and
also
for
families
that
don't
know
or
don't
have
the
language
and
that's
a
barrier
for
them
as
well.
So
it
was
just
something
that
stuck
with
me
and
we're
trying
to
do
what
we
can
to
help
this
young
family.
V
B
Thank
you,
I'm
councilor,
Fiona
I'm,
the
executive
board
member
for
children
and
adult
social
care
and
health
Partnerships.
So
Dentistry
is
under
councilor
Harris
portfolio
rather
than
mine
in
terms
of
being
Public
Health.
But
as
a
ward,
counselor
I
would
say
it's
probably
the
health
complaint
we
receive
the
most
it's
about
Dentistry
much
more
than
I
can't
get
to
see.
B
B
Looked
after
that,
obviously
children
come
into
our
care,
primarily
because
of
abuse
and
neglect,
and
that
often
means
that
Health
needs
haven't
been
attended
to
and
they
have
really
poor
oral
health
and
it
feels
it's
really
shocking
hearing
the
I
didn't
know
all
the
stuff.
You
said
about
the
health
impacts
it
can
cause
and
yeah.
It's
really
shocking
to
think
that
we're
it's
it's
yet
another
Health
inequality
that
children
are
dealing
with
who've
had
a
really
difficult
start
in
life.
B
So
my
particular
interest
in
this
discussion
really
is
around
children
particularly
looks
after
children,
but
I
just
wanted.
To
conclude,
really
by
saying
thank
you
for
sharing
your
experience,
I
think
it's
a
really
generous
I
think
it's
really
generous
thing
to
do
to
share
a
really
negative,
difficult
experience
in
the
hope
of
making
things
better
for
other
people
as
well
as
for
yourself.
So
thank
you
very
much.
Thank
you.
Chair.
A
Thank
you
very
much,
councilman
I
know
with
your
portfolio
we've
looked
after
children.
You
did
write
to
us
specifically
on
Orthodontics,
so
we
do
have
that
on
the
agenda
today
to
explore.
So
thank
you
very
much.
One
of
the
thing
good
things
about
this
board
is
the
experience
of
lots
of
the
board
members
and
their
expertise
and
been
a
great
board.
A
We've
been
working
with
for
the
last
two
years,
so
I
will
now
first
of
all
call
on
Dr
Bill,
who
obviously
he's
declared
to
let
you
know
that
he's
a
member
of
the
British
Dental
Institute
for
a
retired
dentist
himself.
So
I
would
like
you
to
set
the
scene
for
us
and
then
board
members.
We
would
be
open
for
you
all
to
make
comments
and
also
ask
questions
so
over
to
you,
Dr
Bill,.
C
Thank
you
very
much.
Chair
can
I
reiterate
thanks
to
Mandy
for
coming
and
sharing
her
story
with
us
very
powerful
story
and
can
I
thank
you,
chair
for
allowing
a
patient
voice
to
be
heard,
because
so
often
we
hear
from
you
know
the
Commissioners
and
the
providers,
and
we
don't
actually
hear
from
the
person
who
actually
it's
all
about,
and
that
is
very
valuable
for
us
to
to
hear
us.
I
have
to
say
looking
around
the
table
and
thanks
to
all
those
who've
come
and
shared
with
us
today.
C
The
one
organization
that
I
would
like
to
have
been
in
front
of
us
to
ask
some
questions
and
make
some
comments
is
the
government,
because,
at
the
end
of
the
day,
the
problem
is
one
of
finance
and
whether
it's
a
conservative
government,
whether
it's
a
labor
government,
whether
it's
a
coalition,
it's
not
possible
with
the
money,
that's
available
to
provide
a
comprehensive
dental
service
for
everyone
and
we've
I.
Think
I'll
do
one
of
two
things.
C
Well,
the
government's
got
to
do
one
of
two
things:
they've
either
got
to
put
more
money
in
and
of
course,
we
all
recognize
the
financial
situation
as
it
is
at
the
moment
that
may
well
not
be
possible
or
they've
got
to
come.
Clean
and
they've
got
to
say.
If
we
want
to
have
a
dental
service
for
everyone,
it
has
to
be
a
core
dental
service.
C
There
are
strictly
dental
service
and
not
a
comprehensive
service
with
the
money
available
in
order
that
everyone
can
get
access
to
some
dentistry
and
get
them
out
of
pain,
get
them
out
of
trouble,
then
we
might
not,
sadly,
and
I
would
really
regret.
It,
of
course,
might
not
be
able
to
offer
comprehensive
care
for
the
current
level
of
funding
in
the
system,
but
we
haven't
got
the
government
in
front
of
us,
so
I
can't
say
that
to
them,
but
can
I.
C
So
I
think
we
need
to
bear
that
in
mind,
but
I
just
want
to
pursue
this.
This
subject
of
hearing
the
voice
of
patients
and
I
went
back
to
the
NHS
Constitution
for
England
and
there's
a
a
phrase,
a
clause
in
that
Constitution
working
together
for
patients.
Patients
come
first
in
everything
we
do.
We
fully
involve
patients,
staff,
families,
carers,
communities
and
professionals
inside
and
outside
the
NHS.
We
put
the
needs
of
patients
in
the
communities
before
organizational
bound
countries.
C
We
speak
up
when
things
go
wrong,
so
I
want
to
just
pick
up
on
two
of
the
things
that
are
in
the
health
watch
England
report
and
say:
where
was
the
voice
of
patience
and
the
first
one
is
the
rapid
oral
health
needs
assessment.
I
have
to
say
that
was
very
good
at
looking
at
what
are
called
the
normative
needs.
That
is
the
number
of
decayed
missing
and
filled
in
this
population
in
this
age
group
and
so
on.
A
a
very
good
piece
of
work.
But
where
was
the
voice
of
the
patient?
C
I
did
and
then
we
will
remember
I
suspect,
accidental
commissioning
executive
of
which
I
was
a
member
before
it
that
executive
was
was
abandoned.
I
was
representing
the
local
Health
watch
across
Yorkshire,
and
the
Humber
and
I
was
not
allowed.
I
did
ask.
I
was
not
allowed
to
see
a
draft
which
I
could
share
with
the
health
watch
across
the
the
county,
because
I
know
Emma
says
that
she
had
access
to
the
health
watch
reports,
but
there's
a
lot
of
information
that
healthwatch
have
that
doesn't
get
into
the
reports.
C
Such
things
as
Mandy
has
been
talking
to
us
today.
That's
that
not
included
in
detail
in
the
reports,
but
healthwatch
know
about
that,
and
yet
we
were
denied
the
possibility
of
sharing
that
draft
in
an
early
stage
to
the
healthwatch
across
this
region,
so
that
we
could
hear
them
if
not
a
whole
load
of
individual
patients.
C
We
could
hear
them
as
representative
of
the
patients
feeding
back
what
they
knew
about
the
needs,
not
just
in
terms
of
how
many
decayed
missing
and
filled
teeth,
but
what
the
impact
of
that
was
on
the
individuals
who
were
the
potential
patients
and
and
often
weren't
able
to
become
patients.
So
what
steps
did
Health?
C
Wouldn't
it
be
a
good
idea
to
actually
talk
to
the
third
sector
communities
which
represent
and
support
people
from
those
communities
and
have
sold
no
we're
not
doing
that
I
have
to
say.
Actually
my
concerns
were
not
only
with
talking
to
the
third
sector
communities.
I
I
do
personally
have
concerns
that
the
Community
Dental
Service
doesn't
see
patients
who
fall
out
of
the
system
entirely.
They
do
have
learning
disabilities.
C
N
I'll
pick
up
those
points
in
the
where
there
were
questions
so
I'm,
sorry
that
you
felt
that
you
weren't
allowed
to
see
the
oral
health
needs
assessment,
Dr,
Bale
I
think
it
was
the
first
of
the
type
that
we've
conducted
in
Yorkshire
and
the
Humber
and
West
Yorkshire
I
think
we
have
lots
of
learning
to
do
from
it.
It
is
not
a
definitive
document.
We
would
really
like
it
to
develop
and
expand.
N
We
have
I
think
what
we
probably
said
is
it's
a
point.
Mayor
22
was
when
we
presented
it
as
the
document
as
it
was
then
we've
gone
on
then
to
develop
those
Place
profiles
that
are
referenced
and
one
of
the
things
that
I've
asked
the
team
to
do
is
to
think
about
how
we
engage
with
our
local
dental
network
and
colleagues
as
we
move
through
the
next
sort
of
weeks
and
months.
So
it's
a
point
in
time
and
I
think
it's
fair
to
say
that
we've
learned
a
lot
from
it.
N
We've
certainly
had
feedback
about
where
we've
collected
our
responses
and
our
thoughts
and
I
would
really
like
us
to
do
that.
It's
one
of
those
documents:
I
think
that
would
be
difficult
to
end
to
have
a
finite
position.
People
have
different
views
about
what
an
oral
health
needs
assessment
will
do
and
how
it
will
impact
on
us
trying
to
find
the
solutions
that
we've
just
heard
about
today.
So
I'm
really
really
Keen
that
that
is
seen
as
that
and
I
would
very,
very
much
welcome
feedback
from
colleagues.
N
We
have
talked
in
the
Dental
network
about
how
we
engage
not
just
Health
watch
as
a
voice,
but
also
our
other
colleagues,
and
get
some
of
that
patient
feedback
and
I
have
brought
somebody
in
the
team
to
do
that
so
to
work
alongside
our
Consultants
who
are
developing
the
needs
assessment
and
then
thinking
about
how
we
do
bring
in
some
of
those
broader
themes
and
feedback.
So
I
hope
that
there
is
some
confidence
from
colleagues
that
we
will
actually
see
that
as
a
developing
piece
of
work.
N
N
N
One
of
the
things
we
need
to
do
is
to
make
sure
that
we've
got
the
services
in
place
to
be
able
to
engage
with,
and
the
patients
that
use
that
service,
how
we
might
manage
that
and,
unfortunately,
our
contracts
were
due
to
end,
which
would
have
made
that
very
difficult.
We
would
have
been
finding
ourselves
in
a
situation
where
contracts
were
ending
and
we
were
trying
to
review
at
the
same
time,
which
just
seemed
completely
disingenuous.
N
N
A
K
Thank
you
chair
and
thank
you
to
everybody.
Who's
spoken
this
afternoon,
but
what
haven't
heard
this
afternoon
is
which
of
you
are
concentrating
on
prevention
of
tooth
decay.
What
are
we
doing
about
children?
Not
getting
tooth
decay?
In
the
first
instance,
I
mean,
apart
from
the
parents
being
responsible
who
is
responsible
amongst
you
all
for
trying
to
do
the
best
for
children
and
I
mean
these
in
this
rapid
oral
health
needs
assessments
absolutely
shocking,
what's
happening
with
children's
teeth.
That
is
entirely
preventable.
G
For
instance,
people
are
thrown
off
dental
surgery
less
if
they
miss
an
appointment.
I
know
everybody's
busy,
so
my
question
is:
is
there
anything
we
can
do
to
perhaps
review
why
they've
missed
that
and
I
know,
there's
a
a
resource
implication
about
winning
people
or
poor
writing
them
a
letter
giving
people
a
second
chance.
But
you
know
if
people
particularly
today
there's
lots
of
mental
health
issues.
People
are
suffering
while
stress
it
just
seems
so
harsh
final
and
cruel
to
say:
you've
missed
an
appointment.
R
Well,
if
they've
done
that
more
than
twice,
we
can't
afford
to
keep
them
on
the
books,
because
then
it's
taking
time
that
another
patient
could
use
and
also
then,
as
a
practice
that
half
hour
40
minutes
that
the
surgery
is
sat,
empty,
we're
still
having
to
pay
the
staffs
and
we've
got
to
hit
our
Target.
So
we
can't
do
that
now
as
a
practice
we
could
EAS,
we
could
take
more
patience
and
expand
the
service,
but
because
of
the
way
the
contract
is,
we
physically
are
not
allowed
to
do
extra.
R
So
at
my
practice,
I've
got
two
NHS
dentists,
including
myself
and
one
private
dentist.
So
if
you
were
a
patient
and
you
missed
two
or
three
appointments
with
me
and
you
wanted
to
come
back
to
the
practice,
you
would
be
offered
an
appointment,
but
at
that
stage
You've
Lost
Your
NHS
appointment,
because
you've
wasted
nearly
two
hours
of
surgery.
Time.
G
And
come
back
and
thank
you
for
that
and
and
I
know,
our
practice
is
perhaps
operate
differently,
so
what
I'm
getting
at?
Perhaps
we
need
a
unifying
approach
to
it
so
that
no
matter
which
practice
you
are
and
some
practices
will
be
more
lenient
than
others,
that
people
are
trapped
in
the
in
a
very
similar
manner,
wherever
we
go
and
I
do
appreciate
your
point
about
wasting
time
and
how
expensive
that
is,
but
perhaps
there's
something
for
us
in
that
and
for
us
I
mean
my
exec
board
members
and
public
health.
G
N
N
N
Some
will
say
it's
ten
years,
but
you'll
be
aware
that
patients
can
sit
on
a
number
of
different
lists,
so
they've
never
been
validated
so
we're
just
we've
just
started
last
week,
a
piece
of
work
with
practices
to
help
them
understand
the
waiting
list
that
they
have
and
start
to
think
a
little
bit
how
they
could
prioritize
those
patients
as
part
of
that,
what
we're
saying
is:
what's
the
Sir?
What
so,
if
we
know
that
and
practices
know
how
many
patients
they
have
waiting
and
the
breadth
of
need
that
they
have.
N
What
can
we
do
to
help
those
practices
communicate
with
patients
and
help
understand
understand
stand
some
of
the
things
like
implications
if
you
don't
attend
Etc,
so
we
are
looking
at
trying
to
build
some
protocols
to
help
practices,
helping
them
with
some
communication
tools,
but
also
going
back
to
Dr
Bill's
point
about
patient
engagement
thinking
from
patients.
What
would
be
helpful
for
them
to
be
aware
of
when
they're
booking
their
appointment
or
when
they're
trying
to
book
so
there's
a
practical
piece
of
work
happening
that
started
last
week.
G
Can
I
come
back,
thank
you,
and
perhaps
that
could
be
sorry
if
I'm
speaking
for
other
people,
but
perhaps
I
could
be
joined
up
so
that
we
can
actually
speak
to
people
on
the
ground
and
our
constituents,
because
that's
where
the
message
and
I've
just
got
one
last
question:
it's
very
quick.
It
was.
We
spoke
earlier,
oh
you'd.
Rather,
you
spoke
earlier
the
collective
view
about
increasing
capacity
and
in
the
document
here,
there's
a
passage
about
increasing
capacity
by
10
that
looks
fabulous
when
it's
written
down.
G
N
It
starts
a
really
good
point
when
we
say
we've
increased
capacity.
We've
we
have
offered
funding
for
this
year,
so
this
financial
year
to
practice
is
to
be
able
to
put
on
some
more
appointments
both
for
patients
who
have
an
urgent
need,
but
also
those
who
would
like
to
be
seen
as
a
regular
patient
feedback
that
we're
getting
from
practices
is.
We
can
give
them
more,
sustained
funding
or
over
a
longer
period
of
time.
Then
they
can
think
more
creatively.
They
can
recruit.
I.
N
Think
my
dental
colleagues
was
there
it's
far
easier
to
be
able
to
recruit.
If
you
know,
you've
got
funding
for
say
six
months
and
it
is
to
say
here
it
is
for
a
month
so
and
we
are
seeing
some
some
and
also
an
opportunity
to
retain
staff.
It's
not
just
about
recruiting
stuff,
it's
also
about
returning.
N
So
if
we're
saying
actually
here's
some
additional
funding,
you
could
put
on
some
additional
appointments
where,
with
the
feedback
we're
getting
not
for
everybody,
but
certainly
for
actually
they
can
return
retain
staff
because
they
can
offer
them
a
little
more
work
or
a
little
bit
more
opportunity
to
do
some
additional
appointments.
It's
only
one
of
the
issues
that
we've
got,
but
that's
one
of
the
things
that
we're
looking
at.
A
All
right,
thank
you
very
much.
I've
got
a
few
questions,
but
I
would
like
to
like
us
to
move
on
to
Orthodontics
and
then,
if
we
do
have
time,
I'll
bring
my
questions
in
I
believe
Emma.
It
will
be
back
to
yourself
and
really
we
would
like
to
know
just
give
us
a
brief
explanation
on
the
re-procurement
process
and
the
current
position
for
Orthodontics.
Please.
N
Under
Jim
will
be
able
to
help
with
this
as
well
as
our
orthodontic
lead.
So,
yes,
we
have
undertaken
a
procurement
across
the
orchard
in
the
Humber
for
orthodontic
services,
so
that
was
to
ensure
that
we
had
one
pathway
for
patients
and
the
criteria
for
being
referred
in
is
consistent
and
across
sermon
across
all
services.
N
We
have
managed
to
with
great
success,
I
think
identify
providers
to
be
able
to
deliver
those
Services.
Unfortunately,
in
Leeds
there
were
specific
challenges
with
regards
to
what's
called
wind
down
contracts,
and
that
is
contracts
for
those
dentists
that
already
have
patients
in
the
service
and
have
them
under
within
treatment.
Pathways
and
then
they've
been
taking
the
contract
to
continue
with
that.
N
Also
one
of
our
providers
that
we
procured
was
a
little
later
in
starting
than
we
would
have
liked,
so
it
has
presented
us
with
a
number
of
challenges
and
I
have
to
say
as
well
an
opportunity
for
us
to
review
how
we
would
manage
procurements
in
the
future.
This
was
one
of
the
larger
procurements
that
we've
done
with
a
number
of
different
lots,
and
whilst
there
were
major
successes
in
many
of
those
areas
for
leads
specifically,
there
was
that
challenge.
N
We
have
now
sorted
many
of
those
problems
out.
We
have
the
capacity
and
patients
have
been
communicated
with.
We
have
some
outstanding
issues
and
I
think
colleagues
have
referenced
it
that
some
of
the
letters
have
been
a
little
delayed
getting
out
to
patients
to
advise
them
of
their
new
Arrangements.
N
So
I
have
had
several
conversations
with
colleagues
and
P
colleagues
as
well,
who
have
been
in
touch
with
us,
so
we
do
think
most
of
our
patients
now
are
aware
of
the
situation
and
have
been
able
to
feed
back
where
those
arrangements
have
been
made
and
are
not
suitable
for
them.
So
that's
our
next
stage
is
to
pick
up
because
obviously
some
patients
have
been
allocated
to
a
new
provider-
that's
not
always
as
local
as
they
would
like.
So
we've
now
built
that
additional
capacity
in
so
we
can
respond
to
that.
Q
The
team
have
been
working
every
single
day
on
making
sure
that
the
patients
that
would
have
been
part
of
that
wind
down
contract
were
allocated
new
providers
and
even
down
to
individual
patients.
We
have
been
working
hard
to
make
sure
that
they
all
had
an
orthodontic
provider
to
continue
their
treatment
and-
and
they
have
all
now
been
allocated
to
other
providers.
They
have
all
got
a
place
to
go,
and
my
understanding
is
that
all
the
patients
are
being
communicated
with
and
and
do
understand
where
they
are
to
go.
Q
So
it
has
been
a
huge
piece
of
work,
but
it
is
pretty
successful
now.
The
other
thing
I
would
like
to
say
is
that
the
referral
management
system,
the
electronic
referrals,
have
been
designed
to
prevent
a
big
waiting
lists
that
historically
built
up.
We
are
still
in
a
transitional
place
at
the
moment
whereby
we
have
had
patients
who
were
referred
on
the
old
paper
system
transferred
into
the
new
referral
management
system.
Q
They
have
all
retained
their
individual
place
on
the
waiting
list
at
the
time
and
point
of
referral,
so
the
patients
have
not
lost
out
by
being
transferred
onto
the
electric
electronic
system,
but
going
forward.
All
practitioners
now
refer
on
the
new
system
with
an
electronic
form
that
gives
much
more
clinical
detail
and
make
sure
that
the
right
patient,
who
is
suitable
and
eligible
for
NHS
treatment
is
sent
to
the
correct
provider.
Q
A
R
No
I
think
the
orthodontic
referral
system
is
working
really
well
the
new
RMS
electronic
referrals,
because
in
the
past
we
were
getting
a
lot
of
patients
where
we
knew
they
probably
wouldn't
be
suitable
or
the
parents
knew
there
was
a
three
or
four
year
waiting
list
so
before
the
child
was
at
the
appropriate
age.
Dentists
were
getting
almost
bullied
into
referring
these
children
onto
the
orthodontists
I
think.
R
Historically,
they
have
had
big
lists
and
the
RMS
is
reducing
this
because
then
it
shows
us
a
way
of
telling
the
parent
No
actually
they're,
not
suitable
for
NHS
treatment.
So
it
stops
them
going
on
to
a
waiting
list
inappropriately
regarding
patients
being
told
where
they
are
I.
Think
the
majority
of
patients
at
Northeast
have
been
told
who
the
new
provider
is,
but
I
am
still
getting
the
odd
patient
contacting
me
or
practitioners
from
other
practices
contacting
me
is
the
LDC
chair
to.
Let
me
know
where
patients
haven't
had
a
new
provider
allocated.
R
Are
they
having
issues
in
which
case
I
normally
get
straight
onto
the
commissioning
manager
and
she's,
been
really
good
at
allocating
this
patient
or
finding
out
who's
going
to
be
the
provider
and
finding
the
information
for
them?
So
things
are
settling
down,
but
I
think
generally
in
West,
Yorkshire,
there's,
probably
not
as
much
Orthodontics
commissioned
as
could
be,
but
that's
the
same
with
all
the
dental
services
we're
not
commissioning
enough
services
to
cover
the
population.
S
Thank
you
and
I
agree.
I
know.
Yesterday,
I
got
an
email
from
someone.
I
was
trying
to
help
saying
yeah
they've
received
the
letter.
It
has
a
big
did
this
start
in
April
the
whole
process,
because
it's
you
know
it's
taken
a
very
long
time
and
people
shouldn't
need
to
be
contacted
healthwatch
or
a
local
MP.
They
should
have
someone
to
contact
to
know
where
to
go
with.
You
know,
questions
about
what's
happening
with
their
child.
S
I
was
kind
of
would
like
some
reassurance
that
there's
learning
from
this
in
around
the
whole
communication
with
people,
because
a
lot
of
the
time,
if
people,
even
if
they're,
told
it's
going
to
take
a
while,
you
know,
but
if
you
have
got
any
issues
call
this
number
that'll
be
better
than
just
waiting.
Six
seven
eight.
However
many
months.
N
A
really
fair
points
to
it
and
I
think,
as
you
know,
when
we've
had
our
discussions.
Yes,
we
do
need
to
learn
from
this.
I
think
that
the
common
theme
hasn't
just
been
the
patient
experience
has
it,
but
it's
been
the
patient
communication
and
our
communication
with
patients
and
not
just
patients,
but
parents
and
other
other
aspects,
so
I
totally
take
that
point
in
time,
like
some
of
our
services
started
in
here,
plus
some
in
June.
N
So
it
has
been
the
first
approach
in
terms
of
bringing
those
services
on
board,
but
at
Turkey
Point
entirely.
It
shouldn't
be,
who
you
know,
we
should
have
a
clearer
and
I
think
we
thought
we'd
put
that
in,
but
we
didn't
quite
appreciate
the
volume
that
would
come
through.
So
we
did
make
every
attempt
to
do
that,
but
it
was
enabled
to
be
able
to
respond
to
the
volume,
so
I
think
that's
the
third
point
and
I
would
take
take
that
as
and
learning
point
forwards.
Thank
you
thank.
T
I
just
like
to
make
a
point:
you're
all
talking
about
people
or
children
that
have
already
got
dentists.
There
are
tens
of
thousands
of
children
in
Leeds
that
are
other
dentist
or
an
orthodontist.
Why
don't
you
just?
Why
do
you
say
or
to
go
back
into
schools,
get
them
at
the
point
we
used
to
have
a
dental
service
that
went
into
schools
twice
a
year.
T
T
That
you're
not
taken
into
concert.
I
know
there
are
tens
of
thousands
of
children
in
Leeds
have
put
Wakefield
homicide,
who
have
never
ever
seen
a
dentist
and
you're
not
taking
them
into
considerate?
Oh
we're
just
moving
this
and
we're
moving
that
moving
this.
You
know
what
about
the
people
that
are
already
on
you're,
not
thinking
about
them.
A
R
I
would
just
consider
regarding
children.
In
Leeds
we
have
the
flexible,
there's
23,
flexible,
commissioning
practices
who
do
take
referrals
from
the
north
to
three
visitors
and
not
to
19..
We
also
they
do
take
referrals
from
the
Community
Dental
Service,
so
once
a
child
or
a
person,
who's
finished
their
course
of
treatment.
R
Originally,
the
program
wasn't
set
up
to
take
patients
who
were
they
looked
up
to
children
or
from
Care
Homes,
but
we
are
starting
to
find
that
referrals
are
coming
through
to
the
flexible
commissioning
practices
to
take
children
who
are
looked
after
our
Asylum
seeking
children.
I've
had
a
few
myself.
These
weren't
contracted
with
the
flexible,
commissioning
practices,
but
the
practices
are
doing
this
so
that
we
can
give
a
preventive
approach
and
try
to
get
these
children
young
so
that
hopefully
we'd
never
have
to
do
any
treatment
of
on
them.
R
A
Okay,
I
think
the
key
word
there
is
some,
so
it's
it's
knowing
how
many
compared
to
the
population
that
we've
got
in
Leeds,
because,
obviously,
if
it's
only
a
Chosen,
Few
or
a
privileged
few
who
are
having
access
to
this,
then
our
problem,
Still
Remains,
so
is
actually
establishing
and
knowing
how
far
reaching
this
service
is
available
to
all
children
in
the
city
and
not
just
a
particular
demographic
or
area
of
our
city.
Sorry
I'll
bring
in
Victoria
and
then
I'll
come
back
to
you
Emma.
Thank
you.
H
So
you
know,
obviously,
that
that's
a
huge
issue,
including
children,
but
broader
than
children
and
I'm,
really
grateful
Mandy
and
she
went
for
all
of
the
comments
she
made
earlier.
So
I
think
there's
something
about
as
colleagues
just
described
over
there,
how
you
build
that
into
services
and
because
that's
partly
what
what
good
dental
care
is
not
just
treatment
book,
but
but
keeping
people's
teeth
well
and
healthy.
So
there's
something
about
access.
H
But
we
make
that
work
and
for
our
population
as
well
as
we
can.
The
other
thing
that
it's
important
and
Emma,
my
colleague
Emma
Newton,
can
answer
some
examples
of
is
that
with
the
people
that
went
from
local
public
health
teams
in
2013?
Also,
all
of
that
results
went
with
the
function.
So
we
now
have
a
very
small
program
of
work
that
we
use
our
general
public
health
Grant
to
to
fund
which
looks
at
some
of
the
things
you've
just
described
about
work
for
from
Health
visitors,
School
nurses
around
healthy.
H
You
know
healthy,
brushing
and
getting
young
children
used
to
using
the
toothbrush
supporting
families
Etc.
So
there
is
some
of
that
work
going
on
we'd
love
to
do
more,
but
obviously
we
need
to
look
at.
You
know
where
the
resources
come
to
support
that
work,
but
I
mean
if,
if
it's
helpful,
Emma
can
talk
through
a
little
bit
of
that
and
I
think
also
to
explain,
share
also
about
the
this
work
around
children
and
young
people.
That's
joined
up
through
the
network
work
as
well
so
I
hope
that's
helpful.
Chair
thank.
W
So
that's
the
health
visiting
School
nursing
service
and
that
also
has
the
integrated
element
of
an
oral
health
leading
that
team,
so
they're
responsible
for
their
annual
oral
health
epidemiology
survey.
So
every
two
years
the
five-year-old
surveys
done
and
we
monitored
the
needs
of
of
that
age
group
and
they're
also
responsible
for
the
supervised
toothbrushing
scheme
and
that's
in
targeted
primary
schools
and
early
years
and
children
centers
across
the
city
and
in
addition
to
that,
there's
the
brushing
for
Life
scheme.
So
that's
at
the
very
early
ages.
W
So
looking
at
building
sort
of
Champions
across
the
services,
and
just
in
addition
to
that,
we
also
commissioned
the
health
and
wellbeing
service,
so
that
incorporates
the
healthy
schools.
So
they'll
do
a
lot
of
work
around
food
policy
and
also
around
implementing
the
curriculum.
So
it's
actually
a
statutory
requirement
in
health
education
to
incorporate
some
key
oral
health
messages
through
both
primary
and
secondary
and
then
finally,
sort
of
in
addition
to
this
does
The
Wider
healthy
eating,
work,
Stream
So.
W
W
W
A
W
F
Thank
you,
chair
I'd,
just
like
to
ask
about
the
correlation
between
the
dentist
and
the
orthodontists
and
the
reason
I
asked.
That
is
because
I'll
declare
an
interest
that
it's
regarding
my
my
own
daughter's
treatment.
Oh
and
she's
attended
Dental
surgery,
since
she
was
about
two
and
it
wasn't
until
I
questioned
the
dentist
about
why
our
teeth
weren't
farming
straight.
But
she
got
referred
on
to
the
orthodontist
and
after
five
years,
she's
still
not
completed
her
treatment
there.
F
Q
Jane,
thank
you,
okay.
What
we
do
is
we
monitor
the
child's
development
with
regards
to
how
the
teeth
are
developing
right
from
the
earlier
stage,
and
then
they
referred
to
the
orthodontist
at
the
appropriate
age
for
treatment.
It's
not
something
that
you
can
prevent
by
doing
something
earlier
and
the
child
is
always
referred
at
the
appropriate
time
to
the
orthodontist.
F
This,
based
on
what
my
daughter
was
a
tooth
grown
in
the
roof
of
the
mouth
and
had
I
not
not
have
said,
can
what's
happening
with
the
teeth,
because
they're
not
growing
straight
and
she
was
x-rayed
in
the
mouth
to
identify
this
tooth,
actually
growing
in
the
roof
of
the
mouth
that
could
have
been
identified.
Much
younger.
It
would
have
been
an
easier
issue
to
resolve
and
it
wouldn't
have
required
an
orthodontist
for
the
at
least.
Q
V
A
G
Thanks
Chad
again
I've
got
this.
This
idea
that
the
more
we
unify
what
we
can
offer
the
further
our
services
will
stretch,
so
it
it
around
prevention.
It
just
strikes
me:
why
don't
we
tie
in
with
prenatal
Services,
because
the
same
people
will
live
in
those
disadvantaged
areas?
Are
the
same
people
are
going
to
the
prenatal
services,
so
why
wait
until
the
babies
are
born
and
then
we'll
all
Panic?
Q
That's
exactly
what
we
do
do
so
we
have
I
sit
on
the
oral
health
Advisory
Group
that
Emma
was
talking
about
and
we
have
programs
to
inform
midwives
and
nurses.
We've
done
a
lot
of
work
around
child
baby
clinics
and
it's.
This
is
the
whole
preventive
message
that
we
get
out
as
early
as
we
possibly
can,
and
we
have
a
national
program
which
encourages
all
parents
to
take
the
children
to
the
dentist
before
the
age
of
one
as
well.
So
it's
a
it's
an
entire
program
of
prevention.
C
A
They
are
sorry
Dr
Bill.
Let
me
come
in
here,
I'm
sure
we're
going
to
give
you
a
medal
for
declaration
today,
but
because
Victoria
was
going
to
set
up
and
start
the
paper
and
on
water
fluoridation.
If
she
can
come
in
and
then
you
come
in
with
your
experience,
if
that's
okay
sounds
excellent.
Excellent.
Thank
you.
Victoria
over
to
you.
H
Thank
you
chair,
so
Emma
and
I
will
do
a
double
act
on
this
one,
this
this
Emma
Emma
Newton.
So
we
were
asked
by
the
board
to
produce
an
update
relating
to
fluoridation,
which
is
in
appendix
four
of
the
paper
pack
page
43.,
so
I
hope
that's
helpful
and
we
were
asked
specifically
to
understand
to
to
to
look
at
the
legislative
development
surrounding
these
schemes
and
and
potentially
how
this
could
have
an
impact
for
leads.
H
I
mean
I'll
hand
over
to
Emma
in
a
second
just
to
draw
out
some
very
brief
points,
because
presumably
everyone's
had
a
chance
to
have
a
look
at
it.
I
mean
in
in
essence
the
the
review
of
The
Evidence
would
still
support
this
as
as
a
thing
that
would
make
a
positive
impact
on
the
on
the
on
the
health
of
the
local
population.
H
The
there's
the
significant
thing
about
the
legislation
is
that
it's
moving
towards
a
national
National
leadership
for
consultation
on
on
validation
proposals,
and
this
was
partly
to
reflect
the
complexities
of
trying
to
do
this
locally.
Just
because
it's
you
know
with
different
water
catchment
areas
and
different
water
boards
and
different
local
authorities,
it
was
just
so
difficult
to
to
ever
ever
get
some
traction
and
decision
at
a
local
level.
H
W
Thank
you
and
so
yeah
just
to
highlight
the
key
points
really
so.
As
Victoria
said,
the
water
fluoridation
causes
of
the
Health
and
Care
Act
came
in
on
the
8th
of
November,
which
means
that
the
secretary
of
state
has
to
notify
local
authorities
of
proposals
for
water
fluoridation
schemes
that
include
their
population,
and
that
includes
the
plans
for
consultation.
W
Acts
does
maintain
the
duty
on
the
Secretary
of
State
to
Monitor
and
report
of
the
effects
of
water
fluoridation
every
four
years,
so
just
in
terms
of
key
points
to
highlight
how,
as
Victoria's
already
mentioned,
waterfall
radiation
supported
by
all
the
UK
chief
medical
officers,
and
it
doesn't
rely
on
the
behavior
change
of
people
but
does
contribute
to
lower
tooth
decay.
So
five-year-olds
in
areas
with
fluoridation
schemes
in
place
were
less
likely
to
experience
dental
careers
than
in
other
areas.
W
Without
the
scheme,
children
and
young
people
in
areas
with
a
fluoridation
scheme
in
place
were
less
likely
to
be
admitted
to
hospital,
which
is
a
key
key
sort
of
issue,
and
then
children
living
in
fluoridated
areas
have
lower
rates
of
tooth
decay
than
those
in
non-floridated
areas,
and
the
effects
were
seen
in
terms
of
levels
of
deprivation
in
the
least
deprived
areas.
Rates
were
seem
to
Fall
by
17
and
in
the
most
deprived
up
to
28
percent.
W
A
Other
colleagues
yeah
thank
you
very
much
and
obviously
we
we
did
have
a
little
subgroup
for
water
fluoridation,
a
while
back
of
which
Dr
Bill
was
was
there
and
I
was
really
for
it,
because
one
of
the
things
with
it,
whether
you
live
in
a
deprived
area
or
you
live
in
an
affluent
area,
we
could
clearly
see
a
reduction.
You
know,
especially
in
children,
at
a
CA.
It's
a
no-brainer.
A
C
Thank
you
chair.
Yes,
just
to
reiterate
what
Victoria
and
Emma
have
said
subsequently
also,
the
government
have
announced
that
the
first
tranche
of
new
schemes
will
be
in
northumber
in
in
Northeast,
where
they
already
have
actually
quite
a
bit
of
water
fluoridation.
The
City
of
Newcastle,
part
of
Northumberland,
part
of
County
Durham,
are
already
fluoridated
and
they
were
in
the
process
under
the
old
legislation.
W
H
G
Well,
surprisingly,
I
thought
I'd
play
a
devil's
advocate
for
my
name,
supposingly
I
know
Friends
of
the
have
got
a
huge
campaign,
haven't
they
against
Florida
fluoridation
of
water
and
there's
this
that
sounds
based
on
four
principles.
One
there's
the
data
that
supports
that
teeth
are
better,
is
unsafe
and
by
unsafe
I
mean
it
would
only
be
safety,
don't
shoot
the
messenger.
G
G
Basically,
there
was
a
whole
thing
about
human
rights,
so
I'm
just
playing
Devil's
Advocate,
because
if
we're
going
to
scrutinize
something
it's
important,
that
was
scrutinize
all
elements
of
it,
isn't
it
and
there
was
a
whole
thing
and
I'm
gonna
do
this
in
memory
that
explorated,
while
it
is
classed
as
functional
food,
that
was
the
term
they
used
and
their
bar
it
was.
It
needs
to
be
trapped
as
if
you
were
administering
a
prescription.
G
So
it's
kind
of
against
your
human
rights
to
just
give
people
a
drug
I'm,
not
saying
that
that's
my
view
at
all
I'm,
just
saying
that
that's
what
friends
of
Earth,
Advocate
and
quite
a
lot
of
groups
who
are
against
it
so
I
think
it's
only
fair.
We
we
kind
of
put
that
out
there
and
give
people
a
chance
to
respond.
A
I
I
think
I
think,
since
we're
playing
Devil's
Advocate
I'll
go
for
a
devil
on
the
other
side.
Well,
that
makes
me
a
devil
or
an
Angel.
Yeah
I
mean
I
think.
Clearly
it
is
a
health
intervention,
as
was
the
covert
vaccine,
which
I
know
was
controversial
and
many
other
health
interventions.
There
are
other
health
interventions
that
nobody
talks
about
such
studying
vitamins
to
flower,
which
again
technically
turns
them
into
a
functional
food.
Nobody
even
really
thinks
about
it
and
I
think
you
know
I
think
there
was
a
minister
many
years
ago.
I
K
You
chair,
I,
don't
know
how
many
other
people
had
this
at
school,
but
we
used
to
have
the
flu
ride,
lady,
that
used
to
come
around
every
Fortnight,
with
her
little
cups
of
pink
fluoride,
with
a
big
bucket
that
we
used
to
have
to
swish
and
then
spit
out
now
being
a
child.
I,
never
really
thought
about.
C
Not
a
lot
to
add,
apart
from
the
fact
that
it's
not
a
Magic
Bullet
and
it
doesn't
replace
any
of
the
things
that
Emma
was
talking
about,
they
still
need
to
to
be
done.
It
is
an
addition
to
the
what
they
are
already
being
provided
with,
so
in
Birmingham
they
don't
stop
doing
all
the
other
things
that
Emma's
talking
about
in
Leeds,
but
they
have
the
additional
benefit
of
the
water
fluoridation.
So
it's
very
important
that
it's
part
of
a
palette
of
things
to
do
rather
than
one
silver
bullet.
G
I
just
wondered
if
anybody
could
comment
on
the
the
health
problems
linked
to
fluoride
ingestion.
You
know
skeletal
weakness
and
again
I'm,
not
an
expert.
This
is
just
things
I've
read
you've
got
to,
and
this
is
from
NHS
website,
not
not
my
words
and
that
overexposure
can
cause
real
problems
and
I
just
wondered
because
we
we
can't
possibly
measure
how
much
individuals
get
how
we
would
and
does
the
benefits
outrage.
The
whisks
at
risks
risks
even.
T
The
public
has
got
that
my
age
group
have
got
fluoride's
got
a
bad
rap
because
of
World
War,
II
and
Germany,
using
it
to
give
to
the
prisoners
to
keep
them
subdued
and
vitamin
D
is
more
important
and
we
took
that
out
of
our
flower
out
of
our
butter
out
of
our
milk
back
in
2012..
It
was
called
the
Codex
element
here
it
and
it
went
across
Europe.
That's
why
Marmite
was
banned.
Thank
you.
H
So
we
we
absolutely
would
take
a
position
of
reflecting
the
the
that
that
the
very
latest
and
current
position,
rather
than
come
up
with
our
own
sort
of
view
of
the
world.
So
so
what
what
was
not
being
proposed
is
our
personal
view.
But
it's
it's
a
summary
of
the
view
from
all
four
chief
medical
officers
are
on
the
balance
of
the
the
very
latest
evidence.
H
Now
we
all
know,
and
particularly
from
the
last
two
and
a
half
years
and
and
and
much
before,
that
you
know
that
there
will
be
a
range
of
different
views
of
people
around
any
interventions
which
which
bring
kind
of
you,
know
additives
or
or
unnatural
products
into
into
people's
lives,
and
that's
absolutely
legitimate
and-
and
we
wouldn't
you
know,
we
wouldn't
want
to
kind
of
con
control
that
in
a
way
that
doesn't
hit
that
doesn't
hear
that
I
mean
I.
Think
I.
H
Think
all
of
our
learning
from
covid
really
reinforces
that
we've
got
this
range
of
views
and
we
have
to
support
people
and
respect
people's
and
choices
around
their
own
town,
their
own
health.
So
I
think.
Any
approach
that
we
take
would
need
to
completely
balance
the
the
the
the
voice
of
people
and
the
and
and
the
the
rights
of
people
to
to
hold
strong
views
across
that
Spectrum
and
not
to
brush
those
under
the
carpet.
H
H
A
Q
Well
speaking,
is
the
clinician
I
can
just
reiterate
that
there's
absolutely
no
evidence
of
any
harm
caused
by
fluoride
whatsoever,
and
one
thing
you
need
to
remember
is
that
fluoride
exists
in
natural
water
supplies
as
a
trace
element
in
a
lot
of
areas
anyway.
So
we
do.
We
have
plenty
of
areas
where
fluoride
is.
It
occurs,
naturally
in
the
water.
A
R
Just
like
to
agree
with
Jane
with
fluoride,
if
there
was
an
issue,
there'd
be
a
lot
more
sick
people
in
Birmingham
compared
to
Manchester,
where
the
water
is
fluoridated
and
statistically
there's
not
much
different
dot,
but
no
difference.
Also
I've
seen
we
had
a
patient
who
used
to
always
use
a
fluoride
toothpaste.
She
came
in
one
of
our
dentists
or
her
all
of
a
sudden
about
15
of
her
teeth
had
Decay
and
then,
when
we
did
a
full
history,
she'd
stop
she'd
read.
R
Fluoride
was
bad
for
her,
so
to
a
year
and
a
half
two
years
previously,
she'd
stopped
using
fluoride
toothpaste
and
she
thought
it'd
be
better
to
do
a
coconut
oil
rinse
or
something
in
her
mouth
and
she's
ended
up
with
a
lot
of
decaying
problems
and
I.
Think
it's
all
down
to
her.
Stopping
the
fluoride
that
she
was
using
previously.
R
A
N
And
Sandra
Wiston
that
Victoria
rifle
is
in
our
team
and
we're
receiving
a
briefing
very
much
in
line
with
this
next
week.
So
I
think
at
that
point
we
will
be
having
some
discussions
with
our
ICB
colleagues
to
reflect
on
that
position
and
agree,
because
obviously
this
is
a
longer
term
view.
Isn't
it
it's
not
something
that's
going
to
happen
over
the
next
weeks
and
months.
So
we
need
to
make
sure
that
we're
working
as
a
system
I
think
part
of
the
challenge
for
us
as
NHS
England
and
Commissioners
has
been.
N
We
haven't
always
been
able
to
work
in
that
system
and
some
of
the
challenges
around
engagement
with
water
boards,
Etc
has
been
a
challenge
and
you
I
think
it
was
Bill
referenced.
Our
South
Yorkshire
colleagues
I
think
they
have
some
quite
big
challenges
to
share
with
us
that
we
can
learn
from
in
terms
of
trying
to
engage
with
our
systems.
But,
given
that
it's
a
longer
piece
of
work,
I
think
for
us
in
NHS
England,
it
will
be
making
sure
that
we're
aligned
with
our
system
and
can
do
this
as
one
voice.
N
Think
it's
been
incredibly
helpful,
certainly
to
have
the
patient
voice
and
to
gain
some
sense
of
what
I
think
we
already
knew
in
terms
of
the
challenges
for
our
system,
not
just
and
sometimes
I
think
we
can
get
quite
focused
internally.
So
it's
really
important
that
we
do,
for
we
do
work
with
our
systems.
N
D
Yeah
I
mean
just
to
agree
with
Emma
I
found
it
a
really
helpful
conversation,
I
think
bringing
the
the
groups
together
around
the
table
to
have
this
discussion
has
been
really
powerful
and
really
helpful,
and
particularly
thanks
to
Mandy
for
sharing
her
story.
I
mean
I'm,
taken
by
what
John
said
at
the
start
of
his
comments,
which
is
actually
we've
been
dealt
a
pretty
difficult
hand
on
some
of
this
stuff
in
terms
of
the
the
contract.
The
funding,
the
workforce
pressures,
but
what's
also
clear
from
the
conversation,
is
there's
stuff.
D
D
We
can
do
around
preventative
Services
across
West
Yorkshire,
using
the
examples
that
Emma's
given
us
I
think
we
need
to
have
a
look
at
the
point
around
for
getting
kicked
off
lists
if
they
miss
one
appointment,
because
clearly,
that's
not
right
and
shouldn't
be
happening.
So
it
has
been
really
helpful
for
me
to
sit
and
listen.
I
think
we
need
to
be
realistic
about
what
can
be
achieved
over
what
time
scale,
but
there's
some
really
good
practicing
ideas
that
I've
heard
that
that
we
can
absolutely
take
forward.
A
A
A
Thank
you
and
thank
you
very
much
Stuart.
Thank
you
to
each
and
every
one
of
you
who
have
contributed
today
and
obviously
we
will
be
in
touch
with
yourselves.
Obviously,
in
terms
of
updates
and
hopefully
in
the
New
Year,
we
will
have
another
better
meeting
with
with
more
positive
impacts
on
what
you've
done
and
taken
away
from
today's
meeting.
A
So
thank
you
very
much
from
all
of
us,
I'm,
not
sure
if
you're
all
staying
and
feel
free,
if
you
need
to
stay,
but
if
not
we're
cracking
straight
on
to
agenda
item
number.
Eight.
Now
sorry,
of
course,
yeah
so
agenda
item
number
eight
leads
Health
and
Care
System
resilience
and
winter
planning.
So
the
scripting
board
has
previously
maintained
an
interest
in
the
leads
Health
and
Care
system
resilience
and
winter
planning
process,
and
so
we
have
requested.
A
The
request
from
the
board
today
is
that
a
briefing
paper
has
been
provided
by
the
Leeds
Health
and
Care
Partnerships,
which
sets
out
the
issues
and
actions
linked
to
the
current
process,
so
I
believe
we've
got
Shona,
Helen
and
Mark,
so
you
just
introduce
yourselves
I'll,
give
you
a
minute.
Actually
you
know
what?
Let's
have
two
minutes
break
everyone.
Two
minutes
I'll
be
right
back.
A
U
X
A
X
They
have
about
any
of
the
areas
of
demand
that
we've
described
and
if
the
areas
of
capacity
that
we've
described
or
any
questions
and
concerns
that
they
have
and
I'm
joined
by
assistant.
Colleagues,
who
are
all
expert
in
this
Arrangement.
Apologies
from
these
teaching
Hospital
colleagues
who
had
a
winter
planning
event
at
the
same
time
but
I'm
happy
to
try
and
answer
questions
on
their
behalf,
if
necessary
or
if
not
I,
can
defer
and
ask
them
to
come
back
to
to
members.
X
A
B
I
One
specific
bit
just
a
anecdotal
observation,
really
the
vaccination
plan
this
year,
based
on
my
own
experience
and
what
I've
seen
can
happen
in
my
own
Warden
because
of
Roswell
and
Alton
seems
to
have
started
earlier
with
stronger
communication
and
more
Vigor.
Now
I,
don't
know
whether
that's
just
my
Snapshot
experience
or
is
that
something
that's
replicated,
because
it
feels
from
what
I've
seen
of
what
I've
seen
in
social
media.
O
Thank
you
so
I
would
say
that
locally
we
have
been
able
to
get
more
communication
out
more
social
media
out
I.
Think
if
I
were
to
make
a
criticism,
the
the
national
comms
have
just
been
a
little
bit
later
than
we
would
have
wanted
this
year,
and
but
as
soon
as
we
had
vaccine
available,
we
were
out
vaccinating
and
making
sure
that
we're
getting
to
our
Target
groups.
We've
got
comms
leads
on
the
vaccination,
Steering
group
and
they're.
A
A
C
O
Absolutely
we're
learning
learning
all
the
time
what
we
found
that
was
really
helpful
was
to
get
out
to
local
communities
rather
than
expecting
them
to
come
to
us.
So
we
continue
to
do
pop-ups.
We
continue
to
go
to
areas
of
high
footfall
such
as
shopping,
centers
and
so
on,
and
we
have
a
cultural
diversity
lead
who
works
within
the
program
looking
at
how
we
can
best
engage
with
different
communities.
So
we
continue
to
do
that.
V
Thank
you
thank
you,
chair
yeah,
Dr,
Bill's,
question
and
Conrad
as
well.
Thanks
for
that
feedback,
that's
really
good
and
that's
really
important.
I
think
from
from
our
perspective,
as
well
from
a
public
health
perspective,
it's
important
to
learn
the
lessons
we
did
learn
in
the
last
couple
of
years,
but
actually
not
stop
there
and
actually
make
sure
that
we're
carrying
on
with
the
word
that
was
being
done
just
picking
up
locally
and
anecdotally
as
well
in
terms
of
access.
V
You
know
we're
still
at
the
fire
station
we're
still
at
local
Bilal
Center.
There's
all
of
that
work
still
happening
and
communities
are
picking
up
on
that.
So
just
really
thank
you
for
that
as
well.
For
all
that
work,
that's
going
on
it's
really
important.
Just
because
covert
is
we've
moved
on
from
it.
There
are
still
very
vulnerable
people
out
there
that
definitely
need
the
vaccine,
and
particularly
with
with
the
sort
of
double
whammy
of
flu
as
well
so
I
know,
I
had
with
the
Lord
Bay
and
Victoria.
V
We
had
the
flu
jab
and
also
the
core,
and
we
made
sure
we
did
the
comms
around
that,
because
it's
important
particularly
to
get
the
message
on
that
we're
getting
the
vaccine
is
important
and
encouraging
local
residents
to
do
but
yeah,
just
sort
of
to
reassure
you
and
the
board
that
that
work
is
very
much
still
on
our
way
down.
It's
still
happening.
Thank
you.
H
Yeah
and
very
briefly,
chair
just
to
add
to
Sam
and
Council
arif's
comments,
I
think
there's
a
couple
of
things
this
year,
which
do
we're
very
mindful
of
I,
mean
on
a
very
positive
note.
In
Leeds
we
have
the
nobody,
no
one
left
behind
program
which
Sam's
leads
closely
with
other
colleagues,
including
Public,
Health
colleagues,
and
we're
really
proud
of
that,
and
it's
something.
H
So
we're
we're
very,
very
committed
to
keeping
that
going,
but
there's
something
about
moving
from
the
height
of
the
pandemic,
when
this
was
the
focus
of
everybody's
sort
of
attention
to
the
fact
that
people
are
often
busy
with
other
things
now-
and
this
is
more
of
a
business
as
usual
thing.
So
there
is
a
challenge
to
how
we
keep
that
going
as
business
as
usual
and
I.
Think
it's
fair
to
say
that,
in
terms
of
the
hesitancy
question,
the
the
the
the
way
that
we
apply.
H
Our
work
now
has
changed
because
their
offer
has
changed
around
vaccinations.
So
a
lot
of
the
groups
who
are
more
hesitant
were
often
in,
for
example,
younger
people.
Now
lots
of
younger
people
aren't
eligible
anymore
unless
they've
got
a
clinical
reason
to
be
so
it's
it.
There's
a
slight
change
in
terms
of
making
sure
that
we
target
the
people.
H
J
J
So
it's
a
standalone
flu
vaccination,
but
the
doctors,
my
surgery,
for
example,
have
I'm
having
my
jobs
next
week
and
they're
going
to
do
the
joint
ones,
so
I'm
kind
of
wondering
why
pharmacies
are
offering
to
do
flu
for
the
same
age
groups
that
we're
talking
about
doing
the
Dual
vaccination
for
because
it's
a
bit
confusing
and
then
I'm
also
aware
that
several
residents
have
still
been
going
to
Harrogate
and
York
to
get
the
kovic
boosters
by
booking
on
the
national
system.
So
I'm
a
little
bit
confused
about
what
the
message
is.
J
O
Okay,
so
all
pcns
are
requested
to
be
part
of
the
program
and
all
the
pcns
have
opted
in.
There
are
some
practices
that
have
have
not
in
the
PCN
areas,
but
all
pcns
are
vaccinating
Community.
Pharmacists
can
then
apply
to
be
part
of
the
project
as
well
and
and
so
people
can
take
a
choice
as
to
whether
they
go
to
their
GP.
They
go
to
a
pharmacy
or
they
go
out
of
area
and
a
lot
of
people
I
think
look
to
see.
How
can
I
get
this?
O
O
O
Is
there
hesitancy
because
people
having
it
together,
you
can
choose,
you
can
have
one
at
a
time
or
both
together,
I
I
think
we
have
picked
up
a
little
bit
of
hesitance
about
it,
one
both
on
the
same
day
and
we've
also
had
if
I've
got
to
choose
one
I'm
going
to
choose
flu
I'm
going
to
choose
covid,
and
so
we
continue
to
work
on.
It
is
the
is
the
honest
answer
and
try
as
much
as
possible
to
have
local
services
for
local
people.
F
Thank
you,
chair
I
was
talking
to
a
gentleman
in
Charlotte
housing.
Yesterday,
who'd
been
and
had
one
of
the
jobs
himself
and
when
they
turned
to
put
his
house
or
his
bungala,
he
told
them
that
so
they
said
that
they
couldn't
get
him.
The
other
one
he'd
have
to
make
another
appointment
at
his
GPS,
so
it's
had
to
make
an
appointment
at
his
GPS
to
go
up
and
add
the
other
one
in
a
few
weeks.
Time
and
I
just
didn't
know
why
they
couldn't
give
him
just
one
of
them.
If
yeah.
O
No
can't
really
work
out.
What's
happened
there
and
I'm
wondering
whether
I'm
presuming
that
you're
saying
that
he'd
had
maybe
flu
in
one
place
and
they
went
around
to
do
covid
and
if
that
were
the
case,
they
could
give
the
covid,
but
I
can't
quite
understand
why
there's
been
a
problem.
So
it's
probably
one
of
those
things
that
you
want
to
talk
to
me
afterwards.
A
Y
From
the
from
a
mental
health
perspective,
obviously
we're
facing
immense
pressure,
as
as
the
rest
of
the
system
are
Staffing
is
a
particular
issue
for
us.
Legion
York
we're
doing
everything
we
can
to
to
recruit
and
maintain
our
stuff
in
we're
planning
for
the
winter.
We
know
that
we've
got
a
immense
amount
of
pressures
ahead
of
us
in
Winter.
The
demand
on
Services
we've
seen
quite
a
high
level
of
need
within
our
services,
struggling
with
staff.
Y
Our
staffing
at
the
moment
in
terms
of
the
flu
and
the
covid
we're
doing
really
well
and
we've
had
a
good
uptake
with
the
vaccinations,
but
you
know,
as
we
move
deeper
into
winter,
we're
not
sure.
What's
going
to
happen
there
really
we
are
seeing
as
I
say,
the
high
demand
on
on
particularly
around
patient
beds,
and
we
are
using
an
increased
amount
outside
of
leads
a
number
of
beds
outside
Elites.
Y
E
Yes,
thank
you
just
very
briefly
when
you
say
patients
are
being
sent
outside
of
leads.
Obviously,
we
I
mean
I'm
sure
we'll
appreciate
coming
back
capacity
and
staffing
issues.
There
are
obviously
a
number
of
stories
I've
been
circulating
within
the
media.
Some
real
horror
stories
in
terms
of
can
I
have
patients
being
sent
from
one
end
of
the
country
to
another
purely
to
deal
with
capacity.
Y
It
does
vary
mostly,
we
try
and
start
within
the
Yorkshire
region,
but
we
have
we.
We
are
usually
We've
commissioned
some
bets
up
in
Darlington,
so
in
the
north
of
Yorkshire,
but
we
have
sent
people
quite
far
afield
on
very
few
occasions,
but
we
prioritize
them
for
coming
back
into
area
as
soon
as
possible.
X
I
think
it'd
probably
be
safe
to
say
as
well.
That
depends
on
the
level
of
need.
So
if
it's
a
psychiatric,
Intensive
Care
Unit
bed,
where
there
are
there's
a
a
few,
there
are
fewer
of
them
than
people
who
might
be
more
likely
to
have
to
go
further.
Whereas
if
it's
a
more
General
bed,
there
will
be
sometimes
at
least
more
of
a
choice
and
colleagues
will
always
choose
the
nearest
possible
bet.
X
So
I
think
it
is
that
I
think
that
Mark
just
mentioned
that
that
booking
sorry
booking
a
group
of
beds
in
in
Middlesbrough
one
of
the
reasons
Darlington.
One
of
the
reasons
I
wanted
to
do.
That
was
so
that
we
can
make
sure
that
we
look
after
those
people
with
that
Outreach
team,
so
that
it's
easier
for
them
to
feel
that
they
belong
to
the
system
that
we've
got
access
to
their
notes.
X
We've
got
access
to
their
home
social
workers,
and
that
makes
that
length
of
stay
in
out
of
area
as
short
as
it
possibly
can
be.
So
that's
always
our
priority
to
find
a
safe
placement,
but
then
to
bring
those
people
back,
as
that
is
that
we
can
it's
harder
with
psychiatric
and
it's
a
careers
they
Mark
and
the
higher
the
level
of
the
need.
Y
Y
They
control
the
single
point
of
access
and
we
we've
moved
a
single
point
of
access,
so
we
can
be
more
responsive,
we've
put
in
measures
a
treehouse
system
that
we
can
deal
with
referrals
more
quickly
and
and
prioritize.
Those
with
a
higher
level
need-
and
we
sit
there
within
our
crisis
service
now
and
and
being
able
to
respond
to
those
with
a
higher
level
need
more
urgently
as
well.
Y
So
our
community
service,
both
for
adults
and
older
people,
are
very
much
part
of
the
transformation
program.
We're
also
looking
at
other
areas.
Diagnostic
areas,
for
particular
patient
groups,
are
very
much
part
of
that
that
transformation
project
we've
got
senior
staff
within
those
areas
working
alongside
the
transformation
team
to
to
progress.
Some
of
that
work.
Y
We
recognize
that
that
is,
is
a
significant
change
for
us
only
for
the
positive
really-
and
we
know
that
that
it's
a
direction,
a
travel
that
we
want
to
take
and
we
sign
up,
obviously,
with
everything
that's
gone
on
over
the
past
couple
years.
It's
it's
stored
a
bit,
but
we're
back
on
aiming
to
get
back
on
track
and
a
lot
of
activities
occurring
around
that.
O
Can
I
just
point
about
the
Primary,
Care,
Mental,
Health
and
Leeds
mental
well-being
service
are
all
part
of
the
mental
health
transformation
as
well.
I
think
it's
a
real
opportunity
for
us
to
bring
it
all
together
so
that
we
don't
have
people
falling
through
the
cracks
and
we're
working
as
one
system.
K
K
E
E
O
Perfect,
okay
and
this
this
will
be
quite
a
comprehensive
answer,
so
get
ready,
I
suppose
and
I
think.
The
most
important
thing
is
for
us
to
always
consider
admission
avoidance
first,
so
that
we
can
provide
support
to
people
before
they
actually
go
into
hospital,
and
then
they
less
likely
to
decondition
in
hospital
and
need
have
a
heavier
levels
of
care
coming
out,
but
once
they
are
in
hospital,
we
have
a
transfer
of
care
Hub,
which
is
a
joint
service.
O
It's
run
by
myself
and
Shona's
team
and-
and
we
look
at
how
we
can
get
people
to
the
next
place
as
as
quickly
as
possible,
and
so
we've
looked
at
streamlining
processes
and
I.
Think
that
we're
well
on
with
that.
But
we've
also
looked
at.
How
do
we
ensure
that
we've
got
the
right
capacity
on
in
community
services
to
get
them
out?
So
we
have
had
some
investment
this
year
in
terms
of
increasing
the
number
of
night
cities
that
we
have,
because
often
people
are
left
in
hospital
because
there
isn't
someone
to
see
them.
O
24
7.
and
we've
had
increase
in
therapy
budgets
so
that
we
can
have
more
therapists
that
are
working
on
on
their
independence
and
making
and
rehabilitating
them
quicker,
and
we
have
more
investment
in
self-management.
So
a
lot
of
people
often
leave
hospital
and
they
need
some
kind
of
low
level
intervention,
but
we
could
actually
teach
people
to
do
that
themselves.
Hence
improving
their
independence
as
well.
O
So
I'm
really
proud
of
that,
and
at
some
point,
when
we
have
time
I'll
talk
about
the
outcomes
that
we
have
got
with
self-management
because
they
they're
phenomenal
and
and
then
we're
also
working
together
around
active
recovery.
So
the
re-ablement
service,
that's
provided
by
the
council
and
our
neighborhood
teams
provided
by
Health
work
together
to
try
and
get
people
out
of
hospital
as
quickly
as
possible,
again
with
a
real
focus
on
getting
them
home
rather
than
into
long-term
care
and
a
real
focus
on
Rehabilitation
and
Independence.
O
U
Thank
you,
Sam
we're
seeing
a
sustained
Improvement
in
the
ability
of
our
home
care
services
to
pick
up
packages
of
care
in
a
timely
manner,
and
that's
helping
enormously
for
those
people
who
do
need
a
package
of
care
when
they
leave
hospital.
We
prioritize
the
hospital
for
any
packages
that
are
required.
U
We've
also
implemented
this
year,
a
bed
brokerage
service
which
has
started
to
impact
on
the
pace
of
time
that
it
takes
to
get
somebody
from
where
we
identify
the
need
for
long-term
care
service
to
the
point
where
they're
in
the
home
that
will
meet
their
needs.
We've
done
that
through
developing
a
bed
brokerage
service
which
is
developing
better
relationships
with
the
Care
Homes,
reducing
the
number
of
people
that
are
ringing
them
every
day
and
targeting
the
the
right
home
for
the
right
individual.
U
A
X
You
very
much
Shawna
I
mean
it's
worth,
adding
that
in
terms
of
assurance,
I
think
it
is
absolutely
the
area
that
we
remain
focused
on,
because
we
know
that
people
we
will
try
all
we
can
and
I
think
our
diversion
work
is
really
paying
off.
Our
admission
rates
are
not
have
not
been
significantly
higher,
but
they've
been
lower
than
some
previous
years,
but
we
do
know
that
people
who
do
come
in
will
be
slightly
sicker
slightly
later.
X
If
we
have
about
a
flu,
or
we
have
people
just
generally
more
unwell
as
they
come
into
Hospital,
partly
because
we've
diverted
the
people
who
are
able
to
be
diverted,
which
means
the
people
who
are
in
a
sticker.
But
we
have
a
very,
very
strong
focus
on
it
through
all
of
our
governance
structures
and
all
of
the
actions
that
we've
identified,
some
of
which
are
described
in
in
your
plan,
include
that
continued
tightening
up
so
that
we
look
for
every
opportunity
to
reduce
the
delays.
X
I
mean
you
know,
small
things
that
can
make
a
big
difference
if
you
multiply
them
over
lots
of
people.
So
we've
invested
very
heavily
in
more
ward-based
staff
to
to
really
just
be
on
top
of
that.
We've
reopened
a
discharge
Lounge
to
encourage
so
that
people
can
sit
out
in
the
morning
so
that
if
there
is
someone
to
come
in
that
we
we
can
try
and
find
those
people
a
bed
most
appropriately,
and
we
continue
to
do
everything
that
we
can
across
that.
X
So
our
winter
plan
that
we've
described
just
in
very
brief
detail
in
the
in
the
paper,
is
focused
on
increasing
capacity
and
flow
for
people
with
no
reason
to
reside
so
that
we
can
free
up
those
beds
for
people
with
an
acute
need.
So
that
is
the
sum
total.
So
it's
some
additional
beds
for
acute
capacity.
But
by
and
large
what
we've
tried
to
do
is
invest
in
alternatives
to
hospitals,
so
that
those
people
can
then
move
more
quickly
and
continue
to
look
for
any
opportunity
to
reduce
any
delays
so
in
the
ongoing
care.
X
So
the
the
the
Home
Care
work
has
been
really
really
helpful
in
that
and
the
work
that
showed
us
also
shut
us
closely
invested
in
some
more
capacity
to
just
try
and
get
on
top
of
some
of
the
delays
that
we've
had
over
the
summer
due
to
vacancies
in
all
parts
of
the
system.
So
we're
really
consolidating
over
the
last
four
weeks
and
more
to
do
but
I
think
there
are
some
glimmers.
I
think
the
difficulty
is
because
the
pressures
are
so
significant.
X
It's
sometimes
hard
to
see
the
improvements
and
the
counterfactuals,
so
that
I
know
that
it
would
have
been
worse,
but
it
doesn't
actually
feel
great
if
you're
sitting
in
an
early
Department
with
too
many
people
in
it
to
say
it
would
have
been
worse
fields.
You
know
it's
not
a
very
encouraging
thing
to
say
to
staff
who
face
those
pressures
every
day,
but
I
do
there
definitely
are
improvements
that
you
can
quantify
it's
just.
X
X
But
that's
not
without
pressure
on
the
any
Department
we've
made
a
system
choice
and
the
providers
made
a
real
strong
choice
to
do
that,
because
they're
knock-on
effect
for
people
and
someone
in
their
own
home,
then
waiting
for
an
ambulance.
We've
made
a
judgment
that
at
least
in
any
department
or
in
a
another
area
in
a
hospital
they
have
some
oversight
side,
whereas
if
you're
on
your
own
waiting
for
an
ambulance,
you
have
no
oversight.
So
it's
important
I
think
that
scrutiny
is
cited
on
that,
because
that
is
one
of
the
things
that
we
do.
X
It's
a
balance
of
risk,
but
we've
made
that
judgment
as
a
system
to
prioritize
ambulance
handovers
because
of
the
knock-on
effects
to
well
our
residents,
but
also
the
yd
West
Yorkshire
and
Yorkshire
Ambulance
Service
residents,
so
I
think
that's
another
pressure
that
sits
in
our
a
e
Department,
which
obviously
is
not
ideal
for
the
experience
of
patients
in
those
departments.
But
it's
certainly
improving
the
response
times
that
otherwise
people
would
otherwise
face
when
they're
waiting
for
an
ambulance
at
home,
which
is
probably
the
most
stressful
thing,
any
of
us
ever
do
so.
I
just
think.
E
You're,
absolutely
not
going
to
be
able
to
do
justice
to
the
couple
of
quick
questions
that
I've
got
here.
Firstly,
it's
great
to
hear
about
obviously
they're
working
together
in
Partnership
working
between
the
organizations.
That's
really
positive,
I
suppose
my
my
first
question
is
thinking
about
the
workforce
and
how
how
we
are
how
different
roles
are
being
utilized
across
the
system.
Obviously,
we've
got
some
amazing
docs
and
nurses.
E
We've
also
got
our
fantastic
ahps
who
do
a
remarkable
job
in
terms
of
helping
people
to
get
from
hospital
back
to
home,
and
so
how
are
those
roles
been
being
utilized
and
obviously
new
roles?
Well,
newish
roles,
for
example,
like
an
advanced
nurse
practitioners
Etc
within
within
the
Ed,
and
my
second
question
is
what
safeguards
are
in
place
to
ensure
that
we're
not
discharging
medically
unwell
patients
now
I'm
playing
devil's
advocate
here,
because
I
appreciate
that
there
will
be
safeguards
in
place.
E
O
Let's
start
on
and
Workforce,
then
so
I
think
the
roles
that
I've
previously
talked
about
in
terms
of
self-management.
That's
not
a
registered
role.
It's
getting
people
to
be
very
competent
in
Regular
procedures
and
then
teaching
people.
So
that's
something
quite
different
and
it
also
brings
in
a
new
Workforce
in
terms
of
therapy.
O
Previously,
we
wouldn't
have
been
able
to
discharge
people
who
perhaps
needed
the
care
of
a
relative
just
to
keep
an
eye
on
them,
so
not
to
provide
any
clinical
input
but
keep
an
eye
on
them,
and
we
have
commissioned
the
third
sector
to
act
essentially
as
proxy
family
and
and
that's
been
we're
just
getting
the
evaluation
of
that
at
the
moment
and
has
some
amazing
amazing
results.
Can
I
insult
you.
O
O
He
was
staying
overnight
going
home
the
next
morning
and
basically,
the
enhanced
team
and
went
to
talk
to
him
and
he
said
I
hate,
Saturday
nights,
I'm,
always
lonely
and
my
family
had
gone,
and
now
they
have
a
regular
15-minute
contact
with
him
on
a
Saturday
afternoon
to
keep
him
straight.
So
I
think
it's
12
weeks
now
that
he's
not
caused
an
ambulance,
and
that
seems
like
really
Petty.
X
I
think
if
we'd
speak
to
the
the
other
roles,
I
think
Mark
referred
to
them
earlier
and
we
talked
to
counselor
talked
about
the
Community
Mental
Health
transformation.
We
are
working
really
closely
with
third
sector
staff
I
think
across
all
about
Pathways
I.
Think
the
other
work
and
general
may
want
to
add
is
is
how
we
support
registered
social
workers
in
doing
registered,
Social
Work
tasks
by
finding
some
of
the
other
other.
The
information
gathering
some
of
the
talking
to
families.
So
we
have
support
from
carers
leads
we
have
support
from
huk.
X
We
have
support
from
the
care
home
trusted
assessors
run
by
the
leaders
care
Association.
So
we
have
other
colleagues
who
are
helping
with
some
of
that
process
stuff
and
talking
to
families
to
try
and
meet
some
of
the
challenges
that
we
know
that
the
healthwatch
report
identified
about
how
we
really
support
people
through
discharge
and
help.
People
feel
that
that
it
is
a
process
where
they're
supported,
rather
than
kicked
out,
which
I
think
speaks
to
your
offer.
I
think,
in
terms
of
whether
we're
pushing
medically
unwell
patients
out
I
think
what
are
the
work?
X
The
things
that
we
do
with
our
transparent
care
up
is
really
evaluate.
What's
the
best
place
for
that
person,
and
some
of
that
dialogue,
then
that
we've
now
put
into
that
process
will
then
actually
go
well.
Actually,
this
person's
not
ready
to
go
home
today
and
sometimes
we'll
have
found
a
placement
for
somebody,
and
actually
something
has
changed,
and
so
I
think
that
level
of
Engagement
back
with
the
world
staff
to
go
well,
we
have
got
somewhere
for
them.
Are
you
sure
they're
ready
to
go
then
creates
that
challenge?
X
We
do
know
that
many
of
the
people
who
the
national
definition
of
no
reason
to
reside
is
somewhat
different
from
some
of
the
medically
optimized
words
that
we've
used
previously
and
they
have
changed
the
threshold.
So
you
know
you
can
be
still
relatively
unstable,
but
not
meet
those
very
strict
criteria
and
I
think
we
are
seeing
them
that
that
people
are
trying
to
encourage
people
to
move
to
another
setting
earlier
than
we
probably
would
have
done
three
or
four
years
ago
be
interested
in
shown.
This
video
on
that
and
so
I
think.
X
Inevitably,
some
of
those
people
then
will
not
necessarily
manage
to
stay
in
their
new
setting
and
that's
a
balance
that
we
juggle
every
day
the
balance
on
of
actually
are
you
just
creating
churn
in
the
system?
Or
can
we
provide
the
appropriate
level
of
support
for
those
people
to
to
be
managed
and
I
think
that's
a
judgment
that
we
probably
won't
always
get
right
every
day
because
of
the
pressures
but
I
think
it's
a
it's.
A
really
good
challenge
to
us,
which
is
our
red.
X
Mission
rates
haven't
gone
up,
but
if
they
had
gone
up,
that
would
be
a
real
concern
to
us
and
I
think
monitoring.
The
admission
rates
is
really
important
because
that
would
suggest
that
we're
getting
it
wrong
I
think
more
often
we
find
a
package
for
someone
and
then
we
waste
the
package,
because
the
person's
actually
not
ready
I
think
that
probably
happens
more
often
than
an
unplanned
readmission.
But
again
people
are
rail.
I
think
would
be
Shona.
Did
you
want
to
add
to
that.
U
Thanks
Helen
the
Community
Care
hubs,
which
we
run
through
of
in
partnership
with
Leeds
Community
Health
they're
called
the
recovery
hubs.
They
support
people
on
their
journey
home
from
from
hospital,
and
we
have
noticed
in
the
five
years
that
they've
been
commissioned,
that
people
are
coming
to
the
service
less
well
than
they
were
previously
they're,
taking
longer
to
recover
they're,
perhaps
needing
a
bit
of
time
to
feel
better
before
they're
then
supported
to
develop
their
therapy
activity,
so
they're
spending
longer
in
those
homes
as
a
result
of
being
less
well.
U
That's
not
suggesting
that
that
was
an
unsafe
discharge.
It's
saying
that
in
general,
those
people
have
been
admitted
have
been
treated,
are
being
discharged
and
are
less
well
they're,
probably
older.
They
may
have
experienced
the
impact
of
of
covid
there's
a
range
of
reasons
why
but
they're
certainly
staying
longer
in
those
homes
to
the
point
where
they're
able
to
get
better
and
then
get
back
home,
so
I
think
that
supports
what
what
Helen
was
saying.
U
A
Okay,
thank
you
very
much.
Council
Farley.
Maybe
you
missed
it
earlier
LT
HT
unable
to
be
here
today
because
at
the
same
time,
they're
also
having
their
winter
resilience
planning
meeting
and
all
the
directors
and
heads
there
at
that
meeting.
So
Helen
has
done
a
very
good
job
today
in
helping
us
out
with
some
of
the
answers
that
we
need
Victoria.
Would
you
like
to
come
in
yeah.
H
Thank
you
chair.
It
was
just
a
brief,
broader
Point
around
the
the
content
of
the
plan
and
how
it
joins
up
more
broadly
across
the
city.
So
what
we've
done
with
colleagues
is
ensure.
We've
joined
up
the
the
activities
across
Health
and
Care
Services,
with
some
of
the
work
that
we're
doing
out
in
communities
to
keep
people
well
and
supported
well
through
the
winter.
H
We
want
to
go
even
further
Upstream
in
into
prevention
and
making
sure
we
we
do
the
things
that
keep
people
out
well
and
out
of
hospital
and
and
and
obviously
ultimately,
avoiding
poor
health
and
and
and
sadly,
the
excess
deaths.
We
we
see
in
winter,
so
there's
four
main
parts
of
that,
and
one
one
of
them
is
about
being
really
proactive
in
preventing
and
managing
disease
and
infection,
and
particularly
in
our
highest
risk
communities.
H
So
all
of
the
work
that
still
goes
on
with
our
infection,
prevention
and
control
service,
working
with
Care,
Homes
and
other
vulnerable
residents-
you
know
we
we
do
keep
outbreaks
to
a
minimum
and
and
and
and
very
low,
so
that
all
helps
keep
people
well
and
reduce
pressure
on
the
system.
The
second
area
is
supporting
people
living
with
Frailty
through
the
winter
period
and
other
clinical
conditions
that
make
them
more
vulnerable.
H
So
we
know
by
being
proactive
and
there's
some
examples
of
some
of
the
programs
that
do
that
and
which
I
know,
as
as
members
you'll
be
very
aware
of
in
your
own
communities
and
just
what
a
difference
that
makes
to
keep
people
supported
through
the
winter
period.
I
think
particularly
relevant
this
year
is
doing
everything
we
can
and
increasing
our
activity
to
reduce
the
harm
of
cold.
H
We
know
that
all
of
the
evidence
suggests
that
cold
is
the
biggest
potential
harm
to
health
through
the
winter
period
and
with
the
pressures
on
heating
costs
this
year.
We
know
that
we
Face
extra
challenges
so
that
that's
that's
very
important
and
cold
and
damp
together.
You
know
you
know.
The
combination
is,
is
very
harmful,
so
there's
increased
work
on
on
that
this
year,
with
with
housing,
colleagues
and
others,
and
then
finally,
and
going
back
to
the
point
about
mental
health.
H
A
It's
very
helpful
Victoria.
Thank
you
very
much
and
I
do
know
within
our
communities.
Lots
of
the
different
activities,
keeping
warm
centers
and
all
of
that
going
around
to
make
sure,
especially
our
vulnerable
people,
are
kept
safe
and
warm
in
these
very
difficult
times,
and
we
do
take
note
of
all
the
risks
that
have
been
mentioned
in
on
page
58
as
well.
A
It's
a
lot
easier
to
dwell
on
the
negatives,
but
we
do
have
some
positives
going
on
around
in
the
city
in
making
sure
that
our
residents
are
healthy
and
they're
kept
safe,
but
at
the
same
time
we
do
not
want
to
shut
our
eyes
on
what's
going
wrong
and
that's
why
we're
here
to
be
critical
friends
to
each
and
every
one
of
you
so
I
just
want
to
use
this
opportunity
to
say
huge.
Thank
you
on
behalf
of
the
board.
You
know
to
teaching
hospital
to
our
offices.
A
Exec
members,
you
know
it's
been
a
very
long
year.
It's
been
a
it's
been
a
very
tough
year
as
well,
but
our
resilience
has
brought
us
to
where
we
are.
You
know
we're
we're
all
alive
and
we
we
will
keep,
keep
fighting
and
we'll
keep
going.
So
I
will
just
call
on
our
principal
scrutiny.
Advisor
on
agenda
item
number
nine.
Just
before
we
close.
L
Thank
you
chair.
Yes,
this
final
item
relates
to
the
board's
work
show
John.
The
latest
version
is
set
out
in
appendix
one
as
we've
referenced
in
the
the
covering
report,
which
is
to
to
point
out
in
terms
of
the
item
that
was
around
Liberty
protection
safeguards.
The
board
had
previously
been
advised
of
the
intention
nationally
to
replace
sort
of
current
definition
of
Liberty
safeguards
with
a
form
which
forms
part
of
the
mental
capacity
act
with
Liberty
protection
Safeguard.
L
So
it
was
suggested
it'd
be
helpful
to
bring
a
report
back
to
the
board
to
discuss
the
implications
of
this
change.
This
is
this
had
been
scheduled
for
the
boys
February
meeting.
However,
the
chair
had
sort
of
recently
been
advised
of
further
implementation
delays
nationally
and
so
I've
agreed
to
remove
the
item
from
the
boys
Workshop
until
we
can
have
assurances
surrounding
the
implementation
time
frame
and
then,
with
regards
to
the
budget
working
group,
this
has
now
been
confirmed
for
14th
of
December
at
four
o'clock.
L
E
Thank
you
chair.
Just
a
very
quick
bit
of
aob
I'm
sure
some
of
us
will
be
aware:
Julian
Hartley,
the
chief
executive
at
my
apologies,
sir
Julian
Hartley,
chief
executive
of
police
teaching
hospitals,
has
been
appointed
to
be
the
chair
of
NHS
providers
and
I
understand
that
he'll
be
leaving
Lee's
teaching
hospitals
and
therefore
I
was
going
to
suggest
that
Taps
as
a
board,
and
we
pass
on
our
thanks
to
to
Julian
for
his
service
to
lease
teaching
hospitals
and
the
service
to
the
city.
E
I
think
I
think
he
was
appointed
in
2013,
so
maybe
2014..
So
it's
about
seven
about
seven
or
eight
years
that
he's
been
there
and
he
has
done
yo.
I
I
will
declare
what
interest
I
did
used
to
work.
At
least
teaching
hospitals
and
I
did
work
with
Julian
in
the
communications
team,
but
he
has
done
a
remarkable
job
in
terms
of
running
running,
researching
hospitals.
A
A
Is
act
members
officers,
the
public
you
know
for
being
buried
with
us
at
you
know
three
and
a
half
hours
every
month
is
is
a
long
time
to
be
in
meetings,
but
we're
truly
grateful
and
have
a
wonderful
Christmas
if
we
don't
see,
make
sure
it's
as
joyful
as
he
can
be
and
stay
warm
so
take
care
everyone,
and
thank
you
for
all
your
contributions
to
all
the
board.
Members
truly
truly
appreciated.
Thank
you.