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From YouTube: Leeds City Council -Scrutiny Board (Adults, Health & Active Lifestyles) 5th October 2021
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A
My
name
is
angela
brogdon
and
I'm
the
principal
scrutiny
advisor
to
the
adults,
health
and
active
lifestyle
scrutiny
board.
So
before
moving
to
the
former
meeting
agenda,
I
have
been
asked
by
councillor
marshall
catton,
who
is
chair
of
the
scrutiny
board,
to
relay
her
apologies
for
today's
meeting
and
in
her
absence,
counselor
andrew
scopes
has
been
nominated
to
chair
today's
meeting.
So
please
can
I
ask
all
board
members
for
their
agreement
for
this
nomination.
Please
brilliant!
Thank
you,
everyone
so
just
to
confirm.
A
B
B
We've
taken
some
precautions
due
to
covid
in
that
we
have
fixed
seats
and
the
windows
are
open
and
with
that-
and
the
next
thing
I'd
like
to
do
is
just
give
everyone
a
chance
to
introduce
themselves.
Unlike
a
zoom
meeting,
we
can
just
go
around
the
table,
so
I
start
with-
and
I
probably
start
with
myself,
so
I'm
council
andrew
scopes,
I'm
sweetly
chair
of
strategy
and
resources
board,
and
I'm
substituting
here
for
councillor
marshall
qatar.
We
pass
over
to
harriet.
B
C
Thanks
chair
under
agenda
item
number
one:
there
have
been
no
appeals
against
the
refusal
inspection
of
documents
under
agenda
item
number
two.
There
are
no
items
for
exclusion
today
under
agenda
item
number
three:
there
are
no
late
items
of
business
and
under
agenda
item
number
four.
Could
I
ask
members
to
declare
any
interest
today?
Please.
C
B
B
A
B
Thank
you
very
much.
Angela.
Any
members
want
to
raise
any
horizon.
No
great
super
okay.
So
we're
going
to
move
on
to
the
first
substantive
item,
which
is
item
7
on
page
23
of
your
packs,
I'd
like
to
ask
aleister
to
introduce
yourself
again
just
give
us
a
high
level
of
what
you
want
to
talk
about.
I
think
it's
safe
to
assume.
We've
all
read
our
papers,
so
thank
you.
L
Hi
there
so
I'm
alistair
belly,
I'm
the
lead
clinician
for
stroke
services,
thanks
for
inviting
us
back
this
time,
face-to-face
which
is
nice
to
see
everybody
just
want
to
give
you
an
update
really
on
the
progress
of
our
inpatient,
rehabilitation,
ward,
move
and
the
development
of
a
vision
for
stroke
services
in
leeds
you've
all
had
the
paper
so
I'll
skip
over
that
bit.
But
since
the
paper
was
sent
out,
there
has
been
a
delay
to
the
move
to
chapel
alton
by
a
number
of
weeks.
L
Any
new
date
set
by
ltht
will
also
rely
upon
the
availability
of
your
ambulance
service
to
provide
patient
transport
on
the
day,
so
we're
in
close
conversation
with
them.
Clearly,
this
is
very
disappointing
for
all
concerns.
Communication
with
the
patients
and
staff
was
paramount
in
the
dissemination
of
this
information.
L
Staff
engagement
was
re-undertaken
again
to
listen
to
their
concerns
and
answer
any
questions.
General
manager
met
with
all
therapy
teams
on
the
24th
of
the
9th
and
on
the
30th
of
the
9th
head
of
nursing
and
matron
met
with
all
nursing
teams,
and
I
myself,
the
clinical
lead
met
with
all
teams
on
the
30th
of
the
9th
of
clinical
governance.
L
Although
the
staff
were
understandably
disappointed
about
the
delay,
there
is
an
understanding
behind
the
changes
and
that
there
is
a
clear
wants
and
needs
for
this
move
to
be
safe
and
for
the
patients,
safety
is
paramount,
but
perhaps
every
cloud
does
have
a
silver
lining,
and
this
delay
has
allowed
for
a
much
more
coordinated
solution
to
the
initial
reduction
in
the
bed
base.
We
would
have
experienced
if
the
original
date
had
been
kept.
L
We
would
have
lost
some
beds
with
the
initial
move,
with
no
immediate
plan
to
create
more
beds
for
those
not
medically
fit
for
transfer
to
c6.
This.
There
would
therefore
would
have
displaced
some
patients
in
non-specialist
stroke
areas.
This
was
a
concern
and,
after
our
experience
with
l12,
was
used
for
covered
patients,
something
that
we
as
a
service
were
not
keen
to
repeat.
However,
following
robust
concise
conversations
where
our
concerns
were
aired
and
more
senior
operation,
teams
listened
to
a
fair
and
reasonable
solution
was
found.
L
An
increase
in
dedicated
stroke
beds
across
the
lgi
site
will
occur
in
tandem
with
the
move,
an
increase
in
dedicated
stroke
beds
on
the
lgi
site
and
will
create
an
overall
capacity
greater
than
what
we've
had
before
stroke
had
needed,
an
increase
in
total
bed.
Since
we
became
the
comprehensive
stroke
center
offering
thrombectomy
to
the
region
and
taking
harrogate's
acute
stroke
patients,
this
increased
number
of
beds
we'll
see
the
work
we
did
pre-covered
on
the
digital
pathway
for
stroke,
patients
become
a
focus,
creating
a
pull
system
rather
than
a
push
system
pathway.
L
L
L
L
Finally,
I'd
just
like
to
talk
about
the
new
tia
pathway.
During
the
first
few
days
of
kovid,
there
was
a
shift
in
the
emergency
department
where
there
was
a
need
to
remove
the
clinical
decisions
unit
where
we
saw
our
transient
ischemic
attacks,
otherwise
known
as
tia
patients,
who
were
particularly
at
high
risk,
were
seen
through
the
emergency
department.
However,
within
days
we
set
up
another
satellite
unit
in
a
part
of
the
hospital
not
used
and
staffed
and
run
by
nurses,
with
medical
cover
being
provided
remotely
via
telephone
and
video
conferencing
when
needed,
it
was
apparent.
L
There
was
no
going
back
to
the
old
system
and
we've
set
out
to
make
this
a
permanent
change.
Working
collaboratively
collaboratively
with
both
the
emergency
department
and
primary
care.
We've
been
able
to
offer
a
much
more
seamless
and
dedicated
pathway,
providing
a
one-shot
stop
for
diagnosis,
review
and
treatment
review,
taking
place
commonly
within
24
to
48
hours
from
referral
for
all
patients.
Previously
there
could
be
a
delay
of
up
to
12
to
14
days
for
non-urgent
tia.
L
R
The
ambitions
that
we
expect
to
receive
we're
currently
got
the
project
group
which
we'll
be
meeting
in
october
and
say
we'll
have
a
first
draft
by
april
2022
we've
had
some
real
success
when
we've
adopted
this
approach
for
the
diabetes
strategy
for
leeds
in
2019
and
we'd
like
to
be
able
to
build
on
that
and
set
up
an
ambitious
program
that
will
set
leads
to
be
one
of
the
best
cities
either
to
be,
if
you're,
at
risk
of
or
have
a
stroke.
Thank
you.
B
B
M
I'll
take
power.
Hunt.
Excuse
me
so
dr
steven
wilson,
I'm
clinical
director
for
the
neuroscience
service.
Just
for
the
record
again,
the
issue
we
had
with
medical
cover
is
essentially
partly
due
to
the
rehabilitation
consultant
body
at
chapel
allerton
supporting
covered
ward
cover
at
this
and
james's
site.
So
we
were
effectively
spreading
that
cover
very
thinly,
we're
also
relying
on
our
stroke,
consultants
from
the
lgi
site,
doing
support
wardrobes
into
the
chapel
allerton
site
to
support
the
newly
appointed
rehabilitation
consultant.
M
But
it's
been
recognized
over
the
last
few
weeks
that
that
did
introduce
some
fragility
when
the
support
network
that
was
around
him
was
being
spread
very
thinly
to
support
covert
cover.
So
in
order
to
bolster
that,
we
have
advertised
for
an
additional
consultant
in
rehabilitation,
medicine,
we're
also
going
to
advert
for
an
additional
stroke
consultant
essentially
to
to
bolster
both
teams,
and
so
that
we
can
provide
absolutely
sustained
cover.
24
7
365
days
a
year.
B
E
Thank
you
chair.
You
mentioned
that
there's
been
an
increase
in
the
capacity
lgi,
but
there's
still
a
decrease
in
the
capacity.
Isn't
there
for
beds
at
the
new
chapel
alton
site,
is
it
22
and
then
they're
living
flat,
so
23.
you've
already
you've
already
is
that
is
that
right?
Can
you
answer
that?
First,
one.
M
We
will
still
be
able
to
treat
the
same
number
of
stroke
patients,
but
our
intention
and
our
desire
is
to
treat
them
in
a
much
more
effective
manner
by
co-locating
the
outlier
patients
on
the
lgi
site
in
terms
of
the
difference
between
l12
and
c6
you're.
Absolutely
right,
there's
five
beds
less
on
c6
than
there
are
on
l12,
and
we
can't
get
away
from
that.
M
M
So
again,
as
alistair
pointed
out,
part
of
the
global
package
of
care
for
this
and
and
the
overall
bundle
is
to
enhance
the
our
ability
to
deliver
better
stroke
care
on
the
lgi
site
for
patients
who
need
lgi
based
care,
but
very
much
more
considerably
enhance
the
care
that
the
rehabilitation
aspect
of
the
patient
population
are
receiving
by
moving
them
to
a
site
in
a
center
that
is
bespoke,
designed
and
built
to
deliver
high
quality
rehabilitation
to
move
those
patients
through
that
pathway.
Much
faster
and
also
integrate
better
with
the
community.
M
E
Thanks
yeah,
so
the
headline
weighs
as
you've
just
outlined,
obviously
to
if
you've
got
a
technically
a
reduction
in
capacity
is
to,
firstly
improve
the
quality
of
or
the
amount
of,
the
quality
of
services
they
receive
on
the
ward,
obviously,
as
you've
outlined
with
the
with
the
intention
of
reducing
inpatient
time
there
so
and
in
in
the
report.
Immediately
after
this
and
the
neurological
rehabilitation
services
engagement
redesigns,
it
mentions,
as
a
suggestion,
increased
specialist
provision
on
inpatient
units,
and
so
I
want
to
drill
down
on
your
first
point.
E
I've
got
to
say
I
will
come
back
for
the
second
point
about
the
community
support,
but
drilling
down
onto
that
first
point:
is
there
an
increase
on
staff
and
specialist
staff
in
support
at
chapel
allison
hospital?
You
mentioned
lgi
with
the
encrypt
with
the
specialist
consultant,
it's
great,
but
what
about
the
specialist
support?
So
I'm
talking
about
salt
oats,
you
know
specialist,
nurses
etc.
Is
there
an
increase
from
those
in
that
different
provisions?.
E
So
going
to
going
on
to
the
community
support
sorry,
I
have
taken
some
notes
because
I
went
through
it
all
so
around
front
line
preventative
services,
so
you
recognize
under
4.6.
That's
covid's
played
a
role
in
the
increase
in
stroke,
new
numbers
due
to
kobit
19
being
linked
to
changes
in
clotting,
and
you
also
cite
as
well
associated
behavior
due
to
lockdown
so
exercising
less
less
healthy
diets.
E
No
doubt
drinks,
part
of
that
as
well,
so
there's
been
a
consequential
rise
in
demand
for
community
services
and
some
patients
who
receive
less
therapy
than
we
would
have
wanted
with
increased
complexity,
meaning
that
resources
are
spread
more
thinly
within
the
community
team.
Coving's
not
going
away.
There's
a
and
there's
another
point
about
adult
social
care
and
the
cuts
to
adult
social
care
as
well.
On
top
of
that
is
it
is
it
safe
to
assume
that
the
capacity
within
the
community
stroke,
rehabilitation
services
is
currently
reduced?
N
N
Some
of
some
of
the
pressure
has
eased
from
when
the
period
was
at
its
most
acute,
and
so
there
is
still
some
impact.
I
think
part
of
the
stroke
strategy
is
how
we
take
that
forward.
We've
always
already
started
to
look
at,
and
there
has
been
learning
during
that
in
community
in
in
terms
of
the
liaison
with
acute
services
and
some
of
the
new
ways
of
working
some
of
the
ways
of
using
technology
to
be
able
to
kind
of
enrich
into
and
liaise
with
therapists
between
therapists
has.
N
We've
done
some
really
good
learning
to
enable
that
and
to
involve
carers
within
that
process
as
well
to
ensure
that
they've
got
the
information
they
need
when
people
come
out
of
hospital.
I
think
there's
some
way
in
some
of
the
some
of
the
patients
that
perhaps
are
lower
risk.
We've
established
that
some
proactive
work,
some
working
groups
and
peer
support
work
will
help
with
that
as
well.
So
I
would
say
there
is
an
ongoing
impact
it's
nowhere
near
at
the
level.
E
E
I
guess
what
the
question
I'm
asking
is:
do
you
do
you
currently
have
the
resources
to
deal
with
what
is
now
probably
an
increase
increase
in
in
instances
of
people
with
strokes,
given
the
given
the
impact
of
covid,
do
you
have
those
resources
and
I'll
come
to
to
my
third
point
at
the
moment,
which
is
around
adult
social
care?
So
we
know
you
know
the
adult
social
care
has
been
massively
hit.
E
It
is
a
de
facto
cult
and
it
doesn't
look
because
because
of
the
impact
of
the
global
pandemic
and
the
failure
of
the
government
to
actually
to
to
provide
the
resources
we
need
as
a
city,
we
know
that
there's
a
a
rise
in
national
insurance
that
was
recently
announced,
but
from
from
what
I've
been
briefed
that
it
isn't
likely
that
that
will
be
that
will
go
to
frontline
adult
social
services.
So
has
so
essentially,
there's
been
a
de
facto
cult
in
adult
social
services.
That
was
part
of
your
plan.
E
J
Hi,
if
it's
okay
I'll
come
in
there,
I'm
lindsay
springer,
head
of
pathway,
integration
for
long-term
conditions
at
the
ccg.
I
guess
as
part
of
the
strategy
and
vision
development
work.
That's
very
much
the
discussion,
we're
keen
to
help
with
stakeholders
and
wider
partners
over
the
next
six
months,
including
social
care.
Colleagues,
around
mapping
carefully.
J
All
of
the
activity
we've
seen
over
the
last
12
to
18
months
across
acute
and
community
care,
and
also
individuals
managed
and
cared
for
within
social
care,
to
really
map
that
through
and
understand
the
need
and
areas
where
we
may
need
to
invest
collectively
going
forwards.
So
that
is
very
much
the
work
planned.
M
Rather
than
relying
on
us
trying
to
identify
those
patients
and
again,
this
move
gives
us
an
opportunity
to
re-engage
that
process
and
really
develop
those
integrated
pathways
and
what
we
found
by
doing
that
was
that
leeds
community
health
actually
had
more
resources
than
we
thought
they
did,
but
also
where
they
were
struggling.
It
was
an
opportunity
for
them
to
talk
to
us
about
that
struggle,
and
certainly
we,
as
an
organization,
are
very
committed
to
things.
M
You
know
strategies
to
try
and
improve
that
like
development
of
shared
posts,
because
we
know
that
we
can
recruit
quite
easily
or
quite
well
within
leeds
teaching
hospitals-
and
it's
not
always
the
case
in
the
community,
but
by
integrating
shared
posts
into
that
role.
Not
only
can
we
have
people
who
understand
how
the
community
works,
but
they
will
also
understand
how
the
hospital
works,
and
this
all
forms
part
of
that
global,
integrated
stroke
strategy.
M
That
brian
was
referring
to
earlier
on,
and
so
I
think
by
re-engaging
that
digital
pathway
work,
we
saw
a
reduction
in
average
length
of
state
stroke
patients
of
around
about
two
days,
pre-covered.
That
has
obviously
crept
up
as
a
result
of
the
kovid
pandemic.
But
we're
very,
very
hopeful
that
we
will
be
able
to
pull
that
back
down
again
through
reintegrating.
G
Thanks
chair
thanks
everyone,
I've
just
got
a
couple
of
points
and
questions
around
outcomes.
Please
looking
at
figure
two
where
there's
the
figures
around
the
hospital
discharged
community
stroke
team.
It
might
just
be
me,
but
I
think
for
me
the
figures
would
be
more
meaningful
if
there
was
a
breakdown
of
the
actual
leeds
outcomes,
because
it
I'm
taking
into
account
that
some
of
those
people
who
are
discharged
are
part
of
the
harrogate
side
as
well.
G
That's
so
that
would
just
be
a
request
for
further
information.
If
that's
available,
and
also
following
on
from
the
outcomes,
I
just
wonder
how
much
measure
is
put
into
the
outcome
journeys
of
the
of
the
patients
that
land
up
being
the
outliers
as
compared
to
the
patients
that
land
up
in
stroke
beds.
G
M
Thanks
very
much
yeah.
No,
I
think
that's
absolutely
fair
and
it's
a
piece
of
work
that
we've
been
looking
to
try
and
develop
within
lead
teaching.
Hospitals
we'll
have
to
go
back
and
have
a
look
at
the
data
set
to
see
if
it's
that
straightforward
to
extract
leads
versus
harrogate,
because
we
tend
to
sort
of
see
all
the
patients,
especially
having
taken
over
harrogates
hyper
acute
stroke
care.
M
But
we
can
certainly
look
at
doing
that
in
terms
of
the
difference
out
the
difference
in
outcome
between
patients
who
are
managed
within
the
stroke
beds
and
with
and
outside
the
stroke
beds.
It's
certainly
something
we're
really
conscious
of,
which
is
why
we're
really
keen
to
co-locate
those
what
we
call
stroke,
outliers
into
a
single,
essentially
additional
stroke
ward,
so
that
we
can
designate
them
almost
as
stroke
beds.
M
But
we
know
from
the
snap
data
set
the
reason
why
one
of
the
snap
standards
is
the
time
spent
in
us
in
a
dedicated
stroke.
Bed
is
because
we
know
that
patients
who
don't
spend
all
their
time
in
a
dedicated
stroke
bed
don't
necessarily
do
as
well
in
terms
of
their
outcomes.
So
we
are
absolutely
committed
to
to
trying
to
improve
on
that
snap
standard.
L
Just
with
regards
harrogate
patients
as
well,
we
we
only
look
after
them
for
the
first
72
hours
of
their
care.
We
don't
look
after
them
throughout
the
whole
journey.
They're
discharged
once
seen
once
being
fit
for
discharge
from
the
hyper-acute
stroke
phase
of
their
care.
So
that's
why
it'll
be
difficult
to
extrapolate
their
outcomes
because
their
actual
outcomes
are
taken
over
by
harrowing.
G
Thank
you
because
the
second
part
linked
to
that
was
thinking
about
the
the
next
stage
of
outcomes
in
terms
of
communications
with
other
directorates
for
discharge
planning
and
how
much
that
impacts
on
on
people's
stay
and
discharge.
So,
for
example,
links
with
housing
links
with
adult
social
care
for
care
packages
just
wondered
if
we
have
any
data
on
on
whether
or
not
that
creates
further
delays
for
patients.
L
M
M
We
effectively
identify
any
patient
that
is
now
deemed
as
no
reason
to
reside
within
the
acute
bed
base
with
a
view
to
trying
to
expedite
whatever
the
block
is
to
them
being
discharged,
whether
that
be
a
social
issue,
or
you
know
trying
to
find
the
appropriate
home
care
home
for
them.
And
that
is
very
much
a
collaborative
approach
with
leeds
community
health
and
with
our
social
care
partners.
Because
we're
absolutely
we
absolutely
recognize
that
we
have
to
be
as
supportive
as
we
can
of
them.
M
G
Thank
you
just
just
a
couple
of
points.
It's
it's
great
to
see
and
hear
about
how
the
tiaa
service
kind
of
organically
develops,
and
I
think
leading
on
from
that
on
the
preventative
side,
it
would
be
really
good
to
see
some
kind
of
community
health
cafes
and
looking
at
kind
of
the
fast
and
tracking
people's.
You
know:
blood
pressures,
cholesterol,
things
like
that
in
out
in
the
community
in
groups
where
people
are
already
meeting
and
if
I
may
just
a
small
bit
of
feedback
on
the
youtube
video
that
welcomes
the
unit.
G
L
Sadly,
I
agree,
but
I
think
once
we
have
some
patients
in
and
have
experienced
this,
we
can
revisit
that
video
and
make
it
much
more
interactive,
we're
not
interactive
but
more
on
what
it's
like
to
go
there,
so
that
we
can
sort
of
show
people
what
it's
what
it's
like
when
they're
before
they
arrive
yeah,
I
would
agree
we
can
that's,
certainly
something
I
would
agree.
We
should
do.
Thank
you.
R
An
additional
6
000
patients
who've
been
anticoagulated
during
the
period
of
covert
a
number
of
patients
who
were
requiring
house
visits
who
were
on
warfarin,
were
suitably
identified
and
then
transferred
over
to
a
newer
anticoagulant.
That
doesn't
require
a
significant
monitoring
and
we
will
continue
to
push
forward
on
that
journey
that
we've
built
up
over
the
last
three
to
four
years.
R
F
Yeah,
just
just
a
few
points
and
interesting
listening,
you
get
more
points
that
you
want
to
raise
as
you
go
around
and
some
of
the
good
ones
you
really
had
have
been
taken
already,
but
I'm
really
interested
on
the
discharge
packages,
because
delays
in
discharge
are
a
huge
issue
across
all
sectors
of
the
health
service
and
when
you
are
discharged.
One
question
is:
how
closely
are
the
gps,
the
social
prescribers
and
the
voluntary
third
sector
involved?
F
When
people
do
discharge,
and
do
you
think
that
pathway
is
actually
delivered
in
a
smooth
and
even-handed
way?
That's
not
the
right
word,
but
you
know
what
I'm
saying
the
other
one
is.
You
mentioned
diagnostic
centers
and
diagnostics.
Obviously
the
government
have
announced
goodness
knows
how
many
diagnostic
centers
to
be
opened.
Do
you
know
how
many
we're
getting
in
leads
and
where
they
will
be
and
have
you
any
idea
how
that
will
actually
aid
prevention
in
leeds
and
at
four
point
three
you've
got
from
bec
to
me.
L
I'll
take
the
thrombectomy
section.
Is
that
all
right,
so
thrombectomy
is
fast
approaching
the
best
treatment
we
can
offer
for
someone
who's
having
a
stroke
only
if
there
is
a
clot
identifiable
on
ct
and
on
ct
angiogram,
and
we
are
a
regional
center.
We
offer
the
times
of
operation
on
monday
to
friday,
nine
to
five.
Well,
nine
till
four.
L
At
the
moment,
we
are
at
seeking
with
our
partners
around
the
region
to
increase
that
there's
a
national
shortage
on
people
who
can
actually
perform
this
procedure,
and
we
have
the
nursing
infrastructure
in
place.
We
have
other
pathways
in
place.
The
issues
is
around
about
medical
staff
who
can
perform
this
procedure,
so
there
is
a
demand
and
there
is
work
looking
at
the
moment,
there's
something
called
the
integrated
delivery
network,
which
every
area
has
a
delivery
network
and
we're
looking
at.
L
We
have
looked
at
where
we
would
be
best
to
increase
our
first
points,
so
our
first
point
of
inquiry
should
be
weekend
cover,
so
we're
looking
at
how
we
can
provide
that
with
the
limited
resources
we
currently
have
to
offer
this
into
a
much
more
wider
time
frame
than
we
currently
have,
eventually,
our
obviously
to
be
a
24
7
service.
This
is
a
slow
progress,
so
there
is
some
disadvantage
for
thrombic
to
me
at
the
moment,
and
we
are
working
with
our
partners
in
the
wider
network
to
increase
that.
M
I
can
expand
a
little
bit
on
that.
Alice
is
absolutely
right,
so
thrombectomy
was
recognised
by
nice
about
four
years
ago
and
it
became
a
commissioning
standard
about
three
or
four
about
three
years
ago
with
a
view
to
delivering
a
24
7
service
in
each
of
the
neuroscience
centers
over
a
period
of
five
years,
and
those
plans
have
obviously
been
somewhat
derailed
by
the
pandemic.
M
M
So
the
royal
college
of
radiologists
is
going
through
a
process
of
trying
to
develop
some
credentialing
in
order
to
have
non-radiologists
be
able
to
do
some
of
those
procedures
and
also
expand
the
numbers
of
those
doctors
who
can
do
it.
So
we
are
somewhat
limited
in
terms
of
our
ability
to
deliver
that.
M
F
I
find
that
really
interesting,
because
you're
talking
about
limited
resources
now
take
it.
You
mean
staffing
as
opposed
to
equipment
and
really
interested
that
you,
you,
you
there's
a
plan
or
a
suggestion
that
perhaps
non-radiologists
might
be
trained
to
do
this,
which
I'm
not
against.
Don't
get
me
wrong.
I
think
that
any
kind
of
form
of
specialism
is
is
really
good
to
get
those
people
in
place
and
it's
it's
a
national
shortage.
I
take
it
of
people
that
can
do
this.
M
F
M
Yeah
no,
there
was
there
was
a
shortage
before
brexit
this.
This
is
not
brexit
related.
This
is
if
I
was
to
be
perfectly
blunt.
I
think
this
is
because
the
advances
in
mechanical
thrombectomy
and
the
people
who
can
deliver
it
have
outstripped
the
ability
of
workforce
modelling
to
be
able
to
keep
up
thrombectomy.
J
Sorry,
thank
you.
I
was
just
going
to
point
out
a
couple
of
points
in
relation
to
diagnostics
within
the
city
and
and
work
around
the
development
of
hubs.
There
has
been
a
lot
of
national
guidance
released
in
the
last
couple
of
months
in
relation
to
diagnostic
hubs
and
the
ccg
as
we're
currently
working
with
lee's
teaching
hospitals
and
these
community
healthcare
to
map
fully
our
our
current
provision
and
understandfully
the
the
financial
monies
that
may
be
available
from
nhs
england
to
support
that
development
of
diagnostic
hubs
covering
x-ray
ultrasound,
endoscopy
spirometry.
J
R
So,
just
to
pick
up
the
point
on
primary
care
and
integrated
working
when
patients
are
discharged
following
stroke,
there's,
obviously
a
discharge
summary
and
identified
actions,
including
medication
changes
or
additional
support.
That's
required
are
picked
up
there,
but
I
think
more
importantly,
we
now
have
one
leads
care
record
across
the
city
that
enables
all
healthcare
professionals
to
be
able
to
access,
understand
and
input
into
the
ongoing
care
of
patients
and
leads
community
healthcare.
There's
communities,
the
community
stroke
team,
actually
inputs
directly
into
system,
one
which
is
a
primary
care
based
system.
R
But
we
would
want
to
ensure
that
we
continue
to
to
build
on
that,
but
that's
been
one
of
the
most
significant
changes
in
all
aspects
of
care,
including
stroke,
and
I
think
we'd
also
want
to
ensure
that
we
build
on
the
work
through
the
six-month
stroke
review,
because
it's
not
just
about
an
absence
of
disease.
It's
about
returning
people
as
closely
as
possible
to
their
previous
level
of
functioning.
What
matters
to
them
is
really
important,
and
we
would
include
that
in
the
strategy
as
being
a
core
principle.
N
Sorry
and
just
going
on
to
the
the
other
part
of
the
community
question
that
came
out
of
there,
so
the
stroke
association
are
actually
embedded
into
the
community
team.
So
all
patients
have
access
to
the
stroke
association
and
we're
actually
offer
that
along
the
pathway,
because
some
people
aren't
ready
for
that
at
the
beginning
of
their
pathways.
They
come
to
us,
but
so
it's
offered
at
several
opportunities
and
from
support
from
the
stroke
association.
N
So
we
work
very
much
alongside
them.
They
can
link
back
into
the
community
team.
Refer
people
back
or
raise
issues
with
the
community
team
are
also
able
to
support
people
and
that
enables
them
enables
them
to
support
both
the
patients
and
their
families
longer
longer
term,
as
well,
so
yeah
working
very
very
closely
with
the
stroke
association
and
which
really
helps
with
us.
Particularly
during
this
time.
N
It's
been
extremely
helpful
to
ensure
that
when
people
perhaps
weren't
able
to
get
things
quite
as
timely
as
we'd
hoped
from
the
community
healthcare
team,
the
stroke
association
has
always
been
there
as
a
source
of
support
and
has
been
able
to
be
timely,
enabled
to
flag
up
any
risks.
Any
concerns
to
the
team
and
to
support
prioritization
of
patients.
F
No,
I
think
this
there's,
I
think,
you've
probably
answered
it,
but
I'm
always
concerned
that
social
prescribers
from
doctor
surgeries
really
need
to
be
informed
of
what
is
on
offer.
I'm
not
100
convinced
that
social
prescribers
actually
do
do
that
at
the
moment.
But
I'd
need
to
do
some
investigation
in
that
and
just
to
plea
to
you
chair
through
obviously
council
marshall
katong,
to
bring
back
a
report
following
the
april
so
that
we
can
see
what
you've
actually
proposing.
B
S
Thank
you
chair.
Can
I
just
reiterate
my
apologies
for
lateness.
I
had
notified
that
at
healthwatch
we
had
the
lord
mayor
coming,
so
I
needed
to
be
there
to
to
welcome
him
earlier
today.
I
su
two
things
and
I
suppose
for
someone
with
a
public
health
background.
I
was
particularly
interested.
I
know
the
the
topic
is
really
about
stroke
rehabilitation,
but
it
does
talk
in
page
35,
36
and
elsewhere
about
stroke
prevention.
S
S
Maybe
you
think
that
we
could
do
better
in
leeds
and
produce
our
own
material.
That's
fine,
but
at
least
getting
over
the
messages
in
what
would
be
secondary
prevention.
I
guess
so
that
people
who
suffer
from
a
stroke
are
picked
up
quickly
and
then
go
to
the
best
place
for
making
sure
that
the
the
after
effects
are
are
as
as
less
severe
than
than
they
might
otherwise
be.
S
So
that's
that's
one
thing
about
secondary
prevention
and
then
I
do
notice
that
we
have
the
director
of
public
health
here
and
victoria
apologies
to
victoria,
who
probably
thought
on
this
item
on
the
agenda.
At
least
I
can
relax
because
no
one's
going
to
ask
me
a
question,
but
four
of
the
most
important
properties
which
may
cause
strokes
to
occur.
S
J
So,
just
in
relation
to
the
points
with
regards
to,
I
guess,
communications
regarding
fast
and
awareness
of
stroke
and
the
signs
and
symptoms,
and
we
as
part
of
the
strategy,
work
visions
piece.
We
are
engaging
with
our
comms
and
engagement
team
and
our
lead
here
is
here
today
around
that
work
and
you're.
Quite
right,
we
need
to
do
more
of
those
activities
around
awareness
promotion.
J
You
know
utilizing
all
avenues
through
gp
surgeries
through
local
groups
that
meet.
I
think
that
came
across
strongly
within
the
leeds
voices
work
within
the
appendix
from
individuals
around
how
we
do
engage
going
forward.
So
we've
got
lots
of
learnings
there
to
take
forward,
and
our
comms
and
engagement
team
are
committed
to
working
with
us
around
how
we
do
that
collectively,
as
well
with
our
our
providers
in
leeds.
R
Brian
paris,
so
if
I
can
just
build
slightly
on
that
point
as
well,
we
do
work
closely
with
what's
on
the
national
agenda.
So
there
are
a
number
of
different
national
days
and
trying
to
ensure
that
we
build
on
the
good
work
from
there
and
we've
done
that
with
diabetes
as
well,
and
have
some
local
programs
in
terms
of
support
to
make
sure
that
we
maximize
the
opportunities
that
we've
got
on
work
together.
R
Otherwise,
people
can
get
quite
confused
if
it
comes
three
or
four
times
at
different
times
of
the
year
in
terms
of
the
secondary
prevention,
and
I
would
suggest
that
this
is
the
piece
that
comes
after
people
have
had
an
event,
and
what
we
would
want
to
do
is
ensure
that
those
patients,
who've
had
a
stroke
are
both
identified
and
supported
to
ensure
we
control
their
blood
pressure,
control,
their
cholesterol
and
control
and
identify
and
control
any
other
risk.
Factors
such
as
smoking
that
you've
identified
as
well.
R
But
additionally,
that
issue
around
the
pre-hospital
care
is
in
trying
to
ensure
that
that
pathway
for
patients
who
present
with
symptoms
of
stroke
are
identified
as
quickly
as
possible
and
signposted
to
the
most
appropriate
place
in
terms
of
care
and
certainly
working
with
the
ambulance,
service
and
training
staff
within
primary
care.
And
so
the
patient
contacts
with
symptoms
suggested
with
a
stroke
that
we
contact
999
and
support
the
patient
until
that's
actually
until
the
ambulance
has
arrived.
But
we
would
also
continue
for
people
who
are.
R
R
And
I
think
the
really
big
driver,
as
I
say,
will
be
on
hypertension
going
forward.
In
fact
here
in
leeds.
Over
this
last
two
years,
we
actually
worked
with
leed
city
council
on
a
program
called
bpys,
where
council
staff
had
the
opportunity
to
have
their
blood
pressure
checked
and
then
to
go
on
to
home
blood
pressure
monitoring
if
they
were
at
risk,
and
we
identified
a
significant
number
of
patients
with
hypertension,
approximately
80
out
of
the
1600
people
who
took
part
and
were
wanting
to
build
on
that
program.
O
May
I
also
come
in
on
the
on
the
fast
point
that
you
that
you
made
as
well
so
hi,
I'm
claire
from
leaves
these
voices,
so
we
conducted
a
number
of
focus
groups
always
with
a
view
to
getting
the
voice
of
people
that
do
suffer
more
greatly
from
health
inequalities
and
it
was
within
those
groups.
I
think
that
the
theme
came
through
especially
people
with
english,
as
a
second
language
had
not
seen
and
did
not
recognize
the
fast
campaign.
O
I
I
I
guess
there's
probably
three
things
and
all
of
the
work
that
brian's
really
helpfully
described
around
the
very
systematic
prevention
work.
That's
going
on
in
primary
care
is
is,
is
incredibly
important
and
we
work
our
public
health
team
in
the
council
work
really
closely
with
with
brain
and
colleagues
and
to
support
that
as
much
as
we
can
to
take
a
public
health
approach,
but
also,
I
think,
what's
really
important
is
as
well
as
working
with
people
who
already
have
those
six
high
risk
conditions
that
are
summarized
in
the
paper.
I
We
we
also
provide
public
health
services
to
support
people
to
stay
healthy,
so
they
don't
prevent
they
don't
develop
those
conditions
in
the
first
place.
So
I
think
that
you
know,
as
well
as
what
we
might
call
secondary
prevention
here,
of
where
people
are
already
at
risk,
and
we
want
to
as
much
as
possible
link
that
with
primary
prevention.
I
So
we
can
stop
this
further
upstream,
so
we,
you
know,
we
we've
we've
worked
with
brian
for
many
years
now,
so
you
know
just
to
just
to
share
with
the
board
that
that's
something
that
we
we're
really
keen
to
emphasize
that
this
is.
This
is
also
connecting
with
our
healthy
living
services,
our
community
public
health
services
as
much
as
possible,
so
it
so
it
is
further
upstream.
I
S
P
Hello,
thank
you.
Thank
you
sure.
I'd
just
like
to
make
two
brief
points
and
follow
up
with
two
questions.
If
that's
okay,
firstly,
I
actually
have
direct
family
experience
of
the
services
you
guys
offer,
because
you
saved
the
lives
of
one
of
my
family
members
in
2019,
which
means
that
I
can
vouch
for
the
quality
of
service
that
you
provide.
So
thank
you
very
much
for
that.
I
can
also
vouch
for
the
fact
that
transferring
some
services,
chapel
allerton,
gives
a
really
nice
venue
and
also
a
much
better
parking
of
opportunities.
P
So
thanks
so
far,
so
first
yeah
just
a
personal.
Thank
you
thanks
for
that,
the
services
you,
your
team's,
offer
two
questions.
One
is
more
of
a
general
one
of
how
do
you
use
as
a
service?
Now
I
realize
it's
a
fast
evolving,
both
discipline
and
you
know
ability
provision
and
treatment
options.
But
how
do
you
see
if
you
were
to
broad
brush
you
the
services
that
were
offered
in
leeds
rank
nationally
compared
with
you
know,
for
example,
you
know
birmingham
or
the
best
hospitals
in
london
or
other
big
cities.
P
Just
to
you
know,
middle
ranking
talking
at
the
top
second
question,
and
we
sort
of
skirt
on
that
and
there's
a
topic
that
this
group
comes
onto
later.
Obviously,
everything
that's
happening
at
the
moment
has
a
kerbin
overlay
to
it
and
again,
I
know
from
my
own
kind
of
experience
and
obviously
the
way
stroke
presents
itself
often
has
a
long
as
a
long-term
impact,
as
has
some
covered
impacts
on
it.
P
I'd
just
like
to
know
more
from
a
clinical
perspective,
rather
than
what
provision
might
be
needed
for
and
from
who
that
provision
might
be
needed
from.
What's
the
current
best
estimate
as
to
what
impact
what
you
know,
if
you
were
to
overlay
the
complexes
that
kerwig
brings
onto
the
services
that
might
be
needed
as
a
society?
P
M
L
And
from
a
national
picture,
I
think
snap
does
tell
you
where
you
sit,
I
think
with
the
right,
and
I
think
we
certainly
have
it
around
the
table.
Now
the
the
right
drive
and
the
right
leadership
and
to
push
this
to
leads
forward
much
further
forward
than
it
has
been
previously
with
thrombectomy
is
the
game
changer
here,
and
that
also
brings
a
lot
of
funding
as
well.
L
N
But
that's
where
we're
doing
the
service
redesign
there,
because
the
patients
who
reach
the
end
of
their
stroke
pathway
in
terms
of
community
health
care
they
there
is
the
opportunity
for
them
to
access
the
community,
neurological
team
for
extra
support,
and
that's
why
we're
looking
in
that
area
for
sort
of
that
that
long
term
support
need.
Of
course,
there
is
still
stroke
association
throughout
this
and
and
the
sector
and
other
support
and
primary
care
as
well,
but
it's
that
extended
not
it's
like
when
people
leave
hospital
that
isn't
the
end
of
their
journey.
N
When
people
leave
the
community
stroke
team,
that's
that
12-week
intensive
pathway
that
isn't
their
journey.
You
know,
as
we
talked
about
before,
that,
six-week,
that
six-month
review
of
of
where
are
people
in
their
lives
compared
to
where
they
were
before,
where
they
want
to
be
and
having
that
longer-term
aspiration.
So
it's
not
so
people
don't
feel
like
they're
sort
of
falling
off
the
edge
of
that
cliff,
so
it
so
it's
that
kind
of
integration
and
between
the
community,
but
also
that
longer
term.
Look
that
we're
we're
trying
to
consider.
K
K
What
are
those
challenges,
because
you
would
say
that,
wouldn't
you
really
on
that
and
people
can
it
can
go
up
as
well
as
down
can't
it,
because
the
technical
challenges
could
skew
the
scores
up
the
way
or
down
the
way.
So
what
and
what's
important
is
the
standard
of
care
that
people
are
getting
and
if
that
can
be
reflected
in
some
other
way,
rather
than
just
a
figure
from
a
technical
database?
K
K
L
K
L
Yeah,
something
essentially
yeah,
it's
a
it's
a
potential
that
the
patient
who's
suffers
a
ti
by
the
very
very
nature
of.
If
you
describe
a
transient,
ischemic
attack
symptoms
lasting
less
than
24
hours.
Anything
longer
than
24
hours
is
considered
as
a
stroke,
but
usually
tis,
last
minutes
and
seconds.
So
anyone
with
those
unusual
neurological
events
if
they
go
and
see
the
gp
or
they
present
to
accidents
an
emergency,
then
they
get
to
come
to
our
clinic,
presumably.
L
L
L
It
doesn't
flag
to
you
that
that
is
a
mistake,
because
it
would
be
a
mistake
and
I'd
identified.
12
patients
in
the
last
month,
who'd
been
put
down
as
wake
up
stroke,
but
with
a
time
of
onset
at
nine
o'clock
who
had
arrived
within
what
we
would
consider
as
thomas's
time,
which
actually
makes
us
a
downgraded
service.
L
So
it's
understanding
that
and
also
then
feeding
back
to
those
that
group
of
people
who've
entered
that
data
incorrectly
and
how
best
to
answer
it.
We
are
looking
at
a
other
option
at
data
collection,
which
is
a
third
party,
not
an
internal
version
which
actually
allows
you
to
input
the
data
and
have
an
immediate
understanding
of
where
you're
sitting
within
the
snap
data
set.
L
So
we
are
looking
at
that
because
our
solution
has
problems
with
data
extraction
and
obviously
data
input.
Whereas
an
intelligent
system
would
see
me
spending
less
time
and
a
lot
less
of
my
time,
looking
at
the
data
and
finding
out
where
we've
gone
wrong
and
how
we
can
fix
it,
because
as
soon
as
I
fixed
that
there's
another
one
waiting
for
me,
this.
L
I
would
agree
it
is
a
little
bit
worrying
it.
It
does
feel
whenever
you
have
these
sets
of
data,
you
can
always
pull
them
to
pieces
and
but
if
everyone's
having
to
do
the
same
thing,
you're
going
to
get
people
who
are
able
to
answer
the
questions
better
and
we've
always
been
quite
proud
that
we
we're
not
manipulating
this
here.
All
we're
doing
is
making
sure
that
we
answer
the
best
question
that
we
can
and
not
disadvantaging
it
ourselves.
L
I
know
that
you
can't
be
a
narrated
service
if
you
have
to
move
one
patient
to
another
area,
because
how
do
you
get
that
figure
right?
So
there's
some
people
who
understand
how
best
to
play
this
game
and
how
to
get
it
right,
but
it
doesn't.
Do
you
any
good
in
the
long
term
when
you
actually
want
to
improve
services?
L
So
I'm
just
honest
and
saying
that,
yes,
we
could
answer
our
questions
better.
Yes,
we
could
pull
out
the
data
and
not
make
these
mistakes
that
pull
us
down.
I
think
at
the
moment
I
would
say
that
we're
a
high
b,
but
I
need
to
prove
that
and
every
time
I
say
I
find
a
way
of
fixing
the
plug
in
the
hole
of
making
the
question
much
easier
to
answer
all
someone
answering
it
in
the
wrong
way.
There's
another
one!
Just
around
the
corner,
that's
gone
down,
so
it's!
L
M
Thanks
so
just
just
to
just
to
clarify,
absolutely
agree
with
aleister:
it's
really
not
a
useful
use
of
his
time,
so
the
trust
has
invested
in
a
data
entry
clerk
as
well
to
try
and
support
that.
But
it's
been
very
clear
that
and
I
think
what
what
I
need
to
point
out
is
that
the
snap
data
set
is
probably
one
of
the
most
comprehensive
national
audit
data
sets
that
you
will
find,
maybe
with
the
exception
of
one
of
those
one
or
two
of
the
cancer
audits.
M
M
Not
then,
if,
if
they're
graded
in
a
they
are
an
a-
and
I
think
we
have
to
take
that
at
face
value,
because
it
is
a
very
comprehensive
data
set
it's
over
400
pieces
of
information
that
they
collect,
and
most
of
it
is,
as
I
say,
objective
it's.
How
long
did
it
take
you
to
do
this?
How
many
times
did
your
patients
see
this
therapist?
How
many
times
did
they
see
see
the
doctor?
So
I
think
it's
a
you
know.
M
F
Just
just
just
quickly
because
the
suggestion
there
was
that
it
you're,
obviously
a
highly
skilled
person
that
doing
this
kind
of
data
analysis
probably
would
be
better
done
by
somebody
else.
Was
there
a
suggestion
in
there
that
you're
thinking
of
outsourcing
this
or
not,
surely,
better
training
would
be
a
way
to
do
that
on
how.
F
And
I
know
it's
400
points,
but
I
am
a
bit
of
a
data
geek.
It
would
be
really
nice
to
to
sort
of
just
have
a
snapshot
of
those
400.
only
if
you've
got
them.
I
don't
want
to
put
you
through
a
lot
of
extra
work,
writing
them
out,
but
if
you've
got
those
400,
it
would
be
really
nice
to
read
what
you're
expected
to
sort
of
answer.
L
L
L
M
It's
not
resourcing
it's
it's
not
strictly
outsourcing,
so
not
to
put
not
to
get
into
too
much
detail,
but
this
is
a
national
data
set.
A
national
audit
data
set
and
the
goal
of
our
trust
was
to
limit
the
number
of
third-party
software
programs
that
we
were
using,
because
integrating
them
into
our
electronic
patient
record
was
proven
to
be
very
difficult.
M
The
trust
uses
a
system
called
ppm
plus
and
whilst
it's
an
incredibly
useful
and
robust
tool
for
looking
at
patient
records,
what
we've
discovered
over
the
last
few
months
is
that
it's
not
particularly
good
at
talking
to
the
snap
portal
that
requires
the
upload
of
information.
So,
historically,
the
stroke
team
would
enter
all
of
their
information
into
ppm
for
the
stroke
patient.
They
would
then
go
into
the
snap
portal
and
have
to
reproduce
that
same
data
set
in
the
snap
portal.
M
So
there
was
a
massive
amount
of
duplicated
work
for
all
of
the
doctors
and
nurses
and
therapists.
The
goal
of
trying
to
create
a
form
within
our
ppm
system
was
that
it
would
both
act
as
the
data
entry
for
the
electronic
patient
record
and
then
automatically
upload.
All
of
that
into
the
portal,
and
what
we've
discovered
is
that
it's
such
a
complex
system
that
it's
very
difficult
for
the
ppm
system
to
keep
up
with
it.
F
So
obviously,
we've
got
nhs
digital,
which
I
was
under.
The
impression
was
supposed
to
make
sure
everything
did
link
together.
Are
they
aware
of
this
and
if
they
are
and
don't
answer
today,
because
it's
probably
it's
not
what
we're
talking
about,
but
I'm
I'm
quite
surprised
that
you're
having
these
problems
when.
B
B
M
B
J
B
B
B
B
Okay,
I'm
going
to
bring
in
sorry
counselor
winner.
No,
don't
don't
apologize.
It's
I
do
understand
it's
a
problem.
I
think
it's
we're
talking
about
it
before
the
meeting
around
the
issues
of
as
the
the
winter
draws
closer.
I
think
it
could
get
worse.
So
we
need
to
have
some
clear
guidance.
I
think,
on
how
how
well
ventilated
the
room
is
perhaps
some
of
the
technology
we
used
for
full
council
in
terms
of
monitoring
how
well
the
room's
ventilated
might
be
appropriate.
B
Thank
you.
Okay,
moving
moving
on
I'm
afraid,
cancer,
venom,
we're
gonna,
provide
some
blankets
and
somewhere
yeah,
maybe
I'll
I'll
pass
all
those
notes
on
to
her
councillor
marshall
katang
from
her
next
meeting.
I
think
I
think
she
might
be
watching
live
so
hopefully
she'll
be
aware.
Can
I
bring
in
councillor
stevenson
next,
please.
Q
Q
So
are
they
proportionate
to
the
sort
of
per
capita
to
the
people
served
in
each
of
those
areas
and
what's
the
sort
of
free
but
freedom
of
movement
within
those,
the
nhs
organizations
and
and
how
quickly
can
those
people
then
get
to
where,
where
they're
needed,
I
think
you've
got
to
act
in
it's
like
six
or
12
hours.
I
think
having
you
to
do
the
procedure.
So
how
soon
can
you
move
people
around.
L
L
Q
Thought
you
said
86
originally
today,
six
in
the
country
and
then
he
said
86
he
clarified
in
the
uk.
So
my
question
was,
for
example,
so
yorkshire's
got
the
population
size
of
scotland,
so
you
would
imagine,
there's
a
similar
number
in
nhs.
Scotland,
as
there
are
in
an
nhs
league.
Does
it
work
like
that
or
is
it
heavy
in
england,
not
enough
in
wales
and
that
cuts
so.
M
B
Q
L
M
They
don't
have
a
service,
but
they
may
have
interventional
neuroradiologists
who
theoretically
could
deliver
the
service,
but
if
they're
single-handed
then
they'll
struggle.
So
I
think
it's
probably
from
my
perspective.
It's
perhaps
slightly
outside
the
remit
of
this
particular
conversation
around
the
stroke
rehabilitation,
but
it's
absolutely
something
that
we
need
to
talk
about
as
part
of
our
global
stroke
delivery
strategy.
So
we
will
look
at
that
piece
of
information
and
we'll
try
and
find
out.
M
L
B
L
Sorry
so
that
was
initially
when
we
had
tia
service
reconfiguration,
we
had
a
consultant
at
home
available
via
video
conferencing.
If
we
needed
them.
However,
the
nursing
workforce,
it
was
very
clear
that
had
already
had
the
right
skills
and
abilities
to
perform
all
the
examinations
and
tests
required
and
that
only
support
from
a
medic
via
telephone
would
be
required.
So
we
don't
have
a
video
conferencing
need
for
tia
services
anymore.
The
only
video
conferencing
that
we
require
is
thrombolysis
and
thrombectomy
out
of
ours.
B
Great
thank
you
for
that
clarification.
Okay.
I
can't
see
anyone
else
indicating
thanks
everyone
for
your
comments
and
your
your
input.
I
think
we've
got
a
couple
of
things
to
follow
up
on
in
the
future,
including
the
confirmation
when
the
ward
will
open
and
also
looking
at
the
the
draft
strategy
before
it's
finalized.
B
B
J
N
N
The
patient
experience
within
the
service
was
variable
in
terms
of
their
pathways
through
the
service,
as
they
were
quite
complicated
pathways
through
the
service,
the
waiting
times
were
leading
to
ineffective
use
of
resources,
because
people
were
having
blocks
of
intervention,
and
then
the
gap
was
so
long
between.
They
were
almost
needing
to
start
again
or
certainly
deterioration.
N
There's
been
a
potentially
lack
of
clarity
around
what
the
service
offered,
as
I
talked
about
disrupted
patient
journeys.
So
there
were
sort
of
impatient
community
elements
and
again
gaps
between
these
elements
and
anecdotally
stake
told
us
where
the
stakeholders
were
telling
us
that
actually
they
were
not
referring
into
the
service
at
all
times,
due
to
the
long
waiting
times
and
we're
trying
to
find
ways
around
it.
So
patients
were
actually
maybe
not
being
referred
or
being
referred
to
other
services
that
perhaps
were
less
able
to
meet
the
needs.
N
Patients
were
basically
not
being
able
to
access
the
right
service
in
the
right
place
at
the
right
time.
The
impact
of
covid,
actually
this
so
there
was.
This
was
a
piece
of
work
that
we
really
wanted
to
move
on,
move
forward
with
regardless
of
covid,
but
covered
actually
gave
us
an
opportunity
to
to
really
the
timing
facilitated
the
timing
of
looking
at
this
and
so
we've,
so
that
was
sort
of
a
little
bit
of
background
of
why
we're
doing
the
redesign.
N
So
we
have
done
significant
engagement
around
this
and
the
three
areas
that
we
have
done.
Engagement
we've
done,
staff
engagement,
so
all
48
of
our
staff
were
given
opportunity
to
attend
a
range
of
staff
engagement
sessions,
a
really
high
uptake,
really
good
involvement
from
the
staff,
and
that
engagement
we
carried
out
stakeholder
engagement.
We
had
45
attendees
at
focus
groups
and
117
completed
questionnaires,
and
that
was
for
a
range
of
health,
social
care,
primary
care
and
third
sector
organizations,
and
we
carried
out
well,
we
very
supportive
valkyrie,
the
patient
engagement
work.
N
However,
saying
that
we
are
confident
that
the
people
that
we
did
engage.
We
were
a
good
representative
of
the
leads
population
and
the
feedback
that
we
received
through
this
engagement
has
been
really
informative
and
jillian's
going
to
go
on
to
share
some
of
the
feedback.
Some
of
the
key
areas
of
feedback.
K
K
That
was
a
key
element
that
needs
to
be
embedded,
which
previously
was
but
was
a
key
theme
that
came
out
across
staff
stakeholders
and
patient
carers.
Feedback
the
length
of
the
inpatient
rehabilitation
needs
to
be
more
tailored
towards
individual
needs,
and
but
it's
important
that
we
know
that,
because
of
a
more
home
first
approach
and
a
more
responsive
community
offer
that
we're
hoping
to
to
put
in
place.
There
is
likely
to
be
a
reduction
in
demand
for
that
inpatient,
rehabilitation,
that's
community!
It's
not
impatient
as
in
a
hospital
bed.
K
Self-Referral
is
a
key
element
of
what
a
service
should
offer
so
that
ability
for
patients
to
come
back
in
if
they
need
it.
Like
we've,
talked
about
being
more
responsive
to
provide
the
rehab
in
the
right
place
at
the
right
time
and
to
be
able
to
deliver
the
intensity
of
rehab
at
the
right
time.
So
the
patients
can
meet
their
goals.
K
It's
really
important
that
we
have
a
really
clear
outline
and
criteria
of
what
service
offers
that
came
through
loud
and
clear
that
people
weren't
clear
what
it
did
offer
and
it
needs
to
be
easily
accessible
and
available
to
everybody
so
speech
and
language
therapy
embedded
within
the
service.
Currently
there
is
community
speech
and
language
therapy,
but
it's
a
separate
service
to
have
that
more
embedded
within
it
and
actually
want
to
a
change
where
the
service
is
able
to
accept
referrals
for
patients
that
only
require
one
discipline
of
input.
K
Previously
they
needed
to
require
more
than
one
discipline,
so
they're
all
outlined
in
the
paper.
But
in
addition
to
that,
there
were
some
key
themes
that
came
out
specifically
through
the
patient
and
carer
engagement
that
we
want
to
consider
in
a
development
of
the
options,
and
one
of
these
was
location
of
inpatient
rehabilitation
and
patients
felt
that
a
smaller
community
hospital
was
much
more
welcoming
than
a
larger
hospital
like
lgi
or
saint
james's
patients
that
were
coming
into
a
clinic
or
an
outpatient,
setting
fed
back.
That's
really
important
to
them.
K
K
Something
that
came
out
was
the
value
of
peer
groups,
but
actually
patients
and
carers
saying
they
want
the
service
to
provide
more
information
about
those.
A
lot
of
patients
felt
that
they
had
to
seek
those
out
rather
than
being
shared
with
them,
and
also
having
an
advice
line
to
support
that
self-management
and
to
gain
professional
support
when
when
they
do
need
it
to
help
manage
their
condition.
K
So
the
next
steps
for
engagement
is
there
will
be
a
plan
to
feed
back
what
we've
heard
from
the
engagement
initially
to
those
people
that
have
engaged
with
and
provided
their
details
as
part
of
that,
and
that
feedback
will
be
ongoing
as
we
move
through
to
the
implementation
phase.
So
initially
it
might
be.
We
heard
we
heard
you.
This
is
what
we
did
tomorrow.
You
said
we
did
approach
from
a
perspective
of
the
model
and
the
governance
throughout
october.
K
B
Thank
you
very
much
just
to
remind
board
members.
Our
role
here
is
to
feed
into
the
design
of
this.
So
I
think,
there's
probably
opportunity
to
give
comments
as
much
as
questions
on
this
item
and
angela
will
prepare
a
note
which
she'll
share
with
the
board
before
she
passes
it
on.
So,
if
there's
comments
that
you
want
to
feed
into
the
the
strategy,
please
indicate
now
and
I'll
bring
you
in.
E
E
Yet
that
doesn't
say
that,
but
I
noticed
that
with
any
service,
but
I
noticed
that
it's
it's
not
on
your
point
for
incorporation
of
the
themes
from
three
areas
of
engagement
into
developing
a
model.
It
isn't
mentioned
on
that.
So
I'm
presuming
they're
talking
about.
I
don't
know
system
linking
up
with
the
mental
health
community,
mental
health
system,
etc.
You
know
asc
as
well.
I
have
outcome:
it's
not
there.
N
I
think
we
are
actually
able
to
see
more
in
community
of
what
happens
in
acute
services.
There's
a
real
challenge
for
acute
services
to
see
what's
happening
in
community
in
terms
of
the
systems
and
process
we
feed
into.
So
there
is
a
bigger
piece
of
work.
So
I'm
not
saying
it's
not
extremely
important,
and
this
is
what
we're
feeding
into.
But
it's
a
it's
a
a
bigger
piece
of
work.
That's
happening
city
wide
across
leeds
about
looking
at
that
digital,
I
don't
know
lindsey.
If
there's
anything
else,.
E
K
I
think
I
think
there
are
things
that
we
can
do
internally
within
these
community
health
care.
That's
that
will
support
the
redesign
and
how
we
structure
our
systems
internally,
but
yeah
externally.
It's
it's
part
of
that
wider
digital
strategy.
So
we
will
look
at
what
we
can
do
within
our
gift
of
what
we're
able
to
do
within
the
system
as
part
of
it
to
be
as
effective
as
as
we
can
be,
but
some
of
it
is
outside
of
our
our
remit.
B
N
S
Thank
you
chair.
My
question
is
really
around
what
you
do
with
this
information
because
there's
a
long
list,
some
of
the
things
are
probably
fairly
simple
and
you
can
implement
more
or
less
tomorrow.
Others
will
take
time,
possibly
will
take
more
money,
maybe
need
more
staff,
so
it
will
be
a
matter
of
prioritizing.
S
S
S
Others
may
only
have
been
mentioned
by
one
or
two
people,
but
actually,
when
you
look
at
it,
you
think
actually
that's
a
very
important
point.
We
need
to
address
that.
So
it's
a
matter
of
prioritization
things
that
you
can
do
things
that
you
want
to
do,
but
you
need
more
staff,
more
money
or
whatever
and
things
which
would
be
nice
to
do
sometime,
but
we're
not
in
a
position
to
actually
take
that
forward.
Now.
N
Yeah,
I
think,
obviously
part
of
this
as
jillian
was
saying,
is
feeding
into
the
that
we
are
designing
in
the
process
of
designing
the
options
and
the
models,
some
of
which
will
be.
This
is
what
we'd
really
like
to
do.
This
is
what
we
might.
These
are
some
choices
we
may
have
to
make
and
that'll
feed
into
that.
So
definitely
in
the
future,
we'll
be
in
a
position
to
come
back
and
say
this.
F
N
Yeah
I've
made
note
of
the
social
prescribing
because,
as
I
say,
I
think
it
goes.
It
goes
across
the
right.
So
many
things
doesn't
it,
but
but
yeah,
absolutely.
I
think,
as
part
of
the
redesign.
We
are
very
much
looking
at
how
we
link
in
so
the
right
per
when
we
talk
about
the
right
person,
the
right
place,
the
right
time,
that's
not
just
about
registered
or
qualified
or
health
service.
N
That's
about
social
care,
that's
about
that's
about
the
third
sector
and
that's
about
all
different
groups
that
are
currently
out
there
that
are
doing
things
and
how
we
link
into
those
groups,
and
some
of
the
information
that
we've
got
from
valve's
been
really
helpful
for
that.
To
think
about
how
we
need
to
do
that
and
in
the
as
part
of
the
when,
when
we
are
further
down
the
line
with
the
redesign,
there
will
be
a
full
equality,
quality
impact
and
quality
impact
assessment,
and
part
of
that
will
be
thinking.
N
F
No,
I
think
that's
really
important,
because
I
don't
know
if
this
this
report
or
the
last
report
did
actually
comment
that
some
research
should
be
done
in
leeds
and
a
lot
of
communities
across
the
city,
bearing
in
mind
were
one
of
the
most
diverse
cities
in
the
country.
I
actually
felt
just
totally
disengaged
not
and
they
felt
they
had
no
part
or
didn't
know
about
services.
So
I
think
that
part
of
it
will
be
really
important.
Thank
you.
O
I
think,
certainly
as
well
for
quite
a
lot
of
people
from
diverse
communities.
They
get
very
used
to
being
part
of
consultations
and
then
never
seen
anything
happen
and
we've
just
talked
about
how
it's
going
to
take
a
year
for
that
change
to
happen.
So
I
I
think
to
hold
that,
and-
and
you
mentioned
how
I
mentioned
it
before-
but
we
have
the
you
said
we
did
concept
that
doesn't
happen
straight
away.
N
Yes,
absolutely,
which
is
why
they
sit
under
our
umbrella.
I
think
there
is
the
stroke
community.
Stroke
team
is,
as
mentioned,
a
12-week
pathway,
so
people
are
coming
out
of
hospital
are
referred
into
that
pathway
or
who've
accessed
hospital,
whether
that's
they
have
a
stay
or
not.
Accessing
that
12-week
pathway.
There
are
patients
where
that
pathway
isn't
suitable
for
one
reason
or
another,
and
they
might
come
straight
to
community
neurology.
There
are
people
that
go
through
the
stroke
pathway
and
come
to
neurology.
N
B
B
It
starts
on
page
127
of
our
pack,
and
this
clearly
affects
a
lot
of
residents
and
leads
particularly
some
of
the
there's,
a
whole
number
of
people
in
the
paper,
particularly
effects,
but
can
the
three
of
you
introduce
yourself
and
then
I
think
it's
lisa
speaking.
So
thank
you
very
much
hand
over
to
you
lisa.
H
C
H
H
However,
the
service
being
operational,
the
team
has
been
awarded
the
british
medical
journal
award
for
clinical
leadership
of
the
year,
the
medipex
award
for
management
of
long-term
conditions,
and
we're
really
proud
that
a
clinical
booklet
developed
in
hearing
leads
very
early
in
the
pandemic,
which
helped
to
guide
people
both
in
terms
of
information
and
advice,
and
also
in
terms
of
self-management
for
rehabilitation
which
was
developed
by
leeds
teaching,
hospital
trust
and
lee's.
Community
healthcare
trust
has
been
adopted
by
the
world
health
organization
for
sharing
internationally.
H
Furthermore,
leeds
has
been
successful
in
securing
a
3.4
million
pounds,
research
grant,
which
has
launched
in
the
city
to
identify
the
best
way
to
treat
and
support
the
estimated
1
million
people
in
the
uk
now
living
with
long
covered
and
led
by
the
university
of
leeds
and
lee's
community
health
care,
trust
and
funded
by
the
national
institute
for
health
research.
The
study
helps
to
wishes
to
create
a
gold
standard
approach
for
the
treatment
of
one
curvate.
H
Well,
we
know
that
in
leeds
long
covered
is
more
commonly
reported
amongst
people
aged
35
to
69
years
of
age
by
people
predominantly
a
female
who
identify
as
female
people
from
the
more
deprived
areas
of
leeds
those
people
with
existing
health
conditions
and
significantly
amongst
health
and
social
care
workers
in
terms
of
prevalence.
Our
most
recent
information
from
the
office
for
national
statistics
on
the
16th
of
september
estimated
that
one
in
40
or
2.5
percent
of
people
who
had
tested
positive
for
curvid19
experienced
symptoms
of
lung
covered
for
at
least
12
weeks.
H
What
do
people
present
with
when
they
access
the
service?
Mostly
people
present
with
fatigue,
shortness
of
breath,
cognitive
problems,
often
described
by
people
as
brain
fog,
memory
problems,
trouble,
concentrating
trouble,
processing
and
understanding,
new
and
old
information.
Many
people
have
experienced
anxiety.
H
Some
people,
post,
traumatic
stress,
disorder,
gut
and
digestive
problems,
voice
and
throat,
issues
and
post-exertional
malaise,
which
can
be
extreme
fatigue,
brought
about
often
by
what
we
might
consider
as
everyday
tasks
in
life.
Perhaps
reading
a
document
that
might
be
very
stressful
for
people
with
their
concentration
or
taking
a
flight
of
stairs
and
people
often
complain
about
pain,
chest
pain,
headaches,
muscular
pain
and
joint
pain,
and
because
of
that,
you
probably
recognize
some
of
those
symptoms.
I've
described
might
be
common
to
a
range
of
illnesses.
H
I
think
it's
important
for
us
to
consider
today.
This
is
a
very
new
condition:
it's
ever
evolving
and
we
are
ever
responding.
So
there
are
some
caveats
to
some
of
the
data
that's
available
to
us.
The
data
in
terms
of
prevalence,
for
example
through
the
office
for
national
statistics,
is
self-reported.
H
H
H
We
also
know
that
long
cover
is
likely
to
amplify
existing
inequalities,
as
disadvantaged
groups
are
more
likely
to
experience
the
wider
health,
financial
and
social
impacts
of
long
covered
and,
finally,
for
this
point
is
to
say
that
whilst
there's
uncertainty
in
predicting
the
population
needs
for
a
condition
which
continues
to
evolve,
we
can
be
assured
that
the
lead
system
will
respond
at
pace.
Ensuring
the
future
is
representative
of
our
past
in
using
the
latest
data
evidence
and
research
to
model,
innovate
and
respond.
Thank
you.
G
Thanks
chair,
thank
you.
Everyone,
that's
a
really
interesting
report
and
just
a
couple
of
questions
one.
I
was
just
wondering
whether
any
we're
getting
any
data
coming
through
of
people
who
have
been
suffering
symptoms
and
then
had
an
antibody
test
and
realized
that
they've
had
covered
without
realizing
it
and
are
therefore
suffering
long
covered,
and
I
might
have
missed
whether
the
referral
was
self-referral
or
whether
that
was
via
a
clinician
and
also
just
a
question
on
how
much
follow-up
we're
doing
on
people
with
a
learning
disability.
C
C
So
we
agreed
that
we
could
have
that
six
weeks,
but
as
yet
we
haven't
had
a
referral
through
and
so
the
service
we
have
linkedin
they're
very
aware
of
us.
We
just
haven't
had
that
service
through
it's
gp
referral
or
if
they're,
in
existing
community
teams
that
have
matrons,
for
example,
that
can
be
referred
that
way
or
through
the
respiratory
team.
The
reason
for
that
is,
like
lisa,
said,
there's
a
lot
of
symptoms
that
can
overlap
with
other
things,
and
we
don't
want
to
be
treating
rehabbing
somebody
for
long
covered.
C
So,
that's
why
it's
a
referral
in
that
way,
we
haven't
ruled
out
self-referral
for
people
that
have
already
been
referred
into,
the
pathway
and
but
we
haven't
had
many
of
them
come
up
we're
taking
them
case
by
case,
so,
if
they're
coming
in
with
what
they
think
might
be
long,
symptoms,
long-covered
symptoms,
but
they've
never
experienced
them
before.
Then
we
are
asking
them
to
go
through
the
gp.
If
it's
that
they're
having
a
real
relapse
and
they
need
our
support
again,
then
we
can
take
them
back
in
that
way.
G
G
C
Yeah
we
do
have
some
people
that
did
kind
of
say
they
had
a
really.
I
mean
the
predominant
and
people
that
we
get
and
not
the
hospitalized
people,
so
they
are.
The
people
that
were
treated
at
home.
85
were
treated
at
home,
some
had
quite
a
minor
initial
infection,
so
some
of
that
then
was
reinforced
when
they
had
an
antibody
test
and
they
kind
of
then
went
yeah.
This
picture
is
building
now
I
did
have
it
now.
C
B
Thanks
councillor
cunningham
and
jenny,
I
think
that
point
around
not
having
to
have
had
serious
covid
to
get
long
covered
is
a
really
important
message
to
get
out
there
and
I
think
it's
probably
under
knowing-
and
it's
it's
quite
quite
worrying.
Just
following
up
on
councillor
cunningham,
you
you
mentioned
about
the
antibodies,
it
is
that
a
I'm
guessing
there
isn't
a
simple
test
for
long
covered.
Obviously,
but
is
that
an
indicator?
C
No,
it
doesn't
seem
to
correlate
to
long
covered
symptoms.
What
we
do
have
is
that
people,
particularly
when
the
vaccines
were
getting
rolled
out,
lots
of
people
got
tested
to
see
if
they
still
had
antibodies.
We'd
have
people
with
long-covered
symptoms
with
no
antibodies,
and
some
that
did
so.
It
doesn't
seem
to
correlate
to
what
we
found,
but
I
think
you're
right
then,
and
on
the
point
of
getting
that
message
out,
we've
been
on
radio
quite
a
lot.
C
We've
been
on
the
news
quite
a
few
times
and
we've
presented
at
different
conferences
and
things,
because
I
think
that
is
really
important
to
know,
because
we
get
a
lot
of
people
that
report.
They
feel
like
a
fraud
because
they
weren't
very
well
because
they
weren't
that
poorly
in
the
first
place
and
they
almost
are
apologetic
for
taking
up
services.
So
I
think
that
is
a
really
key
message
to
get
across
there.
So
we
continue
to
really
try
and
raise
that
profile.
S
S
Are
there
any
statistics
and
maybe
there
aren't
which
actually
show
the
number
of
people
affected,
because
there
may
be
a
gender
difference
or
an
age
difference
of
people
who
actually
do
have
it,
but
don't
present
for
one
reason
or
another.
So,
first
of
all,
do
we
have
any
hard
data
about
its
actual
prevalence
rather
than
presentation?
S
And
secondly,
if
I
could
just
ask
a
question
about
some
of
the
tables
and
let's
look
at
the
one
on
page
142,
the
top
appendix
2,
there
are
a
number
of
columns.
There's
the
ethnicity,
then
there's
the
testing
rate
per
100
000
and
then
there's
two
columns
which
lti
and
uci,
which
I
assume
are
lower
confidence
interval
and
upper
confidence
interval.
I
mean,
strictly
speaking,
a
single
figure
is
not
an
interval.
So
you
need
to
look
at
the
two
to
see
the
interval.
S
S
T
Thank
you
for
your
question.
Yes,
firstly,
the
confidence
intervals
are
95
confidence
intervals,
the
the
the
data
in
the
table
in
there
you're
quite
right,
so
the
left
columns
indicate
the
the
confidence
into
the
lower
confidence
interval
and
the
upper
upper
confidence
interval
and
then
the
two
columns
next
to
that
they're,
just
basically
the
fog,
the
figures
to
implement
into
the
graph.
T
So
when
you
look
at
the
graph-
and
you
can
see
those
those
lines
at
the
top
which
indicate
the
the
confidence
interval
ranges,
those
figures
have
been
used
to
basically
calculate
those
those
ranges
to
put
in
the
graph.
So
in
terms
of
the
last
two
columns
that
they're
not
really
that
important
for
this
paper,
it's
the
confidence
interval.
The
two
left-hand
columns
are
the
the
key
really
to
show
the
range,
so
the
first,
the
first
that
the
figure
in
the
covid
case
rates.
T
B
T
It's
been
really
tricky,
trying
to
get
an
accurate
picture
of
the
overall
presentation
of
long
covid
there's
a
number
of
different
studies
that
have
been
delivered
over
the
last
12
months.
The
one
that
we
have
paid
most
attention
to
is
the
office
of
national
statistics,
long
covered
study,
which
has
been
releasing
a
regular
update
over
over
the
last
12
months
in
terms
of
updating
the
prevalence.
T
You'll
see
the
two
figures
that
we've
provided
in
this
paper.
One
one
of
those
figures
is
based
on
the
number
of
people
who
are
experiencing
symptoms,
self-reported
as
as
lisa
alluded
to
earlier
associated
with
long
covid
for
people
experiencing
those
symptoms
within
four
to
12
weeks
after
their
covid
infection,
a
suspected
covered
infection.
T
Another
important
point
within
that
data
is
it's
compared
to
a
control
group
as
well,
so
people
who
have
experienced
those
common
symptoms-
you
know
just
in
general,
you
know
not
associating
it
to
them
having
a
covered
infection
previously.
So
there
was
a
control
group
used
and
that
that
figure,
the
latest
figure
that
was
released
in
september
is
to
two
and
a
half
percent.
T
So
it's
estimated
that
two
and
a
half
percent
of
those
people
who
have
had
a
covered
infection
have
gone
on
to
have
long
covered
or
long-covered
syndrome
type
symptoms
for
at
least
12
weeks.
So
that's
the
figure
that
we're
paying
most
attention
to
at
the
moment.
But
it's
really
important
to
appreciate
that.
Not
everybody
who
gets
long
covered
and
I'm
sure
jennifer
will
will
you
know
you
know
elaborate
on
this?
T
Not
everybody
who
gets
long
covered
requires
the
support
of
the
specialist
service,
because
it
you
know,
there's
varying
symptoms,
but
equally
important
is
getting
access
to
help
and
support
self-care
help
and
support
to
people.
So
it's
it's
a
complex
picture,
but
we're
doing
the
best
we
can
with
the
data
that
we've
got
we're
monitoring
it
all.
The
time.
C
Yeah,
just
in
terms
of
the
the
symptoms,
we're
still
getting
people
that
won't
be
coded
on
gp
systems,
for
example,
so
we're
still
getting
referrals
for
people
that
had
suspected
coverage
right
at
the
beginning
of
the
pandemic.
There
was
no
testing,
there
was
no
coding,
so
we're
never
going
to
know
that
true
figure,
and
so
it's
really
difficult.
C
So
we
just
take
people
part
of
the
criteria
and
what
nice
advice
as
well
part
of
the
criteria
for
referral,
wasn't
that
you
have
to
have
a
positive
test
so
we're
you
know
we're
really
sticking
to
that.
We
are,
you
know,
assessing
everybody
that
comes
through
to
look
at
them
individually,
and
there
is
an
argument
to
say
as
well,
where
the
way
that
we're
set
up
we're
one
of
the
only
services
that
could
deal
with
all
of
them
symptoms
irrelevant
if
it
was
your
covered
initial
virus
or
not,
so
we
very
much
take
them.
S
S
B
P
Thank
you,
chad,
two
questions,
please
one.
I
know
it's
on
page
134
about
the
demographic
age
group
of
the
present,
with
long
curvy,
I'm
struck
by
the
absence
of
60,
70s
and
80
pluses,
just
like
a
little
bit
of
background
relating
to
that.
Is
that,
because
of
your
fatalities
in
the
early
stages,
is
it
because
they
were
the
first
group
to
be
to
be
vaccinated
or
is
it
because
they're
less
likely
to
present
anyway?
So
that's
a
quick
question,
one.
P
The
the
second
question
is
unrelated
to
that,
but
is
I
was
struck
by
when
you
were
going
through
this.
The
signs
of
all
the
presentations
of
what
classes
has
long
covered,
and
I
was
there
was
one
I
was
waiting
for
you
to
say
that
didn't
come
out
and
actually
I've
just
googled
the
12
stages
and
it's
not
on
there
either,
which
is
olfactory
because
of
peop
of
a
couple
of
people.
I
know
that
I
talk
of
them
as
having
long
covered.
P
What's
gone
is
or
what's
gone
or
has
been
severely
affected,
is
sense
of
taste
and
smell,
and
I'm
just
curious
as
to
whether
that
is
clusters
long
curved
and
what,
if
it's,
not,
then
what?
What?
What?
How
do
they
get
into
the
medical
system
to
kind
of
get
to
get
the
treatment
from
my
experience
sounds
as
though
they
need.
C
So
the
taste
and
smell
one
first,
we
do
get
them
referrals
through
and
we
do
have
dietitians
that
are
within
the
core
team
that
work
on
the
taste
and
smell
retraining,
and
we,
I
don't
think
we
get
as
many
referrals,
because
it's
very
we
don't
get
that
many
that
just
have
that
symptom.
So
they
normally
come
with
a
range
of
other
symptoms
and
fatigue
normally
goes
alongside
that
one.
Definitely
and
if
they
have
it
in
isolation,
they
can
still
access
our
service
and
go
through
the
dietitians.
C
If
we
think
that
it's
more
likely
to
be
damaged
and
we'll
liaise
with
the
gps
about
whether
they
need
ent
referrals,
I
do
think
that
maybe
the
gps
understand
what
our
services
and
what
we
can
offer,
and
maybe,
if
it's
that
symptom
in
isolation
they
are
referring
across
to
ent.
That
could
be
one
possible
explanation,
but
yeah,
it
is
definitely
a
long-covered
symptom
and
we
do
still
see
it
reported
quite
frequently.
Just
there's
two.
I
think
it
was
204
symptoms
for
long
covered.
C
So
you
have
to
be
really
high
up
there
to
get
in
the
top
twelves,
but
it
is
on
that
elderly
people
was
one
thing
that
we
looked
at
particularly
early,
because
when
we
set
up
the
service
we
set
up
to
deliver
a
home
service
where
we'd
go
and
see
people
at
home.
We
were
expecting
elderly
people
coming
out
of
hospital
that
needed
more
intensive
rehabilitation.
C
That
didn't
happen
now,
whether
it's
some
of
the
factors
of
the
survival
rate
in
the
early
stages
and
the
other
thing
is
that
if
people
come
out
and
they
need
support
with
things
like
personal
cares
and
mobility
and
things
they
will
go
to
our
existing
services.
So
they
would
go
to
the
neighbourhood
teams,
for
example,
who
would
escalate
to
us
at
12
weeks.
But
often
they
did
such
a
good
job
in
them.
C
12
weeks
that
we
didn't
get
that
escalation
point
or
they
liaised
with
us
and
kind
of
said,
do
we
need
to
hand
this
patient
over?
Are
you
going
to
do
anything
different?
Can
we
carry
on
here
and
we
did
do
some
targeted
work
around
the
neighborhood
teams
and
around
care
homes
in
particular,
to
highlight
what
long
covering
might
look
like
in
an
elderly
person,
because
I
do
think
as
well
that
they
might
not
be
presenting
to
gps
they're
accepting
of
the
fatigue
they
may
be
retired.
C
So
it's
not
impacting
on
their
day-to-day
as
much
and
the
conversations
I
do
have
with
older
people
often
start
with.
I
just
don't
know
if
it's
me
just
getting
a
bit
older
and
slowing
down,
so
we
try
and
do
the
promotion
around
that
work,
which
we've
done
within
our
existing
services
and
care
homes,
for
example,.
C
We
had
brilliant
students
who
made
amazing
posters
to
start
off
with,
so
they
went
round
to
all
of
the
care
homes
in
leeds
104
care
homes.
Is
it
something
like
that
that
we
yeah,
so
we
did
two
big
posters,
one
about
how
you
can
support
in
the
first
instance
and
one
about
who
we
are
and
how
to
refer
to
us.
If
you
need
us.
B
I
Thank
you
chair.
It
was
just
to
make
some
brief
comments,
partly
in
relation
to
dr
bill's
question,
but
it
does
relate
to
the
last
one
as
well
as
colleagues
have
highlighted.
This
is
a
very
kind
of
emerging
understanding
of
of
what
we're
calling
long
covet.
Just
from
my
point
of
view,
we
have
weekly
calls
with
chris
with
his
chief
medical
officer
nationally,
and
he
and
we
had
one
last
night.
He
is
very
keen
to
stress
that
that
this
is
a
very
fast-moving
landscape.
I
There
is
still
a
lot
of
clinical
disagreement
around
what
this
thing
is
called
long
covered.
You
know,
and-
and
you
know,
as
chief
ed
medical
officer
he's
right
in
the
middle
of
that.
I
think
that
what
is
very
clear,
it's
not
a
single
condition.
It's
a
whole
range
of
different
symptoms,
so
I
think
that
the
more
we
kind
of
understand
that
how
fast-moving
this
is,
the
better,
the
in
terms
of
how
people
how
how
we
get
the
numbers.
Dr
beal,
I
mean
it
is.
I
It
is
literally
self-reported
data
at
the
moment,
which
obviously
has
lots
of
flaws
and
and
depends
on
people
to
report,
and
I'm
just
practically.
When
the
report
came
out
in
september
from
the
office
for
national
statistics,
we,
you
know,
we
quickly
made
sure
that
was
in
the
report,
because
it
was
significantly
different
than
the
estimates
from
the
previous
month's
report.
I
It
is
it's
moving
that
quickly,
so
I
think
that
what
it's
it's
fabulous,
that
lead
is
at
the
forefront
of
of
learning
and
responding
to
this
emerging
picture,
but
just
to
really
stress
that
that's
the
message
we're
getting
all
the
time.
Please
don't
over!
Simplify
this.
It's
not
just
one
condition.
There
are
many
other
post-viral
conditions
as
well.
You
know
people
can
have
you
know
long
flus
been
in
the
media
this
this
week
as
well.
I
So
I
think
the
more
we
understand
to
send
it
as
a
range
of
conditions
that
are
part
of
a
post-viral
kind
of
suite
of
symptoms.
People
can
have
the
better
and
the
research
elements
so
important,
because
the
more
we
work
with
university
to
understand
this,
the
better
so
you're,
absolutely
right,
dr
bill
around
getting
the
numbers
right,
but
I
just
wanted
to
make
that
point
about
just
just
how
fast-moving
this.
The
understanding
of
this
this
conditional
range
of
conditions
is
thank
you.
B
E
Thank
you
chair.
I
mean
it's
just
all
been
said.
I
mean
to
be
to
begin
with.
Well
done,
you
know
setting
up
a
service
in
the
most
difficult
circumstances,
so
you
know
you've
done
fantastically
and
I'm
sure
everybody
on
the
panel
here
appreciates
everything
that
you're
doing.
I've
got
a
question,
though
about
I
mean
most
people
here
will
will
be
aware
that
that
the
impact
of
deprivation
on
well
you've
highlighted
it
so
I'll,
just
quote
you
long
covered,
it
is
lightly.
Sorry
long
covered
is
potentially
more
prevalent
in
deprived
areas.
E
Now,
if
we
look
at
chart
five,
which
is
referrals,
kobe,
rehab
pathway,
referrals
by
postcode
area,
so
if
we
look
at
where
there's
the
most
referral
set,
I
don't
know
top
four
or
five:
it's
round
hey
pudsey,
calvary,
herewood,
bram,
hope
heavenly
weekwood,
some
of
the
most
affluent
parts
of
leeds.
We
look
down
at
the
bottom,
where
the
referrals
are
city
center,
kirkstall,
burley,
woodhouse,
beast
and
some
of
the
least
most
deprived
areas
in
the
city.
E
T
I'll
I'll
answer
that
in
part
and
then
jennifer,
if
you
want
to
come
in
from
a
service
perspective
yeah,
so
the
the
the
data
that
we've
got
looking
at
the
the
variation
of
access
to
the
specialist
service,
you
know
you're
quite
right.
It
highlights
that
you
know
some
variation
there,
but
it's
also
important
to
appreciate
that
some
of
that
variation
could
be
actual
prevalence.
T
Some
of
it
might
not
be,
and
especially
where,
because
we
know
that
there
is
under
representation
when
we
look
at
in
terms
of
the
most
deprived
communities,
so
some
of
those
postcode
areas
that
sit
in
the
most
deprived
communities,
if
it's
low,
you
know
we
would
assume
that
we
need
to
do
more
than
increase
the
uptake
or
increase,
raise
awareness,
and
you
know
make
make
those
communities
aware
of
the
service.
We
have
a
small
working
group.
T
That's
looked
at
this
alongside
some
of
the
emerging
data
which
I've
alluded
to
in
the
paper
so
including
public
health,
ccg
colleagues,
third
sector
and,
fundamentally,
the
the
focus
has
been
on
getting
the
message
out,
raising
awareness
of
what
what
long
cove
it
is.
Jennifer
and
the
service
have
been
doing
some
stuff,
which
you
can
touch
on
shortly.
T
C
C
This
isn't
getting
trying
to
get
that
message
across
from
the
service
point
of
view
where
we've
been
working,
particularly
with
brian
and
the
gps,
and
doing
some
in-service
training
on
what
we
are,
what
we
offer
so
and
we've
targeted
work
with
gps
with
lower
referral
rates
as
well,
so
we're
trying
to
address
that
our
picture
is
the
same
as
the
national
picture,
but
that's
not
so
the
national
picture
is
right.
Have
we
just
got
early
adopters
in
in
certain
areas
which
we've
seen
a
lot
of
long-term
health
conditions?
C
So
we're
not
sitting
down
and
saying?
Oh,
that's,
okay,
because
it's
the
same
as
the
national
picture
and
we
are,
and
as
a
yorkshire
group
we're
now
analyzing
that
data
across
yorkshire
as
well
to
say,
is
leads
the
same
as
airdale
and
etc,
and
then
analyze
further
down.
There's
going
to
be
a
particular
group
that
then
look
at
that
even
more
to
say
why?
Why
is
that
happening?
We're
not
accepting
that
that's
a
national
picture
and
saying
right!
It's
fine.
H
R
It
is
so
just
really
wanting
to
pick
up
as
well
on.
The
point
is
what
we've
ensured
that
there's
ongoing
engagement
and
updating
into
primary
care
in
terms
of
consideration
specific
to
covert
19
related
specific
guidance
and
also
pathways
that
we've
developed
with
secondary
care
clinicians
in
terms
of
the
management,
so
that
that
issue
around
the
olfactory
issue,
so
there's
some
very
specific
guidance
about.
If
that's
a
single
thing,
that's
continuing
for
longer
than
three
months,
the
patients
refer
directly
into
ent,
etc,
but
also
along
a
range
of
other
symptoms
as
well.
R
So
when
we
did
the
initial
review
in
terms
of
where
the
referrals
were
coming
from,
we
became
very
much
aware
of
of
that
issue
of
practices
not
referring.
So
there
was
more
detailed
work
going
into
those
individual
practices
and
pcns
to
increase
awareness
of
the
service
and
support
them
in
referring
in
and
that
that
has
happened
as
we've
gone
forward
with
it.
But
I
think
it
is
going
to
be
again
going
back
to.
B
K
Thank
you
chair.
I
don't
know
for
those
of
older
people
in
the
audience
you
might
remember.
In
the
1980s
there
was
something
called
a
yuppie
flu
which
I
can't
remember
what
it
emanated
from,
but
the
symptoms
were
very
similar
to
this
fatigue
being
one
of
the
major
ones,
but
for
those
who
weren't,
it
is
just
very
similar
to
what
people
are
describing
as
long
covered.
K
I'm
quite
surprised.
This
report
has
come
to
us
so
early
and
I
would
like,
if
possible,
if
you
could
maybe
return
that
won't
be
down
to
me.
But
if
you
return
next
year,
perhaps
with
an
update,
because
you
will
have
more
data
more
knowledge,
perhaps
some
treatments
you
will
also
might
know
what
is
not
long
covered.
C
Yeah,
I
think
you're
right
and
that's
why
we
do
really
try
and
make
sure
that
people
have
that
pathway
and
we
encourage
people
to
see
the
gps.
We
do
have
a
phone
line
that
people
can
access
and
the
gps
normally
access
to
see
if
it's
relevant
referrals
but
you're
exactly
right,
and
I
think
when
people
talked
about
youtube
fluent
things,
you
know,
we
now
know
a
lot
more.
C
It's
it's
me
or
it's
cfs,
and
you
know
we
don't
want
people
with
long
cover
to
have
that
same
journey,
because
that
was
awful
for
people
to
be
so
belittled
and
so
not
listened
to,
for
so
long
is
what
we
hear
from
them:
population
groups
and
we're
dealing
with
very
similar
population
group.
So
but
yeah
you
point
on
the
menopause.
We
do
have
a
lot
of
that
problem.
C
We
have
many
conversations
of
is
this
long,
but
we
don't
mean
it
for
us
and
there's
research
going
into
the
hormone
side
to
see.
Actually
what
we
think
might
be
happening
is:
is
it
actually
putting
people
through
menopause
or
is
it
affecting
the
hormones
that
that's
why
they
present
the
same?
But
we
get
men
with
very
menopausal
symptoms
as
well,
so
yeah.
D
D
The
deprived
population
is
only
a
minimum
in
the
brochure
I'm
wondering
if
you
work
in
third
sectors
in
the
very
deprived
area,
because
you-
and
I
know
third
sectors-
is
the
art
of
a
community
and
some
patients
say,
for
instance,
asylum
seekers
and
who
can
go
to
doctors,
will
more
talk
to
sectors,
and
they
can
maybe
answer
just
think.
You
should
work
with
third
sectors
in
the
very
deprived
community.
C
D
C
C
Yeah
she
was
just
yeah.
She
was
just
an
example
she's
one
of
our
directors
on
our
board.
So
when
we
were
talking
very
early
on
about
the
patterns
that
we
were
seeing
and
that
we
weren't
happy
with
what
we
were
seeing,
she
she
got
involved
as
as
onto
the
working
group,
but
also
her
other
hat
was
that
she
was
involved
in
touchstone.
So.
Q
B
R
Yes,
well,
if
I
can
pick
up
the
last
point
first,
I
I
would
strongly
support
the
fact
that
gps
are
seeing
patients
face-to-face
and,
in
fact,
about
one-third
to
one
half
of
the
patients.
I
currently
see
are
face-to-face
consultations,
which
has
increased
as
we've
gone
over
the
last
two
three
months
and
overall,
I
think
it's.
The
order
of
54
consultations
are
now
being
delivered
face-to-face.
R
There
are,
however,
and
quite
rightly,
a
number
of
patients
that
you
would
need
to
see
in
order
to
be
able
to
do
further
assessment
and
establish
the
diagnosis
and
even
in
those
cases
very
often
some
of
the
initial
investigations
can
be
done
prior
to
seeing
the
patient.
So
a
lot
of
this
is
happening
to
streamline.
R
I
would
accept
that
there
are
a
number
of
patients
who
feel
they
want
to
see
a
gp,
and
we
would
absolutely
want
to
see
them,
but
we
do
need
to
understand
what
the
clinical,
what
the
added
value
is
going
to
be
behind
doing
that.
But
I'm
not
coming
across
gps
who
don't
want
to
see
patients,
and
I
think
in
entirely
the
opposite,
because
there
is
a
significantly
greater
risk
in
terms
of
doing
consultations
remotely.
Then
you
will
want
to
be
absolutely
sure
that
your
supporting
those
patients
and
diagnosing
them
correctly.
R
So
that
would
be
the
point
about
primary
care
and
I
think
that
that's
the
situation
that
will
evolve
going
forward.
I
think
the
remote
consultations
are
here
to
stay
and
a
lot
of
outpatient
consultations
have
happened
remotely
as
well
secondary
care
consultations
regarding
the
covered
symptomatology.
We're
trying
to
ensure
that
the
guidance
and
support
that
we've
provided
for
gp
has
specific
considerations
related
to
the
the
covet
symptoms.
R
And
there
are
a
very
small
cohort
of
patients
who
suffer
long-term
damage,
both
their
lungs
and
to
their
their
heart
as
a
result
of
covert,
and
we
need
to
be
aware
of
how
those
patients
can
be
best
supported
and
managed
through
the
through
the
pathway
and
in
terms
of
the
management
of
the
fatigue.
I'm
going
to
hand
over
to
jenny,
because
the
program
that
they
have
built
in
the
long
covered
rehabilitation
service
has
helped
to
address
that
issue
along
with
others,
but
be
better
more
detailed.
Thanks.
C
Thanks
friend,
so
the
fatigue
is
a
lot
of
what
we
do.
So
a
lot
of
people
are
surprised
by
how
you
know
what
you
do
for
fatigue
and
one
of
the
things
you've
got
to
consider
with
fatigue.
You
mentioned
there
about
how
it
might
be
hard
if
you've
got
a
labouring
job
versus
a
different
job
fatigue.
Isn't
physical
fatigue,
it's
not
just
physical
fatigue,
should
I
say
it's
physical,
emotional,
social
and
cognitive.
C
What
can
we
do
to
conserve
energy
so
that
we
can
use
it
on
the
things
that
we
want
to
do
and
that
can
be
really
simple
things
like
sitting
down
to
have
a
shower,
having
a
shower
stool
from
some
really
really
basic
things,
but
also
what
else
is
driving
your
fatigue?
It
do
you
need
to
see
the
physiotherapist,
because
you've
got
a
very
dysfunctional
breathing
pattern
when
you're
not
breathing.
Normally
that
takes
a
lot
of
energy
expenditure.
C
So
can
we
get
you
breathing
correctly
again
and
to
take
down
that,
and
also
from
the
psychology
point,
if
we
think
of
fatigue
as
them
for
prongs,
have
we
got
a
lot
of
anxiety?
Understandably,
because
you
don't
know
what
your
future
holds
anymore,
you've
had
a
life-changing
event,
you
may
have
lost
your
job.
You
may
be
under
a
lot
of
financial
strain.
C
So
do
we
have
a
lot
of
emotional
fatigue
that
then
we
need
our
psychology
team
on
board
and
we've
recently
recruited
into
that,
because
we
were
using
existing
services,
but
we
found
that
we
couldn't
match
when
we
were
delivering
therapy
and
because
of
their
wait
times
or
our
wait
times.
So
we've
now
just
about
to
bring
that
in-house
with
some
psychology
psychology
in
there
as
well.
So
the
medical
management,
you
said,
is
really
the
blood
test.
C
Is
there
anything
else
going
on
once
we're
happy
that
we
are
dealing
with
long
curve,
then
it
is
very
much
a
therapy
driven
rehab
program,
and
then
you
mentioned
exercise
really
contentious
issue
in
any,
and
anyone
that
knows
anything
around
me
or
cfs
chronic
fatigue
syndrome.
Exercise
is
really
controversial
to
the
point
where
nice
have
just
delivered
their
guidance
on
that
matter.
So
what
we
are
very
focused
on
is:
can
we
restore
you
to
your
normal
level
of
activity?
C
So
we
are
set
up
for
the
85
and
we're
working
with
third
sector
to
look
at
what
exercise
might
look
like
with
just
surveying
everybody.
That's
on
the
caseload
at
the
moment
about
1000
people
to
see
what
they
want
when
they're
discharged
from
us
and
that
exercise
element
may
come
after
so
once
we've
got
your
fatigue
stabilized.
How
do
we
then
build
you
back
up.
B
R
I
think
really
helpful
if
we
just
have
some
what
we
call
point
of
care
in
terms
of
knowing
and
understanding
what
the
patient
is
is
is
actually
contacting
us
about.
That
really
helps
to
focus
me
in
terms
of
when
I'm
looking
at
somebody's
record
to
ensure
that
I'm
doing
the
right
and
that
I
know
what's
what's
coming
and
I've
got
the
background
already
there.
R
We
have
a
needs
as
well
work
quite
closely
with
our
prescribing
colleagues
in
our
medicines
teams
to
ensure
that
guidance
is
available
and
followed
by
practitioners
in
terms
of
prescribing
for
all
commonly
related
condition
and
that's
widely
available
on
needs,
health
pathways
and
in
primary
care
systems.
And
we
do
monitor
and
audit
the
use
of
antibiotics
and
the
appropriate
antibiotic
prescribing
in
practice.
And
our
microbiology
colleagues
are
also
very
keen
to
ensure
that
we
don't
increase
the
rates
of
resistance
I'll
stop
there.
But
it's
something
that
we
feel
quite
passionate
about
as
well.
B
Is
really
important?
Yeah
thanks
dr
power.
Clearly
it's
not
not
on
the
agenda,
but
our
interests
as
well.
So
thank
you.
I
can't
see
anyone
else
indicating
to
speak,
so
thank
you
very
much
for
coming.
Clearly
the
work
you're
doing
is
fantastic
and
it's
great
that
lead
to
is
at
the
forefront.
That's
what
we
always
love
to
see
as
a
selected
member.
B
So
thank
you
very
much
and
we'll
move
up
move
on
so
the
the
last
item
is:
is
the
work
program
clearly
accounts
that
marshal
tongue
isn't
here,
and
so
the
work
program
is
as
it
is.
If
you
have
any
items
that
you
want
to
raise
in
the
future
or
discuss,
please
email,
counselor,
martial
tongue
and
angela.
S
Yes,
chair,
you
may
have
mentioned
it
before
I
came,
but
going
back
to
the
minutes
of
the
last
meeting
on
page
9
18,
it
talks
about
the
discussion
we
had
about
access
to
dental
care,
just
to
say
two
things.
First
of
all
leads
like,
I
think
virtually
every
health
watch
in
the
country
finds
that
patients
potential
patients
contacting
them
about
difficulty
of
accessing
dental
care
is
the
most
common
reason
for
the
public
contacting
health
watch
right
across
the
country.
S
The
second
relates
to
what
you've
just
said
about
antibiotics,
because
one
of
the
email
trails
that
I've
been
involved
in
is
some
dentists
prescribing
antibiotics
inappropriately
for
patients
with
abscesses
the
correct
treatment
and
just
to
explain
for
those
who
don't
know,
I'm
a
retired
consultant
in
dental
public
health.
But
but
I
do
remember
my
industry,
antibiotics
is
not
not
the
right
right
form
of
treatment.
Some
patients
are
undergoing
a
series
of
courses
from
sometimes
different
dental
practices,
each
prescribing
antibiotics,
which
is
totally
against.
S
A
Yeah,
just
on
that
point,
particularly
dr
bailey
you're
right
dentistry
was
raised
numerous
times
at
the
last
meeting
in
in
conversation
with
councilor
marshall
catong.
We
are
trying
to
arrange
in
our
november
meeting.
There
is
an
item
about
generally
understanding
the
impact
of
carbon
19
on
the
ongoing
recovery
measures
across
local
health
and
care
system.
So
we
are
going
to
try
and
get
someone
from
nhs
england,
so
there's
a
dentistry
element
to
that
and
if,
if
from
there
we
it
stems
into
a
more
discreet
agenda
item,
then
we
can
factor
that
in.
F
Yeah
I
I
like
dr
bill,
I
also
raised
dentistry,
is
quite
an
issue
for
the
whole
of
the
city,
and
I
really
appreciate
it's
going
to
be
on
the
agenda
going
forward.
Is
somebody
from
the
dental
hospital
actually
going
to
be
in
attendance
and
if
they're
not,
it
would
be
quite
interesting
to
have
them
to
just
see
how
they're
coping,
because
you
know
from
from
casework
that
I've
had
they're
not
taking
referrals
from
dentists.
F
J
Thank
you,
chad.
I
just
wanted
to
expect
the
points
that
have
been
made,
really
that
it's,
it's
probably
one
of
the
most
common
complaints.
I'm
getting.
I
mean
it's
not
technically
in
my
portfolio,
but
I
think
people
think
it
is
so.
It
comes
to
me
and
I
would
say
in
terms
of
access
to
health
care
over
the
pandemic.
It's
it's
possibly
been
the
complaint
that
I've
had
the
most,
both
in
terms
of
us
award
counsellor
and
in
my
cabinet
role,
and
it's
not
doesn't
seem
to
be
improving.