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A
Great
good
afternoon
and
welcome
to
the
first
live
streamed
meeting
of
the
leeds
health
and
wellbeing
board.
My
name
is
council
rebecca
charlwood,
I'm
chair
of
the
leeds
health
and
wellbeing
board.
I'm
just
going
for
my
members
to
turn
their
microphone
to
mute
when
they're,
not
speaking,
use
a
hand
well
and
go
in
the
chat
to
indicate
if
you
would
like
to
speak
so
we
can
move
through
the
agenda.
A
I'm
going
to
ask
all
members
to
introduce
themselves
in
turn
and
I'll
just
take
people
as
I
can
see
them
on
my
screen.
So
if
I
could
ask
jason
brock.
A
F
A
H
Good
morning,
I'm
julian
hartley,
I'm
chief
executive
of
leeds
teaching,
hospitals.
A
F
F
A
Conference
great
thank
you
and
chris
dickinson.
G
K
Hello,
my
name
is
paul
bola,
I'm
head
of
leads
plan.
J
L
B
F
Yeah
good
morning,
everybody,
simon
hodgson,
here,
head
of
service
for
safer,
leads
deputising
for
paul
money.
Thank
you.
A
The
whole
time,
no,
no
that's
fair
enough,
and
if
anyone
has
any
yeah
connection
issues
yeah,
you
know
this
sort
of
thing
happens.
Doesn't
it
so
that's
fine
and
thank
you.
Holly.
J
Morning,
I'm
holly
dunhauser
partnerships,
development
manager,
on
behalf
of
the
organizations
represented
on
this
board.
A
F
Debbie,
just
looking
after
the
webcast
for
us
today,
chair
so
sure
it
might
not
be.
A
Great,
so
anybody
who's
watching
has
now
been
introduced
to
everybody
who
you
can
see
on
the
screen,
and
it's
really
important
that
people
know
who
who
people
are.
As
you
can
see,
it's
a
very
wide
range
of
stakeholders
from
right
across
the
city
in
our
health
and
care
system.
So
very
welcome
today.
A
Thank
you
for
coming
right,
so
some
housekeeping,
so
please
make
sure
your
zoom
username
is
the
same
as
your
actual
name.
Please
turn
on
your
videos.
If
you
can,
but
if
you're
having
connection
issues
it
can
help
to
turn
off
your
video
if
you're
having
any
technical
issues,
it
sometimes
helps
to
leave
and
rejoin
the
call
you
can
contact
by
directly
messaging.
A
Our
fan
hussein
in
the
health
partnerships
team,
if
you're
having
issues
with
connections
or
any
issues
with
the
meeting
he
and
he
will
try
and
help
you
also,
if
you're
watching
on
youtube.
Please
do
ask
questions
and
we'll
try
to
bring
in
relevant
questions
if
we
can
and
but
we
do
have
a
very
big
and
packed
agenda
so,
but
it
would
be
really
interesting
to
hear
what
people
are
thinking.
A
So,
just
a
bit
of
a
preamble
on
the
current
situation
that
we're
all
facing
on
behalf
of
the
health
and
wellbeing
board.
We
would
all
really
like
to
thank
everyone
in
leeds
who's,
doing
so
much
work
to
respond
to
the
covert
19
crisis.
A
The
virus
is
impacting
on
a
huge,
you
know,
a
large
part
of
our
city,
all
over
our
city
in
pockets,
and
you
know
the
the
impact
of
it's
going
to
be
felt
for
some
time
on
health,
but
also
on
issues
around
economy
and
well-being,
and
we
really
want
to
work
as
a
board
to
try
to
support
people
to
have
healthier
lives
and
live
in
in
communities
which
are
healthy
and
support.
A
But
we
have
you
know
a
key
role
now
more
than
ever,
to
respond
in
a
strategic
way
to
the
the
crisis
that
we're
facing
in
the
issues
that
we're
facing
as
a
country.
So
how
we
structure
and
deliver
our
services
to
be
representative
of
the
diversity
of
our
city
and
make
progress
on
our
vision
of
improving
the
health
of
the
poorest,
the
fastest,
is
more
important
than
ever
so.
A
The
strength
of
our
relationships
and
our
ways
of
working
as
team
leads
has
kept
us
connected
and
helped
us
respond
really
quickly
and
effectively,
and
it's
really
important
to
keep
doing
that,
and
I
want
to
thank
all
the
members
of
the
board
for
their
teams
and
all
the
work
they're
doing.
I
know
people
are
working
night
and
day
to
respond
to
this
issue.
A
I
would
really
like
to
take
the
opportunity
as
well
to
congratulate
and
welcome
dr
jason
brock
as
the
new
clinical
chair
for
nhs
leads
ccg
he's
replacing
dr
gordon
sinclair,
who
retired
earlier
this
year,
jason's.
Of
course,
no
stranger
to
the
health
and
wellbeing
board.
His
amazing
knowledge
of
leeds
the
health
and
care
system
and
his
passion
for
improving
the
health
and
well-being
of
people
is
exactly
the
type
of
person
we
need,
and
it's
wonderful
to
have
him
back
on
the
health
and
well-being
board.
A
So
I'm
just
going
to
go
through
the
formal
items
on
the
agenda,
which
is
the
bits
we
have
to
do
for
formal
recording
purposes.
So
I'm
going
to
ask
how
it
to
respond
to
me
on
these.
Is
there
any
appeals,
no
appeals
chair?
Are
there
any
exempt
information,
no
exempt.
F
A
Items
any
declarations
from
the
board
of
disclosable
procurement
interests:
that
is
a
financial
interest
that
directly
affects
you
or
your
partner,
relevant
on
the
on
the
agenda.
Today,
no
okay,
any
apologies.
F
A
Thank
you
and
thank
you
for
the
those
substituting
for
people
who
couldn't
make
it
here
today,
they've
introduced
themselves.
Thank
you
for
that.
Okay,
do
we
have
any
questions
and
public
reputations
item
seven.
C
Thanks
chair,
we
have
one
question:
that's
coming
an
excellent
question
actually
from
dr
ruth
gillette
of
living
streets
leads
living
streets
leads
campaign
for
liverpool,
I'm
walking
environments
across
the
city
and
elsewhere,
and
the
question
is
quite
a
long
one,
but
I
will
read
it
it's
an
excellent
question.
C
Actually
it
says
how
will
the
nhs
work
with
partners
to
support
measures
to
increase
physical
activity
among
the
communities
they
serve
in
the
proposed
active
travel
neighborhoods
now
these
are
proposed
neighborhoods
in
in
hyde
park,
holbeck
lincoln,
green
chapel,
town,
beeston
and
oakley,
and
the
aim
is
in
those
neighbourhoods
to
make
more
space
for
walking
and
cycling
by
closing
roads
and
promoting
active
travel,
and
the
question
outlines
the
strength
of
the
evidence
base
for
walking,
cycling
and
active
travel,
particularly
in
and
around
tackling
certain
diseases,
cbd,
diabetes,
many
cancers,
etc,
etc.
C
So
the
question
is
specifically
to
nhs
colleagues,
so
I'm
going
to
ask
probably
jason
julian
sarah,
there
and
tim
if
any
of
them
would
like
to
come
in
and
comment
about
how
they
can
work
in
partnership
with
local
government
and
third
sector
to
promote
active
travel.
Ultimately,.
H
Yeah
happy
to
do
that
really
important
thanks
for
reading
out
the
question
tony
and
to
the
thank
you
to
the
questioner.
We've
got
together
with
our
partners
across
the
nihs
in
leeds.
I
think
for
all
of
us
a
very
clear
ambition
about
health
and
well-being
of
obviously,
our
staff,
but
also
of
the
wider
population,
and
a
lot
of
that
manifests
itself
in
the
work
we
do
collectively
as
anchor
institutions
and
leads
on
the
health
and
well-being
strategy,
but
also
in
our
own
plans,
and
certainly
here
in
these
teaching
hospitals.
H
We
have
got
as
part
of
our
own
health
and
well-being
strategy,
a
lot
of
work
that
we
do
both
internally
with
our
staff
in
relation
to
fitness
and
have,
but
also
crucially,
with
local
communities.
H
You
mentioned
in
the
question
the
community
of
lincoln
green,
that's
the
particular
area
for
us
right
on
our
doorstep,
where
we're
working
with
the
local
community.
A
lot
of
that
is
about
development
of
health,
awareness
and
education,
and
a
key
part
of
that
is
fitness
and
health.
We're
also
working
more
broadly
across
the
city,
with
the
promotion
of
greener
travel
options.
Cycle
lanes
we've
already
seen
the
development
of
cycle
lanes.
We've
been
working
with
the
city
council
for
healthier
transport
and
cycle
lanes
that
connect
our
hospitals.
H
So
there's
a
lot
of
work
going
on
and
I
think
we're
always
keen
to
connect
with
partners
so
I'll,
be
grateful
to
make
sure
that
we're
connecting
our
work
to
those
of
the
the
points
raised
in
the
question.
E
You
and
echo
a
lot
of
what
julian's
already
said
and
just
additional
response
really
there's.
Two
approaches
to
this.
E
A
Okay,
thank
you
very
much.
I
have
victoria
eaton
who'd
like
to
comment.
G
We
work
right
across
the
city,
including
closely
with
our
nhs
colleagues
and
so
just
to
mention
a
couple
of
key
things
that
this
week
we've
gone,
live
with
a
new
referral
system
from
gp
practices
to
a
whole
range
of
healthy
living
services,
and
within
that
it's
the
first
time
that
gps
can
refer
to
active
leads
which
supports
people
in
a
whole
range
of
physical
activity
opportunities,
including
walking
and
and
green
travel.
G
So
that's
something
that's
new
and
has
happened
within
the
last
week,
which
is
is
a
really
positive
development.
G
I
think
the
other
specific
thing
to
say
is
that
we're
we
run
something
called
physical
activity,
clinical
champions,
training
for
clinicians
across
primary
care
and
secondary
care
who
are
interested
in
supporting
people
to
be
more
physical,
physically
active,
and
so
this
has
just
started.
But
already
we've
got
55
clinical
champions
across
the
city
who
have
taken
on
this
role
and
that
work
will
continue
so
and
they're.
Just
a
couple
of
examples
of
the
things
that
are
in
place
thanks.
A
Thank
you
very
much,
so
we've
got
some
really
strong
responses
from
right
across
the
sector
and
the
city.
Today,
I've
got
sorry.
I've
got
dr
john
bill
who'd
like
to
speak.
Is
it
on
this
issue.
I
Yes,
chairman,
although
it's
not
specifically
about
the
nhs
but
more
widely,
because
I
think
that
in
many
cases
it's
become
the
social
norm
to
jump
into
your
car
and
drive
wherever
you're
going.
Even
if
it's
on
fairly
short
journeys
and
social
norms
are
are
learned
early
in
life
and
anyone
who
lives
near
a
school
will
see
the
very
high
proportion
of
kids
who
actually
are
driven
to
school,
irrespective
of
how
far
away
they
live
so
particularly
perhaps
in
the
active
travel
neighborhoods,
but
also
more
widely.
A
Yeah,
thank
you
very
much,
dr
bill,
so
that's
very
helpful
as
well,
and
I
can't
see
any
more
indications
of
people
who
would
like
to
speak
on
this.
Oh,
I
have
now
hannah.
Would
you
like
to
say
something
sorry.
E
Yeah,
just
just
to
say,
I
think
it's
also
got
a
sort
of,
particularly
in
light
of
covid
and
moving
into
winter,
we're
hearing
from
a
lot
of
people
in
terms
of,
and
we
know
that
the
united
people
won't
be
able
to
get
out
as
much
an
impact
that
will
have
on
sort
of
social
isolation,
particularly
around
older
people.
So
I'd
be
interested
to
think
as
a
city.
How
we?
E
How
are
we
considering
that
that
people
can
be
active
and
get
out
and
walk
and
and
also
be
active
within
their
own
homes
as
well
during
winter?
A
Yep,
absolutely,
I
think
you
know
the
issues
around
winter
and
the
restrictions
that
are
being
placed
upon
individuals
is
something
really
important
that
we
have
to
consider,
and
I
think
we
all
want
to
try
and
get
our
heads
together
about
the
sorts
of
something
we
can
offer
the
city
around
that
and
not
least
about
physical
exercises.
It
is
hard
to
get
out
when
it's
cold
and
raining
and
snowing
and
all
of
those
things
as
well.
A
Okay,
are
we
happy
to
move
on
at
this
point?
Thank
you.
I've
I've
not
received
any
indications
of
any
live
questions
that
have
come
in
yet
from
the
youtube
forum,
so
I
think
we'll
move
on.
If
that's
okay,
if
there's
anything
that
comes
up
later,
we
may
find
a
way
of
putting
it
in
trying
to
be
as
open
to
the
public
as
possible.
A
Okay,
thank
you.
So
we'll
go
to
minutes.
That's
item
eight.
Can
we
agree
the
minutes
from
the
20th
of
february
meeting
as
a
true
record?
A
Anybody
who
doesn't
agree?
Could
they
pop
it
in
the
in
the
chat,
and
I
can
bring
you
in
I'm
happy
to
accept
those.
As
a
true
record,
I
can't
see
any
indications.
Thank
you
right.
So
we're
going
to
go
on
to
one
of
our
main
items,
which
is
item
nine
and
for
the
publix
benefit.
A
We
had
a
a
private
session
at
the
beginning,
where
we
heard
some
incredible
personal
stories
about
people's
experience
of
using
maternity
services
from
black
asian
and
minority
ethnic
backgrounds,
and
it's
really
important
as
a
board
that
we
hear
the
voice
of
the
public
and
the
service
user
and
people
who
have
strong
experiences
within
our
system
so
that
whatever
discussions
we
have
and
decisions
we
make
as
a
system.
We
can
root
that
in
personal
experience
and
what
means
what's
important
to
people
rather
than
something
about
buildings
or
or
or
something
less
personal.
A
A
J
Okay,
great
thank
you
chair,
it's
james
schanker
here
and
I'm
going
to
start
off
before
passing
on
to
sue.
So
if
we
just
go
to
the
first
slide,
our
friend,
please
okay,
so
the
item
we're
here
to
discuss
today
is
a
refresh
of
our
maternity
strategy,
so
we've
had
one
for
five
years.
This
is
our
final
year
of
the
first
one,
but
we
need
to
refresh
that.
There's
lots
more,
that
we
want
to
do
and
need
to
do
so.
It's
a
really
exciting
time.
J
We
have
achieved
a
lot
in
the
last
five
years,
but
we
do
recognize
there
is
more
to
do
as
will
unfold,
so
I
just
want
to
say
that
we
have
a
real
strength
in
our
city
in
the
maternity
services
and
it's
a
key
arm
of
our
very
excellent
integrated
work
that
we
do
across
the
partnership,
which
includes
public
health,
health,
visitors,
children's
centres,
the
third
sector
and
perinatal
mental
health
services.
J
It's
a
key
contribution
to
giving
the
best
possible
start
for
every
baby
in
leeds
and
you'll
have
seen
from
the
supporting
paper
that
the
way
we've
drafted
our
priorities
for
the
next
five
years,
strongly
informed
by
local
population
data
from
our
health
needs
assessment
from
insight.
That's
come
from
women's
and
families,
voices
about
what
matters
to
them,
and
I'm
going
to
pass
to
sue
for
the
next
couple
of
slides.
Just
to
really
show
this
some
of
the
strengths
and
opportunities
that
we
have.
L
L
Progress
made
is
reassuring,
as
a
survey
does
ask
women
across
all
aspects
of
pregnancy
birthing
afterwards,
and
our
current
lead
maternity
strategy
is
certainly
supported.
Our
progress
alongside
the
collaborative
integrated
approach
that
is
such
a
strength
in
leads
choice
and
personalization
alongside
improved
outcomes,
is
vital
as
much
as
possible
to
ensure
the
uniqueness
and
embrace
the
experience
for
each
woman
and
her
family's
experience.
L
L
We
need
to
understand
our
data
and
strive
for
those
improvements
in
outcomes
and
in
the
overall
patient
experience
next
slide.
Please
often
so
one
of
the
really
exciting
things
to
consider
for
the
next
five
years
in
our
strategy
is
the
maternity
service.
Reconfiguration
colleagues
will
know
that,
following
public
consultation
in
july,
our
commissioners
supported
the
reconfiguration
of
our
hospital
maternity
services
into
one
of
the
new
hospitals.
L
So
we're
really
keen
that
this
is
an
area
of
service,
improve
development,
that's
integral
to
our
strategy,
there's
a
real
opportunity
to
maximize
the
quality
and
safety
of
our
service
and
our
workforce,
as
well
as
have
an
estate
that
is
fit
for
service
and
enhances
the
experience
of
leads
women
and
their
families
and
obviously
wider.
As
we
are
a
tertiary
unit.
L
70
of
our
antenatal
contacts
are
currently
in
the
community
and
we've
got
an
ambition
to
increase
those
contacts
in
addition
to
the
centralization
of
hospital
services,
we're
committed
to
establishing
an
integrated
community
hub
near
the
saint
james's
site
to
support
improved
access,
experience
and
outcomes
for
communities
who
live
in
this
area,
and
I'm
now
going
to
move
on
to
jane
next
slide.
Please.
J
So
we've
promised
that
we're
going
to
we're
going
to
be
quick
and
so
that
there's
plenty
of
time
for
the
conversation,
so
I've
just
got
a
couple
of
slides
here
that
just
bring
out
a
couple
of
key
points
that
kind
of
underline
the
health
inequalities
we
have
in
the
city
and
how
also
that
that
relates
also
to
deprivation.
J
In
terms
of
we
have
a
third
of
our
births,
you
know
there's
10
000
births
a
year
and
a
third
of
those
are
born
into
deprived
leads
and
we
have
an
increased
proportion
of
birth
to
black
asian
and
minority
ethnic
women,
since
2001.
they're
over
represented
in
deprived
lead
with
poorer
access
and
outcomes.
So
we
absolutely
have
to
have
this
as
a
priority.
J
We've
got
an
increase
in
infant
mortality
and
a
consistent
gap
between
deprived,
leads
and
there's
increased
complexity
of
health
and
social
factors,
and
if
we
move
on
to
the
next
slide,
there's
some
recommendations.
That's
come
out
of
the
maternity
health
needs
assessment
and
I'd
just
like
to
thank
nicola
goldsberg
who's
supported
us
in
doing
the
maternity
health
needs
assessment.
It's
an
80-page
document
which
is
absolutely
fantastic
resource
to
help
us
as
a
partnership,
develop
our
strategy.
J
I
just
wanted
to
note
that,
and
today
you
just
the
last
point
just
to
flag
that
data
collection,
reporting
and
sharing
needs
to
be
more
robust,
it's
improved
since
last
time,
but
it
needs
to
get
better
okay
just
moving
on,
and
so
these
are
the
draft
priorities
that
have
been
drawn
from
the
data.
J
The
conversations
and
the
very
the
very
many
routes
of
engagement
that
we
have
done.
Not
least
there
were
more
than
1500
people
responded
to
the
formal
public
consultation
that
we
had
to
do
about
the
reconfiguration,
but
prior
to
that,
in
the
creation
of
our
initial
strategy.
Every
time
we
created
a
pathway
or
developed
a
new
service,
we
engaged
and
co-produced
that
service
with
women
and
families,
and
we
don't
just
use
digital
surveys.
We
work
with
the
third
sector
to
to
reach
out
and
hear
all
voices.
J
So
I
don't
think
there'll
be
any
surprises.
We
think
reconfiguration
absolutely
needs
to
be
a
priority.
It
needs
to
be
central
not
running
in
parallel,
as
well
as
the
exciting
opportunity
for
the
local
families
to
be
engaged
in
the
clinical
design
of
the
hospital
maternity
services.
There
is
tremendous
opportunity
to
really
get
our
community
services
working
effectively
and
particularly
to
explore
that
community
hub
and
creation
in
in
the
site,
nursing
james's,
and
we
would
probably
need
some
help
from
the
health
and
well-being
date
and
it'd
be
more
than
a
maternity
hub.
J
J
So,
just
as
councillor
charwood
mentioned
prior
to
starting
the
formal
group,
we
had
breakout
groups,
we
heard
directly
from
people
representing
black
and
asian
communities
about
the
experiences
of
their
communities
in
relation
to
maternity
services,
and
certainly
the
group
housing
was
so
powerful,
as
provided
so
much
food
for
thought
and
just
to
remind
health
and
wellbeing
board
members
that
these
are
the
things
that
we
asked
you
to
bring
back
for
the
discussion.
That's
going
to
take
place
now.
A
Okay,
thank
you.
You
both
concluded
your
opening
remarks
for
this
item.
Yeah.
I
can't
see
any
indications
that
somebody
else
needs
to
speak.
I've
got
a
couple
of
people,
who've
highlighted
questions.
I
think
I've
got
julian
and
then
I've
got
julian
hartley
and
then
I've
got
councillor
venom.
If
that's
correct,
please
go
ahead.
If
you
want
to.
H
Thank
you
very
much.
Thank
you
very
much
chair.
Can
I
just
first
of
all,
I
think,
pay
tribute
to
jane
and
sue
the
work
and
the
whole
team.
H
Indeed,
the
work
that
you've
done
on
this,
and
particularly
in
relation
to
obviously
the
a
lot
of
work
on
the
maternity
reconfiguration,
the
consultation
it
was,
I
think,
indicative
of
the
quality
of
the
work
that's
gone
into
it,
that
when
we
attended
the
scrutiny
board,
councillor
hayden
who
chairs
the
scrutiny
board,
paid
tribute
to
the
the
what
the
the
very
engaging
and
positive
way
in
which
consultation
had
taken
place
and
described
it
as
an
exemplar,
so
that
that
that's
good
in
terms
of
the
way
that
the
team
of
engaged
colleagues
and
I
know
I've
been
involved
in
some
of
those
meetings
with
a
whole
range
of
participants
and
stakeholders.
H
The
point
I
wanted
to
make
and
the
question
I
wanted
to
ask
was-
I
was
really
struck
by
the
thalmas
points
in
our
session
about
the
experience
and
indeed
education,
of
a
number
of
our
black
asian
and
minority
ethnic
communities
and
and
parents,
and
I
noticed
that
in
one
of
the
key
areas
of
focus
in
preparation
for
parenthood
is
better
parent
education.
H
That
seemed
to
be
a
key
issue
in
relation
to
what
thelma
was
describing
in
her
experience
and
her
role,
and
I
just
wondered
how
we
as
a
system
we
as
a
a
board,
and
indeed
through
the
various
vehicles.
We've
got
like
the
health
and
care
academy
and
other
system-wide
interventions
that
we
can
help
drive
and
support
better
parent
education
in
its
broadest
sense,
across
some
of
our
most
deprived
communities
and
with
a
particular
focus
on
black
asian
and
minority
ethnic
communities.
A
Yep,
thank
you
julian.
I
think
we
had.
We
did.
We
distilled
some
things
down
around
some
people
who
had
who
had
moved
to
to
this
the
city
from
abroad
and
different
cultures
that
perhaps
had
different
levels
of
understanding
around
biology
and
basic
ideas
around
reproduction,
and
things
like
that.
So
it's
it's
addressing
some
real
knowledge
gaps,
as
you
say,
and
ways
for
people
to
keep
themselves
well
and
how
we
address
that.
A
F
Or
a
fun
future,
I
wanted
to
ask
a
specific
question
about
fetal
alcohol
syndrome,
which
is
something
I've
been
reading
a
lot
about
recently,
but
also
I've
met
a
number
of
adoptive
and
foster
families
with
children
who
have
fake
alcohol
syndrome
where
the
child
has
free
clerical
syndrome.
And
I
feel
this
is
an
issue.
That's
not
doesn't
have
the
prominence
that
it
should
have
in
terms
of
the
prevalence
of
the
number
of
babies
that
are
born
with
fetal
alcohol
syndrome
and
just
the
profound
damage
that
that
causes.
F
I
met
a
gorgeous
little
boy
pre-lockdown,
who
had
had
heart
surgeries,
baby
and
had
really
significant
learning
disabilities,
and
I
think
the
physical
disabilities
and
health
conditions
and
cognitive
impairment
front
of
a
better
world
are
really
profound
when
children
are
born
with
fake
alcohol
syndrome,
but
there's
also
a
significant
issue
where
families
sometimes
struggle
to
get
a
diagnosis
which
makes
difference
to
the
support
that
they
can
access.
A
All
right,
thank
you
very
much
counselling
I'll,
also
ask
somebody
to
consider
how
they
can
respond
to
that
and
we'll
bring
you
in
after
john
beale.
I
Thanks
chair,
we
had
a
a
very
useful
presentation
from
heather
who
talked
about
why
some
groups
don't
present
early
for
maternity
care
in
the
first
trimester
why
they
may
adopt
specific
practices
during
pregnancy
and
during
childbirth.
But
two
specific
points
that
came
out
one
is
it's
a
general
point
that
we
tend
to
use:
bame
black
asian
and
minority
ethnic
as
if
they
are
a
homogeneous
group
and
they're.
Not
they
are
a
very
diverse
group.
I
They
include,
for
instance,
black,
caribbean
black
african,
even
within
south
asian,
the
there
are
indian
bangladeshi
pakistani
people
from
different
heritage,
who
may
have
very
different
health
beliefs,
very
different
health
behaviors,
and
we
do
need
to
to
break
it
down
and
not
just
refer
to
to
being
communities.
So
that's
the
first
general
point.
I
The
second
was
as
far
as
the
maternity
services
are
concerned,
there's
been
a
very
extensive
consultation,
but
there
are
some
groups-
and
I'm
not
quite
sure
how
much
has
been
heard
from
these
groups-
that
there
are
some
groups
who
don't
fill
up
surveys.
They
don't
go
to
public
meetings
and
we
do
need
to
identify
those
groups
and
find
out
how
we
can
involve
them
in
the
consultation.
I
A
Thank
you,
dr
bill.
That's
yeah
very
useful
contribution.
Thank
you
for
that.
I've
got
victoria
eaton
you'd
like
to
come
in.
G
Thanks
chair,
yes,
it
was
just
to
pick
up
on
a
couple
of
comments
relating
to
what
julian
said,
and
also
just
in
terms
of
jane
and
sue's
presentation.
I'd
also
like
to
pay
tribute
to
the
to
the
work
and
how
they've
described
the
approach,
which
is
absolutely
one.
That's
been
integrated
across
services,
but
also
taking
that
broader
population
approach
and
we've
worked.
I
think
it's
an
exemplar
of
how
we
should
work
more
broadly
around
integration.
G
I
I
think
it
then
plays
into
some
of
the
comments
around
the
issues
that
have
just
been
discussed,
and
particularly
the
the
part
around
the
preparing
for
parenthood
bit
of
one
of
jane's
slides,
which
just
cover
some
of
the
issues
around
addressing
you
know
drug
and
alcohol
use
in
pregnancy
or
healthy
living
more
generally.
G
But
but
it's
it's
one
part
of
a
broader
approach
that
does
address
a
whole
range
of
other
things
that
that
go
beyond
that
programme.
G
So
the
best
start
program
that
we
as
a
city,
support
which
starts
in
conception
for
the
first
first
thousand
and
one
days,
is
absolutely
key
in
terms
of
improving
outcomes
and
jane
also
mentioned
the
increase
in
infant
mortality,
which
is
really
concerning
for
a
city
that
was
going
the
in
the
right
direction
for
many
years,
around
infant
mortality,
which
has
started
to
head
in
the
wrong
direction,
and
we've
recently
highlighted
that
this
is
one
of
the
one
of
the
four
reasons
why
we're
seeing
the
the
widening
of
the
gap
in
health
inequalities
across
the
whole
age
range,
and
we
know
what
works
around.
G
Reducing
infant
mortality
and
we've
had
some
fantastic,
very
localized
programs
of
working
communities
when
we,
where
we've
got
our
highest
rates,
but
it
does
it.
It
goes
beyond
the
healthy
lifestyle
agenda
into
the
agenda
of
overcrowded
housing.
People
with
drug
and
alcohol
dependency
issues.
All
of
that
all
of
the
the
broader
inequalities
conversations
that
we're
having
around
covid
in
those
those
communities
that
are
most
at
risk.
G
Many
of
those
factors
also
play
into
to
that
to
these
outcomes.
So
I
would
just
emphasize
the
strength
of
what's
in
there
already,
but
but
also
emphasize
that
it
does
go
beyond
that
and
we
need
to
describe.
G
We
need
to
describe
the
whole
of
that
and
part
of
that
links
to
council
ivana's
question
about
fetal
alcohol
syndrome,
because
one
of
the
worrying
trends
is
that
we
have
seen
an
increase
in
fetal
alcohol
syndrome
across
the
city,
and
we
need
to
you
know,
respond
to
that
in
a
robust
way
with
with
addressing
all
of
the
factors
that
lie
underneath
that.
G
So
I
I
just
I
I
just
emphasize
that
that
there
is
that
broader
range
of
programs
that
also
sit
alongside
this
work,
that
we
absolutely
have
to
prioritize
alongside
the
service
transformation,
but
yeah
happy
to
have
further
conversations
after
after
the
board
on
that.
Thank.
A
In
our
in
our
session,
we
also
had
a
discussion
about
how
diagnosis
of
conditions
during
pregnancy
was
found
to
be
difficult
by
some
mothers
who
velma
was
describing
how
perhaps
the
conditions
weren't
being
picked
up
by
gps,
and
that
may
be
because
of
the
way
that
it
was
described
and
the
ability
to
to
articulate,
but
also
some
quite
clear
symptoms
that
weren't
picked
up
in
the
in,
in
their
view,
on
a
recurrent
basis
of
preeclampsia
and
and
things
like
that.
A
So
I
don't
know
if
anybody
wants
to
pick
that
up
in
in
a
moment,
but
I'm
just
going
to
bring
in
them
allison
low.
Who
wants
to
speak
about
the
issue
as
well.
E
Yeah,
so
I
was
really
pleased
to
see
that
one
of
the
areas
of
priority
is
going
to
be
peer
support,
because
I
think
that
the
issue
of
black
mothers
being
five
times
more
likely
to
die
in
childbirth
is
a
huge
issue
that
we
should
all
be
really
angry
about.
E
Actually
and
there's
lots
of
you
know
nice
talking,
but
we
should
be
very
angry
about
the
fact
that
if
you're
blacking
five
times
more
likely
today,
according
to
the
uk
confidential
inquiries,
internal
deaths
and
one
of
the
ways
that
we
could
address,
that
is
through
peer
support.
E
Liz
wigley
once
commissioned
the
best
project
which
my
organization
co-delivered,
which
was
focused
on
working
with
parents
around
their
ability
to
parent
and
over
100
kids
were
not
to
two
and
we
saved
80
children
going
into
potentially
going
into
care
to
result
that
product,
so
peer
support
is
hugely
important,
but
also
the
training
of
medical
staff
about
the
particular
and
different
needs
of
black
women
in
pregnancy.
I
think,
is
a
key
area
that
we
need
to
be
identifying
here
and
doing
something
about,
and
ltht
really
have
to
be
there
here.
E
But
there
are
lots
of
things
that
we
could
introducing
to
the
training
or
midwives
and
for
doctors
on
maternity
wards,
which
I
think
would
transform
the
experiences
of
black
parents.
The
other
thing
that's
important
is
female
genital
mutilation
that
massively
impacts
on
people's
ability
to
get
pregnant,
but
also
once
they
get
pregnant.
There
are
obviously
additional
factors.
E
There
is
an
nhs
funded
pilot
at
the
moment
and
doing
some
brilliant
work,
and
I
wonder
how
the
strategy
is
going
to
include
women
who
have
been
subject
to
fgm,
because
there
are
lots
and
lots
of
people
in
leeds,
as
well
as
in
the
wider
uk
who
have
been
subject
to
that
and
who
experience
different
outcomes
as
a
result
of
that,
and
also,
I
think,
it's
important
to
understand
that
the
issues
for
black
women
are
very
significant.
E
There
are
also
issues
for
lesbian
and
by
women
who
I've
got
personal
experience,
because
my
daughter
is
gay
and
access
to
ivf
for
lesbian
women
is
incredibly
difficult
and
there
has
been
I've
got
lived
experience
of
different
treatment
for
lesbian
and
bi
women,
which
has
not
been
the
case
for
all
the
women
who
were
straight.
So
I
think
there
are
factors
for
lots
of
different
protected
characteristics.
We
don't
need
to
lose
that.
A
Okay,
thank
you
very
much,
so
I
think,
with
a
bit
of
a
feature,
the
discussion
has
been
about
bringing
it
in
views
and
the
experiences
of
a
wide
range
of
different
experiences
and
needs,
and
if
anyone
wants
to
pick
up
those
those
issues,
that
would
be
really
good.
I
was
also.
I
would
like
to
echo
the
comments
made
about
how
this
is
a
great
example
of
integration.
You
know
one
of
our
primary
functions
as
a
board
is
to
further
integrate
everything
we
do.
That
is
a
journey
which
never
ends.
A
I
think
it's
a
tough,
tough
ask
to
keep
integrating
and
what
we
do.
But
if
I'd
just
like
to
say
thank
you
to
everyone
for
the
work
that
they've
done
to
to
really
integrate
this
this
work,
because
it's
right
absolutely,
we
need
to
get
to
every
part
of
our
communities
and
every
every
setting
in
which
people
need
support
around
paternity,
and
that
is
a
whole
range
of
places.
So
thank
you
for
for
that.
I
think
I've
got
hannah
who
wants
to
come
in
as
well.
E
Yeah
thanks
yeah.
Thank
you
just
just,
and
I
don't
know
if
it's
part
of
the
strategy
or
but
it
would
just
be
good
to
play
in
and
sort
of
ask
the
question
around
how
services
are
adapting
in
light
of
covid.
We've
had
some
feedback,
not
a
lot
of
fee,
but
some
feedback
about
people's
experiences
and
the
impact
it's
having
on
them
and
not
having
follow-up
consultations
and
not
being
seen
face
to
face
or
getting
maybe
getting
the
support
they
needed
on
breastfeeding,
and
that
was
earlier
in
the
process.
E
So
you
know
I'm
not
sure.
If,
if
things
are
you
know,
but
I
suppose
it's
you
know
the
the
person
we
have.
The
feedback
was
a
first-time
mom.
It's
a
huge
event.
It's
you
know,
you
know
and
to
feel
alone
and
isolated
is
not
what
we
want.
That's
not
the
best
start
for
the
mum
or
the
baby.
So
just
just
something
around
the
clovid
response.
A
Okay,
now
I
I
haven't
got
anyone
else
indicating
I
I
know
we
need
to
agree
some
actions
that
I'll
be
turning
into
talk
about
in
a
moment,
but
did
jane
or
sue
want
to
come
in
and
just
discuss
any
respond
to
any
points
that
been
raised
and
how
that
might
be
incorporated
in
our
strategy
going
forward.
And
if
I
could
also
echo
the
the
the
praise
about
how
the
consultation
on
the
changes
to
the
maternity
units,
when
I
think
it
was
a
really
really
excellent
consultation.
A
We
were
all
very
involved
and
engaged,
and
I'm
really
pleased
that
that
went
through.
So
do
you
want
to
come
in
jane
or
sue,
and
any
gps
would
like
to
respond
to
the
issue
around.
J
J
I
suppose
there's
so
many
things
here
that
I've
got
noted.
Absolutely
we
had
a
really
good
conversation.
I'm
glad
that
john
flagged
up
about
the
terminology
and
heather
was
suggesting
diverse
communities
is
a
good
terminology
to
use.
I
think
that's
really
good
and
kind
of
linked
to
that.
To
what
john
was
saying
about
consultation,
I
mean
one
of
the
reasons
that
scrutiny
was
so
positive
about
the
public
consultation
we
did
was.
J
J
That's
when
we
really
have
to
engage
with
people
and
co-produce,
and
we
have
to
one
of
the
things
heather
said
in
our
group-
was
work
with
the
organizations
that
are
trusted
by
the
communities
and
that's
absolutely
the
way
we
have
to
do
it
so
that
so
that's
our
intention
and
that
cuts
across
all
priorities.
So
it's
a
key
principle
that
will
cut
across
preparation
for
parenthood,
personalization,
etc.
It
cuts
across
them
all
in
terms
of
the
fetal
alcohol
syndrome.
J
Absolutely
there
have
been
public
health
campaigns
etc
to
raise
awareness
in
the
past,
and
we
probably
need
to
look
at
doing
that
again
with
our
colleagues
in
public
health.
It's
also
probably
worth
knowing
it's
recognized
as
if
still
rumbled
was
here.
She
would
be
flagging.
This
it's
been
recognized
with
across
west
yorkshire,
integrated
care
system
as
something
that
we
need
to
do
a
piece
of
work
on,
and
we
have
leads
representatives
in
a
working
group
exploring
how
we
can
identify
and
support
more
effectively.
J
This
condition
in
terms
of
integration,
lots
of
the
conversations
that
we're
having
is
also
being
reflected
in
the
refresh
of
the
best
start
strategy
as
well,
so
the
best
start
strategic
plan.
I
was
in
the
meeting
the
day
and
we
were
having
conversations
about
what
we
need
to
do
across
for
our
priority
of
getting
the
best
possible
start
for
babies
and
they're.
Also
really
looking
at
the
strategic
plan
about
how
do
we
address
health
inequalities
and
really
focusing
in
on
that.
J
So
there
is
a
real
commitment
and
we
know
we
have
to
do
better
and-
and
I
and
heather
also
kind
of
mirrored
something
that
victoria
said
which
was
about
this
is
beyond
service.
This
is
about
how
people
are
living
in
poverty,
in
poor
housing,
etc.
So
it
has
to
be
a
broader
partnership
to
create
the
best
start
for
for
our
children
and
needs.
J
That's
the
kind
of
whistle
stop
circuit
of
all
things
that
were
flagged,
but
I
think,
in
terms
of
a
response
to
covet
sue's
best
place
to
reply
to
that.
L
Yeah
thanks
jane
well,
as
everybody
can
appreciate,
kovid's
been
challenging,
but
we
still
want
to
put
the
woman
and
her
family
at
the
heart
of
everything
that
we
do
do
so
it
has
been
challenging
and
from
an
inpatient
experience.
Obviously,
we've
got
the
challenges
of
the
estate
that
we're
working
with,
but
that
still
shouldn't
prevent
us
doing
what
we
can
to
address
the
emotional
needle.
A
lot
of
this
has
been
the
the
perinatal
mental
health
of
women
and
their
families
in
particular.
L
So
we
have
worked
with
with
our
colleagues
within
the
trust
from
an
impatient
stay
and
we
have
now
got
an
appointment
based
visiting
on
the
postnatal
award.
There
are
constraints
on
the
antenatal
ward
that
is
much
more
difficult
and
obviously
with
local
lockdown.
There
are
implications
there,
but
we're
working
in
full
collaboration
with
ipc
colleagues
and
estates,
etc.
L
To
address
that
one
of
the
real
areas
that
has
caused
a
lot
of
concern,
not
the
beginning
of
covid,
but
in
recent
weeks,
has
been
the
scanning
issue
and
again
we're
working
with
our
radiology
colleagues
on
addressing
that,
particularly
when
it's
such
a
unique
experience.
L
Isn't
it
pregnancy
and
it's
such
a
precious
experience
that
if
we
don't
get
things
as
as
as
okay
as
we
possibly
can,
the
impact
later
on
throughout
the
family,
the
next
thousand
days
and
onwards
and
onwards
we're
going
to
be
living
with
this
potentially
for
years
and
years
and
years?
So
we've
we've
got
to
work
really
hard
at
recognizing
everybody's
needs.
L
But
again,
remember
the
woman
is
at
the
heart
of
what
we
do
do
so
we
do
have
partners
coming
in
for
scans
now
for
dating
scans
for
20
week,
anomaly
scans,
where
we
examine
the
the
baby
to
make
sure
there's
no
problems
and
an
early
pregnancy
as
well.
I
think
that
we
are
trying
to
get
back
to
normal
in
postnatal
care
with
our
community
midwifery
services,
so
we're
still
doing
a
lot
using
the
digital
platforms.
L
But
again
the
face-to-face
is
really
important.
So
again,
we
are
now
beginning
to
do
we're
back
in
services
and
we
are
doing
face-to-face
bookings
alongside
still
some
virtual
appointments,
but
we're
trying
to
get
much
more
that
person
to
person
appointments
that
risk
assessment
in
place
as
opposed
to
what
we
were
doing
before,
and
I
think
it's
such
an
evolving
field
that
we
are,
we
have
to
demonstrate
flexibility
and
responsiveness
at
all
times
in
order
to
deliver
what
we
can
again
for
the
family
and
the
woman.
L
Just
a
point
about
what
alison
was
saying
about
about
about
black
mothers,
not
only
the
embrace
reports.
You
know
the
covid,
the
response.
L
Our
families
from
the
bay
and
backgrounds,
I
would
really
welcome,
welcome
working
with
you
alison
about
what
you
were
saying
about:
training
for
midwives,
for
doctors,
etc,
because
we've
got
to
look
at
some
things
with
a
pandemic
as
a
real
opportunity
for
improvement,
and
that
is
definitely
one
and
if
we
just
look
at
vitamin
d,
that's
an
easy
one.
To
start
off
with.
So
very
much
would
welcome
welcome
working
with
you
regarding
that.
So
again,
I'm
really
aware
of
ta
of
time
and
counselor
charlwood,
so
I'll
wrap
up.
A
Thank
you
very
much.
I
think
it's
really
reassuring
for
us
all
to
hear
just
how
wide-ranging
and
the
scope
is
of
their
of
your
thinking,
and
that
just
shows
our
leads
approach
that
it's
shared
with
the
nhs
as
well
as
the
council
about
you
know,
organizations
that
are
trusted
and
work
with
the
communities
and
and
our
minority
ethnic
communities
also
include
our
gypsy
and
traveling
communities
as
well.
You
know
a
very
specialist
group
of
people,
people
very
different,
have
very
different
needs
and
vulnerabilities,
no
matter
what
their
background.
A
So
thank
you
for
all
your
all
your
work
around
that
and
I'm
going
to
bring
in
tony.
If
you
can
bring
in.
If
you
can
take
us
through
the
the
three
things
we
need
to
agree
the
actions
and
then
we'll
agree
the
recommendations.
Thank
you.
C
Yeah
yeah,
absolutely
so
one
of
the
things
we've
been
asking
all
report.
Authors
is
to
be
really
clear
about
what
the
ask
is
and
to
identify
any
tricky
issues
and
any
support
that
they
may
want
from
other
bits
of
the
system.
So
we've
got
three.
The
jane
and
sue
have
identified.
C
The
first
one
is
a
task
to
the
estate's
programme
board
and
it's
following
on
from
centralization
of
hospital
maternity
services.
There's
a
need
for
helping
identify
an
appropriate
estate,
progressive
development
of
the
first
integrated
maternity
community
up
in
air
hills
and
also
helping
identifying
any
transport
issues
to
get
to
the
new
hospital.
C
So
one
key
one
there
for
this
state
scored,
there's
one
also
to
to
the
workforce
board
the
city
workforce
board
and
it
links
to
the
earlier
conversation
actually
really
well,
which
is
the
the
opportunity
to
develop
a
workforce
that
represents
all
our
communities
and
one
of
the
things
that
that's
in
paper
is
expanding
the
medulla
model
of
volunteers
and,
in
particular,
the
recruitment
of
support
workers
from
diverse
communities
and
then,
finally,
I'm
not
sure
if
they
can
can
hear
this.
C
But
it's
a
test
to
her
as
the
senior
responsible
officer
for
our
local
care
partnerships
to
explore
with
the
maternity
board
and
the
ability
to
identify
and
recognize
opportunities
locally
for
integrating
lcp's,
best
start
and
early
health
clubs.
So
some
really
key
actions
there
that
we
need
to
agree.
A
C
Yeah,
they
are
indeed,
I
don't
know.
If
anything
can
they're.
A
A
Okay,
I
can't
see
anyone
disagreeing
if
you
want
to
say
anything
about
that
pop
it
in
the
chat.
I
think
these
are
just
actions
that
have
flown
from
the
report
counter
colton
and
if
we
can
now
agree
the
recommendations.
A
A
Okay,
we
happy
to
approve
the
recommendations.
Thank
you
very
much.
Thank
you
for
that
item.
It
was
a
really
excellent
piece
of
work
and
again
oh
sarah
is
saying
she's
already
taking
forward
whole
system
approached
to
recruiting
support
workers.
That's
great
and
you'll
feed
that
through
yeah.
Thank
you
for
your
work
on
this.
It's
a
really
important
area
of
work
for
mums
and
families
and
children
right
across
the
city
really
appreciate
that.
A
Thank
you
very
much,
thank
you
and
thank
you
again
to
those
who
came
with
personal
stories
if
you're
watching
on
youtube.
Thank
you
very
much
for
your
time.
Again,
that's
very,
very,
very
valuable,
okay,
so
without
any
further
comments
on
that
we're
going
to
move
on
to
item
10,
which
is
our
going
further
with
integration
item,
so
this
is
about
pro.
A
So
when
we
share
screens,
I
can't
see
my
yeah.
This
is
about
our
progress
as
a
city
and
the
contribution
of
the
nhs
lead
ccg
shaping
our
future
program.
So
can
everyone
still
hear
me?
Okay,
I've
just
had
a
few
different
screens
pop
up
all
at
once.
There
we
go.
Thank
you
right.
So
without
further
ado,
I
think
I
need
to
just
hand
over
to
catherine
tim.
A
Cathy
is
our
director
of
adults
and
health
and
tim
reilly
is
the
chief
executive
of
the
ccg
and
we're
talking
about
how
we
can
push
forward
together,
as
is
always
our
intention
to
be
more
integrated
in
how
we
do
things,
how
we
deliver
our
services,
how
we
commission
our
services
and
how
we
tackle
health
inequalities,
as
we've
already
described
in
the
previous
item,
at
the
heart
of
everything
we
do.
Can
I
hand
over
to
kath
and
tim
at
the
stage,
and
I
believe
we
have
a
a
presentation
as
well.
F
F
So
I
like
to
think
about
it
as
a
it's
a
bit
like
baking,
a
cake.
There
are
some
core
ingredients,
but
each
place
has
to
write
its
own
recipe
and
what
we're
going
to
hear
in
the
next
few
minutes
in
the
two
presentations
is,
is
some
insight
on
what
those
core
ingredients
might
be.
F
So
in
a
minute
we'll
be
hearing
from
tim,
riley,
chief
exec
of
lead,
ccg
and
tim's
going
to
talk
about
how
commissioning
is
developing
in
the
city,
then
we're
going
to
hear
from
sam
jones
from
operos
health
who
will
be
sharing
international
learning
from
a
provider
perspective,
but
actually
the
reality
is,
I
think,
our
future.
The
distinction
between
commissioner
and
provider
is
going
to
become
more
blurred,
because
actually
our
future
is
about
collaboration
and
partnership.
F
However,
the
starting
point
is
always
the
individual
and
we're
using
the
national
voices
definition
of
integrated
care
as
our
lodestar,
and
you
can
see
that
on
the
screen
now
so
this
is
this
is
how
we
test
have
we
achieved
integrated
care,
so
can
an
individual
say?
I
can
plan
my
care
with
the
people
who
work
together
to
understand
me
and
my
carers.
Allow
me
control
and
bring
together
services
to
achieve
the
outcomes
important
to
me
and
we're
going
to
keep
that
close
to
our
hearts
in
how
we
take
things
forward
in
leads.
F
So
those
are
my
opening
remarks
I'll
now
hand
over
to
tim
he's
going
to
take
us
through
where
we
are
with
commissioning.
H
Thanks
cath
gina's.
D
Going
to
contribute
as
well,
I
think,
as
we
go
for
through
this,
so
I
guess
just
an
introductory
comment
for
me
before
I
hand
to
gina-
and
I
think
it
builds
on
what
kath
has
just
said-
that
this
is
really
important,
that,
as
a
city,
we're
looking
f
much
more
to
build
on
our
collaborative
approaches.
D
Examples
of
where
we're
heading
and
what
we've
done
as
a
ccg
is
well.
We
came
together
from
three
to
one,
but
we
could
easily
have
just
stayed
as
one
very
large
version
of
what
we
were
before,
but
we
recognize
that
if
we
are
going
to
support
that
greater
integration
journey
as
a
ccg,
we
need
to
make
some
significant
changes.
D
I
think
it's
also
fair
to
say:
we've
been
trying
to
be
and
brought
this
work
that
we've
been
doing
into
the
sort
of
spotlight
a
number
of
times,
and
this
is
a
journey
we're
on
as
a
city.
We
aren't
starting
to
collaborate.
We
aren't
starting
to
integrate.
We've
done
an
awful
lot
already,
and
this
is
actually
about
if
you
like,
accelerating
some
of
that,
I'm
gonna
hand
over
a
thing
to
gina.
B
Thanks
tim,
thank
you
yeah,
but
just
in
terms
of
sort
of
describing
and
talking
about
shaping
our
future
program
and
how
it
contributes
to
our
overall
ambition.
B
As
a
as
a
city,
we
thought
it
was
helpful
just
to
start
off
with
the
nhs
leads
strategy
and
the
commitments
that
we've
made
in
that
and
and
really
recognizing.
The
fact
that
the
the
vision
and
ambition
for
the
for
the
ccg
is
is
that
of
the
health
and
well-being
strategy
and
absolutely
shaping
our
future.
B
The
conditions
that
enable
health
and
care
needs
to
be
addressed
around
local
neighborhoods
and
local
care
partnerships,
and
I
think,
just
reflecting
back
on
on
the
really
powerful
sort
of
definition
of
person-centered
and
integrated
care
that
that
catalyst
referred
to
you
know,
delivering
better
outcomes
working
with
people
and
living
more
into
greater
care
can
be
seen,
as
you
know,
really
aligning
with
that
with
our
overall
ambition
next
slide,
please
often,
I
think,
I
think,
from
the
outset,
it's
really
important
to
be
clear
about
why
we've
embarked
on
the
shaping
our
future
journey
as
a
ccg
and,
as
we
said,
I
sat
out
in
the
background
paper
and
it's
been
really
clear
from
the
conversations
already
this
morning.
B
However,
whilst
we
have
made
some
improvements,
we
know
that
people
living
in
neighborhoods
with
the
greatest
socioeconomic
challenges
continue
to
have
poorer
health
outcomes
and
again
that's
come
across
really
really
strongly
from
the
early
conversation
today.
B
We're
also
aware
that,
whilst
we
have
some
really
good
examples
of
person-centered
integrated
care
across
the
city-
and
I
think
the
example
of
the
way
in
which
partners
in
terms
of
both
commissioners
and
providers
of
children's
services
have
worked
together
to
have
a
really
clear,
focused
set
of
obsessions,
with
the
voice
of
the
child.
Central
to
that
and
and
supporting
more
integrated
models
of
care
between
education,
health,
social
care
and
third
sector.
B
Although
we
have
do
have
some
of
those
really
good
examples.
We
know
that
too
often
people
I
receive
fragmented
care
and
which,
which
leads
to
a
poor
experience
of
care.
And
we
also
know
that
we're
often
too
reactive
and
trying
to
solve
the
problems
in
the
here
and
now,
as
opposed
to
looking
in
terms
of
a
much
longer
term
approach
in
terms
of
planning
and
delivering
in
terms
of
the
long-term
needs
of
our
populations.
B
B
And
we
recognize
that
we
need
to
change
the
way
we
operate
commission
and
also
facilitate
change
across
the
broader
health
and
care
system,
in
a
way
that
really
enables
providers
to
make
it
more
easy
for
them
to
work
together
around
integrated
care,
but
also
in
in
a
way
that
enables
to
be
a
lot
more
strategic,
proactive
and
forward
thinking
and
focusing
on
the
health
of
the
whole
population
and
their
long-term
needs,
with
a
much
greater
focus
on
prevention
and
the
wider
determinants
of
health
and
well-being.
B
Next
slide,
please
let
fun
so
in
in
recognition
of
our
need
to
change
the
way
we
operate
and
facilitate
and
commission
more
person-centered
integrated
care.
We
established
the
shaping
our
future
program
in
december
19,
and
the
purpose
of
the
program
is
very
much
to
design
and
implement
a
new
way
of
working
as
a
ccg.
B
A
new
operating
model
to
really
enable
us
to
consistently
and
commissioning
facilities,
facilitate
change
in
this
way
that
really
incentivizes
person-centered
integration
and
a
key
part
of
shaping
our
future
is
around
strengthening
our
capability
as
a
city
to
really
develop
a
strong
and
vibrant
health
and
social
care
system
which,
which
is
able
to
take
a
much
longer
term
approach
to
population,
health,
planning
or
strategic
commissioning,
and
also
enables
a
system.
B
Integration
approach
whereby
providers
and
partners
are
enabled
and
facilitated
through
through
different
ways
of
approaching
pathways
and
building
some
key
infrastructure
across
the
city
and
new
ways
of
working
and
to
deliver
person-centered
integrated
care,
and
we
recognize
a
key
building.
A
key
building
block
of
that
is,
is
actually
supporting
the
design
and
delivery
of
care
with
people
at
locality
level
and
through
local
care
partnerships
and
really
thinking
about
greater
integration
in
terms
of
health
and
social
care.
B
Physical
and
mental
health
and
and
specialist
and
generalist
provision
as
well
and
and
that
integrated
care
wrapping
around
what
matters
most
to
a
person
again
going
back
to
that
to
that
definition
that
we
talked
about
at
this
after
presentation,
the
approach
very
much
builds
on
on
our
track
record
of
partnership
working,
and
I
think
it's
important
to
also
say
that,
alongside
the
shaping
off
future
programme,
we've
also
been
undertaking
some
very
specific
work
as
a
ccg
through
our
health
and
equalities
framework,
which
again
is
around
our
contribution
as
a
ccg
towards
attacking
some
very
specific
issues
in
relation
to
reducing
health
inequalities
across
the
city.
B
So,
just
before
handing
over
to
tim,
I
think
it's
important
to
be
clear
that
it's
our
next
slide.
Please
laugh
fun
and
I
think
it's
important
to
be
clear
that,
although
the
focus
of
our
shaping
our
future
program
and
specifically
the
operating
model,
is
it
really
about
how
the
ccg
needs
to
operate
differently,
and
the
overarching
sort
of
ambition
is
that
is
that
by
operating
differently,
and
by
doing
this,
we
create
the
conditions
to
enable
the
broader
health
and
care
system
to
deliver.
B
Person-Centered
integrated
care
and
in
turn,
improve
population
outcomes
and
reduce
health
inequalities,
and
it's
therefore
been
really
important
throughout
the
shaping
our
future
process
and
for
us
to
co-produce
and
engage
with
our
partners
and
providers
across
across
the
city
to
really
ensure
that
the
directory
travel
aligns
with
with
the
broader
developments
happening
and
the
conversations
happening
between
partners
and
providers
again
around
more
integrated
care
provision
and
networks,
and
also
in
terms
of
how
we
move
towards
more
integrated
commissioning
as
well
through
the
integrated
commissioning
framework
which
we'll
talk
about
later
on.
B
I
think
also
to
say
that
the
the
approach
within
shaping
our
future
and
the
operator
model
is
absolutely
underpinned
by
a
population.
Health
management
approach
whereby
we
take
we
use
data
and
and
leeds
has
got
you
know-
has
got
a
fantastic
asset
and
having
a
really
good.
B
Integrated
data
set
to
really
identify
and
understand
the
needs
of
our
population
across
the
city
and
really
analyze
and
understand
where
the
biggest
opportunities
are
to
improve
population
outcomes
across
our
population
and
then
support
teams
of
professionals,
experts
and
and
people
working
at
locality,
level
and
city-wide
level
to
really
design
and
deliver
solutions
to
really
improve
those
outcomes
as
well.
B
We're
aware
that
to
really
move
forward
and,
as
tim
said,
accelerate
this
new
way
of
working
out
through
shaping
our
future
from
the
new
operating
model
and
we
need
to
develop
new
capabilities
and
new
behaviors,
both
within
the
ccg
and
across
the
broader
city
as
well,
and
I'm
going
to
hand
over
to
tim
now
just
to
talk
through
that
in
a
bit
more
detail.
D
B
Gina,
yes,.
D
Next
slide,
so,
just
in
terms
of
a
little
bit
about
when
we
talk
about
a
new
operating
model,
this
technical
language
in
some
ways-
and
I
think
gina-
is
emphasized
the
importance
of
us
playing
our
part
in
the
city.
Now,
if
we
do
this
on
our
own,
that's
rather
pointless.
D
Developing
those
long-term
outcomes
and
ambitions
that
we
want
to
achieve,
but
driven
by
the
data
and
the
information
that
we
have
so
that
we
are
aware
of
both
the
challenges
that
are
coming
down
the
road
and
we
can
get
onto
that
more
proactive
footing
as
a
system
as
a
place
in
terms
of
what
we
we
need
to
do
and
what
we
need
to
address.
D
So
that's
one
one
part
of
it
and
that's
always
been
to
some
extent
a
role
of
a
ccg
and
a
commissioner.
But
I
think
we
want
to
play
that
role
much
more
as
part
of
a
partnership
and
really
strengthen
it.
The
other
areas
around
the
system,
integration,
capability
and-
and
quite
often,
as
I
said
at
the
beginning,
we
actually
have
a
system
that
is
to
date
being
about
producing
contracts,
creating
competition
and
actually
very
focused
on
service
and
numbers
and
activity.
D
F
D
Focus
on
the
outcomes
that
people
achieve,
rather
than
counting
the
numbers
of
people
going
through
services,
and
also
in
order
to
do
that,
what
we've
discovered
when
we
look
at
sort
of
international
best
practice
and
so
on,
there's
a
whole
set
of
technical
infrastructure
and
cultural
change.
That
needs
to
be
done
and
we're
wanting
to
put
other
resources
that
we
have
as
a
ccg
at
the
disposal
of
the
city
to
support
that
to
develop
faster,
so
very
much
an
enabling
and
function
to
support.
Some
of
that.
So
next
slide.
Please
hannah!
Thank
you.
D
So
what
we've
recognized
we
need
to
do
is
it
requires
new
behaviors
and
capabilities
among
our
teams.
We
have
an
approach.
That's
been
embedded.
I've
been
a
commissioner
for
20
years
in
a
world
of
market
and
challenge,
and
I
I
know
that
needs
requires
a
change.
It
cause
a
change
in
both
the
way
we
think
about
the
world.
D
The
way
we
respond
to
that,
but
also
in
terms
of
the
capabilities
that
we
have
to
support
greater
integration,
more
more
predictive
and
proactive
planning,
and
in
that
sense
it's
very
much
as
it
says
here-
a
symbiotic
relationship
with
the
work
being
done
among
providers
in
leeds,
and
I
I
do
think
it's
really
exciting.
I
love
coming
to
work
in
leeds
because
it's
a
collaborative
city-
and
we
want
to
build
on
that-
I
never.
D
That
is
not
always
the
case
at
all,
and
it's
quite
a
powerful
thing
and
we
know
that
provider
colleagues
are
already
working
a
number
of
partnership-type
relationships,
whether
it's
the
gp
confederation
with
at
least
lch,
whether
it's
work
between
sarah
and
julian
around
how
support
people
with
both
mental
and
physical
health
that
to
need
acute
care,
there's
work
between
lch
and
the
ltht
around
stroke.
Rehabilitation
work,
that's
being
done.
So
all
those
bits
are
happening
are
things
that
we
want
to
build
on,
rather
than
commission.
D
Being
a
block
to
that
commission
being
a
support
to
accelerate
some
of
that
further,
and
it's
also
really
important
that
we
work
very
closely
with
council
colleagues,
as
I
mentioned
already,
so
we
have
an
integrated
commissioning
framework
which
is
in
those
areas
of
shared
ambition.
She
had
responsibility
in
places
like
mental
health
and
some
of
our
older
population
learning
disabilities,
and
so
on
that
we
actually
have
an
integrated
commissioning
framework,
and
caf
may
well
want
to
comment
a
little
bit
more
on
that.
D
The
other
thing
I
just
mentioned
is
this
is
very
much
about
the
national
direction
of
travel
for
ccgs.
I'm
not
sure
ccgs
will
exist,
who
knows
post
legislative
changes
that
are
due
next
year.
But
what
I
do
know
is
those
strategic
capabilities
are
important
for
every
city
and
what
we're
looking
to
do
is
to
work
through
a
city-based
approach
to
make
sure
that
those
are
embedded
whatever
the
future
and
national
changes
to
legislation
are-
and
I
think
quite
powerfully-
and
we
also
wanted
to
make
sure
sorry,
let's,
let's.
A
D
To
the
next
slide,
thank
you
sorry.
So,
just
before
I
introduce
sam
the
only
bit,
I
would
just
play
in
picking
up
a
comment
at
the
side
there,
one
of
the
things
we're
wanting
to
do
and
why
the
gp
confederation
in
particular,
is
a
really
important
partner
in
in
the
work
that
we're
doing
is
around
the
development
and
sorry
and
the
councils
around
the
development
of
local
care
partnerships.
D
Actually
they
become
a
place
where
a
lot
of
the
decisions
are
made.
When
we
talk
about
population,
health
and
management,
population,
health,
what
we've
actually
done
is
we've
been
part
of
a
national
pilot
and
we've
created
data
sets
that
have
now
been
taken
on
by
the
the
lcp
development
team
to
really
support
people
working
in
local
places
to
address
some
of
the
challenges
of
health,
and
when
we
talk
about
health
inequalities
work.
D
What
we're
wanting
to
do
is
make
sure
that
we
steer
that
resource
to
the
people
closest
to
the
communities
where
that
inequality
shows
up
and
that's
part
of
our
approach
and
part
of
the
health
inequalities
framework
that
we've
sent
around
previously.
So
I'm
sure
we'll
talk
a
little
bit
more
about
that
there'll,
be
questions
and
coming
so
I'm
now
going
to
pass
on
to
sam.
I
just
should
probably
introduce
sam
a
little
bit
before
she
speaks.
D
D
So
I
know
colleagues
at
ltht
and
certainly
us
and
ccg.
I've
been,
for
example,
look
at
the
montefiore
system
and
the
work
the
king's
fund
have
done
on,
describing
that
I'm
talking
to
to
staten
island
as
well,
it's
another
part
of
new
york,
which
is
a
very
similar
model
shortly.
D
We've
certainly
learned
from
some
of
the
work
done
in
canterbury,
for
example,
and
then
one
of
the
other
really
good
places
that
we're
all
aware
of,
and
a
number
of
us
have
had
contact
with
in
the
past
in
valencia
and
and
so
in
doing
that.
What
we
wanted
to
do
is
to
say
how
can
we
learn?
How
can
we
garner
support
from
some
of
those
systems
to
help
us
on
our
being
the
good
position?
D
We
are
to
being
an
even
better
position
in
terms
of
our
population
outcomes
and
sam
represents
opera
health,
which
is
very
integral
to
the
valencia
system.
Among
many
others,
as
sam
will
touch
on
what
we've
asked
her
to
do
is
really
focus
from
their
experience
on
what
some
of
the
key
aspects
of
a
really
successful,
integrated
health
and
care
system
might
be.
So
with
that
sam
I'm
going
to
hand
over
to
you,
okay,.
K
Thank
you
very
much
yeah.
Thank
you
and
thank
you
for
inviting
me
today
and
for
your
warm
welcome,
and
I
have
a
long
career
in
healthcare
in
this
country
is
about
31
years.
K
I
think
I'm
a
nurse
by
background,
I'm
a
hospital
chief
executive
by
background
and
more
lately
I
led
the
new
models
of
care
program
nationally,
where
we
were
prototyping
the
new
models
of
care
for
the
healthcare
system,
and
I
start
with
that,
because
it's
important
that
when
we
talk
about
integration,
many
of
us
have
been
thinking
about
it
as
the
holy
grail
for
a
very
very
long
time,
and
it's
always
useful
to
remember
that
it
doesn't
matter
whether
you
look
at
international
systems,
whether
you
look
at
systems
in
other
parts
of
the
country.
K
What
is
the
most
important
is
the
local
community
and
getting
it
right
for
the
local
population
and
because
context
is,
is
everything
so
there
are
some
enablers
which
I
will
talk
through,
but
the
local
relationships
and
the
local
context
are
the
most
important.
I
do
have
a
number
of
slides,
but
I
promise
to
try
not
to
do
death
by
powerpoint
and
I'll
flip
over
some
of
them,
but
obviously
leave
them
with
you
as
well.
Next
slide,
please!
K
If
we
keep
going.
Thank
you
so
just
a
brief
moment
on
what
is
opera's
health,
so
we
support
and
enable
integrated
care
in
the
uk.
So
we
have
four
main
approaches
to
it,
which
you
can
see
three
on
screen.
The
fourth
one
first
of
all
is
by
delivering
strong
primary
care,
because
primary
care
is
where
population
health
management
starts.
I
don't
just
mean
general
practice.
K
I
mean
population
health
in
terms
of
the
local
communities
and
providing
the
care
for
the
local
population
supporting
to
and
designing
a
system
around
individual
patients
and
I'll
come
back
to
this
in
a
second,
because
I
know
we
talk
about
this
a
lot
and
again
in
terms
of
the
holy
grail,
which
gives
some
very
practical
examples
about
what
does
that
mean
using
our
technology
and
expertise
that
we
can
leverage
from
our
international
partners
both
across
in
the
terms
of
the
us
and
also
in
spain,
as
referred
to
by
tim
and
supporting
partnerships
at
a
local
and
a
national
level
in
terms
of
how
to
do
integration
in
practice?
K
K
So
I
was
delighted
to
hear
gina
describe
the
approach
that's
been
taken
in
leads,
and
certainly
from
my
national
work
recently
and
also
again
with
opera's
health.
Of
course
it
needs
to
start
with
the
individual,
the
citizen,
at
the
center
of
their
care.
Now,
if
I
give
you
a
personal
story
at
the
back
end
of
last
year,
I
was
very
lucky
and
privileged
to
spend
time
with
my
godmother,
who
was
diagnosed
and
subsequently
died
with
motor
neurone
disease
for
those
of
you
that
have
had
con
contact
with
it.
K
It's
pretty
horrible,
so
I'd
gone
from
leading
the
national
work
to
being
a
care
coordinator
for
somebody
at
the
end
of
life
and
despite
the
fact
that
every
single
professional
did
their
absolute
best
to
support
her
at
the
end
of
life,
they
couldn't
they
couldn't
communicate
because
the
systems
were
different.
There
was
duplication.
People
were
asking
the
same
conversation
time
and
time
again.
K
Her
husband
was
disconnected
in
terms
of
local
community
support
because
it
was
very
much
a
health
driven
approach
to
end
of
life.
It
wasn't
around
this
care
and
support
in
the
community
and
certainly
in
terms
of
the
relationship
between
the
local
authority
and
healthcare
was
very
disjointed.
Now
that
is
not
because
the
intent
wasn't
right
and
it
is
not
because
people
weren't
trying
hard
it's
just
every
system
is
perfectly
designed.
K
So
this,
what
we've
tried
to
do
here
is
show
actually,
as
we
all
know,
that
the
care
of
an
individual,
the
citizen
in
the
middle
requires
us
all
to
be
joined
up.
It
doesn't
matter
what
part
of
the
system
we're
in.
We
all
have
some
kind
of
contact
with
the
individual
part
of
the
system
and
for
us
fundamentally,
the
model
of
care
is
about
delivering
that
in
the
least
fragmented
way,
the
most
supported
with
the
individual
in
the
middle
next
slide.
K
Please
and
the
one
after
that,
so
integration,
the
right
intent
alone,
doesn't
make
things
happen.
We
absolutely
know
that
we've
been
trying
for
a
very
long
time
to
make
this
happen,
but
we
know
that
you
need
enabling
support,
functions
and
tools
to
make
it
happen
in
practice.
K
All
of
these
models
are
all
about
local
population,
but
again
an
integrator
holds
the
risk
and
it's
all
outcome
based
or
whether
you
go
to
a
fully
integrated
system
in
the
way
the
ribera
salute
have
in
spain,
which
is
that
it's
a
fully
integrated.
It's
a
capitated
based
system
and
the
organization
takes
the
risk
and
I'll
talk
a
little
bit
more
about
that.
But
the
important
point
here
is
that
an
integrated
care
system
needs
to
be
supported.
K
K
So
we
all
talk
about
population,
health
and
we
all
have
fads.
Don't
we
we
go
through
phases
around
different
types
of
things,
but
at
the
heart
population,
health
management
is
about
understanding
the
population
with
them
involved
and
designing
their
care
plan
in
a
multi-agency,
multi-disciplinary
team
way
adjusting
the
risk
and
then
doing
something
about
it.
K
It's
quite
simple
when
you
say
it
like
that,
but
actually
being
able
to
do
it,
and
that
doesn't
mean
health
in
terms
of
the
community
services
or
the
hospital
or
primary
care
or
the
local
authority
or
social
care
community
services,
local
community
services
having
different
types
of
approaches.
It
means
it's
completely
joined
up
and
that
you
look
at
the
individual
as
a
whole
and
their
care
is
provided
on
the
basis
of
the
risk
as
a
foot
of
them
as
an
individual.
K
And
it's
personalized
next
slide,
please
so
the
ribera
salud
model
in
in
spain
and
one
of
the
benefits
of
of
covid
is
enabling
us
to
communicate
so
virtually
so
so
well.
One
of
the
downsides
is
that
you
don't
get
to
go
and
see
places
in
in
reality,
and
I
would
very
much
like
to
have
seen
you
today
in
leeds,
as
opposed
to
in
buckinghamshire,
so
hopefully
at
some
stage
one
day
but
yeah.
I
hope
you'll
be
able
to
experience
some
of
the
taste
of
ribera
salud
here
today.
K
So
over
the
last
20
years,
valencia,
have
they
started
blending
they've
taken
approach,
which
is
the
citizen
in
the
middle?
All
about
the
citizen,
not
the
patient,
absolutely
notice.
It's
about
the
citizen,
supported
by
a
sound
clinical
management
strategy,
as
you
would
imagine,
with
a
modern
workforce
approach
which
is
digitally
based,
enhanced
cross-functional
information
system.
There
are
some
consistencies
in
all
of
these
types
of
systems
and
again
with
a
citizen
at
the
heart.
K
They
call
it
the
the
triangle
of
success
with
the
citizen
in
the
middle
and
it's
a
combination
of
those
approaches
that
make
the
difference.
It's
not
the
tech,
it's
not
the
data,
it's
not
the
workforce,
it's
not
the
clinical
management.
It's
not
the
approach
to
personalized
medicine.
It's
the
things
coming
together
in
what
they
describe
the
triangle
of
success
and,
if
you
think
about
it
as
a
quality
improvement
program,
it
is
exactly
that
with
the
citizen
in
the
middle
next
slide,
please.
K
So
what
this
means
is
using
the
data
that
has
been
described
so
they
have
a
data
set
for
their
population.
Now,
usually,
when
I
talk
about
this,
people
go
yes,
but
that's
not
where
we
are-
and
I
always
say
but
roberto
salud
started
with
an
excel
spreadsheet.
K
It
started
with
an
excel
spreadsheet
and
they
have
been
able
to
using
the
john
hopkins
scale
of
disease
classification
identify
those
individuals
who
are
most
at
risk
in
their
local
system.
If
action
is
not
taken
they're,
the
top
of
the
triangle
that
you
can
see
there,
but
also
they're
able
to
understand
the
cost
per
patient
and
they're
able
to
see
actually
on
a
daily
basis,
what
is
happening
to
that
individual
and
also
to
the
care
that
is
provided
and
the
outcome
of
that
care
with
the
individual.
K
And
what
that
means
is,
as
you'll
have
seen
in
many
places,
that
you
are
able
to
then
risk
stratify,
so
it
is
at
you,
you
apportion
the
care
with
that
individual,
depending
on
the
level
of
risk
and
depending
on
what
is
best
for
them
and
I'll
come
to
talk
about
this
in
a
little
bit
more
detail.
But
the
thing
to
know
about
ribera
salud
is
it's
a
primary
care
led
system.
K
So
it's
the
hospital,
but
it's
a
primary
care
led
system.
So
it's
a
primary
care-led
hospital.
So
therefore
the
care
starts
with
a
citizen
right
at
the
front
is
coordinated.
It
is
digitally
enhanced,
so
I'll
talk
about
that
in
a
bit
more
detail
in
a
second
and
then
it
is
wherever
possible
are
done
in
collaboration
across
the
multi-agency
teams
working
together
and
then,
depending
on
the
level,
it
depends
on
where
that
care
is
actually
delivered.
Next
slide,
please!
K
So
what
they
do
is
they
take
all
of
the
data
they
take
the
population
health
data
that
we've
described
the
single
source
of
truth
and
they
identify
those
individuals
most
at
risk
of
readmission.
K
If
things,
if
things
are
not
done
differently
now,
it's
not,
it
is
not
being
done
to
it
is
being
done
with
the
citizen
and
with
the
family,
and
every
inpatient
receives
the
readmission
risk.
Score,
which
is
updated
daily
and
in
in
really
importantly,
includes
those
professionals
outside
of
the
hospital,
so
they're
already
planning
what
will
happen
to
prevent
those
individuals
coming
back
next
slide
is.
K
And
importantly,
it's
using
the
technology
to
manage
and
coordinate
the
population
health
needs,
so
they
have
a
portal
so
similar
to
many
of
the
things
that
we're
starting
to
see
and
certainly
been
accelerated
through
kovid,
so
citizen
portal.
They
have
everything
on
their
phone.
They
are
able
to
access
anything
that
they
need
24
hours
a
day
to
the
healthcare
professional
they've
got
their
results.
Can
you
imagine
24
hours
a
day
you
just
need
to
it's
like
phoning.
First
direct,
you
need
to
pay
your
bank.
I
just
need
to
check.
K
What's
going
on
with
my
care
and,
interestingly,
they
haven't
been
overwhelmed,
which
is
one
of
the
first
things
that
come
back.
They
have
all
of
their
public
health
advice,
their
public
health
support,
they're
able
to
get
their
results.
All
the
pharmacy
is
done.
So
you
know
the
self-care
aspect
of
it
is
a
very
important
part
of
population
health
management
and
then,
of
course,
as
you
can
see,
moving
up
the
triangle.
K
I
think
that
is
is
actually
showing
where
individual
parts
of
the
system
come
to
play,
so
primary
care
networks
working
together
using
health
coaching,
for
example,
and
then
moving
up
the
risk
score,
making
sure
the
whole
purpose
behind
this
is
to
keep
as
many
people
at
home
as
close
to
home
as
they
possibly
can,
but
that
the
care
is
accessible
as
opposed
to
them
having
to
come
in
for
the
care
next
slide.
K
Please-
and
why
is
this
important,
because
what
we
know
in
riba
salud-
and
you
will
see
this
replicated
in
any
type
of
integrated
care
system
and
whether
it's
in
spain,
whether
it's
in
the
us,
whether
it's
in
canterbury,
you
will
see
very
similar
that
27
of
the
patients
27
of
citizens
in
a
system
account
for
72
percent
of
the
cost
and
that's
the
financial
cost
to
the
system.
That's
not
the
cost
of
the
individual.
K
So,
of
course,
if
you
target
the
care-
and
we
certainly
saw
this
through
the
national
work
here
in
in
the
uk,
if
you
target
the
care,
you
rack
the
care
around-
that
that
individual
and
they're
they're
caring
their
carers
themselves.
You
are
then
able
to
influence
what
happens
to
them,
creating
additional
capacity
and
support
for
those
people
to
prevent
them
moving
up
the
care
spectrum
next
slide.
Please.
K
So,
just
to
break
this
down
a
little
bit.
The
what's
important
is
when,
from
a
clinical
management
perspective,
it's
making
sure
it's
standardized
and
it's
it's
working
in
accordance
with
best
practice.
Now
we
all
have
care
plans.
We
all
have
different
types
of
plans.
Actually,
how
do
we
know
what
really
goes
on
on
a
daily
basis?
K
Why
did
you
take
that
action
now?
It
was
not
being
done
outside
of
clinical
expertise
is
being
done
because
these
individuals,
the
clinicians,
the
patients,
the
carers,
the
practitioners,
the
pharmacists,
etc,
have
all
designed
these
decision
support
tools.
So
it's
working
to
the
best
practice,
but
what
is
absolutely
doing
is
reducing
variation
and
reducing
variation.
We
know
is
one
of
the
biggest
opportunities,
that's
not
about
just
cost,
but
it's
reducing
variation
of
care
in
terms
of
the
individual
experiencing
it
next
slide.
K
Please,
and
we
did
some
some
work
in
nottingham
last
year
and
what
you
can
actually
see
is,
depending
on
the
individual
care
worker.
So,
depending
on
who
you
interact
in
a
care
team,
there
is
significant
variation
depending
on
that
which
individual
delivers
that
care.
Now
we
sort
of
know
that.
But
what
we've
been
able
to
see
here-
and
you
can
see-
is
that
the
chances
of
going
into
ongoing
care
range
from
1
in
20
to
1
in
4,
depending
on
who
was
delivering
that
care.
K
Now,
that's
not
to
say
the
individual
who's
delivering
that
care
is
not
doing
their
best
because
they
absolutely
are,
but
if
they're,
if
they're,
not
working
to
a
care
pathway,
that's
been
agreed
across
the
system
and
they're
not
supported
and
they're,
not
and
information
isn't
fed
back
to
them
and
they're
professionally
developed
to
understand
the
implications
of
what
they're
doing
they
won't
change.
So
when
I
refer
back
to
a
quality
improvement
approach,
that's
what
I
mean
so
reducing
variation,
and
you
will
certainly
know
this
from
the
work
with
virginia
mason.
K
So
what
is
this
really
like?
That's
all
very
interesting,
sam
and
there's
some
great
management
slides
there,
but
what
does
this
actually
mean
to
an
individual
who's
experiencing
it?
So
what
we
try
to
show
here
is
jim's
story.
So
if
you
start
on
the
left,
so
patient
portal,
as
an
agent,
is
able
to
access
his
care
plan,
he's
able
to
interact
with
care
professionals.
K
He's
got
his
results.
He's
got
his
information,
he
can,
he
can
say
how
he's
feeling
and
he
can
contact
the
care
team
if
he
has
any
concerns
now.
What
happens
there
is
that
jim
is
part
of
a
segmented
system.
He
doesn't
know
he
is.
He
doesn't
make
any
difference
to
him,
but
what
we've
done
as
a
system
is
look
at
the
population
needs
and
we've
been
able
to
segment
them.
So
he
we
know
he's
got
multiple
long-term
conditions,
including
heart
failure
and
diabetes.
K
So
there's
a
dedicated
multi-agency,
multidisciplinary
care
plan
for
him
of
which
he
is
involved
in
the
discussion
around
his
care
plan
and
that
the
workflow
management
that
is
then
put
together
is
based
on
his
care
plan.
So
everybody
can
see,
irrespective
of
where
they
sit
in
the
healthcare
system.
K
Everybody
can
see
what
it
is
that
is
required
to
manage
his
care
appropriately,
and
that
requires
that
join
up
into
how
many
times
have
you
spoken
to
people
who
go?
You
know
I
have
to
tell
my
story
400
times
I
need
to.
I
have
my
results
repeated
100
times,
except
my
blood's
done.
This
is
to
the
workflow
management.
K
So
it's
just
showing
you
some
of
the
outcomes
from
rivera
salud
perspective
before
they
started
population,
health
management
and
then,
after
in
terms
of
so
you
can
see
there
the
impact
themselves
itself
and
this
is
independently
audited.
It's
published,
you
can
look
in
the
harvard
business
review.
You
can
the
individual
audits,
which
I
can
share
with
you.
But
what
is
absolutely
clear
is
that
they
have
reduced
the
a
e
attendances,
they've,
absolutely
reduced,
outpatient
appointments,
not
because
people
don't
necessarily
need
care,
but
it's
how
that
care
is
provided.
K
Their
length
of
stay
has
reduced
and
their
readmissions
have
reduced,
and
this
isn't
just
as
a
snapshot.
This
has
been
ongoing
for
years
and
very
able
to
are
very
happy
to
share
more
of
the
audit,
so
people
would
be
interested
so
moving
on
to
the
next
slide.
K
So,
irrespective
of
which
system
you
look
at
whether
it's
in
this
country,
whether
it's
in
nottingham
or
whether
it
be
in
leeds
or
in
northumbria,
you
will.
There
are
very
similar
types
of
enablers
that
need
to
be
in
place,
and
I
bet
if
we
did
a
look
at
leads
at
the
moment.
You'd
see
many
of
these
types
of
functions
already
being
performed
and
in
one
part
of
the
country
that
we
work
with.
K
There
were
over
30
40
integrated
discharge
teams,
all
working
in
different
parts
of
the
system,
none
of
whom
were
actually
integrated.
So
isn't
it
because
of
our
silo
working
because
of
the
way
that
we've
built
our
structures.
But
what
we
know
is
that
there
is
a
real
opportunity
to
bring
the
system
together
and
to
focus
some
of
the
functions
so
reducing
duplication
and
absolutely
maximizing
the
chances
of
the
people
being
able
to
work
together.
So
next
slide.
Please.
K
That
this
I
took
from
our
national
work.
So
what
do
you
actually
need
to
deliver
an
integrated
system
or
described
here,
a
multi-specialty
community
provider,
but
an
integrated
system?
It
doesn't
just
happen
by
intent,
as
I've
talked
about,
and
certainly
you
go
okay
now.
Where
do
we
start
because
it
feels
so
big?
K
Well,
we
start
like
any
other
transformation
program,
which
is
there
has
to
be
a
shared
local
vision.
We
took
these
themes
from
a
lot
of
international
work
and
a
lot
of
local
work.
So
if
you
don't
have
a
shared
vision,
there
isn't
any
point
in
starting,
so
what's
the
shared
vision
and
who,
who
is
actually
driving
and
managing
that
transformation
program.
So
when
we
all
talk
about
integration,
we
go
yep,
it's
the
most
important
thing.
We
know
this.
This
makes
sense
for
us
as
individuals.
K
K
So
what
is
the
engine
room
as
it
was
described,
and
how
is
that
transformation
program
being
managed
and
how
decisions
made
do
people
really
know
how
decisions
are
made?
Is
there
is
actually
there?
A
board
that
takes
collective
system
responsibility
and
is
able
to
move
things,
but
do
people
know
so
I'm
not
one
for
drawing
lots
of
structures
on
on
the
governance.
Chart.
K
That's
important,
but
what's
really
important
is
that
people
know
how
those
decisions
are
made
and
share
that
collective
responsibility,
and
I'm
not
sure
I've
said
this
strongly
enough,
but
people
that
have
had
me
talk
before
basically
say
I
bang
on
about
this.
If
there
isn't
a
single
source
of
truth,
if
you
don't
understand
your
population
as
a
collective
with
that
data,
it
won't
happen.
So
when
I
was
a
hospital
chief
executive,
I
had
my
three
times
a
day
conference
calls.
K
Whilst
we
were
trying
to
go
through
when
we
were
all
under
pressure,
different
types
of
alerts
and
we'd
all
sit
there
and
go
yet
we're
absolutely
all
the
system.
Leaders
looking
at
the
same
bit
of
information,
but
actually
we
had
our
own
separate
lists
and
we're
looking
at
our
own
separate
bits
of
data,
because,
if
we're
not
looking
at
the
same
thing
and
if
we
don't
understand
collectively
the
needs
and
therefore
the
actions
that
need
to
be
taken,
we
don't
have
a
single
source
of
truth.
K
What's
really
important
is
to
understand
how
and
what
are
the
interventions
that
are
going
to
lead
to
the
changes
that
are
needed?
Sometimes
we
don't
know
what
they
are,
but
the
logic
model
associated
with
means
that
you
can
actually
track,
and
you
can
stop
doing
things
if
it
does
isn't
making
a
difference
to
the
individual,
the
people,
the
citizen
of
leeds
and
the
transformation
program
itself
and
again
the
value
proposition.
The
financial
case-
and
I
refer
to
this
because
people
go
yep,
but
we
don't
have
any
money.
K
K
There's
no
question
that
we
know
when
we
have
different
parts
of
the
system
being
able
to
design
and
document
different
parts
of
the
care
reader's
design
around
the
local
population,
the
lcps,
the
voluntary
sector,
the
community,
we
all
we
kind
of
know,
and
they
certainly
know-
and
those
individuals
who
are
delivering
their
care
and
certainly
the
individuals,
the
citizens
and
themselves
who
are
both
potentially
going
to
receive
care
or
are
receiving
care.
They
absolutely
know
what
they
need.
K
So
the
care
design
isn't
really
the
most
important,
but
what
it
is
is
bringing
it
all
together
and
then
making
sure
you
plan
you
plan
and
you
plan
and
you
execute
as
a
as
you
would
do
with
any
normal
change
program
and
adapt,
and
I
think
there's
one
other
bit
at
the
bottom,
which
I
can't
actually
see,
which
is
a
good
challenge
for
me.
Bear
with
me
once
I
just
confirm
the
last
one
and
then,
and
only
then
do
you
commission
the
new
model.
K
A
Is
that
the
conclusion
of
the
presentation
from
the
presenters
just
to
say
yes,
it
is
yep
great.
Can
I
just
say
that?
Is
it
samantha
or
sam
sorry
either?
A
Oh
well,
thank
you
for
coming
today
and
I
didn't
get
a
chance
to
introduce
you
or
welcome
you,
but
I
really
appreciate
your
time
and
and
bringing
us
your
insights
and
and
the
really
really
great
level
of
understanding
and
experience
from
around
the
world
as
well.
It's
really
really
valuable.
We
always
want
to
learn
and
listen
to
what
others
are
doing
and
see
how
we
can
how
we
can
use
insight
from
elsewhere
to
enhance
what
we're
doing
and
make
it
work
for
leads
as
well.
A
I
think
that
we
have
had
a
really
good
level
of
detail
in
those
presentations,
but
I
don't
think
we're
going
to
do
it
justice
if
we
try
to
make
decisions
today,
because
we
simply
won't
have
time
and
from
now
till
the
end
of
the
meeting
really
to
chew
it
over
so
the
beginning
of
the.
I
will
take
some
questions,
but
I'm
just
saying.
A
I
think
that
we
need
to
bring
this
to
a
workshop
of
the
health
model
being
bored
as
we
discussed
at
the
beginning,
when
council
galton
mentioned
that
we
could
do
with
a
bit
more
discussion
about
this
anyway,
in
terms
of
it
not
just
being
a
one
item
and
then
we
we
know
we're
doing
it's
such
a
big,
long-term
piece
of
work
that
we
need
to
really
get
get
together.
So
I'm
going
to
suggest
that
so
I've
got
a
number
of
people
needing
to
leave
the
meeting.
A
So
I'm
going
to
I'm
going
to
take
that
forward.
Then
it's
as
a
as
a
thing
we
need
to
do.
I
do
have
a
few
people
who
want
to
speak
got.
I
think
counter.
Colton's
question
was
answered
by
lcps
during
the
presentation
and
council
gotten
saying:
the
presentations
are
very
useful
and
help
to
explain
the
the
issues
much
better
than
the
paper
did
for
lay
people
such
as
ourselves,
and
thank
you
and
kath's
also
agreeing
that
it
should
be
taken
into
a
development
session.
A
I
think
so
I
don't
think
we'll
have
enough.
There's
no
there's
there's
not
enough
time
to
go
through
it
properly.
I
think
I've
got
two
people
who
want
to
ask
a
question:
alison
lowe
and
council
harrington.
So
can
I
take
allison
first?
Yes,.
E
Thank
you.
It's
not
a
question,
it's
a
it's
a
statement,
so
I
just
want
to
ensure
that
all
conversations
about
commissioning
at
ccg
level
and
across
the
piece
take
account
of
the
ics
review
into
them.
Experiences
of
health
inequalities,
there's
a
big,
deep
dive
being
undertaken
into
commissioning.
We've
got
lots
to
say
so.
E
I
chair
the
the
vcs
panel
that
shadows
that
group
we've
got
lots
and
lots
to
say
about
that,
and
I
would
also
say
that
we
need
to
co-produce
in
leads
some
commissioning
principles
with
all
our
partners
and
it
really
mirrors
in
somewhere
the
new
lch
first
sector
strategy,
because
we
should
have
a
third
sector
strategy
across
leads
across
all
statutory
commissioning
partners
and
providers
to
talk
about.
What's
really
important,
we
want
to
achieve
better
outcomes
for
all
our
communities.
So
please
look
for
that
piece
of
work.
A
E
Thank
you
chair.
It's
just
a
with
my
previous
work
life
experiences,
there's
roughly
2
300
prisoners
in
incarcerated
in
the
lead
city
area,
so
you've
got
leeds
prison
with
1200
and
odds.
You've
got
wilson
with
800
nod
and
then
you've
got
weatherby
with
a
couple
of
hundred
and
I'm
just
interested
to
know
how
we
integrate
prison
health
care
into
the
broader
community,
because
there's
also
there's
mental
health
issues
as
well
as
physical
health
issues.
The
the
fact
that
computers
don't
speak
to
each
other.
E
The
fact
that
those
many
of
the
prisoners
got
mental
health
issues,
but
then
you
also
have
to
remember
that
there
are
female
prisoners
incarcerated
from
leeds
the
lead
citizens,
sorry
in
wakefield
and
york,
so
that
it's
not
just
about
people
who
are
living
in
the
city
and
you
you
send
somebody
to
prison.
You
forget
all
about
them,
so
I
think
in
the
development
group
I'd
like
to
see
something
some
discussion
on
how
prison
healthcare
is
integrated
as
well.
Thank
you.
A
Thanks
does
anyone
want
to
come
back
quickly
on
how
prison
healthcare
is
currently
delivered?
My
understanding
is
it's
a.
Is
it
an
nhs
england
commissioned
service
and
not
something
we
directly
do
that's
just
a
local
service,
so
tony.
C
Yeah
that
that
that's
right
there
there
are
different
bits
to
it,
there's
obviously
the
prison
health
care
that
did
used
to
be
delivered
by
a
leads
organization
and
then,
as
the
canvas
delivered
also
in
custody.
Suites
and
one
of
the
key
issues
is
obviously
prison
discharge
and
when
prisoners
particularly
short-stay
prisoners
come
back
into
leads
ensuring
that
they
have
primary
care
and
mental
health
and
substance
mission.
C
It
is
something
we've
looked
at,
obviously
in
previous
health
and
well-being
board
sessions,
but
I
do
think
it's
a
good
idea,
maybe
to
to
open
that
up
again-
and
I
know
simon
and
colleagues
in
safe
elites.
A
Yeah,
and
certainly
something
around,
I
was
gonna,
say
discharge,
but
at
release.
It's
certainly
something
we
need
to
be
integrated
about
with
housing
and
support
and
healthcare
as
well
and
social
care
in
imprisons
cats
is
describing
its
commission
by
the
local
authority
yeah.
So
that's
something
we
should
take
forward
as
well
into
our
discussions.
So
I
have
and
john
dr
bill
saying
good
point
is
a
very
good
point.
Thank
you
for
bringing
that
up.
A
So
I'm
going
to
suggest
at
this
point
that
we
move
this
item
into
a
development
session
and
that
we
take
further
discussions
there
and
I'm
going
to
sort
of
assume.
Therefore
we
don't
need
to
move
the
recommendations,
but
someone
from
governance
might
change
might
have
a
problem
with
that.
So
if
anybody
wants
to
suggest
we
have
a
governance
issue.
If
we
don't
take
some
recommendations
through
I'm
not
hearing
anything,
that's
okay,
yep
right
good!
So
we'll
do
that.
A
So
we
we
described
at
the
beginning
of
the,
and
thank
you
very
much
for
everyone
who,
by
the
way,
who
presented
on
the
item
before
one
of
just
one
of
the
things
I
wanted
to
say
as
well,
is
that
it
was
really
great
to
hear
from
tim
that
we
are
a
really
collaborative
city
and
that
we
all
work
the
chief
executives
and
the
top
directors
of
people
leading
that
are
really
collaborative
in
in
their
experience
compared
to
other
areas
they
may
have
experienced,
which
is
really
wonderful
to
hear.
A
Thank
you
to
everyone
for
that,
because
it's
only
by
building
on
that,
but
that
will
make
any
progress
for
our
residents.
So
thank
you
continue
the
good
work.
Okay.
So
we
said
at
the
beginning
of
the
meeting
that
we
wouldn't
really
go
into
the
detail
of
these
papers,
but
we
they've
come
to
the
health
wellbeing
board
before
this
is
their
revised
paper
in
final
form.
Based
on
the
comments
that
we
made
and
the
reflections
that
we
made
the
last
time
they
came.
A
So
unless
anyone
wants
to
mention
anything
about
the
leads
carers,
partnership
strategy
and
I'll,
just
say
that
you
know,
carers
are
absolutely
vital
in
our
city
and
the
health
and
care
system,
and
that
the
issues
affecting
carers
have
become
manifold
in
recent
years
months,
since
obviously
dealing
with
covid
as
well
as
everything
else.
So
thanks
huge
thanks
to
all
the
cows
in
the
city
and
the
unpaid
carers
who
work
to
support
their
loved
ones.
A
Okay,
thank
you
very
much.
If
we
move
on
to
item
12,
that's
the
living
and
dementia
strategy
same
applies.
They
came
to
the
health
well-being
board,
made
amendments
and
now,
in
final
draft.
Anyone
want
to
comment
really
important
piece
of
work
for
our
most
vulnerable
elderly
residents
in
the
city.
I
can't
see
any
comments,
I'm
assuming
you're
happy
to
move
the
recommendations
with
those
thank
you
and
if
we
go
on
to
item
13,
which
is
the
leeds
health
and
care
climate
commitment.
A
So
we
really
welcome
the
leadership
from
the
health
and
care
system
on
this
really
key
issue.
We
all
need
to
contribute
to
climate
change
issues
and
was
one
of
the
pillars
of
our
council's
work.
The
climate
emergency
work.
So
can
we
approve
and
agree
the
recommendations
in
this
report?
A
C
Yeah
absolutely
there's
a
question
coming
in
which
is
ultimately
about
the
interaction
between
covid
and
pollution
and
air
quality,
and
a
comment
that
obviously
poor
air
quality
and
pollution
may
well
exacerbate
problems
with
the
lungs
and
breathing
etc.
C
A
Yeah-
and
I
just
thank
those
on
youtube
for
the
question
that
you've
that
you've
asked
and
also
for
watching
and
engaging
with
this
session
and
any
more
comments
on
that
paper,
happy
to
read
the
recommendations,
yep
great
and
then
we're
on
to
the
c
papers,
which
is
more
formally
as
we
normally
do-
have
items
for
noting
so
go
through
through
those
individually
and
just
accept
that
we
have
noted
those
and
if
we're
going
to
item
18,
which
is
any
other
business,
would
anyone
like
to
raise
any
issues
or
concerns
or
any
comments
that
they've
not
managed
to
have
a
chance
to
say
during
the
meeting?
A
A
Okay,
well,
thank
you
very
much.
Everyone
for
what
has
been
a
really
good
meeting,
we'll
have
discussions
in
the
development
session
as
well
about
format
of
these
meetings
and
whether
the
way
that
we've
worked
it
today
needs
tweaking
even
further
but
huge
thanks
for
all
the
work
you're
doing-
and
you
know,
especially
during
these
difficult
times,.