Health and Care Board
Friday 25 October 2019 at 10:00am 

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  1. Seat 38
  2. Seat 36
  3. Seat 38
  4. Seat 37
  5. Seat 36
  6. Seat 38
  7. Seat 9*
  8. Seat 10*
  9. Cllr T Kelly
  10. Seat 9*
  11. Cllr J King
  12. Seat 38
  13. Seat 28*
  14. Seat 38
  15. Cllr D Goulden
  16. Seat 38
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  18. Seat 38
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  22. Seat 14
  23. Cllr J Warmisham
  24. Cllr J Warmisham
  25. Cllr J Warmisham
  26. Seat 38
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  28. Seat 24
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  55. Webcast Finished

[Seat 38 - 0:00:59]

I go Monnier overcooked apologies as falling from the the Mayor and the political leaders who are having urgent discussions somewhere in this building and will join us as a one day event
the minutes or so but we've got the nod staff anyway so we'll do that
can I welcome everyone here today in observing that theme running through the agenda from young people and welcome particularly when people come and
look forward to the presentations are
I
I do have to mention the word unfortunately breaks it
we had a paper to our
partners as of yesterday we were sure that we are assured by the government
the Amazon
we know that my ankle
we can trust his word
so
it
the issues around
staffing with probably less in a deficit in other places because we don't have as many staff from the EU in the salary of Sir governance assures us that drugs will be available so hope units are
too reliant on those works but the anyway that facet
it looks like a Regs it will laugh OC knock-up now
do or die by the end of
this month but will see what the extension we get it but I assured Ayman because he was clearly worried about this that yesterday that if we ever get this withdrawal deal agreed a solely Phase One we have something of a trade deal to sort out so that more work for you also were committed to come
OK it got the minutes of the meeting on the 26th of July
John
thank you

[Seat 36 - 0:02:56]

save this morning's meeting is a celebration of all the work within doing add to seek to improve the health and wellbeing of children young people and so and so's my Chief Officer's report this morning and can take the report itself as red are but I will of course take any questions comments anybody's got on any aspects of or indeed any of aspects of the partnerships were all I want to use my couple of minutes minutes for this morning is actually
to set a context for the presentations and the discussions that are going to follow
I don't know if any of you saw that the the revised Index of multiple deprivation came out just a couple of weeks has published the first update since 20 15 and on one level it wasn't good reading for Greater Manchester are overall Greater Manchester House become more relatively deprived since 20 15 against the basket of indicators that underpin that index
that we have not been able been able to
is outpace there the headwind of austerity that we faced a over that period however there was a piece of good news within the publication of the index which is when you look at the sub rankings for health and wellbeing which is one of the sub rankings something very different as happened in nine of the 10 districts the ranking has actually improved in Greater Manchester since 20 15 and in all 10 districts we now have less of the the lower output areas in the bottom 10 per cent
in Greater Manchester as in every one of the 10 districts
South positive but we start from a very low position and so any improvement is only ever relative and we know that if we're going to make really significant improvements over the next generation and the only way to do that is to start the very beginning of life and give children young people the very best chance we can add to maximise their health wellbeing outcomes across their lives and tackled at the deficits in terms of healthy life expectancy and of course I have to go across physical or mental health and so going to hear about some amazing work has been happening across several of those domains this morning but what I do want to do and it's the sort of sobering
statement is recognised that whatever we do in the NHS and in children's social care in terms of seeking to improve outcomes is only part of the picture and actually it matters equally what's happening in schools in terms of education and the broader input the children received there in terms of the youth justice system in terms of
the onward journey of young people into employment and into further education and the reality is that when the Children's Board hearing Greater Manchester looks across the whole of our balanced scorecards we have to say the overall were not doing well enough for our children young people in Greater Manchester are actually our educational outcomes are not where they should be and based on the provisional results for last year are if anything getting worse in or if you take a Greater Manchester as a whole were not doing well enough in terms of servicing the needs of children and young people with special educational needs and we know that from a whole raft of austerity as CQC inspections that have been received over the last year year and a half we still have too many of our children young people coming into care I was still not doing enough for our care leavers so today is a celebration of some really amazing work is happening and will hear from the young people themselves as part of that but we must remember that we've got an enormous journey to go on if we are going to give our children young people in Greater Manchester the platform that they deserve to maximise their life opportunities
through the whole of their lives so that's all I won't say chaired by way of introduction and her particularly comments on my report
although from

[Seat 38 - 0:07:11]

many comments or questions on
report
not that sorry to

[Seat 37 - 0:07:21]

and I just want wants to mention the University mental health nurse student proposal which I think is a fantastic example of the type where they can achieve through devolution partnership between ownership commissioners universities and hopefully industry as well so no real looking towards that going live in hope the most comprehensive offer their students anywhere in the country will receive in terms of mental health support and the other thing John is in your report you mentioned healthier together and the capital monies and a no obviously is a number of years now since we took the first decisions around healthier together and you know having spent some time as withdrawals emergency department has recently in what's great work going on there but really we need that capital investments over to scrape you give an update plates

[Seat 36 - 0:08:08]

a very happy to do that so the healthier together final business case was signed off in GM quite some time ago and was also accepted by NHS Improvement from NHS Improvement it then goes to the Department of Health and social Care in the Treasury and for them to review and over the last 2 3 months that they've had the business case they've been sending us at regular intervals sets of questions follow up questions for us to answer none of those questions today to been
showstoppers they've all been points of clarification or extra evidence that we needed to provide our we will continue to am a chase the Department and the Treasury for the earliest possible a decision and final approval for the release of those capital resources at the money for healthier together is are absolute number 1 Capital priority in terms of our health and care system because it unlocks so much else that we want to do in each of our four sectors across Greater Manchester
no because I was not

[Seat 38 - 0:09:10]

report move-on Sue
jeer moving or can welcome colleagues from
Sport
England packs for the posh it what we do
here we resign the and will you what we had photographers
during that earlier a sense been a very successful programmes
over
but until concern
Surrey visits so

[Seat 9* - 0:09:36]

thank you Chair and thank you for everybody fare are allowing us to come along and talk about some of the work we've been doing on GM moving over the last couple of years but particularly and to think about the memorandum of understanding that we have with Sport England are important partnership that has developed into something really powerful over the last few years so this is about the refresh of the MOU and working together so and last week the new data on from Sport England active lives shows that inactivity has reached the lowest level on record in Greater Manchester and that's really amazing news so
not sure where our slides are here again and so really raising use where we're 73 point three percent of adults in our region are now moving for at least 30 minutes a day and that's a real improvement on where we've been previously and Mrs. reflection of the work that were all doing together it's really important bird people of all ages but most particularly for our young people and there they are our future and we need to listen to their voices and experiences to really help them focus on what they
need to do in order to become more active sogang ASL on Barkley one of Greater Manchester's biggest mental Health Champions and physically active person to lead this item on our behalf
welcome Lauren
we all know that an

[Seat 10* - 0:11:00]

active life helps us to be happier healthier and more successful I know as much as anyone that an active life is important and 21 years old and recently graduated from Manchester University I probably appear confident successful and healthy but like many I have had my fair share of difficulty the past five years have included more struggles than I care to name from family problems in school stress to learning to live with and recover from mental illness mental illness that left me feeling alone scared and hopeless I now realise what matters to me what makes me happy and helped me dry I have learned that what helps get me out of the darkness of the little things that show you how life can be beautiful exciting adventurous and worth fighting for these include for me youth activism writing logging sport and physical activity
a huge thing for me is writing a score I found the value and power of during my darkest times honestly from May around session a day helped keep the doctor away
it also helped when I transferred you need to compose her home due to struggling I felt that had taken steps backwards in my life rather than moving forward but going back to my rowing Club made me see that I was moving forward just in a different way and my coach and team-mates were there to support me
I know that being active helps my mind refocus and Rieser and that being on the water brings me a sense of calm and peace that I struggled to find elsewhere on bad days bow if rowing is too much walking as what helps me I step outside to take a breath of fresh air and focus on moving and being rather than living in my head
we all have barriers to activity shown here although now I'm working I find one of the biggest barriers that for me personally as time but I also know that on the days I exercise I feel both mentally and physically better as leaders you need to recognise the inactivity is simply not a result of people's individual lifestyle choices moving has been designed out of all of our lives
just think about your own step count today as she said
we need to remove barriers and decide moving back into life we need to create safe walking routes affordable and convenient public transport more parks and open spaces and active workplaces
we need to keep working together on this and pull in the same direction to keep making progress as I say we because I am followed this movement to through voluntary work I do I am always encouraging people to move more to support the mental health since I connected with GM moving I have realised the I am playing my part two and part the team the latest data is really exciting and it's right to celebrate for a moment but once we have patting ourselves on the back we need to redouble our efforts and continue on investment of time energy and catch
we still have a long way to go with big inequality gaps to close so as leaders and influences Unita design moving back into life and make active lives normal again you need to make lasting changes to create the conditions for people to move more policy practice environment and culture under starting Mercury I want a workplace culture that looks after my mental and physical well-being so I'll be able to so I know on the altar need to move more as part of my working day get fresh air and headspace get mental health support when I need it I'd like to be able to walk and cycle to work and enjoyed cleaner

[Cllr T Kelly - 0:14:13]

I can see through the charity work I've done would lead us in Greater Manchester that you do want to do things differently here is making a difference and if we all work together we can change the world

[Seat 9* - 0:14:26]

thank you Lord turns her sticks and your contribution
so an important part of what we're doing is working as I said at the beginning with Sport England to really focus on how we get people moving in Greater Manchester so I'd like to welcome Tim Hollingsworth chief executive of sporting led to share some reflections on our shared work
thank you for your morning everybody thank you very much for having Ulster and me here this morning and understanding the theme of the day in children and young people and I'm really just tempted to say from my perspective what what she said
because you listen to how Lauren has explained with such clarity how physical activity being active and in her case the sport of rowing is not only a physical activity but a fundamental are provided for you or
a sense of well being I think that also chimes massively where we are Sport England as the national organisation responsible for sport and physical activity or crossing them would say we would love to have everybody thinking the way the that Lauren does
she reference to some positive numbers than they are worth referencing briefly last week
we published our latest national active lives survey which was a record result for us in terms of the number of people in the country now active and indeed a record result in terms of this region
you should all be proud of that and I think those of my colleagues in the room who are working on that should reflect on the great work done in partnership to ensure that is moving forward

[Cllr J King - 0:16:12]

but while we saw 28 million people across the country being active every week and by the way when we talk about being active the measure is one that is quite precise in some ways as the Chief medical Officer's definition of 150 minutes a week but the reality is we now also what it could mean for us each and every one of us in terms of our daily and weekly lives
while we saw 28 million people are active we also saw that the 11 million people in the country who are doing either 30 minutes or less
and therefore we have a huge job still to do and that still reflected also you could see in a slide here that there are some pretty stubborn inequalities in the way that we are as a country and as a region are providing for people to be active and that those stubborn inequalities are most universally present when it is in areas of social economic deprivation so the single biggest barrier that we can identify as that or
economic circumstance so we have to think and behave very differently I think are as Sport England and as partners with all of you to think about ways to be offering a sport and physical activity in a way that can make sense for people fit into their lives both not only affordable but also available you mentioned again Lauren timeliness recognising that we cannot just assume that that which has always gone is that which will still be right for everyone that's why this partnership with Greater Manchester for us is so important as Greater Manchester is one of 10 regions of the country
that is so supporting the new working within this particular period under what school their local delivery pilots
there are 10 very different places Greater Manchester is the largest is the most advanced and this isn't being recorded is it any better said one of the best
but I would certainly say that because it goes beyond just the local delivery pilot with signing today very proudly or refreshment her a new version of an existing memorandum of understanding between a GM moving and
sport England and I am really really pleased that we are because I think it shows an intent to work and behave differently and attempt to collaborate in a way that is not about transactional mechanistic solutions rather understanding the lives of the people were kind of help and support and finding ways and solutions that can work in a sustainable way to improve their opportunity to be active and through that for them all to live healthier and happier lives so I want to leave you with one message to say that as Sport England is the national agency responsible we still care and deeply understand that it's important to allow those who have activity built into their lives in an organised systemise way that they should continue but our focus as it is with you is making sure that there is a right to be active for everyone and that whether it's through walking and the active souls are a big part of them but more importantly was finding that which works for you and can fit into your life is the single most important determinant of whether people will be healthier happier and able to benefit from Sport and physical activity so thank you for having me today and my colleagues thank you for the continued work in partnership and the MOU is just one small part of that thank you
thank you to amend and really exciting and a net that we continue to have a closely together and GM Moving has 12 priorities but one that we really want to highlight days active workplaces and what we can do together as leaders and across Greater Manchester to really take that forward unless an interesting information here about what a difference activity can make to what people sick leave and from work or whether or not there and able to receive benefit from an Howie reform and
the employment good employment Charter is a key part of that and physicalactivities are as is has its role within that and so we would encourage all members of the Partnership to think about signing up for good employment Charter hundreds of 50 companies have signed up so far as 100 thousand people across Greater Manchester and let's do more
and in terms of our reach across health and care and these are the numbers for those that signed up to the Good implement chop charter within the partnership and and finally and the point that he made by active souls and there's the Anti putting on his trainer's there and Warren not here today but very proudly with his suit tie and Turpin wearing his trainers to work and if we are going to make a difference we need workplaces to be more active and encouraging people to do that and perhaps through wearing trainers to work might be something that Richard do and together so please do join the active cells movement as a first step but really think about about what we do as employers to really encourage physical activity and so thank you very much and more than happy to answer any questions

[Seat 38 - 0:21:33]

OK I've spoken to the Minister that you I think for the support we get from Sport England and the recognition that innocence its activities it's important to look not just sport are really important but as you say it dries while being which in a sense a fundamental part of health and so we've always thought that for for our sake
we have coming up in two thousand twenty 21 two major sporting events happening in the North or in references to the US for women's championships are the two venues herein return Manchester and there are also the Rugby League World Cup in the same year and I think we want to you both organisations FA and really want to have a legacy of that so we need to build that it's not just simply about getting
more words play for all four objectives valleys it's actually just getting
a lot of young women to do what Lawrence during office in getting participating in activity thinking it's not strays to see that happening I think we feel we can build on the back of that I think queueing up forward so I'm looking forward to that sewer
Any other comments question I'm sure the Mayor would like to show us your assures your feet on their first

[Seat 28* - 0:22:52]

I wella thereon again today so Earth-like yet active souls revolution grows all the time and you missed another important sporting event a check
we're going to confirm soon that where the House of the walking football World Cup
which I think is going to put us on the map in terms of
all ages being involved so
I think what's growing here is is ought and physical activity moving from a place where it in the national rates or even on the fringes and saw the shouting to try and get heard I think what we're seeing
happening Greater Manchester as it is at the heart of everything that we do because it's actually the thing that's at the heart of all of our communities and that the Westminster world has never understood that fully when it comes to policy on sport but when you get devolution we do understand it because we know it's the lifeblood of our communities is what makes people take its what brings people together
from a health point of view
I think the minute we're getting into a health service that is a first
encounter is encouraging people to change their behaviour through physical activity and other other things that is a 21st century health service rather than just resorting to medication and treatment and I am so encouraged by the figures that we've got Peter the huge increase in the number of people who are physically active and the latest Sport England figures policies have I seen us as already mentioned this the lowest ever levels of inactivity in Greater Manchester I think were on course actually to meet the very ambitious target that we set ourselves a couple of years ago I think the challenge now is to really take out into all ages and send the message out that it's not about part runs necessarily or 10 Kay's all those things although
I have to say myself and the Leader of Oldham Council are doing them Milltown races in Oldham on the Sunday morning the Oldham half-marathon the course of which looks like the Pyrenees when you see it spread out which is a bit of a gulp moment am
I think the message has got to be help everybody be as physically active as they can rather than
pushing the really challenging starts off a people so maybe apart walk for older people really think carefully about how we help everybody get the level of physical activity that they can they can manage so I think we are very proud of this Partnership was supporting than Tim and through the Chair just want to speak because he come of Evelyn greater transparency we are very grateful for the backing that you've given us it's really encouraging to hear you say today that you think we're making something of the support you have given us and we look forward to building this partnership with you going forward because actually it's at the heart Building a 21st century NHS
any further comments

[Seat 38 - 0:25:42]

[Cllr D Goulden - 0:26:22]

any further comments

[Seat 38 - 0:26:47]

ongoing Bill point pistachio domain crosses the
I think in Greater Manchester are generally Merton some boroughs the Daily Mile is a really an IT thing for young children and I think you need to start them off in doing that excuse to celebrate it is fun for them to do it but it's also an important start to get a regular exercise and so
shorter combined with a common sense

[Seat 9* - 0:27:19]

I thank the Member for his conflict but more to the gentleman spend from Stockport and and in your response there around the Daily Mile as well just to reassure are that we recognise that actually fun and enjoyment is a core part of it particularly for children young people next month the active lives children survey will be out and I think we will still see figures that will make us all feel very worried on the one hand but also we can start to see real change in terms of that understanding that one of the challenges among young people is that they have a
the option to be an active in a way that makes it fun and enjoyable and as one small vignette to support your point are we have passed many of you will know a campaign called this Girl Can which sporting and runs to time at women and girls more active we've just on a partnership with Disney where young mothers who otherwise might struggle to get out of the house for their children regularly
can use or an app took to dance along to Disney songs with their young children so it's combining dance fun and indeed am activity Centre

[Seat 38 - 0:28:21]

Q Can we agreed recommendations Kurucz we consume improving maternity outcomes for mothers and babies are as its journey cheatum rudeness

[Seat 23* - 0:28:31]

thank you Chair and he
said
Just to introduce this and on behalf of Richard places the and senior responsible Officer for the Lord Lieutenant system programmes and just to remind colleagues that back in the summer of last year we actually came with the an implementation plan for ever maternity and newborn at plan that links to the wider better verse policy or NHS England that we are supporting and
leading forward so colleagues with me today I'll caravan Croft who is our maternity and clinical lead in both the street clinical networks and for the locum 30 system programme and Cathy Brewster who is our co-chair of our maternity both seized partnership so will Hunter

[Seat 24 - 0:29:32]

thank you very much Chair for giving us this opportunity and I want to update you on the maternity transformation programme a programme that spaced on the secretary of state's I'm Horvat ambition and a better Births' report and on the maternity review
NHS England have influenced the plan as as Greater Manchester five year forward plan so I'm just starting with our vision which is that women and babies will receive kinder safer and more personalised maternity care
in Greater Manchester and East Cheshire and and that's what we're all working towards a but we can highlight some real progress and achievements since the programme was initiated and begun to be implemented in 2 thousand 17
so
here is just a
so here is just some highlights on our from the from the programme thus well we've done lots of work supported by Greater Manchester around Earth smoke-free pregnancies and we've been able to demonstrate that additional 250 babies were born in this last year and smoke in a smoke-free environment this is obviously very important in terms of both bear the health of the pregnancy and ongoing health
in the years to come we can also demonstrate that there have been 23 fewer still births
in this last year compared to the Raven might have been three years ago
and 18 fewer babies were born this year with very serious brain injuries which were thought to be related to care in in maternity impotency so these are real improvements that are women and families are experiencing across Greater Manchester with also done a lot of work around trying to prevent cerebral palsy in a preterm births so preterm births are the riskiest sort of births and in themselves and are important to try and prevent
but magnesium sulphate is particular treatment we can give to pregnant women before they deliver which helps prevent overall policy and we've been able to increase very significantly the uptake of magnesium sulphate and impotent sits impotent birth to 86 percent
in addition fringe and 24 women fewer women have suffered serious
tears during childbirth and again this is really important improvements in morbidity for these women going forward there are lots of other am at metrics I could highlight them in terms of safety
including a reduction in serious major blood loss
and an improvement in babies born with low applause scores which is a way of assessing how well the babies at birth so lots lots of

[Seat 24 - 0:32:50]

significant improvements that we've seen and since we started to collect the data and implemented the maternity transformation progress programme how are we doing this well the local maternity system is working very hard to provide consistent pair across Greater Manchester Members Cheshire and with all providers involved and with developing guidelines to support consistent care across Greater Manchester we've been able to implement
a review of serious incidents
which helps us extract lessons which can be learnt and shared across providers across the whole of the region and we've been able to inch introduce
a significant initiative called exercises which is to help women deliver safe in avoid serious stairs and that's been implemented again across Greater Manchester
we use a maternity dashboard which a real time provides takes data from all providers and provides them with real time comparisons across Greater Manchester so that we can highlight
providers who are doing well in terms of our safety improvements and those not doing so well and we can highlight good practice and share that across across the region between providers and this is a really useful tool to help them help hold the providers and improve and reduce variability
I am going to hand over now to Cathy who's going to talk to you a little bit about
continuity

[Seat 14 - 0:34:32]

and choice and personalisation
however and he very much her having an I'm a late test and I represent attempt to service users and I'm I'm Chair of admittance to voices Partnership which is an independent NHS body that is made up of women and families staff and commissioners and we all work together to review Miss empty services and look at improvements and

[Cllr J Warmisham - 0:35:00]

Greater Manchester are really ahead of the game with regards to co-production and actually designing the services with the people that use them so these are just a few examples of co-production that we've done in our local retention system and we've developed a website called my birth my choice which has information about all the maternity units in Greater Manchester in Eastern Cheshire so that women and their families can see what their options are and their choices for where they can give their which developed a personalised intends to cap plan which is a little book club and that women can use to talk about what's important to them in their maternity care all out into providers have fiscal cliff to use with remained for the next two years and looking forward were going to be developing a digital version
we've taken part in what's called the 15 steps challenge for maternity so are women and their families with staff have walked round with into units looking at how they feel are they welcoming safe an informative and this has been taking place across all arm sent to units which is a national first for local maternity systems and the trust are now have those reports and can look at some simple changes that they commit to environments and information to improve experiences for women and family and we have maternity voices partnerships at 6 of Armitage's units currently and that's going to roll out across all of them tend to units hopefully and next year
so continuity of care which means seeing the same healthcare professionals throughout your whole pregnancy during birth and post thankfully is
a huge part of the better births recommendations and they target for March 20 19 this year was to achieve 20 percent of women booked on to continuity of care pathways and were very proud to say that we hit the target
our heads of midwifery and characters enrich midwifery led by copy Murphy at St Mary's have put in an incredible amount of work to achieve this target and very proud of them we're now looking forward to how we can increase this at the national ambition is to get most women so fifth over 50 per cent books and continuity of care pathways by 20 21 and we've got a lot of work to do to hit that target but you can see with consistently been maintaining 20 percent are next to it from March next year to get to 35 and really hard to get where we are and continue to do so
and then just finally postnatal and parent Infant mental health which is another area of focus for our transformation programme so we've

[Cllr J Warmisham - 0:38:00]

made a huge amount of progress across Greater Manchester since the programme began early 2 thousand 18 we now have specialist perinatal community mental health teams across Greater Manchester and they should be fully in service by 20 21 and we've been building capacity in them ever since early February 2 thousand and 18 and we are following a trajectory that will take us to full implementation as per our target and we have also been working around parent Infant mental health teams and since April last year we now have nine localities established an and or none culture is already established or who are working towards establishments and this is a team that will help with bonding and attachment to babies and these teams in work with voluntary services to support women and their families and provide a wide reach and role so rolling out early support for partners and fathers with Homestart programme across GM called Dad matters
and some localities have already invested in this and will have further investment going going forward then
so
thank you very much for allowing us to up day I think there's lots of

[Cllr J Warmisham - 0:39:26]

positives here and we continue to work very hard to make sure that we deliver all of the programme stretches in the longer-term
to your

[Seat 38 - 0:39:39]

questions or comments
rumours clear right from the during bankers

[Seat 3 - 0:39:50]

health and wellbeing Bolton and also approximately Dwyfor and former adviser
for the CQC
maternity services at just I think the report that is just being highlighted his very commendable with some of the achievements however I'd just like to ask really one of the aims was about postnatal care particularly and I just really liked to ask about how pulse NE thought care is being further supported because obviously developing parental resilience and improving our quite poor breastfeeding rates quite important and also women actually say very clearly which was fed into the maternity review that postnatal care was a Cinderella service so can I just really clarify
what is actually being done and how midwife's can actually see women if you choose to see them pulse Nathalie thank you
so

[Seat 24 - 0:40:43]

we do have them a work programme around postnatal care as you say it's really important and important aspects of the care that we deliver
the work programme is
delivering different aspects of the things you talked about we have got them increase provision around breastfeeding and in the long term plan have extra support to deliver
breast feeding initiatives across Greater Manchester
and we are expecting and indeed already working towards all providers
having agreed
assessment around breastfeeding are making sure that we're all purchasing to the highest standards
the there is further works for them with in person and postnatal care we are awaiting still the
report from the National Programme around postnatal care standards and how we implement those we further work going on about improving physiotherapy postnatally
but I absolutely accept that further work to be done to a lot of the perinatal mental health work is
directed to the postnatal
time and includes care up to two years of
the chance to year birthday
to try and support women their families and their children through that difficult time as well so we are approaching it from different ways but there is a further work to be done definitely

[Seat 29* - 0:42:26]

thanks to Sir Anthony Hassall chief commercial officer in Salford
we are I think about two miles away from a single site which is Greater Manchester's only freestanding Midwifery Led Unit
we were visited by Jacqueline Dunkley been England's first chief midwifery officer a couple of months ago who are sited Ingleside as the most innovative model of its kind in England
and yet are all the evidence says we still have
too many women not being able to exercise choice and not being able to have their baby outside of a
acute hospital
what's the programme doing to really drive choice and ensure that we move away from a broadly medicalised model of maternity which of course would support increased numbers of births are at being able site Centre acts

[Seat 24 - 0:43:35]

and very fine and them this is our out but I never get answers and would help
inform women about the different options and the benefits of using out of hospital bed sensors that you think or 5 am particularly for low-risk women I'm
also
having continuity of care can really help women to feel more confident and trust their care provider and gives them confidence cheaper outside hospital
yes you're right it's a challenge and obviously there's lots of things going on with regards to safety there are more women are being offered induction which obviously has to happen in a hospital so in some respects the
number from him that the
i'm would be eligible to
a centre is reducing but the best thing we can do is to tell women about their choices and given the evidence and let them decide what is best for them and have outlets

[Seat 23* - 0:44:53]

[Seat 38 - 0:44:55]

we will place through the early years and school readiness before journey

[Seat 23 - 0:44:59]

[Seat 16* - 0:45:15]

having now yes the report provide you with an overview of Greater Manchester school readiness programme and
for the purposes of this morning I pulled out a few slides that I will
take you through to just highlight some of our progress to date and the impact that we're happening
in a moment
you again
so just a bit of background then them or think you're the case for why earlier years is important as is clear and am remains a key priority across a number of strategies Heron Greater Manchester
backing 2 thousand 12 our performance for a children achieving a good level of development in GM with around 47 percent are and at that time we recognise that actually we needed to do more than what was being done and developed what was called the Greater Manchester early years delivery model and essentially what that delivery model is m is a a programme of at Universal assessments from pregnant pregnancy through to school age for all children across universal services supported by evidence based assessments and evidence based interventions and since implementing that delivery model we have seen our performance make significant progress so this year at 68 per cent 2 per cent of Greater Manchester at children reach that good level of demand ERT development at the end of reception an air in school however we recognise that within a we still lag
behind the England average and we recognise that within our cohort of children at school age there are some vulnerable groups of children where we need to have a more targeted approach for addressing a support for children and families and so we've set ourselves an ambitious target to close the gap between Greater Manchester and England over the next two years
this graph shows you that the performance and progress that we've made since 2 thousand 15 I aren't you can see that
as with the England average our performance over the last couple of years I started to at taper off and steady off so again just reinforcing that needs for us to refresh our strategy and take a more targeted approach to the work that we're doing so as a result of that we secured some additional transformation funding investment through health and social care partnership
revisited our strategy and refocus our energies around the things that we know will make a difference for our children and family in the families in those early years
I would like to point out though that
data that we expect the FE to publish next month will show some of that the improved
I performance we've managed to make for some of our vulnerable groups and this shows performance for children who are eligible for free school meals and you can see here that we will have closed the gap between Greater Manchester children and the rest of England for children who are falling into that particular characteristic
again that reinforces the work that we've been doing beyond having high quality early years services here in Greater Manchester and making sure that we've got a targeted offer of for some of our vulnerable families
to just to give you an overview of of of the work that we are prioritising in this next phase in this latest Strategy refresh
and our pick out some of the examples in in the next few slides but essentially our work cuts across three domains it recognises that there is a role for Greater Manchester and for localities and all of our partners in ensuring that we maintain our evidence base delivery model and that we sustain that and that we maintain that system leadership integrated governance and investment across Greater Manchester
however our recent stocktake shows that there is still more work for us to do in terms of evidence base pathways and implementing those consistently across Greater Manchester and recognising that within an hour earlier Sarah's stillsome particular
areas of development that we know will make a difference and where our children perhaps are falling behind and that there are some system enablers had if we focus on those and work on those together across Greater Manchester will be able to make even a further progress so for example and in the best practice pathways with doing a lot of work in the antenatal an early intervention and prevention
area within a lot of work with our parent Infant mental health pathways and were doing a lot of work around our complex needs and making sure that all of those pathways are integrated in our place-based models are across neighbourhood seemed Greater Manchester
in our enablers work was starting to look at them I workforce development strategy and recently we've invested in a digital platform and integrated an assessment framework that will allow all of our frontline practitioners to have access to information and assessment tools early but fundamentally that that information about a child allows us to both identify when additional support is needed but that that information can follow the child through their journey or indifferent services in their early years
so just to pull out and a few headlines and across a of the work that we've been doing and will continue to focus on in these next or 18 months two years
across those three remains think it's absolutely critical that the work that we do continues to add value and ease developed and implemented within the context of our wider unified public service delivery model so we continue to focus on how integrated provision and support children and families and we have some excellent examples here in Greater Manchester and Stockport family team around the early years
work is is really starting to
have a significant progress and essentially that surround your midwifery health visiting children's centres early education providers and schools settings integrating their provision around children and families with the support of the system and are integrated leadership and behind them
a significant focus for her as an as being the development of our speech language and communication pathway and am again we've got an evidence base pathway that has received national recognition that we've been implementing here in Greater Manchester
but more recently now stopped tape it was clear that there was variation to how that Impa air pathway was being implemented so we am made an application to the DFE for some additional funding we were successful in that an application and we are now working with all of our partners to ensure that that pathway is consistently implemented and sustained and that our workforce are supported to deliver that pathway
across a range of different services
links to that erm again one of the priorities have pulled out from the enable as part of the programme is our workforce
and I think I don't need to point out the importance of having a reformed workforce who are able to deliver and Phil trusting relationships with families and across a range of services in those early years so a again we'd be now an ambitious in our approach here and recognise that we're probably
much further ahead than other parts of the condition and have set out an ambitious programme for development in early years workforce Academy that's am in its early days we have a prospectus that sets out our ambitions out a high level but we will be holding stakeholder engagement events over the next
couple of months to develop that further we secured some initial seed funding through the Health and social Care Partnership a transformation fund but again will be looking at how partners from beyond
statutory and public sector services and support us in the delivery of that
so to conclude am I think it's about its next phase recognising the performance and the impact that we've had of the the last few years and as supporting that the programme of work over this additional

[Seat 16* - 0:55:42]

funding and refreshed targeted
focus efforts in the next 18 months to two years
1
what
judges

[Seat 18 - 0:56:28]

thank you for just in terms of
the JLT mean the national average over the next two years hence
the is quite commendable
objective I would just worry how we can take our parents community with us on this journey is one things we find is a practitioners and teachers and people involved in the early years
setting understand the need for children to meet the GLD
Standard or both or perhaps some of our parents are lagging behind an understanding and that's where some of the gaps can come in our services whilst how to ensure took those vulnerable people who may be for example a under the troubled families agenda of whom may have complex family settings how can we ensure that parents and carers are on this journey around young people reach in of the GLD because of course that has a significant impact in terms of Key stage 1 Key stage 2 and and further further down than in school lives I just wonder what they know what the views on now

[Seat 28* - 0:57:31]

first I just echo what you said Peter the graph early on Free School meals was quite striking was nip and that that shows that we're having the right impacts were then we need to although when we look at the headline figures more to be done and we do need to to refreshes as Jane is saying
just to reiterate I think everybody knows this these numbers are at the heart of the response to strategy on everything else would we want to achieve for people in terms of their health and their life chances it all comes from from this are that this set of
figures that we've got in making changes here make Q changes then across across the life course so we need to relentlessly can't come back to it and challenge ourselves question I've got Pete orders to the comments that are out there is also we have put a significant amount of resource into building or
an IT infrastructure
that for the first time in Greater Manchester will allow
other professionals to see the data held by Health visitors
on
two
18 month in two year olds who are not on course to achieve a good level of development by the time they get to primary school
so it was just to put the suggestion out there that I think when that new capability is fully in place
we need to have a lot of active that's the moment when I think we can make a step change in when we can encourage people to think and work differently have different conversations in their communities health visitors GPs working with primary schools to identify those young people then who are on course not to be school ready
under Rodgers was being encouraging the partnership to think about how we get that message out ones that that capability is in place

[Seat 16* - 0:59:24]

so just to pick up the point of and how we working with parents and supporting powers to recognise that their children's needs early I think you have just a couple of things at really miss Fonseka first is absolutely this programme sits within our wider public service reform and kind of integration agenda so that that principle of working with families working with communities working from the air asset strength based approach and is at the heart of that and our workforce development programme really does start to progress from that position so it recognises the importance of all frontline staff being able to have that good relationships with parents and go on the journey with parents families together according to their needs and circumstances as opposed to hear standard off the shelf doing too early intervention surfing though that's probably the first thing I would say one of the other programmes of work that I perhaps hum highlighted in today's presentations this whole
notion of at the home learning environment so within all of our pathways but as specific her within our speech communication and language pathway is his recognition of being able to equip families to have a really rich home learning environment in those early years and again we're starting at that point of pregnancy and midwifery how they can initially as start to equip parents of the messaging around that
we have also done work with the BBC recently on without digital information again making sure that there's quick easy digestible
accessible information in format and within the home for all of our families so
workforce working with asset base building trusting relationships it's kind of your getting beyond I'm a health visitor or our an early years practitioner in the Children's Centre but recognising that relationship is
the first important thing a homeland environment supported by accessible information and but really sign to engage with those community level or voluntary sector organisations as well

[Seat 38 - 1:01:53]

Greco's recovery has been running out of time

[Seat 30 - 1:02:00]

because from Rochdale council are just delighted to hear about the improvements but also have the concern for our
emerging communities who are not engaged with the system and are not established at so don't have those relationships or understandings of our education system at all I am particularly those that are vulnerably housed because they did not have the links into any other services at all

[Seat 38 - 1:02:28]

there were then move on to the Young jeans' Health Wellbeing programme job

[Seat 13 - 1:02:33]

yes
here

[Seat 13* - 1:02:43]

Good morning everybody thank you Chair I am going to talk you through
the progress of the better monster children young people's health and well being framework and I am also going to ask us to day to approve the direction of travel and a process take questions
you will recall that in May 20 18 we brought a paper to the Board it was the framework in its in its first
production and it had 10 objectives and if you turn to one point to in your paper health that will summarise for you what those objectives were the paper was endorsed and since then programmes have been in development so we have three programmes and Janice very eloquently told you about our early years work and school readiness
but also weeping concentrating on improving mental health and resilience and also preventing avoidable admissions we have three programmes which are
perhaps a step back and development but still underway which has Orion seamless transition of children through their services to adult services supporting protecting children Young people and families at risk and working closely with schools for all the reasons that have already been articulated today to improve the health and wellbeing of our children
four of the objectives are the enablers are the first is one which is around the Youth Charter and participation of children young people and my colleague Nathan who will introduce himself in a moment or two will tell you more about that
using the power of digital technology we have already heard that day the importance of having joined up information around our children and their families but also looking at Digital Innovation and solutions developing a modern safe effective workforce and sharing data and using that data to hold for the framework to a tight so at this point I'm going to hand over to Nathan are young person representative to tell you about participation
but

[Seat 13 - 1:04:47]

I am so I'm Nathan and am also a former chartered wasn't mental health services
are also in a charge or summons loyal service Scotland are and how through an apprenticeship
I've also been able to see first hand and Benacre benefits that participation engagement can have on individual
I'm now work fee focused northwest the north-west leading youth engagement charity and I have an upcoming role to take him I myself back in search of adolescent mental health services to deliver engagements
I believe it's important for young people to not only to be asked about the services but also through part of the development and delivery of those services as well as giving young people tangible ownership and a sense of belonging to the services that they use
are the great much to children's health and well-being framework was endorsed at the Health and Campbell in 20 18
are any updates on progress and achievements
against the temporary cities isn't the daigneault
so are we involved on children young people so far are we've engaged in for a myriad of opportunities are what we do know about great Manchester is that there is a range of projects already working on and alongside young people and therefore it is important bright some of those opportunities to engage with are within the existing groups we've identified recognise involved many other great organisations and projects already are many of them involving young carers and some of them to do with your minds 42nd streets and the 10 Youth Councils amongst some of the groups I have that we have worked with and within the Greater Manchester Youth Combined Authority and their working group within health
the result of this engagements and through his work with young people has been identified that young people are unaware also some young people are unaware of what they should expect from a great match the Health and social Care Partnership
there is all this being with the services of lost an element of accountability to their own service users
1 wising person at the age of 14 has already stated how can we have a say about service if we don't know what we can expect from it
so Yadier of aeth agreement and that's emerged worth gathering Partnership young people and staff from across the health and social care partnership co-produced the first Yarmuth agreements
this Agreement sets out the 10 commitments that can be utilised as both a set of expectations and an assessment of quality a kind of we say and we do commitment from the GM and social Care Partnership setting some commitments let's say we value young people in their voice
so how did the commitments comes lie and lie to the supreme go next while the curtains have been have come from an extensive review of previous consultations undertaken with young people there was a review of national data and the review your welcome and we also reviewed the your welcome standards and include them within less
than for the States has been collected the proposed commitments were sent to the wider youth groups across Greater Manchester and the Greater Manchester Combined authorities Health working group
these are whittled down further and presents its young people at the GM Health conference where approximately 100 young people from Greater Manchester were attempting and engaged
the scheme was developed nonetheless through the journey sorry although this agreement has been developed the journey has not stopped their building on a challenge set by the Health and social Care Partnership we are continuing to involve young people in the Quality Assurance Officer agreement working with young people's quality ashore and check if the standards are not working across Greater Manchester is still in its early stages but we are hoping to work with young people in services to create some Young inspectors that will hopefully be visiting services after the new year
i'll bring the engagement section as out to a close and at the ICA Khalsa Carol
monkey Monkey Nathan
so just to two to carry on and

[Seat 13* - 1:09:01]

ensure that you hear some headlines about what the earth the programme has been achieving
first of all an asthma is a real problem for this for the four hour conurbation and our data we've just begun to set up a Quality dashboard
which is collecting the data showing that we've had 153 last children admitted to hospital with asthma and that you could say is a relatively small number but what's happening behind that is that there is a bundle of interventions that has been taken up across Greater Manchester for example having senior nurses at the front door and vertically departments having multi-disciplinary teams having senior clinicians having telephone hotlines rapid access clinics and so on and we come together every two months to share good practice to address the challenges and to see how we can improve further so please bear with us we have also developed a set of standards for asthma diabetes and epilepsy and those standards helped to guide the journey of the children Young people through the various services
a special educational Needs and Disability Board has been established absolutely key to quality with it within our within our partnership and it brings together people from our Clinical Commission commissioning groups local authorities but particularly our parents and carers are at the heart of it and were looking to redress that balance so that everybody gets a fair and effective and
a child person centred education health care plan but also were looking to adopt our good practice joint commissioning models of good practice across the conurbation
we have a mentally healthy schools pilot which was set up after the Green paper which was published on 28 team and in that paper following the paper the project has used evidence base and again a number of interventions to improve the resilience of our pupils in schools and colleges but also to inform and support are leaders in schools and our staff as she recognising and supporting children with mental health problems so we've gone from initially 31 schools 225 schools and colleges and the data is already beginning to show that there is improvement in those areas which I outlined
we have recently had a setting up two reviews comprehensively views to look at our care leavers looked after children and also our children with complex needs and that will come back to our Executive Board for discussion further improve our plans and Nathan has talked and I want to emphasise the importance of that use agreements to look at how we are actually being held to account by our children and young people across the system
I did refer to the 10 objectives I let one night slightly and purpose which was about and holding ourselves to a kind being transparent and again we have a unique Cam set of measures which is part of the Quality dashboard which were developing an for example am I wish I could talk to you about mental health access that tells you where the referrals are coming from age band gender etc and this will really enrich us to to help improve our mental health programme
just going on to I suppose grow weekly or we are 9 compared to where we were it was pretty obvious there was loads of really good work going on across Greater Manchester but a lot of it was fragmented and what we're trying to do by having this framework is to become more cohesive and we were gathering the evidence that's the rationale are through a dashboard are we've got our Committees are Boards we've got good governance structures accountability structures for me personally and I'm sure many of you will share this in this room it's about the relationships which we develop with each other in order to make this framework will forward I own I heard just this morning that there was an excellent meeting yesterday of my colleagues at the strategic clinical network with Local Care Organisation representatives and that's particular to authorise preventing avoidable admissions and to see how we can take on those problems at Further and try and improve our plans we've got Primary Care Networks in developments are we've already met with primary care commissioners so again is about building those relationships to improve our framework
lastly were very much in line with the Greater Manchester Children's Plan where also in alignment with the 8 deliverables in the NHS England long-term plan so for example creating a transformation board moving to 0 to 25 years of service but obviously clearly linking up with mental with maternity as well mental health learning difficulties and autism transition to adult services reduction and asthma attendances at emergency departments immunisation which is a joint programme with ourselves and population health and lastly health support for children with long term conditions so I hope that you can see from this that we are making progress but we must not be complacent we've got a lot of work to do but if we work together we can get there and

[Seat 38 - 1:14:39]

Will we wrote attempts to fake Site regionally to note the Improvement suddenly direction trouble and then move on to
presentation Salford Charles Arriva's silver teeth but welcome

[Seat 29* - 1:14:56]

[Seat 28* - 1:15:03]

why thank are things that excellent presentation thanks to Nathan as well
I don't think we get a description of the can pass without saying that the number one health issue for young people it seems to me and it grows all the while as mental health
and I know this partnership prioritise mental health for children young people a couple of years ago and the stats of ink show some improvement however can anyone be happy that 45 percent of children and young people responded with a diagnosable mental health condition or getting treatment that over half are not so I just think we mustn't just end this item here we can pat ourselves on the back to a degree JA and we are publishing the waiting time data and that clearly is bringing an improvement with the only area in the country publishing that but this is this is the issue of our times affecting children and young people and if over half are still not getting what they need when their being referred then there is nil room for complacency on this as far as I am concerned and I just wonder how we go to the next level in taking those via vote that that should be 100 per cent in my view if a child needs mental health support it should be instant and that what we should be aiming towards and I just how realistic that is unveiled taken to concede John nodding but it just the public out there whenever I do a any public event this issue comes up almost immediately and it's our response yet is not matching the level of concern that there is amongst the public

[Seat 36 - 1:16:33]

so it's really important festival to explain this indicator and because I'm not going to in any way
yes of argue
with you and in terms of what you set out we should be starting to do more but it will never be 100 percent for good reason which is the and the the percentage is of the young people is a prevalence as statistics so not all of the young people have got diagnosable mental health condition will need to in-treatment
they may well be having their condition managed within the community and
and so that that data it will never be 100 10 nor should if they
but he shall be higher than it is and that that's the distinct Shard makes so at the moment where the third highest performing area in the country of 45 percent for Rochdale are actually achieving over 60 per cent and also it will be by the end of the year in terms of their current trajectory that's probably why we should be as probably about the level that we should realistically be aiming for in terms of the number of young people with a diagnosable condition you would expect to be in treatment at any particular time but still way way of of the national target for which fights his way above the National target as well but I think if we could aspire to get up the level of the best and the best is Rochdale at the moment then that will be a good place to be

[Seat 29 - 1:18:06]

thank share am Anthony Hassall chief counter-offer Salford
CCG
and Charlotte
he will ensure staff are met which is going to do a joint
presentation when we get the first slide
there it is OK so what we're going to just do it hopefully bring the discussion that you've had this morning to life in terms of the and the actual actions and delivery that we have we had with when we are undertaking on the ground here in Salford I was going to talk about our integrated arrangements as they relate to children talk about our transformation priorities give an insight into the real change that we are delivering and let me just headline this by saying that from an NHS perspective let's be really clear traditionally as treatment service particularly of
older
people we I'm sure I'll PRUs would admit that we haven't always seen
Children's Services as at the top of our priority
and we need to change that I'm and if we think about from a financial perspective some of the real cost pressures in our system are around earthships around children in particular and children's social care or hence why this is so important
so
just to give you a flavour of what we're doing in Salford so we have a fully integrated commissioning arrangement now between the CCG and their local authority
we have a we are put 800 35 million pounds of our money together
and that's split across everything that we do around health and social care including children's adults public health and primary care
and why that's really really important is that that allows us to
make the best use of every single pound that we get around health and social care for Salford and it means that in the context of this fund that we can use underspends in one PA system to fund overspends in another and that might sound a bit technical but it's really important in terms of being able to manage some of the financial pressures that we face an equally important this is both clinically and politically led with GPs and elected members sitting on all of our Committees around children adults and primary care making decisions together in these areas
what we've done therefore are and focusing now on children or let's be clear by 20 to 22 23 in terms of health and social care in Salford if we do nothing we are facing a financial challenge of actions 5 million and that and the vast majority of that is in Children's Services
we can't afford therefore to do this separately at so what we what we've done in terms of our integrated children are integrated commissioning arrangements we have set aside 4 million pounds from the CCG's allocations for a transformation fund for children at we've done that off our own batch and we've prioritised a number of areas that you can see a on that slide so no wrong door which is about creating and developing an integrated service for adults and adolescents with complex needs who are sometimes in often on the edge of care are apt transforming care and special educational needs programmes which are about focusing on supporting families that who fall into crisis due to compounding issues such as the empty learning learning disabilities Autistic spectrum disorders and are achieving change together programme which is a real strengths based relationship and evidence Programme for children who are at risk of exploitation and at risk of entry into care and their supplemented by our programme around domestic abuse and trauma
and of course I referencing and his point previously redesigned programmes around mental health and speech and language therapy and we're doing this
yes because it's got a we think some financial benefits but because this is the right thing to do to address the pressures that we face are in these areas and shall give more detail about specifics of some of those programmes

[Seat 29* - 1:22:31]

thank yes it could obviously talk about any of the programmes but for the person this week Chasen's talk about to this very health-related so the first one being speech and language and communication which is a real priority area for us we started work on this way before we actually developed are fully integrated funds and we had a joint CCG and Council review of all of our system and including how we were delivering services and we mapped all of our commissions and we looked at what was happening in scores what was happening through the speech language service etc and took purchase for the and spelling mistake undertook a needs analysis and we used am the I thrive mothers are framework we use that for most of our reviews so we looked at within a speech and language context what needs to be provided in terms of getting advice about language Friendly environments where we needed early help provision around speech language where we need a specialist provision and then in terms of the risks of poor we obviously didn't bring in anything which was crisis around speech and language but what we did look at was where speech language and communication issues applied to young people who are in crisis so that was very much focused around criminal justice around our looked after children's system and so on and young people in PRU's and young people who were struggling with their behaviour management who needed that kind of crisis intervention and asked that we devote one service specification which we signed off Joe shall signed off jointly and agreed outcomes framework which we've been a monitoring and progressing what that's resulted in is huge and very significant support in that whole early years pathway we know how significant that is I know there's been a presentation on early years this morning we've also looked at allocations around schools so every school has a dedicated speech and language allocation which is partly for oversight and advice and partly to support individual children who need speech and language is results in a dedicated and very proactive and support arrangement within I as Justice Service and dedicate allocation in our virtual school so read a strong focus on prevention and thanks to transformation investment and we've really
been able to develop our approach around early years and I just want to share the next slide with you from back quotes which way
I
am one of the things that we introduced as part of our early years pathway was the welcome assessment process that's an early intervention process which can be applied if anybody doesn't need a speech and therapist is that this is an early screening tool for children around the age of three are looking at whether the language and communication development is in line with their age and linked which as a whole toolkit about promoting communication and language development which can be applied in all settings so we use transformation funding that we had to roll this out with what we've rolled it out with just under 200 primary schools and early years settings and we've screened now vast numbers of children so this is the Armitt slide that shows the impact of that during the the last year which was our first year but we did it so we started in August 20 18 and you can see that the number Children's screened are there were 2 thousand 679 of them and 30 percent were achieving an age appropriate communication and by the end of the July in the follow in July 19 space per school year they were rescreened and that have gone up to 61 percent so that was because we'd identified them early and applied those tools through earlier settings and we saw a real transformation in terms of their ability to communicate at an age appropriate level so that work is obviously increased since then are we scraped we've screened well over 4 thousand children now are and that process is now embedded so whereas we had a huge investment in impose implemented in the first place is now embedded in our mainstream training and development but thanks to obviously being able to have transformation funding in the first place
it's very important to apply it in terms of how how it's been successful so this hasn't been a pathway that simply a clinically led pathway because obviously out of it some of those children were identified as needing clinical intervention is being delivered through our family partnership model which is our early Help base Neighbourhood muddle and if you can see on that is totally relationship base so it's looking at the characteristics of parents and children and also the causes of helpers as well as their skills in order to then work out how most effectively to help those families so the roll-out of speech language and communication score has been done in a way that engages families and becoming agents of their own change that's really critical when it comes to engaging harder to reach individuals so we've been able to use that holistic approach to create system change and to engage with and those who are more resistant or less able to access the support and that's been really really important to think it's not just about clinical pathway is about whole system process
and then the secondary just to touch on briefly I am very conscious of the time mental health has been a huge priority for our so again we'd done a significant piece of work again map using the I thrive process around how we have a whole systems approach to emotional mental health and we've been doing that over the last three years as well and that's led to our mostly friendly schools approach led by our educational psychologists working right through various approaches around linking with CAMHS up specialist CAMHS prevention as part of that we've been ready focusing on the development of trauma inform practice and that's really around identifying those adverse childhood experiences experiences of trauma that people have had in life and the impact it's having on them as individuals and how we then response to them and how we then build resilience with them and to enable them to recover from things that they've experienced and move on to
their adult lives have been having resolved some of the issues that they've had
we've made lots of progress on that so we've trained a huge number of frontline staff were rolling this out further currently that's our 7 minute briefing that you can see on there are withheld trauma informed conference we've worked with lots of partners to provide the lens on trauma across all of our settings and that's actually starting to reap real benefits in terms of people understanding the why behind behaviour so had been changing our language from challenged behaviour to distress behaviour and looking at the reasons why some young people really struggle to manage their behaviour and what's happening for them and we're obviously linking that into the put the family partnership model as I just shared before and it's one of our social work practice and the practice of our partners and so just wanted to focus on one specific area in relation to that which is youth justice which is obviously very high risk area both in terms of young people who have poor speech language communication very often and so struggle to deal with the communications that are important to them in understanding the consequences of their behaviour but also a disproportionate number of them have experienced trauma so again that the behaviours that there often exhibiting in terms of offences that they commit and their struggle to engage positively as often linked to trauma in their backgrounds so we've done a huge amount awareness and development amongst our staff we've got CAMHS and speech language within the Youth Justice Service to support that and were working with parents and carers to help them understand the impact of family circumstances on their children's behaviour and I think what this is doing is showing that we are adopting in through our integrated approach across health and social care both for a holistic early Help environment
for the early identification of need right through to really intense intervention that we hope over time already have an impact on those who need highly specialist support and having seen as pathways of support linked to a whole systems approach is what we believe we're starting to see as result of the Integrated Commissioning and Integrated delivery processes and that within putting in place thank you
version there

[Seat 39* - 1:31:16]

this

[Seat 27* - 1:31:35]

in the two programmes those around how we should make an effort to engage with current community leaders I think it's really important around hard to reach groups especially those from an ethnic minority that they get the the messages about signs signposting to all of the fantastic services that colleagues had described because often these groups are very difficult to to engage in those matters and across other result then miss out from the opportunities that have been described by colleagues
also present
can we wish you well in your trip to Papua New Guinean returned safely

[Seat 38 - 1:32:19]

the next meeting is on the 31st of January which calls could be the extension to embrace
thank you Lord