F24 The Wigan Deal Master Class | In association with the Chief Executives’ Forum, Public Sector Chairs’ Forum and SOLACE | Alison McKenzie-Folan, Chief Executive, Wigan Council & Prof Kate Ardern, Director of Public Health, Wigan Council



This on-demand teaching master class explores how the public sector, particularly medical professionals, can create true partnership working to effectively deliver changes for the benefit of their citizens. This session will be led by the Chief Executive for Wigan Council and the Director of Public Health from within Council, who will discuss the Wigan Deal, a human relationship approach to local government and healthcare integration that was born out of austerity. The two experts will provide insight on the six Marmot pillars and the importance of relationships, public sports, and community leadership in driving change. Attendees will have the chance to ask questions and discuss the implications of the Wigan Deal and leave with tangible next steps.
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Camille Oung, Nuffield Trust has just mentioned - Re. support for unpaid carers:

Join us this October for the leading conference in Northern Ireland's health and social care calendar!

The Northern Ireland Annual Conference and Exhibition 2022 (NICON22) provides a unique opportunity for colleagues and partners from across the health and care system, as well as the private and voluntary and community sector to come together, share ideas, reflect, network, and learn.

At this year's conference, entitled 'Recognition | Ambition | Mobilisation', you can expect to hear from a wide range of local leaders, international speakers and frontline staff across over 40 sessions. Over the two days, we hope to inspire and connect you as we recognise the contribution of our workforce, explore our shared ambition for our health and social care services and agree how to mobilise to tackle waiting lists and deliver a world-class service for our citizens.

We are delighted to confirm that our speakers will include:

  • Peter May, Chief Executive of the HSC; Permanent Secretary, Department of Health
  • Sir James Mackey, Chief Executive, Northumbria Healthcare NHS Foundation Trust; National Director, Elective Recovery, NHS England
  • Alison McKenzie-Folan, Chief Executive, Wigan Council
  • Prof Kate Ardern, Director of Public Health, Wigan Council
  • Matthew Taylor, Chief Executive, NHS Confederation
  • Maria McIlgorm, Chief Nursing Officer, Department of Health
  • Prof Siobhan O'Neill, Mental Health Champion for NI


Wednesday 19th October:

09:15-09:25 | Welcome Remarks | Mark Carruthers

09:25-09:55 | Health and Care 2030 - International Perspectives | Dr Anna van Poucke, Global Head of Healthcare, KPMG International; Healthcare Senior Partner, KPMG in the Netherlands

09:55-10:15 | Ministerial Address | Robin Swann MLA, Minister of Health for NI, Department of Health NI

10:15-11:05 | Health and Care – Mobilising Around Our Shared Purpose | Peter May, Permanent Secretary, Department of Health NI, Jennifer Welsh, Chief Executive, Northern HSC Trust & Ursula Mason, Chair Elect, Royal College of GPs NI

11:05-11:30 | NETWORKING - Please go to 'Sessions' tab on the left and join a networking session

11:30-13:00 | The Annual HSCQI Awards Celebration and Showcase | Master of Ceremonies: Mark Carruthers

13:00- 15:15 | LUNCH & NETWORKING - Please go to 'Sessions' tab on the left and join a networking session

15:15-15:50 | Integrated Care Planning – Through the Mental Health Lens | Martin Daley, Service User Consultant, Belfast HSC Trust, Dr Maria O’Kane, Chief Executive, Southern HSC Trust, Dr Petra Corr, Director of Mental Health, Learning Disability and Community Wellbeing Services; Consultant Clinical Psychologist, Northern HSC Trust, Simon Byrne, Chief Constable, Police Service NI & Grainia Long, Chief Executive, NI Housing Executive

15:50-16:45 | Leading Recovery | Sir James Mackey, Chief Executive, Northumbria Healthcare NHS Foundation Trust; National Director, Elective Recovery, NHS England, Maria McIlgorm, Chief Nursing Officer, Department of Health NI & Neil Guckian, Chief Executive, Western HSC Trust

16:45-17:00 | Reflections and Close of Day One | Heather Moorhead, Director, NICON & Michael Longley CBE, Poet

Thursday 20th October

09:30-09:40 | Welcome remarks | Jonathan Patton, Vice Chair, NICON; Acting Chair, South Eastern HSC Trust

09:40-10:15 | Co-creating a Digital Future for Health | Dan West, Chief Digital Information Officer, Department of Health NI & Prof Sultan Mahmud, Director of Healthcare, BT

10:15-11:00 | What is the Wigan Deal? What could a citizen-led approach mean for Northern Ireland? | Alison McKenzie-Folan, Chief Executive, Wigan Council & Prof Kate Ardern, Director of Public Health, Wigan Council

11:00-11:30 | NETWORKING - Please go to 'Sessions' tab on the left and join a networking session

11:30-12:30 | The Future of Social Care – How do we get a Step Change? | Matthew Taylor, Chief Executive, NHS Confederation, Camille Oung, Researcher, Nuffield Trust, Sean Holland, Chief Social Work Officer, Department of Health NI & Anne O’Reilly, Chair, NISCC Leaders in Social Care Partnership

12:30-13:40 | LUNCH

13:40-14:05 | Party Leaders’ Address – Recognition | Ambition | Mobilisation | Michelle O’Neill MLA, Vice President, Sinn Féin & Sir Jeffrey Donaldson MP, Party Leader, Democratic Unionist Party

14:05-14:55 | Our Big Debate – Leadership for Ambitious Implementation | Cathy Jack, Chief Executive, Belfast HSC Trust, Cathy Harrison, Chief Pharmaceutical Officer, Department of Health NI, Roger Wilson, Chief Executive, Armagh, Banbridge & Craigavon Borough Council & Prof Mark Taylor, Northern Ireland Director, Royal College of Surgeons of England (RCSEng)

14:55-15:00 | Conference Round-up & Concluding Remarks | Michael Bloomfield, Chair, NICON; Chief Executive, NI Ambulance Service

15:00-15:30 | BREAK

15:30-17:00 | F24 The Wigan Deal Master Class | In association with the Chief Executives’ Forum, Public Sector Chairs’ Forum and SOLACE | Alison McKenzie-Folan, Chief Executive, Wigan Council & Prof Kate Ardern, Director of Public Health, Wigan Council

Learning objectives

Learning Objectives 1. Summarize the approach taken to healthcare integration in Wigan England 2. Identify stakeholder and community partners involved in healthcare integration 3. Describe how partnership working across public sector can drive change 4. Analyze the role of sport in relation to health and wellbeing 5. Critically evaluate the role of citizens in healthcare transformation.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

around, please. The bad news is you've got me again. I didn't know. Yeah. Okay, folks, you're all very welcome to this master class on on the wagon Deal. Um, I do want to welcome you on behalf of the chief executive for, um, we have apologies from David Sterling, who's the chair of the chief executive for? Um um, I'm a CF board member. I was also here, Um, so as I say you've got you've got me again. But I very much hope you'll not be hearing too much from me. It is great to have a good, uh, spread of people from across the the wider, uh, public sector. For those of you who have been at the Nikon conference over the last two days that the the importance of and benefit of true partnership working right across all sectors. But you know, including and particularly those of us within the public sector in delivering the changes that we need for our citizens, regardless of whether they're seen as health changes or anything else, that was really one of the the strong themes. So it's really good, as I said, to see good representation from right across the public sector, pleased in particular to see so many of our colleagues from local government given you've got such an instrumental role in this agenda. So again, you're all you're all very welcome. Um, a number of people in the room have already heard from our colleagues from Wiggins. So it's Allison Mackenzie Fallen, who is the chief executive of Wiggle Council, and Professor Kate Order now who is the director of public health from within council and and at the risk of starting to of upsetting anybody, it was one of the strong, Most positive feedback from any of the session is over the last two days. They were all wonderful, but there was particularly positive feedback and a lot of discussion. I heard a lot of chat after the session over coffee about the the approach you took in Wigan and the opportunities that might present here and how it aligns with some of the work that is already being done here through community planning and so on. But it doesn't identify anything that gives us an opportunity to do more or go further. So there are quite a few people here who have already heard from from Kate and Allison having having been here earlier, So I'm not going to in anyway. Try to do a poor attempt at summarizing the approach. We're let's hear directly from Alison and Kate themselves. And then whenever we've had the opportunity to do that, we want to get into some good quality discussion among ourselves. What are the implications for that? How does that relate to what we're doing here? And are there any particular actions our next steps? It would. It would be really good to leave here this afternoon with a few tangible things that we think we need to do to, to continue to, to move this agenda forward. So, as I say, we'll hear from Alison and Kate, and we'll have an opportunity just maybe, to take any immediate reflections and questions for them. And then we'll get into some of the wider discussion. So Alison and Kate over to you. Thank you. Roughly. How many people in the morning? Uh, right. So not not everybody managed to establish that. Um, so Hi, everybody. My name is Allison Mackenzie Fohlen. I'm Chief Executive Council, Um, and placed based lead for healthcare integration under the new ICS arrangements. Um, Kate and I are just going to do maybe a cancer through the slides. We did a slide set this morning that a little bit longer. Um, we've got some reversion of those. So apologies for the people who were in the room this morning, but at least you get a chance to check whether what we said this morning is still the same, but it definitely will be. But what we thought we do is we'll do a quick, quick slide set because I think, as you said, the most important element, perhaps of this session is to open up the discussion so we can we can hear and talk a little bit further and maybe delve deeper into some of the issues. And as you said, more importantly, hopefully move to action, which is what we all need to do. Um, so on that basis, and we've also got a video to show you, So I'm going to do a few slides, and then I'm going to hand over to Kate. Um, I've done this one earlier. So, um, who's been to? We did so when we were on earlier, Matthew played Northern Soul music which one is famous for? Kate had a much better attempt than me to do a bit of a dance across the four hours Too embarrassed and shy. But, um, has anybody been to Wiggin? Well, we've got a few people who want to come one person's been to, so Oh, you're all coming to begin. Yes, it's going to be We're gonna have a party, and we're gonna and somebody's been to our famous fancy dress parties on a on a boxing day. So, yeah, um, So for those who haven't we're smack in the middle of the Northwestern England Great location. We're not just wiggling. We've got 14 proud towns. It's really important when we're thinking about our communities that we celebrate all our communities. It's a big borrow, so those communities are quite different. You know, the difference between winning and Lee is quite stark, and that's through heritage history, families, connections. Um, as I say, we are a big dose of this 325,000 residents with the second largest and greater Manchester part of the combined authority. So we work as 10 councils very much together as a team, Um, and with the ninth largest bureau in the country. We also have a rich mining heritage, which case we'll pick up on in terms of some of those health inequalities things that we've been looking at over many years and, um, some of the progress that we've made. Um, but lots of that mining heritage is now being changed into beautiful green spaces. So again, link into health in terms of nature, biodiversity. And, um, just a couple of weeks ago on that photo there, it's one of our flashes so reclaimed land that's been turned into open water with amazing biodiversity. And one of the things that we're trying to do is get our local people out into their as part of their part of their own wellbeing. Um and then a massive sporting tradition which is really important, too, is with rugby and football. We hosted the rugby league World Cup at the moment and we had the women's euros. But community sports, big and investing in community sports really good in terms of people's health and wellbeing and changing their lives. And we've got many stories of people who perhaps might have had a different path in life. It did not join their local sports club. So part of our role has been to really think about sports again alongside health and wellbeing. So the work that we've been doing in Wigan really takes into account Marmot six pillars. So we've been looking at these through out of our, you know, throughout our development and really thinking, What does that mean in terms of our approach and what we're trying to do? And essentially, our approach was born out of austerity. Um, and what we've been trying to do is take a really, um, citizen lead a human relationship approach to local government service and working with the NHS. So bringing together our services and integrated a way around the person. And that's very much what we've been trying to do in terms of our transformational journey. And it was born out of austerity. But it was built on lots of other good work. Which case we'll talk to you about. But lots of it was a package of things that came together. So we've been working with Hilary Cottam. You may have read her book Radical Help, which talks about actually thinking about how we radically redesigned society to really think about humans and human relationships. We did some innovative work with Nestor thinking about actually, What is it to work deep in your community? Do we really know our communities? Many people in their jobs now feel quite removed from the communities that they're not embedded in their communities anymore. They you know, they don't know who lives on particular streets. You know, they don't know people who are down the community center that the real community activists, the real citizen, lead leadership. That actually is behind a lot of the deal. So we pulled all of these programs together. We also have a program called Building Self Reliance. And actually, we thought, We need to change our approach. We can't go into austerity without hope, without positivity, without actually trying to do something radically different in terms of those relationships and what we were trying to do at the heart of the wig and deal, we didn't want sort of a death by 1000 cuts. We didn't want to be talking to a staff about what they can't do anymore, because we haven't got any money. So I was trying to turn everything on its head and what we developed through that was this way of trying to say We've all got a part of playing society. And if we empower our communities are individuals, we give them the power and we let them come up with solutions. Whether it's our staff, whether it's our community groups, our business is. Then together we'll find much better collective solutions. So shifting our mind, setting the council to be in perhaps traditional, very paternalistic thinking we know best to actually say, Actually, how do we have a conversation? How do we listen to our communities for them to be able to come forward and actually think about how they play their part and how we play our part? And this is why you get this, um, in effect, this this contract, um, and this unifying philosophy that we've had for many, many years, that sort of bonds us together. So the principles people say, So I still don't get what you mean. I listen to keep. We don't quite understand what you're talking about or what actually goes on behind this, and I think we're quite humble about this, that these principles of work for us, they might not work for everybody, but they just worked for us. And one of the first things was having worked with some of the early projects with the work that I talked about earlier. We really went hard and at scale on What does it mean to have a different conversation? Staff went on two days. Training course is to actually become many ethnographers. We an anthropologist around the course to who took staff through that journey themselves about what does it mean when you really have a deep conversation with somebody? So staff, in effect, learned to change their mindset about what it was to talk to people because many of our staff had felt disconnected from the communities through the way. We set ourselves up in terms of traditional sort of silo mentality and also think because, you know, legislation and tech list and everything else lead them into a situation that when they walk into someone's house, and perhaps they were doing some rehabilitation or assessment, they had already decided what was wrong with Allison. Uh, and they put me on two a tick list. I never actually asked me what my hope, spheres, aspirations, dreams and everything else was. And by asking our staff to flip the conversation into a much more positive one about asking Alison, what does she dream about? What? But she really liked to do the fact that she's not particularly mobile, the fact that she can't go out, but actually she really likes embroidery. Or she really likes, you know, engaging in art. So there's a local community group down the road. Maybe we could have a different conversation about doing the things that matter rather the things that she can't do so very much around, uh, scaling that up And it was scaled across the council colleagues, all parts of the council and then all parts of the N. H s. So we actually had a whole floor of a bit of a redundant office building where we had a be wicked experience that people went into, and they understood what the journey was. For a different conversation, GPS went into their primary care. Nurses are the council staff, and they took time to learn what it meant toward in a different way. We also spent time asking our staff in the early days to get to know their communities better go out and find an 85% of our staff live in the borough that they're working and we go out and find out what's going on. We actually had people who were known as community link workers, and we'll talk more about that. We've really embraced what it means to, as our director of adult services would say, Go trainers on and go out and find out what's going on. We actually did bus tours for people at one point, didn't we? Where we connected businesses with community groups to say, Did you know there's a business down here in a community group here? If you actually start talking to each other, you could really help each other. So we did a lot of work on getting to know your community better, and that's pay dividends because it's helped us know where all of the, um, the people who who can make a difference and out in the community there's some amazing activists. They're the ones who will tell you that the council's particularly rubbish or not doing great, but they'll also be the one who will be the greatest ally. If you want to get things done so. Knowing who those people are has been really important to us and supporting them and believing in them and investing in them as part of our journey. To then call locating teams are very much about bringing housing the police, N. H s schools, education together in our neighborhood. So that's very much. And we'll talk about how that's been aligned to primary care networks. And, uh, you can see on the map their how we've divided up the borough to really work deep in our neighborhood's and then trying to grow community capacity is really important to us. So going out and finding out that actually, some people do want to go into social care. They're happy to sell their own charities or businesses and actually invest in those and commissioning differently to think about the solutions to some of the crisis that we could be actually in our community itself. And that's been particularly important to us in homecare residential care and our work, um, particularly in terms of integration and then the other thing is around permissions and freedom. So I think we've talked about that a lot today, but very much around not having to blame culture giving, you know if people make a mistake and it's okay to make a mistake and move on and giving that freedom and innovation because you go out and have to ask staff or community groups or partners. People often know the solutions, but there's some sort of block in the system, whether it's politics, whether it's relationships, whether it's our own sort of functions within the organization, you find these blockages don't, don't you? So it's actively saying So what are the blockage is how do we sort it out and giving those permissions for people to really think differently? And then again, someone talked about earlier in terms of attitude, attitude is so important. If you got the wrong attitude and an organization, none of this is going to work. So you need to talk about the values and the behaviors of the organization virtually every day. And I think one of the things that we've learned is that sometimes, uh, you know, just having them on the shelf for using them once a year or doing something and your performance appraisal process is just a total waste of time, really, because people don't live and breathe them. They don't become those things. So actually, embedding them the cultural journey was as difficult and is as important, if not the most important thing to to really think about, um and then the recipe really, for things that have worked for us, that may work for you. Maybe you could take one or two things there and have a go at them. But certainly, um, these are things that work for us. So we had a hook. We didn't have a narrative that was in one part of the system, one part of the organization. Everybody was hooked into the concept of what it meant to work in this way. And that then becomes profound because it isn't just a project. It isn't just someone doing a transformation project. It's actually becomes, you know, social movement for change. And when you get that social movement for change, people get passionate about wanting to do things differently, and they really feel invested. They feel that you believe in them, they want to do things differently. So for us it was really tapping into why we're all public servants and why why, Why we why we get up in the morning and people really, really, you know, really valued that and recognized it. It also takes leadership so obviously within the local authorities working in the political environment, and this is very much about the politicians driving the agenda. But alongside the relationship between the offices and the politicians, it was has been, um, really positive and really strong, even when there's been bumpy decisions along the way and you got to back each other and again that no blame culture needs to extend all relationships, particularly the polyps. You know, the politics can be really difficult. I'm sure it is in many of your organizations and places are holding firm and really being truthful to each other about what that journey is. If you if you're not being honest with the relationships, certainly we're good. Kate weren't They were really strong between politicians and officers, and we learned to trust each other. We learned to call each other out when things weren't going particularly right. And then I've talked at length about the different relationships and the permissions and then redesigning systems to really sort of working on, you know, thinking about how do you sort of I suppose it's like test and fail isn't doing something. It doesn't matter if it doesn't work. Move on. Let's do something else. That that call to action. Keep keep moving. Um, the session that Kate and I did this morning, there was, uh, sultan and damn doing some talking around the digital strategy in Northern Ireland. And it was really interesting around how much we really need to all be digital leaders, part of our innovation. And we're going to very much embrace What is digital leadership? How do you bring our new innovations? New technology? How do you think about that? And then really thinking about I mentioned earlier about commissioning. How do we How do we commission differently and which parts of the organization are blocking? Where are they? Talk about it and and do something about it. This is probably the most important slide, I think. Certainly the ones I'm I'm going to do. Then hand over to Kate. Um, this is what we're about in Wigan and we talk about it all the time. I mean, every new recruit that joins the organization, whether they're joining as a a lawyer, a green space worker, someone who works as a community work or wherever they and we talk about what it means. And I say to them, Congratulations. You've been You've joined the organization because when you came for an interview, we tested you on these things because we only want people with that attitude who can be courageous, who can be accountable, positive and kind. And they sit within everything that we do. And we talked about them all the time. We have sessions with our staff listening to action sessions with the politicians and officers, and we talk about them. We have big conversations where we where we are staff to unpack these. So what is it when I'm courageous and what is it when I'm not courageous and similarly all all of the other three there, So they're really, really embedded because it's really important about how we do our work. And this has been ultimately the cultural journey about talking about these behaviors all of all of the time and the be kind one is really, really important. We talked about that earlier today that kindness and compassion, kindness and leadership, and the way we talk about in witness to say it's not a sign of weakness. It's not a sign of an organization that you can't make tough decisions. It's not a sign of actually, um, you know, being overly positive about everything. But it is actually just a sign that we are humans together. And we need to have that compassion now more than ever. It's so important. We live in such a divisive world, and we need to stick with kindness. And so we talk about that as an organization, Um, a few pictures of our community groups, but they are so important to us, we believe in them and they have been amazing. They've been on this journey with us, and we've got so many community activists who have done most of the work. Actually, they've been the ones who who perhaps should be up here talking rather than Kate and I because they're so passionate about supporting their local communities. So I'm going to hand over to Kate to do a few slides. We then got a very, very short video, which hopefully brings to life some of the work we've done, and then we're going to open it up into more of a discussion. Thanks, Kate. I'll bring it down because I'm slightly shorter. Hello? Um, one thing that will be different. I think between what Alison and I describing and your, um you know, experience here in Northern Ireland is that I'm a doctor, but I was a council chief officer. So public health in England, through the Lansley reforms, returned to it's ancestral and rightful home, by the way, in local government. But within was a little bit unusual because I've actually been working across the NHS as an exact director in our old primary care trust and as the chief officer in Wigan Council since 2008. So I was a joint appointment, and I think that was actually a very far sighted, you know, approach from wigan. Uh, and I think particularly from Peter Smith. Actually, Alison, who was our late for my counsel leader, um, thinking about that wider wellbeing perspective and the need to bring that focus back into local government where it's so rightfully belongs. If you look at all the history is very important and picking up Allison's theme here that geography, that sense of place is absolutely crucial to people's wellbeing, never more so actually we found during Cove ID when our social geography and Wigan, despite being the second biggest borough in Greater Manchester. And by the way, that population is bigger than a number of U K cities in our borough. 325,000. Um, actually, that sense of history, tradition and social networks means that our our population tend to actually socialize with Surely with Warrington with Saint Helen's, the Rugby League Burroughs and also the former heart of the Lancashire coalfield, the former mining communities. Uh, if you notice our demographic were predominantly white borough, um, we do have, uh, you know, different traditions and cultures within the borough in the east of the borough inlay. Never ever tell either that they're a wiggler, by the way, uh, if you really want to, you know, get out alive as it were. But leaders in lead. There is a tradition of Eastern European, uh, migration to the coal mines, because Eastern Silesia in Poland was a former mining community as well. Whereas if you look at our neighbors in our geographical neighbors in Baltimore, Greater Manchester, you will see a much more diverse population because there are former cotton town. So understanding some of the context around the demographic and social mix is incredibly important, and it informs a lot of what we do around health. Which is why Michael Marmots report on fair society. Healthy lives was so crucial, and part of that thinking was about getting away from a more professionally lead approach to health and wellbeing. We do not do traditional health promotion or health education in Wigan. In fact, had I inherited that 14 years ago, it would have got scrapped quite frankly, because the only people who read leaflets and posters are basically middle class folks. It doesn't get to the people who you really need to get to, and you really need to actually engage the approach of actually investing in people's ideas and creativity and experience. Uh, community experience is absolutely crucial here. So part of developing the wig and deal was to actually work with modeling ourselves very much on North Carolina in Finland, who had transformed their experience of cardiovascular disease, the biggest single cause of preventable premature mortality for them in the 19 seventies and for Wiggin, you know, in the two thousands, they done it by a grassroots movement for change and pushing a whole societal whole system approach. They were spending lots of money on it, but it was all in cardiology when actually, what they needed to do was to push that investment upstream, but that linked with a very much grassroots champion movement. So we also partnered up with the Royal Society of Public Health and started to create that citizen lead approach to public health, which now has 23,000 citizens of all ages engaged. We bring people in according to what they're interested in using a Level two qualification, which, of course, is GCS C level and entry level to health and social care. Uh, and I mean, I've 55 putting doctors through that particular program, for example. So in terms of growing your own work force, it's a really good way of engaging people. We've also found particularly working with RV CSE sector, that for many people, this was the first exam they ever passed. Can you imagine getting to the age of 40 50? Being always told you are a failure and you do begin to believe it and then passing your first exam and suddenly realizing you're not a failure at all. You've got knowledge, skills and experience which are absolutely vital. And we were getting this back, particularly from women in the borough. An absence of praise, very important and can't be understated. How that confidence is and self belief is incredibly important because people do not want to be healthy to save the NHS. Sorry NHS colleagues. They don't want to be healthy to save for, actually, Weight's on A and E or the elective waiting list. They want to be healthy because they've got hope, confidence and belief in their own futures and those of the families and loved ones that they have. Um, so the Health Champions Program is incredibly important, and it links in to all the work we do, for example, on debt management, on fuel, poverty, on food insecurity, because you've got to get all of those things right as well. That has to be part of that deal program. We've also borrowed some really good practice from elsewhere, not just North Carolina. One of the things I said this this morning that we used to hear 14 years ago, and it was a contrast to where I worked previously in Liverpool, where you have a very engaged community who will always challenge rightly so people who are decision makers. We didn't have that in a week and we now have much more challenge. Actually, that's a good thing, not a bad thing. It's a really good thing that the community is more much more challenging. Um, but we used to hear from professionals. It's good enough for Wigan and what they meant by that was not something they would have ever accepted as being good enough for themselves. We see that across a number of fields, and I would say you would see that across a number of what our euphemistically described as left behind communities or left behind towns. Poverty of aspiration for that community and what we try and do is actually foster the confidence and empowerment of those those citizens that we're very proud to serve. When Chris Nail and Dan Wellings did the King's Fund Independent report on Wigan, uh, it was really interesting. They went out and talked to our staff. They talked to the community and I said to Chris, give me some initial thoughts when they as they were coming back and I think a really powerful comments, and I think it really speaks to what Alison said about that investment in our belief in our front line stuff, to do things differently, he said. I don't care whatever any else we find in Wigan, the one thing I can definitely say is You've given your staff there vocation, back vocations, A very old fashioned word. But it's a very important word. So look, building on people's ideas. We've worked, for example, with our earlier settings on the schools on The Daily Mile. And much to my delight, the earlier settings came back after we started the Daily Mail. We worked with the Lane Wild, the inspirational head teacher from Scotland, who who's a great idea that was, and the earliest guys came back and said to us, We like this date. Can we Can we do something with the under five? And we'll call it the Daily Toddle. Brilliant. So all our primary schools do. The Daily mail are early years, folks do the daily toddle. We sold that one back to Scotland, by the way. I'm always. I'm always trying to be entrepreneurial in some things and are young health champions incredibly important in terms of building up confidence knowledge early on in life. So, you know, I have seven and eight year olds in the borough who know far more about how to look after their heart than I ever did when I first went to med school, which I have to say is more than 40 years ago there has it made a difference. Well, yeah. I mean, when this slides a very important one. When I first went to work and 14 years ago, every single health staff was going in the wrong direction. So the gap between us and England was widening. Um, what we're seeing and clearly we have to factor in some impacts from, for example, cove it. But also, you know, uh, Brexit, uh, impacts as well. But what we've seen is a trend that's booked. England's were improving very unusual for a community like Wigan to start to turn around things like healthy life expectancy. And we started to see this trend, uh, being booked within five years of starting the deal or an electoral cycle. We'll possibly not in Westminster terms at the moment, but Larry the cat apparently has been asked to be PM but grown up in charge for once, but the point being in a normal sort of counsel electoral cycle. It's actually something that gives politicians confidence. And if you building the measures around, for example, smoking prevalence around, uh, benefits around investing in fuel, poverty, etcetera on a and E admissions, you start to build that evidence around what works and build the confidence in doing something different. Public health does not take 25 years to deliver. It can deliver within an electoral cycle. What does that mean for our integrated care landscapes? Well, very important that geography, that sense of place. Those 14 townships are how we organize everything. And it's the geography that the community understands. The organizations fit our geography around the community geography, and that includes the NHS. So when our primary care networks were being set up and fantastic leadership from Tim Dalton, who's the chair, was the chair of our clinical commissioning group instead of going with their mates because we'd organized and we were doing the deal around our 14 townships with our registered populations, schools, GPS, very important to bring them together. If you think about the whole family. Then our GPS felt it was a no brainer to organize the primary care networks around the same geography. So in other words, we've got co terminus community geography that recognizes and respects the way in which the community operates that importance of acid based and actually investing in the skills and incubating the ideas of the community absolutely critical and thinking about that investment in health and wellbeing, about developing the economy, the skills skilling up for the future. It links to things like the climate change agenda, for example, and seeing this as a whole system leadership. I was just the person with the job title of being director of public health. I've always seen the the the What I'm about as being an expert on tap as opposed to being an expert on top and every single citizen is actually their own DPH very, very important, uh, sort of distinction about empowering and fostering the leadership of others. And it is beholden on experts to do that. In other words, share the knowledge, give up the power, be a servant leader. What does that mean in terms of the sort of going forward for the deal? 2030. Well, I am now not part of Wiggins Journey, and it's been a huge privilege over 14 years to be that. But I sadly turned 60 in January, so I had to retire and move on as it were, Um, but that's important, actually, because it's about passing on the torch, isn't it to others and not seeing yourself either individuals or a team or a single team as being, You know, the solution to everything. It's about being a steward, and I think stewarding is a really important concept. So, marmot 10 years on, Michael and his team have also done working Greater Manchester, which is incredibly important, that community wealth and health building working with the Center for Local Economic Studies and others on building community assets. And we've learned a lot, Haven't we listened from our colleagues in East Asher around community, their community empowerment legislation in Scotland? We haven't got that in England, but we've taken some elements of that to help us with. It did. We don't have a university based in the borough, but we've developed a formal partnership with Edgehill College, who are a new med school and through some of my links, Um, very good connections, obviously with the Kings fund with Sulfa University with chest, the university and others to actually bring in that sort of academic and formal expertise to help us evaluate what we're doing. Very important to do that. And, as Alison said, learn from what doesn't work as well as as much as what does work, I guess, a a sort of great anecdote from Stewart, actually, our director of adult social care and health. The first time he knew about this was opening the pages of the wig and evening post and seeing the headline Rusty Rocks Up Heath Side. He's Side is one of our care homes to care homes that the council still runs. And Natalie, who's the fantastic manager there, had been doing reminiscence work with her residence, found that they all had been to Blackpool on holiday loved riding donkeys. So she brought about Blackpool Donkey in. As Stewart said before the deal, what would have happened is risk assessments in triplicate hurts going through various stages of management. He would have had to sign it off. Alison would have had to sign it off, and probably someone at some point would have said no because it's too risky. The first Stewart knew about it was reading it in the pages of the wig in Evening Post, and that's and as he said, the deal works because Natalie felt empowered to do that, he said. I'm sure she did a risk assessment on whether the donkey would put on the floor or bite a resident. Fine. That's the point. That's staffing, empowerment and engagement and the opposite of that. And I think it's important to sort of look at a story where you know something didn't quite go right. But again, that no blame culture was one of our o ts took out. I always took a group of adults with learning disabilities out to one of the local cafes. She did her deal training and thought, I've never asked them what they really want to do. So the next time she met them, she said they were in the calf. She said, What do you actually enjoy doing and and to a to a person, they said, we like roller skating. You know what's going to come next door? So they all started going roller skating and did you know all the risk assessments, but one of them fell over and had a colleagues fracture. Of course. Now did we blame her? Know? Of course not. They're still roller skating to this day, by the way, this this group because, as I pointed out at the time, they got one of them could have easily tripped over the leg of a chair in the cafe and ended up with a colleague fracture. Because accidents do happen, the right risk assessments were done. The right support was given to her in terms of, you know, doing the right thing and doing the thing that her clients actually really enjoyed doing and still enjoy doing to the day. And you know how easy it would have been. Don't you to stop that activity? Actually, we didn't. We said, carry on, do it. Uh, and for me, that's really liberating To be able to take those kinds of decisions. So what's our key learning? Well, I'm going to I think you're going to enjoy hearing the the video that we have, because I think it brings it to life what it's like to be a resident in Wigan. But for me, um working with the coalition of the willing is incredibly important. There will always be blockers in the system. They're often professional. They may be community, they maybe political. But find the people who share the same philosophy and work with them. And then you never know. You might make some really interesting friends. Um, tell the story of place. There is no one size fits all model. You know Alice and I can share are learning the journey we've been on and some principles, but nothing can simply be imposed on the community. You've got to go out and work with the community and develop your own narrative. But telling the story of place is as important as the statistics, and you may think that's really surprising coming from a director of public health. But context is everything. Stuart has another phrase which we always love, infecting the NHS with wellness. The NHS is great at sickness because that's what it was designed to do. But if you look at, go back and look at the original models for the NHS, particularly Peckham center Um, it was very much around the well being model and a local authority place based model as well. Interestingly, World War to change that because of the context. Look at where people, places that have done whole societal whole system approach and see what you can learn from them because we certainly were inspired by North Carolina. And I have to say North Carolina is how we should be doing it across the United Kingdom. We have the same problems. They've gone from being one of the worst, as they were in the 19 seventies, now being one of the best internationally. It's been well researched by W H. O. But we didn't because it wasn't invented. Certainly in England, um, so look at that best international practice and see what's relevant to your experience. And now we're saying we again. It's not good enough for Wiggin. Only the best is good enough for Wigan. And I think that should always be the mantra if you, like, move to that using expertise in a in a really democratizing way. So that expert on tap rather than on top. And I guess that means with that investment in communities ideas you can't just socially prescribe to something unless you invest in it. By the way, um It's about citizen lead, public health, citizens, lead health and wellbeing. Some really good links here, which I'm sure you want to go away and explore. And I'm now going to hand over to our own citizens to talk. Can we have the video, please? Thank you. Well, next to the rugby league club that he's reaching out to supporters with dementia. Weekend warriors have set up a rugby memories group where fans of the team meet up once a week to watch an old game and reminisce about the glory days with the club hopes the scheme will also help tackle loneliness in the community. Chris Whole went along to this week's meeting, where a very special guest drop by I first went when I was 17 to watch Wigan and I'm 89 now, so I've served my apprenticeship. Mary and Lily share more than the love of rugby league. Both have dementia and met after losing their husbands, but they found comfort remembering the other men in their lives. Those wearing cherry and white Favorite member was Billy Boston, Eric Ashton, Johnny Lorrison Remember Johnny Lorrison? Reminiscing about their favourite players isn't just nostalgic. It's therapeutic here at the for Clamped Cafe in the heart of Weekend Warriors HQ, a rugby memories group, is open to anyone with and without dementia to protect against loneliness and social withdrawal. They really come to life when they start to tell their stories about when they first started to watch the rugby. We have the old programs. We have old photographs today. Some of the ladies brought their own photographs and share those with the group. So it just brings those memories to life, especially when their favorite player, John Bateman, pops in to say hello and invites them to watch his next match from the comfort of a corporate box. I never watched me bad. That was brilliant. Best best day of my life. Never forget it. Never forget it. Well, we can't wait for the 11th. Were in a box. Aren't? Well, I'm going to go like this. I'm not going to be drinking tea. I can tell. You know, they've cheered Wigan to dozens of trophies, but those memories are slowly being taken away. Dementia is growing in the UK 850,000 have it now. By the time John Bateman is in his thirties, one million of us will have it enough to fill the D W Stadium 40 times over. So the Warriors are sending their young players to these sessions to learn how to care for those with dementia and to get tips on tackling technique. It's just more tackling than anybody in rugby league goodness. Get the legs you can go without. Yeah, tackle the legs because I got room without the leg. So I have to go back to train and tell the lad. So, yeah, we're going to come and see people like this and see how much it means, obviously, just to put a smile on your face and just turn around and say It was fantastic and one of the issues. I mean, it just it means a lot. And it's fantastic to see people like John Bateman is our favorite player. Oh, is it? He will be when they go to watch him. He's in the memory making business to keep the smiles on these faces. Chris Hall I TV news with, um, what a great Mary and Lily you are superstars we love. You need to get them in the dressing room now, Still to come. Okay. It's not just fantastic. You know, that's how we all want to be spending her later years, sort of thanks to Allison and Kate, and I can certainly say I hope it's the same for others who were here earlier and seeing and hearing that again. And you did make it different. But seeing and hearing that again even more was coming out of the benefits in no way I felt repetitive. So So thank you for that before we just getting a bit of discussion, a quick apology for me. I only realized when I sat down, I'm pretty sure I didn't even introduce myself. And that's because I said my only excuse for that. I've spent the last two days off this stage constantly, but I am very conscious. We're joined by other colleagues. So in case for those of you don't know me and Michael Bloomfield, chief executive of the Ambulance Service and also chair of Nikon. And as I said, standing in today for David Sterling from the Chief Executive Forum, Um, I think seeing that that little video, Lilly and Mary really brought out what I loved hearing about your approach is just the really practical nature of those small things you were saying, like bringing bringing the donkey in or the roller skating or the bus trips. And and I don't know to what extent that happens more widely, but it just sounds so refreshing. And it's like giving people, particularly that stage of life, some continued quality and added in those in those latter years of life, just having fun and not enjoy. And what that must do for the overall overall well being is remarkable. Also really liked Alison what you said, and you said it made me think a bit, um, that you meet every single new recruit to your organization, And I'm sure we all like to think that, you know, we're very good at making sure we go along and speak to various groups, etcetera. But I'm just not sure how again, how widespread that would be. A commitment to meet every single new recruits, your organization and what that can do for organizational culture. I just think it is so important. So certainly a really interesting tip that I picked up. We're gonna have some an opportunity for some discussion, folks. Some some questions. If there are particular points of, you know, you would like to ask a little bit more detail about. And then, as I said at the start, I would quite like to see Can we turn that into? As Kate said, There is no one size fits all. So it's not a case of saying this seems to be having great results in Wigan. What do we need to do it here? I'd like to see that we have to explore some more discussion around how this compares to what we do here. Do we see opportunities from from this approach? And if that is the case, uh, to get some of those outcomes? If that is the case, what would that mean? That we would need to do If anything, that is different to what we're doing now. I think that would be quite useful discussion to have towards the end. But before we open it up a bit, gonna ask David Burns, who's chief executive of Lisbon and Castle Ray Council, just to give us some initial thoughts he has placed. Thank you, Michel. And thank you to Allison Case. I think it was a great presentation. Uh, sorry. I missed the station earlier this morning. I think it would have been really valuable. How you nervous? Did the young rugby player look and I love this story about the roller skates because it just made me think of my own circumstances. And I bought my son a trampoline when he was about six and I placed it too close to the house. And within two hours we were at the hospital with blood pouring down his head. Now the sort of a bureaucrat, and we might have said we'll do away with the trampoline. But the sort of logical side would be just moving to a safer part of the garden, so that's what we did. I just felt it was a really great example of doing with rather than two, and I think that's a lesson that we need to take away from this today. It was refreshingly simple language, without the overlay jargon, mystic language that we'll use a roundabout coproduction, cocoa design co creation and then the rest of the nonsense, getting the trainers on rolling sleeves up. And it's all very similar, isn't it? Get out there and get to know your people in your communities. But it's a blow into Northern Ireland, and I think I can speak with an element of reflection on this is my experiences since since coming to Northern Ireland. Um, and I find that people here really kind. So when Allison was talking about kindness and like some of them were already there, people want to do a good job and they are really friendly. So they're really good starting point there for us and just in terms of that sort of whole health journey. And I like, I feel that the people here is real strong family values. So some of the issues about empowering people to make their own decisions and looking after your older people, some of that already exist here, and some of the challenges and from talking to the machine just about care is it feels as if there's an under investment and the support that we can give to the older people that often just get them up in the morning, get their clothes on, and then you're out the door. But families themselves and communities maybe have a far bigger role to play there. Beautifully maintained towns and villages here yesterday, I was at the Northern Ireland Immunity Council, best kept awards and whether it was done more strong, Ferd's Randallstown or Royal Hillsboro. All these places were picking up awards, not for the role of the council or any other government agency. It's because of the role that all the communities playing and really looking after those places so fabulous parts and greenways in the in the lake across Northern Ireland. But we've also got fantastic. Business is an amount of innovation that exist in this country is absolutely remarkable. So those are really strong assets that I think we should be using to build on what really is good at. I don't think we're good at listening and taking on board feedback, and I think that's because of the fragmented nature of the public sector here. So if I go out to the hilt, they couldn't care less whether I'm from the council, the roads department, education, health or whatever. I just want something done and I don't want to hear about it. It's not my job, and I'll have to refer it onto someone else, or I get a letter two weeks later to say that's not my department So for me, that's a big issue that we need to overcome. Red tape generally. And it was interesting that Alison and Kate both pulled out just about bureaucracy, bureaucracy, pace, decision making blame. Blame the big issue here. It's almost like you want to cover yourself so much so that nobody comes back and slacks for a decision you made. Sometimes you just need to suck it up and get on with it. Fragmentation and risk and the roller blades was a key thing there for me. So what does all this mean for Northern Ireland? But in terms of counseling, we couldn't do it on our own or two small. We're nowhere near a wig in, and it would take three of the council's in Northern Ireland simply to meet the demographic numbers that exist there in Wiggins. So so for me, with the machine along with the morning down and are you in northern down, even on my Banbridge, what is the sort of collective opportunities that exist there a regional basis? But even just in terms of those other services that exist in terms of roads, education, how do we get people around the table to make a real good conversation going, but keeping the agility that exist in local government. So it's community planning partnerships right for them. If it is, how do we change the message? So it's not just a talking shop. How do we start getting things done and start to make make a change and to be very organizational cultures to apply the weekend deal model? Or is the things that we're going to have to change before we get that? How do we collectively support our staff in our communities to build on our strengths that we have that have already mentioned? And there are things that need to change in our process is to allow us to make progress quicker. But in summary, I think we've got really strong athletes here in Northern Ireland, and we've got really good people. So for me, it's just about cutting through the rubbish. It exists and start to focus on the health and well being. Both Kate and Alice never referred to today, so hopefully maybe just gets a wee bit of thinking, and I'll pass back to Michael for hopefully our after questions and thoughts from the floor as well. Okay, Thank you. Thanks a lot for that, David, I think, actually post quite a few questions there towards the end of the sorts of things that we need to be thinking about. So maybe just to kick things off, folks, Any any initial reaction, thoughts, queries, clarification, etcetera, for for listening. And Kate on on what you've heard, I just I'll kick one off while you're getting ready. But I was fascinated by the fact you said this was born out of austerity and that over. I think it was a 10 year period. You deliver 170 million lbs savings, and I can imagine our reaction might be What's it going to cost to do this as opposed? It was born out of austerity. Could you say something about that, please? How come that wasn't a constraint? How did austerity help trigger this? Yeah, sorry. I'm just reflecting because it's It's a long We've both been in 14 years. It feels a long time ago. We've got another set of problems getting us now. We put a lot of it was down to the Lord Peter Smith and some of the work that had happened, and he was adamant that austerity wasn't going to destroy the council and the burro. So I think it was a strong political mandate that said, We've got to do something different. I think the first thing, I think the fact that the relationships between the politicians and the senior team was so strong that you could have that really honest dialogue about So what are we going to do? Um, the issues around previous work where we were sort of fumbling around, we had a building self reliance program. We had lots of things so that they all seem to come together at the same time. But we didn't ask What's it going to cost to make this happen? It was actually, this is a moment, you know, This is a moment in time now where we need to radically think differently. But they've been contributions along the way to help some of that thought processes. So although the deal concept, uh, was born in effect or became became alive, there had been a lot of early work that sort of contributed to it. I think the other thing that we did, which we can talk about, but it wasn't on the slides is it also takes the financial part of our organizations to be a bit more open and risk taking and, um, less and more thinking about the long term benefits of doing things. So, you know, having strong financial stewardship, who are prepared to take risks, you know, thought through risks and do things differently. So what? The other thing that we did was we set up to do all of that work? We actually set up transformation, uh, reserves and funds to make sure that we could pump primed the work that we needed to do rather than sort of just slash and burn. So we actually did some investment. And when we talked about the bureaucracy, we knew we found out through that where some of the blockages were in the organization. So I'm you know, I'm not going to sort of say it was in a particular part. But there are blockages and organizations. It's either individuals or particular teams. I think having that much more transformational mindset helped us say we need to get through these blockages. So I think it was a combination of things. It wasn't sort of a you know, something that we dreamt up overnight. There was lots of contributions, but Kate might want to have their thoughts. Okay? Oh, yeah. Can you hear me? Um, yeah, it was taking out transactional, So Yeah, hands up in different places. Hands up. Oh, um, sexual. So part of actually getting money out both too much. Thank you. Uh, take a costs through really looking at our own systems and processes. And I think the other thing to recognize was that if you salami slice prevention and early intervention, you're merely storing up huge amounts of cost at the high end and cost of the pathway within 12 to 18 months. So it's a false economy, In other words, and I think Peter's background as an LLC trained economist was incredibly helpful here because it actually helped reframe the way we thought about finance and resources in terms of how do we best invest what we've got to produce better outcomes. And I think that strong political leadership from from him from David Mullinix, who who was the deputy leader and now is the council leader, was very important. One thing David said to me, actually, when public health came home in 2013 was You've got a grant that comes with you, the public health grant. But if we only spend that on public health and don't think about the entire way in which the council invest, it's resources, staff and, you know, money to improve the health, wellbeing and lives of our citizens, then we've missed the whole point of public health coming back to local government. And what very wise words those are and actually reflect. What Michael Marmot was saying. Peter and David were very, I think, influenced by what Michael Marmot, sedentary society, healthy lives and the little anecdotal will tell you, having taken them to see him a present. His interim report. Peter was very tall man. He was about 6 ft seven and 5 ft one, Um, and he came out of that room. And he was also for a politician man. Generally a few words because he was so impressive in terms of his stature, and he looked down at me and said, Kate Marmot, that's how we're going to do public health in Wigan, isn't it? To which the answer, of course, was yes, leader. Thank you. And that's very interesting in itself that that that idea of financial risk deciding we're going to do it and being prepared to take financial risk is probably something that we're not that comfortable with and the pump priming of transfer me. Certainly our experience, certainly within health, can't. I can't speak for some of my other colleagues here, and we're good at putting in the pump priming The additional non recurrent funding to get transformation started were not very good at taking out the recurrent savings that it's meant to deliver. We end up double running for much longer. But any question Maria, I think it is. First of all, thank you very much for the presentation. I really thoroughly enjoyed it and I'm really hard to hear about the positive risk taking that has gone on because I think it's absolutely fundamental to any kind of a constructive change. What I wanted to ask you about is how do you stop? Message is getting lost in translation because, you know, all of us in this room, our skilled professionals. We've been doing this for a long time, but actually we're not very good at communicating our vision to the public, and also we're not always very good at hearing what they have to say back to us. And I just wonder, how do you manage the subtleties of that? You know that the flow of traffic in either direction because it strikes me, that that's probably key with the public. It's probably changed over time. So back in the early days, we used to do the deal listening into action sessions out in communities so the politicians and people from the council would go out and sort of do that listening type exercise. Um, and then that's changed, I suppose, over the years, and what we've been doing over the last couple of years is big listening. Well, first of all, we did the big listening project back in 2019, and the whole deal 2030 concept, which is the next 10 years of where you know where we see the dreams and aspirations and how we want. We're going to be the best place came out of that big listening project. So we went out. We spoke to 6000 residents. We had dropping sessions. We have digital booth. We went to schools. We went everywhere to talk to people. We put a big green sofa in the middle of places. So supermarkets GP surgery, schools on the High Street, you name it. It went out on the you know, some of our staff were putting it I/O of a transit van and got bigger muscles by the end of it. But and we did it in a non sort of typical survey type way. So we we said, you know, come and sit on the couch and let's have a talk. You know, you live in, you live in Standish. What's your dreams for your Children? What do you want to do differently? What? You know what you're not happy about and what would you like to see in the future? So it was an acid based open conversation, not a predetermined were here on a consultation. I've got 10 questions that I need you to answer, and then I'm going. It was much more around that conversation, that big listening, and that's really helped, as I supposed to try and become much more in tune of Hopefully nothing getting lost in translation. But things do, don't they? We've got to be honest with each other and, you know, you know, there is still sort of spiky issues, but I think it helps to have that type of approach and similarly with the staff we do with our teams and our staff. And we really embrace that. So we have a big conversation. We have big listening exercises with our staff, and they will. They will tell us how it is. And we've got to be prepared for that open dialogue and really go with it. And, um, that's been a real journey. Hasn't okay? Yeah, very much. So it's And it's about leadership having the confidence to be challenged and not take it personally as well. See, it's really constructive challenge. I'll give you a sort of example. One of the, um, an example of perhaps the way I sort of approach the work director of public health have to produce a statutory annual report. Who reads them exactly. Does it influence decisions? Know. So I took a decision, um, to not do a standard public health annual report. But in fact, to create community movies, so worked with Martin Green, who is a local actor director, and Ian, his colleague, who is a BBC train cameraman. What I did was set the theme for the year. And it was something, you know, that we were, really, you know, keen to sort of explore more with the community. Um, the last one was actually called a sense of belonging. The last one I did before I retired. And that was all about art, culture, heritage, you know, the work of the libraries Alison featured on it because culture is her passion. Um, and it was What we did was to send Martin and Ian out to do filming over nine months of the year right across the borough with a range of demographics. There was some key groups, you know, we really wanted to hear from, um and they would come back after nine months with a wealth of material all filmed, and he would do first edit. And then we edit it down into a into a reasonable size. They're all on council YouTube. But the point about doing that was I didn't know what was going to come back from the community on the theme of culture and health or housing and health and homelessness. What I was doing was listening to what they have to say and then framing my recommendations around what the community said. So instead of it being, uh, yeah, technically, my annual report. In fact, it was the boroughs Creative public health annual report and doing it by film and listening to people's wisdom and experience was as much you know, a learning point for me as as, as you know, the person with the job title as it was, You know, that kind of engagement for the community and, you know, cut down snippets that people can show in community groups or take around the library. Very important. So in other words, adopting a much more creative approach to communications was incredibly important. And we did that through Cove it as well. And one of the things I did through Coated was a fortnightly live Facebook Q and A with the public. I had no idea what they were going to ask me. They sometimes asked me about the markets, actually, Alison So I used to have to defer that one, but the we advertised it and they were very popular that they were proved to be very popular because it was about that having that trusted vase and voice that but also accessible expertise that the public could question. They could send questions in advance if they wanted to. I could do an update on the You Know how covert was doing in the borough and any national policy changes. But most of that half hour was devoted to people asking me questions live and also being able to say, Well, some of those things I can't answer now. But I'll go away and get you the answer and then, you know, feeding back again. So using, you know, digital social media, using different types of communication and it being highly interactive. And you being prepared to listen and act on what you're hearing is incredibly important. Can I just start one tiny little thing there? So building on that would be to have a really strong PR and calms team? And part of that messaging is that you continually messaging the same thing. So as a place as an organization, you you you try and be consistent so things don't get lost in translation. So we've got an amazing PR team and calms team. They're really and they do amazing stuff, so invest in your PR and calms teams really great people in their Thanks a good message in there. Could you whoever come asking, Would you mind just saying who you are and where you're from for the benefit of everybody but Martinez, your next Thank you so much. So my name's Martina more. And I'm the director within the Department of Health who's developing new integrated care system here in Northern Ireland. So, um, fascinating. I'm just sorry I missed this morning, the presentation. And to be honest, I think I take the two years in the room somewhere just to learn so much From what you said today, probably a few different things that we want to reflect on. The difficult conversations are the different sorry conversations is something really, really grasped on there. And I think you talked about bringing GPS into the room, bringing nurses into that training, and I just wanted to get some feedback from you and how you actually embrace that to bring those other partners in at that point and really get them to commit to that, because I know how difficult it can be. You know, that was obviously the weekend deal, and it was driven by austerity. But how you brought those other people in that that early stage and kept them committed? I was thinking what you said. You turn that around in five years? Great. Because I think our reflection is you know, when we're looking to change how we do things and we're looking to change the population's outcomes, this is gonna be a long term challenge we've got. So how do we hold our nerve and keep everybody on board with this way of working as we make our way through that? So we've got a partnership called a healthier working partnership, which is bringing together the council, the social voluntary sector, the NHS primary care, everybody in that family. Really? And that's been a big sort of O D development program because we speak different languages come from different organizations. So people have learned through the healthy working partnership, probably in existence about eight years. Um so it's very much been about trusted relationships. So picking up the phone to each other, learning about each other, uh, working really closely with GPS, the hospital doctors and, I suppose, understanding what's high stakes understanding what's low stakes understanding where the tensions are so it's really based on relationships. And then once you've got those relationships, you can then start to do the magic together. I think that's where we've been able to say, Well, we did the deal training for all of the staff in the council first and they and then, um, people just wanted to come along. People wanted to buy into it. They could see the vision. They wanted to be part of it. But the healthy working partnership, the whole concept around it is based on all of the same principles of the deal. All of the things that Kate and I talked about, so I think essentially, it's been about a long journey of, um, culture, organizational development, relationships and trust between all of the partners. There was a quote. Somebody said over the last day, I remember who it was. But trust is the fuel that drives transformation, and I think the relationships and trust is so important to try to do. You have a bit of confidence of doing things together, and if they don't work the feel fast and no blame, it etcetera. One of the things I would say to you is you can't put people just in the meeting room and expect them to get on. You've got to be that O D investment in O. D and leadership development and building those relationships and trust and challenging bad behavior as well. Because it's not just about sort of being all nice, easy and fun with each other. The trust has to be sufficient that can actually challenge people's behavior really important. The deal journey, that that deal experience that we're talking about in terms of training was also it actually started off. It was the, uh, deal for our streets. It actually started off in environmental services as a an experience. And then we adapted it, working with NHS colleagues for, um, for NHS staff as well so that people take through the journey and they can see when they do the deal experience NHS leaders who're part part of that which is incredibly important. One of the things I think Alison and I would both say, say to you about investing in people's development, get an anthropologist really important. The NHS is very good at systems and science, but actually it's understanding how people take. That's really important So the best investment you could make is to get an anthropologist in and train staff and get them really experienced and confident in anthropology. Because that really does make a big, big difference. Okay, thanks. I think I have another question. Yes, Routine culture. Southeastern Trust. I'm over here. Uh, can we do some of that light? Sorry, guys. Think it's causing a wee bit of a problem We could manage without it. Do you think or thank you? I actually think it's really great that you presented this morning and again this afternoon. So, you know, listening to twice and getting more information this afternoon has been so beneficial. So I will say, on behalf of a number of us, we have wanted to hear about the wig and deal for a long time. So thank you very much for finally making it over here. It's something that we have heard about it. Read about. And, you know, I do think it fits and sits very well with Northern Ireland and, you know, just sitting reflecting. I can probably talk for half an hour trying to keep a very brief would say so much. But that's nothing new. for me, but, uh, you know the Northern Ireland deal? I think that's where we need to go. I really do. I think that probably every single person in this room has brought in to this as a movement. And, you know, there's tremendous opportunities. It's really this is about optimism. This is about opportunities. This is about, you know, how we want to go forward for citizens in our communities. And there's a lovely line that, you know, many of my predecessors taught me, Which is, what are people that live in Northern Ireland really interested in? Honestly, they're not in interested in whether it's the health service, whether it's the Council, whether it's the fire service, they're interested in what you need to make your life work. And, you know, whenever I work with communities and through our community plan and partnerships, we're trying to join all of that up. To say it shouldn't It doesn't matter to the person who the agency or the body is. So if that's the case, then how do we be radical and change? So you know, for and I mean I'm reflecting myself, we you know, David says it how it is, and you're right about cutting through the silos often were contacting each other about who's responsible for this service. Could we do something in this space? And it is. It's possible, but it's very, very chunky, and it's and it's It's a small scale, you know? So I really think you know, there is potential here for a couple of things. Over the last two days, we've been talking about the importance of leadership and the importance of keeping things simple and my challenge out to us all working, particularly with the council partners. I think it's absolutely fantastic that they're here with us today. That says an awful lot. There's an awful lot that you know, the ingredients for success, or here in Northern Ireland there is a lot that you've heard and will not repeat why we know we we can move in this direction. But I would put out a plea to say, You know, we're trying to do a lot of different things, and perhaps we need to simplify it. You know, there is a challenge and I will say, but you know, the public health agency in Northern Ireland, how it works where it sits and how it how it goes forward. You know, I do think there's opportunity, the integrated care system that Martinez leading again. That's another thing. The community plan and partnerships. That's another thing. You know, we've got our well being hubs. We've got a healthy living partner ships and, you know, is there Is there something that we can do to really look on top of this to say to listen to people who live here and what is really important to them? I do think we can learn an awful lot from within if we get the right people and make sure that we take our citizens with us. Do I think the politicians will buy into this? Absolutely, yes. And communities they will buy into it. Absolutely. Because this is your demonstrate. Kate and Allison improved outcomes, you know, improved health and wellbeing and happier people living in their communities. So this is something I think that in the middle of all the crisis and everything else that we've been talking about over the last two days, this is what where we need to focus. This is where we need to go forward. So you know the thing is, you know, can we do something different to locate teams and agencies in one place? I'm going to finish now. I'm not interrupting. Yeah, I want I want you, I think. Can we use what Russian just said to do something different in our last we said This will go to a quarter past five. We'll get out of a quarter past five. Can we take based on Russian side, which is what I wanted to get to really from today's session? Can you take five minutes in your tables to give some thought to what you've heard? What David's response to? I think particularly what Russian is saying there. And we've got to be honest folks, you know, if if we don't think there's something different in this or New York possible equally, let's say it. But is there something what I heard this afternoon that we think provides another opportunity here a better opportunity if to do something differently than we are currently doing? If so, what is that? What is it that we we we need to do to get some of those outcomes? Could you have a chat for five minutes at your tables with feeding back and we'll try to feed back. You know, there's not that many tables. We'll try to take most of them and the feedback on the one or two things that you think that's coming out of today, that instead of leaving here and saying that was all very interesting and we carry on and don't do anything differently is there something that you think we need to actually plan to do and how we might take that forward? And then we'll give each of our panel an opportunity just to comment on that and bring it to our clothes. Happy to do that. I do see the tables aren't you know, they're They're fairly sitting in groups from organizations if anybody feels inclined to do a little bit of moving and, uh, sharing dividing some of those groups. But please do that. But five minutes just talking at your tables to feedback on what? What do we do from from this session? Thanks. Okay, folks, hopefully some thinking coming out of that. So can we do a fairly quickly? We'll go a couple of tables and then ask if anybody's anything else that, uh, that anybody want to start From what you've heard, Do you think there is something there particular learning for us, Something we might do different that needs some action. So what might that be, Michelle? So we reflected on how we engage with our population or how we tend to engage now, which is largely we need to do something. We need to see something really, really quickly. So we go out fairly transactional. What do you think of this? And then we take that back and do something. And what we were saying at our table was, we feel there's a kind of the big Northern Ireland conversation to be had with our population, but that it is locally sensitive, and I think you're absolutely right, sensitive for lots of different reasons here in Northern Ireland. But we also talked about the risks of that. The worst thing that you can do is go out and have a conversation with a population, and then do what you are always going to do. So our messages partnering in Northern Ireland to have a conversation, and that conversation really is mostly one way. It's a listening journey way the other way, so the term we used was meeting. People were there at not where we're at. Okay. Thanks, Michele. Anybody else? I did see that rushing. Maybe the only person Who is she, who did? I asked, uh, I went and joined a different table. So come on. There must be something coming out of that table. There's too many sitting around and not to have some thoughts. Yeah. Yep. I think some of the conversation we had was around the need for us to show share leadership and joint resource. And we thought those were two things that would be particularly key for us here in Northern Ireland and making some of this work understand how we all come together as parts of a bigger picture and that go of some of that, uh, the parts that are looking at our own organizations and the things that we're trying to drive and find a better way than we currently have to pull those things together and to find a way then to make that actually happen, because that's the best we're struggling with that. The minute is the shared leadership in the joint resources and any thoughts of So that's what we're lacking any thoughts, how we would actually make progress and that I'm really I'm trying to get to the what and who at our table. Anyway, we had a conversation around the opportunity still within community planning. We know it's had very good success across Northern Ireland. There are elements of best practice they're definitely to be hooked into. But there's a there's a mechanism there, and there's an opportunity. Were just at the right time now to look at making the most that mechanism that we have when we look at integrated care partnerships, when we look at some of the opportunities coming forward around piece, when we look at all of those things that are happening at the minute, this is the time to make community plan and take it to the next level and see if we can use that as the mechanism rather than starting again with another set of very similar, uh, initiatives and governance. Thanks. Okay, Thank you. Anybody else. This table and then the conversation with ourselves was very much on the last speakers point about the political support will, um and again, not one starting with the challenge around when you've got political leaders who are very focused on their department. There isn't a huge opportunities around that collaborative mindset or the support a collaborative funding and risk taking. What what we talked about here was actually trying to take what the example has been in Wigan trying to come from that innovative position. Uh, and certainly from my background, where I've seen success in this haven't worked in England. Uh, Northern Ireland is actually a plan and evidence base that it's very difficult for those in leadership not to go with you on that journey. Now, you know, 14 years ago it was probably an early stage around the evidence base about a preventative approach and getting up stream. But actually, you know, we've sat and listened to an evidence based this afternoon, and there are other examples. So it's almost grasping the evidence base of why this isn't something we should do, something that we cannot afford not to do and get up stream. And we have a preventative approach and actually get the main players and partners again. There's some legislative changes which enable that in England and my experience to come together a bit more straightforward than here. That shouldn't prevent us. Just you use that evidence base to say why these are the outcomes that are important for our public and use an innovative mindset to make that. The one point we we stressed here was that this was going to be about soft skills, the cultural piece, and I was really interested in hearing more even from a listen around, how he actually turn services who are focused on transactional on the majority of their work, into a transformational mindset where they put the citizen of the center of the services being delivered because in Northern Ireland were heavily public sector late. So how you actually get that transformation of getting that citizen in the in the leadership role and informing the information to shape the services? Well, I'll ask him maybe to pick that up in buying remarks when I ask each of the three. So I'm going to go to this table, but I'm going to I'm going to make a comment. Yes, Can I just say James Brady? We've got a new head of civil service and we've got a massive program for government with loads and loads of priorities, and she's working on a set of three key things that we might be able to do so that might be an opportunity to line around whatever those three things are. So when that comes back, we're going to go to comments coming in online. And then I think this table at the front and will cause that that and give each of our three panel members opportunity comment. So what are we getting online? So some great comments online, uh, hardly has commented. I agree with the comments, and we have all the ingredients already, and we also have the structures. Three main partnerships. Community planning, C Y, P, S P and civil contingencies. Emergency preparedness. There's much going on at community level. It needs to join together across councils, from community to strategic. And we need resilience through an entire systems approach. And it's one way in which we're looking at underpinning an entire model. Okay, thanks and thank you. And for sending that in, and then lastly, we'll come to this table at the front. It's just building on, actually, the Russians table over there. I think it's about agility and what we've had quite a lot is about actually taking action, and I think for us it's probably reflecting on. Perhaps we spend too much time, particularly in central government, about developing process is as opposed to taking action. And there's maybe something you know from the community plan and partnerships and what we're trying to do. The integrated care system, which is really to actually work with community plan of partnerships and building what's there and actually take some action now doing something together. I couldn't agree more. Martina have to say I am much in the Let's just do something, can we? Just doing nothing is the worst option. Usually, let's let's just do something and let's be careful how we interpret that, what permission we need. And I wonder sometimes are we slightly cautious in that? And let's get on and do that? Yeah, because, for example, partners, let's not lose sight of everything that we have done and how you know how we have worked together. I think you know, the environment is here to enable us to make different decisions. And, you know, the point that Martina made is actually right. You know, we can't be hampered by all of these processes. Procedures, risk assessments business cases and all the rest of it. You know, I think you know, now is the time for, you know, leadership cross system leadership to be able to, you know, take things forward for communities. I really think you know, if we're serious about this, you know, some of the things that you put out to escape and Allison or told us how you've done it. So if you can do it, why can we not do it? Why can we not co locate, you know, partners and agencies together in one place? We need to join up communication. I'm sure you can hear how passionate I am about this, but I am really, really committed to getting sensible, consistent public messaging night to the communities of Northern Ireland. Why would nearly morning down Council Arts and North Down Council and Lisbon Castle Ray Council and the Southeastern Trust all develop four different straps lines? Four different visions? Mission statement documents four different communication teams. Honestly, this we've got to stop this industry because you know we're going to just choking people up with words. That's a good point rushing, thank you very much for the way. But that that does sound like a potential for some further discussion coming out of today. Last last, because I know you're about to fail miserably in getting out here. Quarter past last comment here at this table, and then we'll one minute each from from our panel to pick up any final comments. Thank you, Michel, Um, from the Innovation Lab. Malcolm Bitty. One thing that struck me gin covered and Robert and I were on a working group led by Peter May the pace of which decisions can be made and the clarity of thought and the pace we've lost that again. How do we get it back? And that's part of this equation. Surely let's get rid of the bureaucracy. Let's try and make quicker decisions and that we better risking. But do them sensibly. I'm appealing. Don't hold back. But let's get the mindset back. Absolutely, Malcolm, and let's take the positive from that that we know we can do. It shows you who's really runs things around here. Every time I say last. Heather says it one more So sorry. Yeah, you don't want to hear from, you know, during a Carville controller and Auditor General, so um, just listening today and thank you for your you're talking. It has been, um, congratulations on what you've done as well, because I think there's a lot that we can learn from you. What I was most taken by was the slide around behaviors, actually, and courage and accountability being up their side beside, you know, you you would expect me to say that, but, you know, we will always have accountability for public money. And I don't think anyone ever lose sight of that. Quite genuinely. I think we all have that concern. But what we do have to do is get to a point where we are balancing risk and innovation. And and I think that is the key. And what we're hearing today is just the importance of collaborative partnership working in that space. And, you know, you've talked about it at the community level. We're talking about it here at counsel, cross sectoral level. But it needs needs to even be a wider Northern Ireland level as well. And bring, you know, regulators in there. I say, you know, to to move away from the the blame culture perspective as well. Our political leaders I don't know how we bring our our media colleagues with us on that because they play a part here as well in that blame culture. But we do need to move to supporting risk and innovation and, you know, moving away from a negative blame culture to one where we accept mistakes and learn from them and move on. Um, so I think we we have all got a very important role to play in that, including organizations like myself. So you may not feel that probably probably, especially including organizations like yourself during, because I think it's really important that you're in part of that discussion and understand if we do think there's a need to do things differently, making sure that it's, it seems appropriate governance around it. So thank you very much for that. I'm going to have to say 60 seconds each, folks. So, David, maybe start with yourself moving back up the line. Okay, Thank you for that, Michel. So I think it's a tough on agencies, isn't it? We've all got pressures, our own challenges, own budget challenges in there as well as our own priorities. Um, it's a fragmented approach. We've got just now, isn't it? Community planning partnerships was a statutory requirement for partners to be around the table. But maybe that's actually hindering some of this as well, because you can tell by the body language that some of them, because they're told by a piece of paper that they've got to be in the room. So for me, maybe when I look at the community plan in partnership in our area, the best work that was done is the relationship is on the ground amongst the front line workers. So how do we actually grasp some of that and make a change? And it's maybe going to have to be the bottom up and some of this I think if you're talking about Northern Ireland wide level, will still be talking about this in three years' time for me. I want to be having a conversation with brushing over How do we start making a change across those two organizations, and if his partners want to come with us, then we bring them together. Let's demonstrate change. Let's demonstrate change quickly. See quick wins amongst willing partners and let's just get on and get it done. Great. Thank you, David Alison. Is that 60 seconds? You did very well. You did very well. I probably just start by saying, I think we said at the beginning that there's so many gifts and talents in this room already, and there's so much experience, so you this room can make it happen. And as you said, the coalition of the willing and Cove it did. You know if we can take anything from that, we did make it happen in Coated, didn't we? Wherever you were, we made it happen, and we made it happen because it was about relationships. We all knew that we had to get on and make it happen. So if we think about anything in this room today, learn to trust each other, learn to just put relationships at the heart of everything that you do and you can make changes, you can make it happen. I think that's what you've got to hang on to, because that's what we're here for. Isn't as public servants, and that's that's that's what it's about, really important again. It's sort of echoing what Alison and David said, but one strong piece of advice I would give you focus on one health outcome. Stop having lots of different strategies for different things. Have one strategy on the page one outcome. That you can focus the whole of society and the whole of the system around and then work through your narrative, your empowerment and those kind of principles of conversation with the community. Be a healthy life expectancy, be whatever it is. Just focus on one thing because we found focusing on one thing enabled the whole system to change. And those healthy life expectancy is on the back of improvements in CBD, in lung cancer, reduction in lung cancer reduction, smoking and, by the way, all the risk factors for all of those impact on the risk of vascular risk dementia as well, which we've seen coming down. Thanks, kid. Thanks, everybody. Fascinating conversation. I think we could go on for quite some time, but we must bring it to an end. Thank all of you for staying to the end to be part of that. Thank the chief executive for him for organizing this afternoon's event and Dixon, director from CF. Thanks and pass that on. Pleased too, to David and colleagues. But a special thanks everybody, please for Kate and Allison from waking from David, also from Lisburn and Castle Ray for participating for their discussion today. See if home folks, I suspect you might have a few people following you fairly soon, but that's our appreciation with thanks, everybody.