Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Communities who are informed, engaged and understand local need, dedicated to individuals, professionals and organizations who work directly with their local populations to deliver for them a wider public sector and a diverse and engaged third sector, working across Northern Ireland to tackle the broader issues which impact on our health and wellbeing. We have a wealth of information and data. We have a health and social care system that is already integrated in legislation. And structurally, what we need is a way of bringing this all together. And I CS and I aims to do just that it is about connecting people and organizations who are working towards the same vision of a healthier happier population. It's about enabling them to come together around the needs of that population to learn from each other, to identify the collective assets and resources that are available and think critically about how they are being used. Do you understand what we do? Well, what we don't and what we can make a difference. It's about coming together in the most effective way. It's about taking action, doing the work with each other, not in silos, it's about culture, we work better when we trust in ourselves and our partners, when we can share openly, let ideas flow and embrace the chance to do things differently, do things better? Resources are stretched and the pressures we face are real. But consider the skills, expertise, knowledge, experience, and resources that each individual part of our system and our partners already have. Now think about what we can achieve. If instead of working in isolation, we bring all of that together if we can truly harness that potential to ensure that we build a society where we can all live long, healthy active lives. I CSN I is a way of working that aims to deliver on that. Ok. Um I suppose what I wanted to do this morning just before we get into our panel discussion was actually just spend a few minutes going over the model. Now, for any of you who have been here the last couple of years, you know, we've done this nearly every year, but I think what's actually happened in this space, it kind of builds on the title of this about building. Our approach is the model has evolved during that space and that's why I think it's turned, it's really important to give that and it has evolved because a lot of the work we've been doing, particularly with our stakeholders has actually been responding to kind of any sort of issues within the system concerns. We've had the test in the southern area, obviously responding to that, but making sure that what we've landed on today is a model that's had that input from everybody that's been working on this. So it's just, it's a really important foundation I think for us just in terms of setting the scene. Um And as, as many of, you know, the work that we've been doing around I CS and I has been very founded in the challenges and we've had a lot of conversation in the last day and a half about challenges shift left. We heard it again this morning. Um And there are all the things that we know that we need to do within the system. And I suppose one of the important things for us when we were starting to this work was actually thinking about if we really need to start to think about how we meet those challenges, how we meet the demands across our system, how we actually make that shift left. What is it we need in terms of our framework for planning services. And I suppose it really comes down to those two elements that are on the screen. Ultimately, if we want to improve the outcomes of our health and wellbeing for our population, if we really want to start to reduce the health inequalities, we heard actually the first minister and deputy first minister focus on this morning. Then there was two key aspects and aims for us in this space. So the first one was very much about focusing on prevention, early intervention in that community health and wellbeing. So keeping our people well in the first place and what we can't do in that, making sure that they get that intervention as early as possible. And again, we heard this morning that need to really start to focus on how we can support our communities to self care where that's appropriate for them to do. So, and the second element of this is actually about how we integrate within health and social care. So how do we maximize our effectiveness and efficiency? How do we make sure that that resource that we do have that we're actually using that to the best effect. So as we know, our population has grown, it's age, it's evolved, people have more complex conditions. So how do we make sure that that pathway when somebody enters our system is joined up and coordinated and gets the best outcome for them through the system? So there are actually two elements to the model. So I know we talk about the A IBS, but I thought it was important in that context because a lot of the work on the second aspect has happened probably over the last year. So I'm just going to quickly take us through both um in terms of the focus on prevention and early intervention. So the AIP PB, which is a place based partnership is our key vehicle for doing that. So one of these within each of our trust geographies. Um As you can see from the screen there, it made up of our partners within health and social care. But also then we have our foundry community sector, our service user and carers and our local councils. So really, we want these groups to really think about those local communities and those local populations. What are the needs within those, where are those health inequalities? What is actually the assets and and resources available within that geography? So very much that asset based approach and how can we start to utilize them differently? So we really start to make those inroads in that prevention agenda. And as I think it was mentioned again, quite a lot in the last two days, only 20% as we know of our um what we deliver in health and social care actually impacts on our health and wellbeing. So how do we connect into those wider determinants? And a lot of the work we've done over the last year has been with our local councils very much in that space of how do we actually align and come in under and support community planning partnerships in this space. They are that main f in communities for actually tackling those wider determinants. What we're setting up in here, I think we're very, very conscious of, it's not about duplication, it's not about replication. If you look at the figures of our health and wellbeing in Northern Ireland, there's so much more we need to do. So how do we actually bolster that effort. How do we come um around the table thinking about our health and wellbeing and really see where we can make a difference. So again, it's about supporting community plan partnerships in that space and we put in the mechanisms now to link those. And actually, we'll, we'll, we'll talk about community plan partnerships now this morning. Um And the other th I suppose I should say sorry in that space, I can't go back. I'll just, we are actually now moving to put these place based partnerships in, into er establishment. So we're going out now this month, actually Southern has converted from the test into a shadow Aib just about two weeks ago. Um And we're rolling out in South East and West. Now over the remainder of this month, our intention then is to go to Belfast and North next year. And that's obviously because we have our encompassed rollout going on in those areas and we need to just make sure that we balance the, the priorities in that space. The other point again, I'm sorry, I flicked on there. The other point in this space is that we do have a regional is forum as well. So that's a partnership forum that's reflective of the membership around those locality based partnerships and it has a couple of key functions. One of it is very much about supporting um the A IPB. So giving them that guidance, particularly in these formative years, because when we looked at work, these type of partnerships sometimes failed in the past, they weren't connected to the system. Quite often, they were set up in isolation and sort of set out the side of the system. We have to make sure that these connect right into the system. And there is that kind of top down, bottom up approach. So the Regional Partnership Forum is actually chaired by a permanent secretary and the five area integrated Partnership are actually represented around that table. So very much about guidance support in those formative years. But also we need a mechanism for regional collaboration place is totally important and it's where you see the difference has been made when you look at this around the globe. But actually in northern Ireland, as I was said yesterday, we're small enough and big enough to make a difference at a Northern Ireland level. So we need to have a mechanism to allow that um to happen. So that has actually has now started it met again, I think it was about two weeks ago as well. So this debate are very much about, you know, form those relationship in terms of reference. But we are moving forward in terms of those er implementations. The other part, which is the part I'm coming on to now. And the part I don't think people know as much about in terms of the I CS framework is actually about the work we're doing to integrate differently within health and social care. So, you know, appreciating we are integrated, oh sorry in legislation, but we don't always integrate as well in practice, delivering together, set out actually the roadmap for this. So, you know, a lot of this is about as well making sure that we're moving to that outcomes based approach. So what is the difference we're making as a health and social care service to the population? How do we actually frame that in terms of outcomes? What we have done in this space then is we've developed a strategic outcomes framework. So that's it a framework we co-produced with focus groups that uh the PCC facilitated for us when we spoke to people about what mattered to them. Um And like I said, there's nine high level outcomes within that strategic outcomes framework. A lot of our work in the past year then has been very much thinking about how do we translate that into actually the priorities for health and social care? So what does that look like in terms of metrics that will actually show us how we in health and social care are actually contributing to those outcomes. We've done a lot of work to you over this last year in terms of uh working closely with our providers within health and social care about what that relationship looks like and what are the operating parameters that we will now all I suppose operate within so very much about ensuring that providers at those local levels can plan and manage and deliver services based on local need and have that autonomy to do so. But again, we recognize Northern Ireland's a small place. So there will always be things that need to happen at a regional level and there always needs to be obviously parameters which we, we need to work. So we're very much in that new relationship space and that that's works just really um commenced. And the other part of I suppose this is, and I think Paul's gonna touch on it later underpinning. It's important all of that. Then we have established and have just established multidisciplinary planning and performance teams. So those teams are co-chair by our strategic plan and performance group on our Ph A they bring those colleagues from primary care, um hospital care, se or community care and public health around the table. So really that opportunity to look at Northern Ireland, what is the needs of our population? What are the services on the ground? What are the outcomes we're getting for the resources being invested? Where are the gaps? I think crucially for me and obviously, they'll need to mature, but the real kind of gain and all of that will actually be developing integrated pathways. So going back to what I said at the start, when somebody comes into this system, we need to make sure that that service is joined up. Um So we can't prevent prevent illness. We've join up our services and when they come out the other side, then we have the support mechanisms in there to make sure that they don't come back into that system. So again, they have just been established. Um And I think Paul's gonna touch on them later. Not sure if there's any more, I suppose, as I say, we are on the cusp now of implementation, we're moving forward A I PBS regional group. We've got our planning teams set in place. But I think for me, the real change happens now and we are going out in shadow form. And the reason we're doing that is because we had a test, we learned from the test, but we actually realize there's so much learning to be gained from putting the whole model up. So this is going out in shadow form. We have an independent evaluation that's going to run alongside it. That's about action learning. It's not about checking anybody's homework along the way. This is about the, the fact that this is an opportunity to do things differently. And as we're moving through this process, if something in that opportunity isn't working or isn't jarring for any one partner, we need to know about it as it's happening so that we can reflect and amend, there's still scope to amend to make sure that this is actually working the way it should do. Um, and I suppose the final point and I think I've probably taken too long of this is, is, like I said, this is where the real change happened. But we, we had been, uh, bingo over last week and we all know the quote, it's not, uh, structures, processes that actually make the changes, people that make the change. And the thing for me is about how we move forward. Recognizing, I suppose, like I said, we've had these types of partnerships in the past, we've recognized where they haven't worked and we tried to put in the mechanisms to try to prevent that happening again. But actually, there's an on, I think in all of us because a lot of us have been in that system before. So I think if, if we can embrace this opportunity now and really, really suppose have that kind of courage to move forward and really move into that preventative space and reflect where perhaps something hasn't worked or is it working? Let's raise our hands and shout. And we'll honestly take that board because this, as I said, is an opportunity to do things differently. Thank you. OK. Uh Thank you, Martina. Um Certainly, I have a few questions as a result of that, I'm sure everybody has, but I can leave the questions to the panel session and then we can come back to that. But it sounds pretty exciting to me. Certainly as chair of Ph A I see us playing a very leading role in this. I see his ph a being central to this going forward. But the, the, the, the thing it really does, um I suppose Rock my Boat is this partnership, working all involved and the issues coming from the community. I mean, we heard yesterday about the importance of listening, so it's good to know that we're going through that process of listening. But moving on, if we can then move to Andy Patterson, who's director, active and healthy communities at Newry Morne and Down District Council. Thank you, Colin. Um So what Colin says, I'm Andy Patterson, director with New Morning Down District Council. And I'm here today representing Solace, which is the network that wasn't part of the presentation. Um uh Yeah, that happens every time I come on stage apparently. Um So I'm here representing Solace, which is the network for local government professionals in Northern Ireland and also represents councils across the UK. So, um and thirdly, I'm wearing a third hat as well. I'm speaking on behalf of our community planning partners. So, uh this morning, I want to highlight how community planning uh can support and complement uh the implementation of the integrated care system in northern Ireland. And I will highlight the role. Uh I'll use the opportunity to highlight the role of local councils in helping to deliver uh that shift to the left that we've all been hearing a lot about. So early intervention prevention and better health outcomes for our local communities. So to rewind back uh a little bit uh what is community planning? Um since 2015, Northern Ireland's 11, uh local councils have been responsible for leading on the delivery of community planning. Uh In essence, community planning provides an opportunity for public services to work in partnership to address local problems, deliver better outcomes and make a real difference to people's lives. Community planning also enables process to be put in place to ensure local people and communities are genuinely engaged in the decisions that affect them. Uh Community planning, partnership boards in each local uh district include government departments, statutory agencies and uh the wider community and voluntary sector. The partners are responsible for developing and and implementing a shared plan uh for promoting wellbeing in the area and supporting community cohesion and improving the quality of life for all local citizens. Uh in my own local area, strong collaboration, trust and cooperation has been built over the past eight years between our community planning partners including the PH A health and social care trust and the CB sector in terms of structure. Uh So there's partnership boards and then feeding into those partnership boards are thematic groups uh which take forward specific actions on things like economic development and regeneration, uh safety and good relations, housing and of course health and wellbeing and underpinning all of this and perhaps the most important part of the Mixer is the support of our local stakeholder forum uh which in Newry Morning down encompasses over 20 community involuntary organizations across the district. Uh This structure and partnership which has had time to evolve and be refined over the past eight years has helped to foster meaningful collaboration and to improve connections with all tiers of government and wider society. And this is the same across all of the, the 11 districts. Uh One example of this collaboration from my own district is uh our community support partnership uh which is multi uh multiagency group that aims to provide dedicated support to vulnerable individuals in the district. This support has included help to access a range of services including mental health, addiction and general health services, assistance with housing issues and helping with opportunities to return to education, employment and volunteering. The partnership includes the Southern and Southeastern Social he uh health and Social care trusts, the Education Authority, the Probation Board and the voluntary sector. So it's just one example of how community planning works in action. Um So how does community planning and I CS fit together community community planning can help with the implementation of I CS in Northern Ireland and I CS in turn can support and complement the delivery of community plans in each local authority area. Key areas where this opportunity for collaboration and learning include having a shared vision and a shared sense of purpose with local partners, building new relationships with communities and working in partnership to build on the foundations of what already exists locally. Uh Community planning partnerships are the mechanism to look at the bigger picture ie the full jigsaw and bring together the many existing partnerships in each district to ensure that collectively, we are achieving the improved outcomes that we all desire for our local residents. To this extent, it's clear to see that community planning can play an important and complementary role to the work of I CS and vice versa. Um I'm also going to use this this morning to um highlight what we're doing in council in that space of early intervention and how that relates into community planning and I CS. So, um in Newry morning down District, we have approximately 100 and 81,000 residents and reducing health inequalities has been a key objective of the council in recent years. Uh One of the council's key priorities to improving the health and wellbeing of local residents is to provide more access to high quality green spaces. So, in that regard, early in the new Year, we'll be submitting a planning application for a new city park in Newry, which will be located on a 15 acre site at the heart in the heart of the city center. Uh This 18.2 million lb investment is being supported by the department for communities via the via the Northern Ireland Executive City Deal complementary fund. Uh Also in conjunction with DA Sport, N I and the Woodland Trust. Um We've invested 1.2 million in creating 13 walking trails in the district since 2017, covering a total of 40 kilometers. And in the next four years, the council will invest 3.5 million to deliver large multi sports hubs in each of our seven DEA S. Finally, we're investing 2.5 million lbs in creating and refurbishing play parks in urban and rural areas throughout the district. These are just some examples of the investment that councils are putting in the likes of Newry morning down but right across the 11 local government district areas. Um and it's, it's our view that this investment in our green infrastructure over the next four years can help, help, can help to support community cohesion, reduce social isolation and help to rebalance the health inequalities of our local population. Recent estimates in England have shown that 2.1 billion lbs per annum could be saved in health costs if everyone have has had good access to green spaces. Evidence also shows that living in a greener environment can promote and protect health and wellbeing. People who have a greater exposure to green spaces have more favorable health outcomes and greener environments are also associated with reduced levels of depression and anxiety. So at a local level in Newry Morning down and across all the LG districts, there is a huge opportunity for community planning partnerships and I CS partners to influence the design and creation of these green spaces. And that's just one example to think of, of where we can work together um for future collaboration. So to conclude the integration of I CS with community planning partnership boards can ensure consistency, oversight and accountability in planning and delivering specialist local services solace and the local authority partners. Welcome the continued opportunity to engage with colleagues in the Department of Health and our other key partners to help bring forward the I CS model and ensuring the approach can be embedded for the benefit of all our local residents. Thank you. Yeah, thank you. And uh Paul, if I could ask you to go to the stage. Um So this is Paul Cavanaugh, who's Director of Hospital Care at PPG more than everyone. Um Here we are talking about I CS as Martinez already said for another year. Uh It's, we're still, it's still developing. So we haven't really locked in on what the integrated care system for Northern Ireland looks like is going to be and in many ways, nor do we need to. Because what we need to rather do is recognize that the principles are about ensuring that we genuinely have integration. I mean that we genuinely begin to work upstream in terms of, of changing the, I suppose that the experience of our, our, our people and our communities of health and wellbeing. So we within what's called a strategic plan and performance group of the Department of Health. Quite a mouthful S TPG for short, the clues in the name we about plan and performance, we work closely with public health agency. And as Collins already said, we, we are partners in, in commissioning planning and performance of the, of the system of organizations within the system and of services within those organizations and across those organizations. And also about what happens at an area level and, and so on that basis, a lot of what we talked about in recent times has been about the area integrated partnership boards. They are key. We've done a lot of work Martinez has done a, a huge amount of work in developing the test in the southern area. But now we're at the point of rolling these out and really trying to, to I suppose, give ourselves a sense of what, what will be the greatest benefit from having all of these various stakeholders and interests around the one table. And we think the greatest benefit will come from prevention and early intervention. And it is largely what what has already been said from Andy in terms of uh what community planning partnerships are doing. We've been involved in community planning partnerships in the past and will be involved again in the future. The health sector in general have been heavily involved in community planning partnerships for 10 years and more. What we, what we need to do now is recognize that we, we need to play an important part in community planning partnerships. And also look at what we can support community planning partnerships with in terms of tackling health inequalities and in terms of work around prevention and early intervention. Minister is very clear as you've heard at this conference, health inequalities are key and we said that a lot in the health service over the years, we've had many programs around health inequalities. What we now need to do is genuinely target those areas of greatest deprivation, target those people who are most vulnerable and think about how we're going to do things differently. Um And some of it is, is fairly basic stuff because it's still thinking about issues like mental health, like smoking, like um alcohol addiction, child health and so on. There, there's nothing new in this space. But what we need to do is begin to genuinely work together to, to make a difference uh to our communities. And targeting those most in need is likely to give the greatest benefit for those communities, of course, but more generally for our society. So a lot of work, I think for A I PBS going forward will be around. How do we do this better and how do we get as close to the people's doorsteps as we as we can possibly get? And I think A IBS will develop further. And I think I would like to see them in the future involved in the degree of pathways and develop and how, how people experience health services and so on. But we'll start when we start in terms of focusing on, on prevention, early intervention health inequalities. But we then in terms of taking forward the uh the integrated care system sale and S PPG with PH A are looking, then at how we, we put together a planning team that we begin to work much more closely together. We already are in each other's pockets in many ways. But actually trying to be much more, I suppose, intelligent in our approach, drawing all of the information and the data that we have, drawing all of the intelligence, we know about what works and begin to genuinely do things differently within the the health system. And some of that, it will be a focus on variation and unwarranted variation. We'll begin to think about across our 56 trusts, what variation there is within Northern Ireland, what variation there is with uh sort of down south uh across in Britain. So we need to think increasingly about, you know, what, what could we be doing differently? What what is one trust doing other trust should be adopting and beginning to actually draw that best practice uh out and, and actually see it implemented and scaled up. We also know we've got to develop service specifications. We need to think about how we genuinely develop integrated care pathways that work and we need to think as well about efficiency. And the one thing that we all know is that we don't have any more money to put into the health service, certainly not significant money. So we're going to have to use the resources that we have much more effectively. And some of that will be and how we work with our community voluntary sector partners. Uh looking at developing services within primary care and so on. Then there's a, a part around regional collaboration. So we've got to ensure that we, we genuinely have regional collaboration partly among our, our, our providers, the the six trusts, the, the general practice and so on other parts of primary care. But also thinking too about that, we've lots of small services sort of doing their best in district general hospitals and so on. And how can we ensure that we will actually maximize those services? Some of them are very vulnerable. They're very small teams and to be honest with you, one or two people getting sick or going off and leaving that makes sex services that is challenging to develop. So we're also going to have to make some choices about what we can and can't do across our whole system, not just within our hospital, you need to think as well about cross border, our care system in northern Ireland won't work, but we don't think about how it works on an all island basis and also how it works on a four nation basis in the UK. And I think there's, there's a lot we already do in that space. Uh Certainly from Britain, we have hospitals who provide inreach services, particularly around things like children's services, complex, children's uh child health services. But also thinking about how we might outreach uh and develop services on a four nation basis. And that cross border opportunity with organization like co operation and working together really offer us all of the tools we need to make our integrated care system collaborative on a wider scale. And Martinez already mentioned that we're looking then at outcomes and outputs strategic outcomes framework, a commitment to genuinely look to the long term, genuinely think about prevention, early intervention and look at those long term uh health and wellbeing outcomes and a system of oversight measures. So and those who are about the output, are we genuinely getting what we, what we want from the, the services that we deliver, whether it's around efficiency, whether it's around performance, whether it's around access to services and quality and safety and so on. Martina put up the fields earlier as you know. So we need to think about how we will ensure that we genuinely are focused on long term and also the right now and getting the most out of what we have. And so, and we're looking to how we'll get the system to really begin to, to come together to deliver those the the the strategic outcomes for you and the system oversight measures and driving those, those uh ministerial priorities and targets in amongst all of that. So performance, it will be a key plank of all of this. There's a lot of planning to do a lot of opportunities to collaborate and work together, but we shouldn't lose sight sight of performance. We're gonna put in place this important intervention framework and that's going to address the variation. We're gonna begin to actually manage to ensure that we overcome variations, particularly where it's unwarranted. We wanna see an improved culture in the organizations that we we commission and we also want to see uh delivery and optimization of of the of the resources that we have because there isn't going to be a huge amount of additional investment. Certainly not for the next number of years. And the lines of accountability then and proportionate autonomy, autonomy will be key. Many of the things that our large health and social care trusts are doing, they can kind of get on and do. It doesn't require a huge amount of, of our involvement as commissioners and so on. But it certainly requires that we are assured that that these things are being delivered effectively and optimized as much as they possibly can. And only where there are problems only where there are issues of escalation should, should we be become centrally involved in trying to resolve those and rectify them? And there should be a clear escalation process which is open and transparent and also a clear deescalation process that shows where an issue has became a problem has now been resolved and therefore any of the issues with the particular provider organization is stepped down. So there's a lot, a lot for us to do. I don't know if I don't think we've got it right yet, but it's a work in progress. We know it's about prevention and early intervention. We know it's about long term realignment of, of health and social care demand. Our waiting lists are remain a huge challenge and a huge priority for us. We need to focus on issues like aging, smoking, obesity, mental health, addictions, and child health among other things. But we need to be begin to focusing on things that we genuinely can make a difference on. We need to plan as well, II suppose to address the burden of ill health because we can't just look to the long term. We've got to also do things for the people right now who require uh health and social care services and indeed a whole range of community services, not just within health and social care. And we need to think then about how we're going to support through the planning process in the I CS, the transformation of our services. We've heard so much about that at this conference and in terms of performance, we want to maximize our resources, ensure that our staff are, are are doing all all that they can in terms of the the capacity that we have, but also supporting our staff, supporting their development, supporting their training and so on. And it is challenging where we have so many much pressure in our system to keep morale going among health and social care staff who, as you've heard this morning from the first minister and the deputy first minister, I think it is valued in our community. But I think that we should also reflect on that, that pressure has continued in health and social care beyond the pandemic. And I think that issue then around variation increasingly having consistency of practice and looking at where the opportunities are to do things differently and also to do things in a way that actually are sustainable. What a challenge for us. We, as I say, work in progress, but we've come a long way and I think we, we're certainly keen for people to continue on the journey with us. Thank you. OK, thank you Paul. And finally on the panel, if we could ask Collette uh Collette Rogers as health improvement lead at the ph A. Thank you, everybody. Um Thanks for the opportunity to speak. Um Well, some of you will know me already. So I wear like Andy, I'm wearing multiple hats today. So I'm the head of Health Improvement in the ph A for the southern area. But I've also been fortunate to be a member of the Board of New Morning. And down community planning partnership. Um I've been involved with the test pilot of the AIP PB and I now I now sit on the Shadow Aib and I'm the current chair of Armagh Ba Bridge Craig, a community planning partnership. So hopefully I'm bringing lots of um experience to the party. Um I have 10 years working in the community voluntary sector with communities tackling health inequalities and then 20 years working in the public health agency. Um So, what I wanted to do is I II really, I'm a strong advocate for partnership work and I think it genuinely works. Um And Andy hit the nail on the head. You've got to have a common vision and people have got to buy into it. If you're very clear about what your purpose is, people can buy into a partnership. Um And you've got to get something out of it. So what I've brought for you today is, I mean, obviously, we'll have a panel discussion, you can ask me questions, but I've brought an example of community planning and action and I really genuinely believe that you'll see how people are involved and how it's empowered people. It's a seven minute video. So I will just take my seat again and let you watch the video and it will speak for itself. Community plan is at its essence is really all about trying to make things better for local people. We're really focused in on improving wellbeing, be that social environmental or economic wellbeing. And we do that through working in partnership. So you see the public sector and that's places like your council, health, housing education, all coming together and working with local people and with local communities to write a plan that's all about improving things and improving the local places that we have as a chairperson. I'm really proud of the work and the commitment of the range of partners that we have around the table. We have taken the concept of shared leadership very seriously within our partnership and many of our partners have stepped up to take leadership roles within the subgroups and the working groups of our partnership. I found out about the program through another entrepreneur who had successfully set up and grew their business through this program. Through the program, I received 1 to 1 support from the Cyto Center and I also received a grant to help start up my business through the A B C's Enterprise pathways program. And there are good survival rate for businesses, there's new businesses starting. But on the other side of that, there are challenges connecting those people that are most excluded with regards to accessing new jobs, jobs that can pay enough for people to survive. And I think throughout the cost of living crisis, there's may be additional pressures going on some working families in that way. And we are seeing some of those challenges people now are at the table who day in day out are involved in dealing with people who are in crisis, dealing with people that are struggling. And we are now because of this process, because of the help of Seamus and his team. We're at the table on those conversations. It's brought organizations together. I think that the cost of living crisis has really affected people significantly having come out of COVID where there were a number of crises that and food response was one of the ways that our community right across the borough responded really well to needs. We saw youth clubs and sporting groups and different organizations coming together at that time and responding quickly and effectively to the needs of our communities. We know from our work that the people have a strong sense of community. We have a very healthy and rich community. We need to keep working at this. If we are to build and strengthen the connections and other partners in the public service and businesses too, we know that good mental health and well being is a priority for many of the people who live in our communities. While we're pleased to see that many of our health indicators have remained steady over the last two years. What we're keen to improve on is the number of preventable deaths and to close the gap in health inequalities that still exist. We're working together across all sectors to continue to focus our efforts on improving health and well being across the ABC area. We based our promoting good mental health and well being action plan on the take five ways to well being. These are evidence based actions that enable people to take very small steps often to improve their mental and emotional well being. And under those themes, we have led on a number of actions as a partnership. I'm a part of the move more group in the Craigavon area and the Banbridge area. I thought my days of fitness was over. I was a very fit keen cyclist and to get the diagnosis of breast cancer, I just thought my journey of life and fitness and being part of a group was all over. But you have that network of friends that they're there to support you and encourage you and be behind you on your journey. And when you're having a bad day, you know, you have that off the move more group and I would recommend it to anybody. We um introduced participatory budgeting through our subcommittee. Um We started very small and what we wanted to do was really see how people being involved in the decisions that we make, um how that would land with the community and then what difference it would actually make soccer after school was absolutely great. You got to develop your skills, play with your friends, enforce teamwork. Do you think Children should have a say? And how governments spend money? Because we should all have a voice. I think everyone should be heard and the government should, you know, listen to Children. Place is one of the three central things that we're working on. Since our last statement of progress, we have developed ambitious place plans for our towns and our city and we have developed a place board which I chair to drive forward this important work. The Armagh Place plan was the very first plan to be developed, followed by the Banbridge Place plan. These plans start with the place and its people and there's been extensive engagement with local people throughout their development. And this partnership approach is continuing into delivery. Over the last two years, we have seen improvements in high street vacancy rates and the number of buildings at risk being saved. However, we know that we still have work to do to increase the number of people who see their town centers is safe and welcoming for everyone and to increase the number of people who are engaging in arts and culture and activities to help people connect with their, to have the community boundary sector around the table with the statutory sector is a dream come true because it shows meaningful partnership and collaboration. And that has been a huge milestone. And for at night of becoming a reality is definitely something we can all be. Our community planning partnership has just recently submitted in November 2023. Our statement of progress for the past two years. Very detailed, a lot of actions in it. Um But the work doesn't stop there. So as, as a planning partnership, we've already got together and we're thinking ahead to the next two years, there are increasing challenges facing our community, higher levels of poverty challenges around housing issues with education, health well being. So all of those things, we need to continue to work on as a partnership as we review our plan at the midway stage. One of the most important things that we want to do is make sure that we focus on engagement. One of the things that has been successful for the partnership is the listening that we have done to all of our partners, all of our stakeholders, we want to continue to do that to make sure that all of our outcomes, all of our actions are still what they need to be and where they need to be, that they are relevant. So we will make sure we do that moving into the final stage of the delivery of our community plan. OK. Um There we go, everyone. Um We're not going into discussion group and I would like to invite Mariaine the Chief executive of the Southern Health Trust to join us to give her obviously very clear insight into the trial that was done. Um We are a bit fixed for time but very much keen to look at questions. I think this morning we've heard about the intent from the department, but we've also very clearly had of the really good activity that is going on. So, I mean, I'll start off with, you know, why do we need, I suppose a new approach, given the good work that's going on through the community partnerships. Why do we need A I PS? Is it? And I suppose one of the things for us and I was reflected on this probably last week when we had Ben go over there, Ben go over here. Sorry. Um, when we went out and started talking about people about we need to focus on prevention. People said, well, we, we said this 10 years ago, we, we're not saying anything new. We haven't actually made the changes we have to make. Now we have the community planned infrastructure which is actually making and in roads then and to obviously, you know, getting into those more wider determinants. But I think one of the things that we've really focused on, on some of the research we've done uh on different jurisdictions across the globe is actually what we need to do as well within health and social care is take a systemic approach to prevention. See it as everybody's role. And I think for us, it was having a mechanism to actually bring health and social care around the table. So we could all take responsibility because it shouldn't always be seen as somebody else's job. You know, it shouldn't just be the job of community planning partnerships. It shouldn't just be the job of ph A if we really want a shift left because we've talked about it for so long. It has to be something that's actually for all of us to do and really interesting. I didn't even realize this. But when we started looking at this, it's actually ingrained in our legislation. So even as trusts, as providers, if you look at the legislation is to improve the health and well being of the people who do or who may use our services. So I think it's just about bolstering really the efforts around this. It's about how we can come in and support community planning, take a systemic approach within health and social care that can make that difference. Ok? We have a question over there. I don't know if we have any. Yeah. Been rushed across to you. Thank you so much. That was really interesting. Um My name is Catherine Duff. I'm the current director for the British Dietetic Association here in Northern Ireland. I'm also a clinician working on the ground. So I think one of the things that really resonated from all of your presentations was about the people and about the communities. And if we look at ourselves, you have entered here today and, and the service users that we meet day to day, we are also the people, we have the families coming through the service. So I think one of the things that I think would be absolutely key to seeing the success of this and the various programs that you have is that communication from board to ward that we as clinicians on the ground know what is available to us, whether we're working in primary care or secondary care, wherever that may be to know where to signpost, those people that we are meeting on a day to day basis. I know myself that sometimes day to day clinically people enter my clinic and nutrition isn't at the top of their agenda, but a signpost into mental health or addiction services. Absolutely is. So that would be so it's how we communicate the work that you're doing at a trust level, at a board level, how that filters down through all of our organizations. Thank you, Mary. Uh Mary. If, if you can maybe take that with your experiences with the the trial and obviously experiences A CEO um Thank you very much. Can you hear me? Yeah. Um So you mentioned from board to to ward, right? I think it should be. Yeah, but just to say to you, I think what we've done has gone beyond that, to think about bored to bed and the bed being in the person's home, right? Because this, this has to have a real community focus in relation to it. So I think, II think we haven't quite got our head around all of this yet. And I, you know what, what we're, when we talk about prevention, that should largely be a public health function, uh which is your department. Yep. Uh And again, some of this, um uh the integration and all of this was very much about bringing uh public health, the trusts, the community together to try and understand how we uh could from the, with the knowledge that's coming from the trust in terms of, you know, what does, what does the end result look like if we don't get this right? You know, um with obesity uh addiction, you know, uh frailness in, in older people, what does that actually look like? You know, um uh and how do we use that knowledge then to try and shape what goes on in the the community with our community planning partners, the councils uh and uh you know, based on the knowledge coming from our public health partners, what does that all look like? So I think we, we have to get increasingly clear about the messages in relation to all of this because I as chief executive, completely understand that I have a responsibility for the health and wellbeing of the public. But I'm not an expert in uh you know, the the domains of, of, of public health because their message is very much around protect, prevent uh and uh uh provide in relation to the aspects that they deliver on. So they will be able to provide me with all of the, the health care data in terms of where's the variation and all of that. But more importantly, where is the inequality and all of that, which is a different thing. And actually, from my point of view, what I'm interested in is if we could get uh more focus in terms of the community and you know, working out how we encourage people better to look after their own health, what can we do then to improve the barriers to health that people experience? So, you know, we know that some of the most disenfranchised people in the system are the frail elderly because you know, because of some of their sensory deficits that actually that makes it difficult for them to access services. We know that if you're, you're living in an area where actually healthy food isn't available to you, that becomes a difficulty in terms of, you know, running the risk of obesity, all of those different things. So II think we have a way to go yet in terms of being very clear about what the message is speaking the same language and being very clear then with the public about what they can actually do then to help themselves. But I suppose what we were involved in over the last year has been the pilot project which was largely about working out systems and processes uh in relation to all of that. I think the next phase now in relation to the Shadowy IPB is really doing the organic bit, which is really engaging with the public in terms of working out how we share information in a meaningful way that we can help people enrich their own lives. Ok. Thank you. Yeah. And, and I think the one thing I would add from a system point of view is that we need to engage with clinicians much, much more effectively, much more meaningfully. So it's, it's as much a kind of you hearing from us in terms of what's the message, but it's also us hearing from you as to what actually is the direction that we should be taking clinical engagement, networks and so on are key in this system. And I think it's one thing that we're going to have, we have a lot of work to do to actually make sort of effective. Ok, thank you. So there's a question over there, a question there and then there. Hello. Um my name is Fidel mccarter and I'm from Northern Ireland, chest heart and stroke. I'm the director of Policy and Prevention. And I suppose the reason my job exists as you know, the main cause of premature mortality in Northern Ireland is coronary heart disease. You have 30% more likely to develop early premature and preventable um cardiovascular disease if you live in an area of deprivation. But I suppose my question to you is your prioritization framework. I mean, how are you going to prioritize? Which areas of prevention are you going to tackle first is a primary prevention. The return is around 5 to 10 years is a secondary prevention. The return was is within 2 to 3 years. So in other words, are you focusing on risk factors? Are you focusing on people at high risk of developing high BP cholesterol af those metrics clinical metrics? And then my second question is um what is your community engagement plan? How are you going to mobilize the community impulse, ensure that those underserved communities are also involved in the process? Thank you, Collette. Do you want to lead on that first? And then Martina can come in. I certainly can. Hi Fel. Um So um in the first instance, one of the, so the A IPB is at the start of its journey. Absolutely. And Maria has said that um and we're continually looking to make sure we get this right. So one of the pieces that the Public Health Agency will be bringing to that partnership is the, the data. Uh um the, so it's a pop we need to look at the populations for each A IPB area. Uh and see what are the issues that are facing people in that geography and that locality. So the Public Health Agency is creating a dashboard which will be available to all of the, the integrated partnership boards and that will be part of the information that helps to uh make decisions around that table about areas of focus one of the challenges absolutely is going to be. There's so many things you could focus on and it's a new partnership. Um And the video I showed you, we're only at that stage because it's seven years down the road, we weren't at that stage seven years ago. So we are gonna have to look at something, um which is backed by data. We're gonna have to look at what's the evidence based approach to that? Um Because we can't be putting our limited resources and efforts into something that's not gonna work. And I know you would totally agree with me. Um I think that decision is still to be made. Uh We need to look at the data uh and engage with the partners around the table. Um And we will have to narrow in on something first to test the theory. Um But the, the hope for me is that if we can get that model right, that we can create better outcomes for people, there are five area integrated partnership boards if I could just, we're holding up the whole thing now. So my, my apologies, everyone. We're just going to have to cut it short there because we go on. But hopefully, I enjoyed it. And hopefully the panel, the panel will be around if we have any specific questions. My apologies, Mary, not there for your question to be answered, but um the panel will be around to take any specific questions. So a round of applause for the panel. Thank you. Me short and sweet.