Well welcome everybody um and good morning and um to the third health and well-being Board of the municipal year before we start these proceedings may I bring to your attentions to some of the housekeeping matters there’s no expected fire alarm today therefore if the fire alarm sounds please follow the fire and
Emergency procedures that are applicable to the council house which is basically leave at the front and we’re supposed to be in the council car park down there but it’s a little bit constricted but never mind um so this meeting will be broadcast live and capable of subsequent repeated viewing by entering the
Warspite room and during the course of the meeting committee members are consenting to being filmed and to the use of the recordings for webcasting please can I ask that you speak clearly and directly into your microphone when addressing the meeting so that online participants and the
Public can hear and that it is Switched Off when you you are not using it and your mobile devices turn to silent right item one apologies Elliot do we have any apologies for absence thank you chair apologies from councelor carile councelor Watkins substituting today and apologies from David Haley director of
Children services welcome Kathy you’re always welcome um Declarations of Interest anybody any Declarations of Interest NOP lovely we can move on then um move on to item three chair’s urgent business I’ve not been made aware of any urgent business all right the minutes are on page 1 to 12 of your pack
Um are you content that there are a reasonable record those of you that can remember that far back this SE um I propose that they can be accepted can I have a seconder please thank you thank you very much Tony um questions from the public oh sorry can I have a second and
Then can I show everybody else agrees we’re all happy with them thank you excellent um moving to item five which is questions by the public have there been any received OT no questions today CH thank you very much thank you so we move on on to a verbal update
From The Vaping working group um so I must have Dave swarts somewhere online Dave the floor is yours thank you chair um yes uh I’ve got an update and um so this is for the health and well-being uh board in terms of a vaping working group and a progress
Uh that we’ve made so uh at the health and well-being board meeting on September the 14th uh Dan Priest and I presented a paper uh that was an update to the 2019 health and well-being board position paper uh on vaping um a key area of uh difference highlighted from the position paper in
2019 uh was the increase in vaping by children and young people uh it was therefore recommended that a focus be made on this area to update the board’s position uh in regard to its uh position paper uh and this was agreed uh an initial meeting with councelor aspel
Who’s the chair for this process it was agreed that we would run a workshop where we would invite a range of key stakeholders to contribute to the lines of inquiry which we’d agree to look at a report capturing the learning and recommendations for the update Position
Will be brought back to the board for consideration and approval linked to the focus on children and young people uh through the work we begun to do we also identified that um a lot of this increase among young people seems to be also associated with a significant
Increase in the use of disposable Vape devices uh the Disposable Vape devices are also more likely to be linked to the illegal supply of unregulated devices um and also there’s a concern in relation to disposable devices uh in relation to how they are actually disposed and environmental
Impact uh that helped us to identify some overarching lines of inquiry uh focusing on regulation children and young people as a population and the environment uh we had an agenda and scoping meeting uh on January the 22nd that’s Monday and and these are some of the key areas that we we captured at
This point in relation to regulation uh we wanted to we picked up on the regulations themselves and the controls that are available uh there was also a range of emerging issues that we were picking up on um for example uh over strength products um counterfeit ecigarettes and the uh child appealing
Marketing of of of that we’re also interested in relation to intelligence and uh insight and how that could be shared with uh uh our trading standards colleagues uh and also examples of enforcement work that’s been undertaken with relation to Children young people as a population we were uh looking at
Issues around prevalence and trend uh understanding factors that influence use um vaping behaviors and by that we’re looking at um the population using nicotine or flavor based Vapes and also a much smaller population but with a uh with a high uh significance uh for those that are vaping uh substances controlled
Under the misuse of drugs act other key issues that we noted of importance was issues affecting skulls uh and we also were looking at evidence for Vaping by under 18 and and messaging that we could use in order to build our prevention and response approaches in relation to the
Environment we were considering the issue of how to safely dispose uh uh of of the the Disposable uh Vapes um there is a significant challenge because the battery is actually built into these devices you can’t separate the battery out from them um they’re currently classified as uh um and regulated as a a
Wii which is a electrical and electronic equipment uh this means they’re treated a bit like electrical toys and toasters we can’t put them in the in our in our bins outside our houses you have to take them to the recycling centers but as I said it’s not easy because the batteries
Are built in not not you can’t um pull them apart so there’s a whole range of issues that are also linked to these disposable Vapes um so we’ve been we’re now going to work through these but as um as you can tell from the scope of what’s come
Out there there’s a lot of things that are covered and linked to to the use of children and young people um we also did identify that we’ve got a lot of work that’s uh in place or being implemented which is new which we’d also like to capture uh going forward so we are
Suggesting that we uh defer defer our report to the board probably until June in orderers to give us the appropriate amount of time to cover this um the the other point of significance around that may be that government May during that period also report on some of the
Recommendations that fall out from their consultation around vaping with young people and we’d obviously want to be uh in line with some of those uh uh so we’d like to kind of defer till June so so that’s the update thank you very much Dave um it
Was very noted that of course with with the consultation that ended um I think it was end of November December that won’t be coming out till till probably the end of January over February time so it seemed rather foolish to carry on until we knew what those recommendations
Were but I want to say big thank you to Dave and to to Dan Priest they’ve done a lot of work about this and um certainly getting the trading standards um Alex from the trading standards was into that meeting was really excellent so thank you to those that uh came along to that
Meeting I think we got a lot out of it um so it is a case of watch this space um but as soon as the government produce their recommendations from it and I’m hoping there’s going to be some really tough ones that we can work with and and
Utilize we’ll reconvene and we’ll get uh then get a a workshop organized and as we say we’ll get a report back to you and if there is anybody here that wants to join that um that Workshop you’re very very welcome we need to make sure there’s a wide range of people there um
So hopefully we can move forward thank you very much Dave for that um I’m impressed you kept to the timing wow thank you we’ll move on now to item seven which is the healthwatch patient I suppose say sorry we need to ask you to note the update and um if you’ve got any
Suggestions please let us know so that we can incorporate that so we move on to seven which is the healthwatch patient experience of Pharmacy Services report and this is very timely because obviously the item after that we’re looking at our Pharmacy and pharmaceutical needs assessment so um
Tony thank you as usual a fantastic report very detailed and very informative so please thank the team that put it together for us um or for everybody from from us all right thank you so the floor is yours thank you chair um I’ve got a presentation really just to pick out
Some of the highlights from the report otherwise we might be here over time um and uh I think what we’ll do is just really concentrate on why we did our report so I think there was a couple of things that happened last year um firstly the announcement of closures um
The uh install pharmacies at Sainsbury’s across the country and then boots making a an announcement they were going to review um their stores and that because of financial constraints um and equally at the same time healthwatch England started to review patient experience across the network of Pharmacy we’d
Previously um published a report in in May 2022 so it was a good chance for us to actually review over 18 months whether things had improved or remain the same um and I think generally what we picked up in the review of our patient experience was that access to service
Waiting times and medic occasion delays were still the uh evident themes that were coming from patient experience so what did we do um I guess we started conversations in July last year about our concerns um and worked with the local pharmaceutical committee and NHS Devon primary um care committee
To raise those concerns uh and and I think the biggest one for us was um if we had these closures and the impact of Staffing um on existing pharmacies what did that mean for the um Community Pharmacy uh first initiative itive that’s just about to come into Force
Um and as a such we shared that intelligence um with those partners and have had some really um useful conversations I think the conversation with the local Farm suitable committee was really useful because it gave some context to some of those issues um rather than you know us just thinking uh
You know it’s it’s a real patient struggle and there are struggles there but the context why those struggles are there was really useful to understand so what did we find then um I guess uh the majority of the experiences uh we looked at and and this is people just contacting us so we
Didn’t go out and do any actual engagement as such um 77% were negative um and the majority of the experiences we re received related to Pharmacy services in Plymouth predominantly um and in particular there was a proportion of that that related to the Lloyd’s Pharmacy um at the outpatient department at dford
Hospital um I think the graph quite uh handily sums that up where that experience has come from so the themes again medication issues with Supply incomplete prescriptions and waiting times around um medication uh being available uh Staffing experience uh around Staffing levels their capacity and sometimes the
Quality of the service that was being provided Administration um is really about systems and protocols and and does include how um scripts are um done whether that’s done electronically through the either online NHS app or or you’re dropping the scripts into the surgery also the pharmacy um and access
To Services uh there was um I think early last year a period where um certainly the chain pharmacies were having to review their Staffing um because of shortages particularly of pharmacist and pharmacist assistants um which led to some temporary closures uh at some of those
Um pharmacies and I I think some of that has now turned into permanent closures one thing I would say is from information we’ve received um via the NHS is that with boots where there has been closures there’s been a redeployment at staff and actually opening hours have been extended in
Those um services that are remaining open so um I think you know there has been uh a look by providers of those Services about how they can continue to provide um a service albe it in a a lesser extent from a locality point of view um the next slide really just
Highlights some of the um the actual uh feedback we received I think it really talks to itself and and um it just a snapshot of what was in the reports I don’t um propose to go through there but it really um I think gives an understanding of the patient
Experience um so we made some recommendations uh to uh stakeholders within this and uh which are there um we asked NHS Devon to provide a response to the experiences and provide details as to how the issues raised in this report will be addressed so there is um a pharmacy um strategy consultation group
Um being set up in NHS Devon to look at Pharmacy uh moving forward and that has key stakeholder involvement um and I’m sure David will add a bit more to that um the this is to who uh as you’re aware Pharmacy is is part of NHS Dev um remit
For commissioning now um under a um what’s known as the Pod um which is Pharmacy Optical Dental Services delivery um so therefore it’s right that they they look at a strategy of how that’s going to happen in Devon given its vast challenges either in the urban or the rural
Setting um we’ve recommended that um answer an answer phone facility is is in place at pharmacies so that if they don’t have capacity to answer the phone at the time somebody rings when they have capacity they pick up the messages um around that and uh the final one is
NHS Devon considers our findings and provide a response and on that note uh I think um we’ve had some good response not only from NHS Devon but from the LPC and also from uhp as well when we looked at the specific issues around L Pharmacy um and I’m happy to say the
Final recommendation on on this one is we do have um links in with uhp we’ve been up for an on-site visit to look at the new Pharmacy yes there are are issues now at the moment for um people with mobility in particular um but I guess it’s it’s the devil in the deep
Blue sea in some respects you know with the the recent period of wet and very cold weather um waiting outside or or waiting inside at that stage um is a question um you know that needs to be resolved and and it’s how you get around the mobility issue and I think they’ve
Got some plans there to look at that including using their little on-site bus service I’m not going to read out the responses they were um in full in the report but um we’ve just preced them here on this slide and then finally the response from uh University Hospitals Plymouth um I would
Say the chief pharmacist up there is very um pragmatic but he’s also got a drive to improve the situation and they have looked at several measures some of which um is outside of their control um and another one they did look at was bringing the outpatient Pharmacy back
Inh house rather than it being contracted because but because they’re in NH HS trust they’re not allowed to do that so there’s some um governance legislation issues that they also have to contend with up there so the next steps um we’re here today obviously presenting here but the
Plan is to present at the uh two other health and wellbe being boards um continue to work with NHS Devon and in particular the LPC and we’ve recently attended uh an LPC committee meeting to discuss the role of Health watch but also to touch on the report as well uh
And we will continue monitoring patient feedback um I would say from a Plymouth perspective over the Christmas period probably about 80% of the feedback we’ve received was around Pharmacy and I’m happy to take any questions thank you Tony um that as usual a brilliant report and um very
Much I think phes becoming one of those hot topics really in Plymouth aren’t they um um which is very unfortunate um in regards of the hospital one I think certainly it is from U Plymouth and um area disability Action Network point of view they are very concerned because of
That steep um incline to where they’re going and of course there’s limited parking so I think that’s something that dford need to take up is you’re not supposed to be parking on that little bit um where the where the pharmacy is going to be but having said that there’s
Going to be quite a few people whose relatives will take have to go up there or whatever so and I think the reliability of the the bus the hopper the bus I mean it’s brilliant service but it’s not always constant because it’s actually run by volunteers and we
All know volunteers can get ill so I think that’s a conversation that we really really need to have with with dord as to how we do that but having I suppose there several of us will have been queuing outside of that door in in the rain and whatever and before they
Brought the chairs there the that um appreciate the fact that the other service will be much much better um but I think we just need to get the logistics sorted out um in regards of the closures of boots I mean we’re being made more and more aware of other
Surgeries aren’t we other um pharmacies now that are restricting their hours or whatever and certainly from the boots point of view I mean I’ve got to be honest and say I go to the one on Salsbury Road and that’s one of those that are closed and of course they’re not getting the
Supplies um back so um the other day she was saying she ran out of some antibiotics so I think that that’s also going to be a problem with these these phased closures that people are going to find more problems um with getting them but I think I can understand their logic
But it’s not thinking of the community really and and the needs of the community I think that’s that’s what really concerns me any other questions John thank you Tony very comprehensive report and it doesn’t surprise me at all from personal experience what I hear from friends about can’t get through on
The phone queuing haven’t got stuff it comes in bits and pieces um and as for dord I think we need to remember that I if I’m correct the the Lloyd’s Pharmacy took over the outpatient prescribing because you know there were such long cues when it was being managed in the
House by the hospital pharmacy I suppose if they have a different site then they if they could run it themselves they might be able to solve that problem but in my day I don’t know Consultants were able to write prescriptions that could be taken to a Community Pharmacy not
Necessarily to the one at dord and I don’t know whether that’s the case and for certain people who have Mobility problems who can’t wait for you know an hour at the pharmacy at dford a prescription they can take to any pharmacy surely is one of the ways
Forward and a lot of people might opt to do that but I think pharmacies have a problem because they haven’t got much space I’m convinced now they’re under resourced probably unlike the rest or some of the rest of primary care um pharmacists are being pinched by GPS who
Are getting you know extra funding to do that and they are and and they haven’t got the space in their small you know shops most of them and when we’re saying to patients well don’t don’t trouble your GP well I think that’s probably who we should be troubling go to the
Pharmacy people actually doing that when they’ve got a queue outside and you know I just can’t see how that’s working so my question really is is general practice creaming off a lot of the resources in pharmacists uh in terms of you know Mana regarding pharmacis and also other palacial premises that really actually
If we’re going to make Pharmacy you know place where people go as a first stop then we need to put a lot more money into it and I don’t think that’s happened and I don’t think it’s going to happen that’s my question um I think with that question uh
Councilor Mahoney that um there’s other people in the room better qualified to answer that one but what I would say um about derer is that in discussions with the chief pharmacist they’re um they are trying to uh if you like where they can prescribe so that it can be collected at
Your local pharmacy or you can take an El ronic or take a script away to go to your Pharmacy I think the issue is that a lot of the medication they actually prescribe at some of those out patient clinics specialist medication and therefore there’s very you know if you
Took the script to your Pharmacy is not going to be there anyway so um yeah there’s some challenges there but I think they understand the challenges and they’re looking at um how they can um get over those or or provide at least where they can a service that allows
Somebody to to leave the hospital with a prescription thank you David do you want to come in there yeah um I think the reality is is that uh undoubtedly the funding has been a significant issue we’ve had flat cash for five years and in an inflationary environment that’s
Very very problematic and um you do get to a point where a lot of those areas are unsustainable in terms of their financial viability which is why you’re seeing what you’re seeing at the moment in terms of access reductions in terms of hours of opening and closures um the
Government are aware of this there been significant conversations going on about um the level of funding uh and uh we have got the pharmacy first service which is the the first injection of cash we’ve had in that fiveyear period um it won’t be enough to resolve the issues
That we’re talking about but it is a positive step um and want we Embrace as a Community Pharmacy area because it gives us opportun to grow into the future and offer a greater level revision to the public so we really welcome those new Services um you you
Asked about Supply Mary I think I think there is a fundamental issue of Supply um it’s one again that isn’t in in the funding envelope to deal with the level of issues that we’ve got where when we we five years ago there was no any of the supply issues we’ve currently got
And it takes huge amount of time to try and resolve um and it’s part of that burden that we’re actually coping with in pharmacies at the moment and that the supply issues are not going away it’s uh it’s a growing issue actually and it’s partly to do with um we have very tight
Controls of cost in the UK compared to others so there is um I guess some extent the market forces is driving where those those goods go to so I just want to emphasize that these issues that you portray are not in any way the result of um unwinding this and Pharmacy
Teams they are working their utmost to do what they can for patients um but there is significant pressures in the system and there are also some really really good positive stories about joint working and where pharmacies providing significant hypertension Services Etc so you know there are some real positive
Examples of of of actual Pharmacy can offer huge things to the community where where those integrated relationships work properly um I think John to to your question um there are there are issues of Workforce absolutely and um clearly the workforce expanded into other areas including practices Etc and that does
Exacerbate the pressures that you see within the workforce AR Arena we have got plans I think the um opening of the School of Pharmacy in Plymouth is a huge benefit um but you know we it’s reasonable to say it’s going to take a few few years for us to actually address
Those Workforce issues um we are we are doing what we can though in terms of initiatives and marketing except to draw people to our area but yeah we do have uh a shortage of Pharmacists and importantly as well probably uh an increasing shortage of technicians who
We will use more and more as as their um ability to actually inter intervene to clinical interventions grows we want to use more and more technicians and again we have a shortage in those areas um space is um is an issue because actually as you do more and more items through a
Particular location the storage of those completed things are an issue but we have coped with that to some extent by Hub and spoke and by director shelf and things such as that but you’re right in some instances in some locations space will be a problem as you reduce the
Number of Pharmacy Outlets you have and and you condense them into into Less locations um so it isn’t isn’t issue but we are doing some interventions that to some extent help that um but I’m not going to decry that that yeah in some instances where you do closes you’re
Going to potentially have a capacity issue and certainly the I’m sure boots will be absorbing their staff into their other branches um so that that that would be reassuring that some of those will at least have a few more people in their in their Staffing jamaa you’ve got
Something to thank you I want David sort of answered one of my questions which is around the government’s place in all this I think we’re on about our fifth Pharmacy uh minister in since 2022 um and so that concerns me so far as the message might get lost along the
Way actually how bad it’s become because um I’ve had emails from residents who are panicking because they you know one of their daily prescriptions that they’ve taken for a long time they’re worried about the supply it which is an awful thing to have to worry about and
It’s not unusual to drive past Pharmacy and see a cure people outside and these are kind of new things and I think I just don’t quite understand what’s that the nub of it what’s what’s what you know why is this happening to all these pharmacies now um in your very
Good report Tony you know there was I sort of laughed when I first read it but reflecting now there was somebody talking about using horse ointment to treat her an iron ction initially before she had to go you know thought well I’ll have to go to the pharmacist because it
Didn’t work well we can’t have people using animal medicines because you know they’re worried about getting a GP appointment and then worrying about whether they’re going to be able to get you know have the time to Quee to to get a to see a pharmacist and also I don’t
See again how it tallies up with the message about as as Council Mahoney was saying go and see a pharmacist to save you know GP time and all the rest of it those those those two messages just don’t marry up um so I think I’m just trying to understand what if you if
You’re able to describe what’s what’s what’s causing this I don’t know how long I’m trying to think how long it’s kind of been an issue with residents and I’ve seen it and I guess there’s a pandemic element to it as well there must be um but yeah I just want to try
And understand what what’s causing this and then my second question is about the government in terms of those discussions that you said have been positive what in terms of funding you said it hasn’t changed for five years what’s what’s coming out of those discussions and do you feel there is an understanding
Actually how problematic this is becoming certainly for Plymouth David do you want to take the um those um it is something that’s that’s been slowly growing in terms of is I think um it isn’t just uh the nature of funding the patient demand has grown too um so and probably
Expectations have grown um and uh reality is is there’s only a fixed resource because we’ve have flat cash so so at some point obviously demand and capacity uh com imbalanced and there’s an element of that going on um in terms of particular case of Plymouth uh and
The Southwest has been more affected by closures than the national average and that’s partly because of the workforce issues we have higher uh costs here in terms of Workforce because of the shortages so locen rates Etc we run off lomes more than the average uh and obviously that has a cost implication um
We also have some um unintended things going on such as um when they do clawbacks we have something called a global sun which um is basically for the amount of margin you make on your purchases um but every they do a a Reconciliation every few months and they
Craw back any um over recovery as or we make and sorry when you say they who are you talking about government um and in our in our case there’s one particular product this time that that was a massive over recovery on so they claw that they claw that back on a national
Average but we don’t use that product here so basically our local pharmacies have been very much hit by that in terms of finances again so there are some of these mechanics that go on that can have unintended consequences um and you know we we we are are definitely probably more financially
Stretched in the southwest than the average across across the piece which which probably doesn’t have help and that is probably why you’re seeing a higher level of closures here there are other mechanics going on as well such as rents for pharmacies in GP surgeries are high and that’s why you’re seeing a
Higher number of those potentially going uh on people moving out of those um so the rents the rents actually are one of the drivers of some of this as as well um because the economics are already critical um so there are really a multitude of factors going on here it
Isn’t one um one one driver there’s a a multitude of factors that are driving whether this happening at this particular point in time just come back there so it’s interesting because obviously one of the things that I’m particularly interested in campaign a bit around is dentistry and it’s that clawback word um which
Often seems to be if not at the but kind of quite Central to ongoing you know Financial issues I’m interested in the rent thing as well then that’s I that’s I don’t know chair whether there’s anything we can think about recommendation wise I don’t know I mean
I guess it’s a a plethora of of landlords I assume is it is it what what what who tends to rent those buildings to those uh pharmacies there’s a multitude um obviously in the case of of the GP practice it will be the GP practice subletting that space um but um
Quite in a lot of instances you’re on the High Street they may actually be owned which will be a better situation for them um but there there is a multitude of different people that own those properties yeah I don’t know it be complicated to do a recommendation
Around that then but I just yeah I mean that’s if that’s a really big driver that’s that’s something we could look at in some way and I think it links into the the the the next item as well I think that’s I mean I wouldn’t be expecting healthwatch to doing stuff
About the rents Etc but I think it does no no no it’s not an apology I think it’s something to note and then it links in very well to the next one um Kathy um my concern is with um suggesting people should see a pharmacist rather than a GP is that
Pharmacists aren’t actually qualified to do diagnostic work um in my experience when I’ve actually um seen a pharmacist instead of a GP I’ve been sold a product which I may not need I may have just needed advice or in one case could have actually caused me harm um and I had to
See a GP afterwards anyway so in fact it was it was time consuming for me time consuming for the pharmacist and I might as well just go and see the GP in the first place can we hold that for the next item I think that that’s much much more there
I think if we can just dwell on the report at the moment and keep to that um I think none of us will be surprised by the content of this report um Tony you contact 100 121 people contacted you is there any way that you would be would benefit by
Plymouth city council putting if you were we’re doing some consultation putting that on our website so that at least it’s there and on it so I mean that presly Gary is something that we could do to help isn’t it this the that contact rate um I thought the report was really
Good Tony and I we can always make those links and references um to those other things to help facilitate more information and feedback really to kind of add strength to that to the report I think the quality of your reports that come out regardless of what the subject
Is is so important to um pans that I think we we need to make sure that that link happens and that um Gary and the team know when something’s cropping up so that we can help you in that I think um that that would be one of my
Recommendations from today um and then I think do you remember if we hold and put when we talk in a minute about the pharmacy pharmaceu iCal needs assessment I think this what you’ve discussed and Cathy’s discussed needs to be added into that because I think that’s that’s
Vital Tony can I ask you to thank the team as I say for the brilliant work they do that your reports are so clear so easy to understand and some of the stories are always heart tugging definitely when when people have had real big problems um but we need to hear
Them and we need to be talking I mean one of the things that I will do is um discuss whether it’s with David or with Chris I’d like to meet up with a chief pharmacist at dford and have a conversation with him um about the new
New the new building and I don’t decry that they need a new building um I think we just need to make sure that we’ve got the fine tuning there for accessibility um regardless of whether you’re disabled or whether you’re older or even younger you know you can’t do
That so so um let let’s have that conversation please thank you very much indeed Tony thank you chair that leads us very nicely into the pharmacy and pharmaceutical needs assessment update um what we we do this every few I think it’s three years and we had done one a pharmaceutical needs
Assessment recently however as we’ve just discussed a lot of things have changed so I really felt very strongly that that needed to come back to us so that we can have a look at it um also um one Devon is also looking at it from various
Things and one of those things we need to do is do we work with other councils or do we um punch our our weight and and do it a pouth thing rather than joining up with other people so that’s what I need to steer from everybody so I’ll hand
Over presumably Rob you’re leading on this yes uh well morning everyone so keeping uh going with the theme of of of Pharmacy um myself and and and Dave are going to do a um a double act on the sort of pharmaceutical needs assessment and then some challenges and options
Going forward so just by way of introduction for those people who don’t know me I’m Rob nder I work in the in the city council’s public health Team and I’ll introduce Dave Dave um I think you all know Dave Beerman director of strategy of what is now called Community
Pharmacy Devon formerly the LPC so the LPC is now Community Pharmacy Devon um right what do I point this one at Elliot am I pointing it at you am I just generally pointing it to move on there you go look at that um so this is what we’re going to going to cover
Briefly what is a pharmaceutical need assessment or PNA and what are the health and well-being boards responsibilities in that regard because you do have responsibilities um then we’ll quickly go through the list of which pharmacies have closed CL or we planning to close I’m just going to mention these things called
Supplementary statements to the PNA we’re going to talk about um our proposal to go early uh with the next iteration of the Plymouth PNA then Dave’s going to take over and talk about the current situation some of which we’ve heard already the opportunities that that presents it’s not all
Challenges there are some opportunities as well we’ll mention the NHS Devon Pharmacy strategy the links to the PNA and the opportunities for for yourselves to get involved in that and then there are a couple of recommendations at at the end that we’ve s uh suggested basically so
Um okay there we go so um starting off with what is a PNA and what are the health and well-being boards responsibilities um it’s outlined on it’s outlined on the slide there just to pull out a a key a few key points of of what it’s supposed to be so it’s a this
Thing about a PNA being a comprehensive assessment of current and future pharmaceutical needs of the local population so that’s what it is in a nutshell and why are we talking about it here at the health and well-being board well it’s because the Health and Social Care Act transferred the responsibility
To develop and update pnas from primary care trust to health and well-being boards from the first of April 2013 so this means that that we or you as a health and well-being board has a legal duty to ensure the production of a p for Plymouth so it’s it’s it’s really
Important that we that we do this and it’s really important that we get it right so we had to produce the first one by the 1st of April 2015 and then publish a revised assessment within three years of that and so there’s that three-year cycle we got slightly out of
Kilter with that three-year cycle during um during the pandemic the height of the pandemic when um the life’s the lifetime of the PNA was extended if you like because there wasn’t the capacity within Public Health teams to to update them and it is normally the public health Team within
The local Authority that that produces the PNA on your behalf um but don’t let not going to let you off the hook there it is your responsibility sort of the public health Team while doing it for you and with you if you like so we last published um our PNA in September
2022 um and that was for the period or should have been should be for the period to take us up to September 2025 so we’ve got a live PNA at the moment published in in um September 2022 to take us up to September 2025 so as I said the PNA for Plymouth
Presents a picture of Community Pharmacy need and provision in Plymouth so the key thing is that if a if a pharmacy or a dispensing Appliance contractor wants to provide pharmaceutical services in Plymouth they’ve got to require they’ve got to apply to NHS Devon to be included in the pharmaceutical list
And this is the key bit their application must offer to meet a need that is set out in the health and well-being board’s PNA or to secure improvements or better access similarly identified in the PNA so in effect in their application they’ve got to address something that is outlined in the PNA
Normally a gap of some sort um so as well as identifying if there is a need for additional premises in the PNA it also identifies whether there are needs for additional services or Services um whether whe to it’s additional premises and additional Services those are the things that the PN PN PNA
Identifies um and those identified needs in the PNA could relate to better access which could be current or will arise within the lifetime of the PNA so what I mean by that is I’ll give you an example if there was a massive housing estate that was being built in or around Plymouth
Then that might change the need for pharmacy Serv services in the lifetime of the PNA so we have to consider those those things as well that might happen during the lifetime of the PNA so in summary the PNA is used by NHS Devon to inform decisions regarding
Which which fun which Services need to be provided by Community pharmacies whether new pharmacies or services are needed decisions about the relocation of existing pharmacies and the commissioning of locally enhanced services so these are those are the key things that the PNA will be used by NHS Devon to to
Decide um and obviously providers we said as I’ve said already providers of pharmaceutical services will use the PNA to inform their applications to provide pharmaceutical Services by showing they are identifying a need or a gap so that’s the key thing in the PNA very often is this thing called the a gap
Analysis which shows where there are gaps in the the city that um providers of of of of Pharmacy Services might um might want to might want to fill so moving on oh moving back there we go we’ve moved on too we’re now back one to where we should be so the list of
Pharmacies which have have have closed or are planning to close there are seven on this list um Lloyds and then Boots the other thing that isn’t on this list just to make you aware of there’s an there’s an application by super at the moment to consolidate their two
Sites in the city center into one location so that’s a thing that isn’t on here cuz that’s an in the application stage at the moment so super drug in the city center I’ve got what’s known as a consolidation application I believe that’s the term um as they want to
Consolidate their two sites onto one but as say you know this is in the pack anyway and I’m sure you’re aware of which of which pharmacies have closed or are planning to close yeah the other thing that we do so we published the PNA the pharmaceutical needs assessment you may have seen it
It’s published on the on the ply city council website um and what we can do is we can issue these things called supplementary statements to the PNA when things change um so supplementary statements are statements of fact um they don’t they don’t make statements or about the need for pharmaceutical services or revise
Need for pharmaceutical Services they’re simply statements of fact um so we are going to to be uh issuing and I’ll show you what a supplementary statement looks like there you go there’s there’s there’s one in the in the presentation it’s literally makes reference to the date the PNA was published the date of
Issue of the supplementary statement you can ignore that it says 8th of January obviously we’ve just drafted these supplementary statements we won’t publish them until after um after this meeting after this meeting today so that that that will change it just talks about what has actually happened in
Terms of um the facility what uh what’s happened in this case it will be closures they talk about um and and it gives some reference to the to to to the provider so after the meeting today we will have to issue I believe seven supplementary State well not seven
Because theyve not all closed yet we we issue them when thearmy Clos those supplementary statements will be is will be added to the PNA but um that’s what that’s what that’s what that’s what we need to do so um as I say we can’t issue we when we issue these
Supplementary statements they don’t say whether a gap or not has been created they literally say that a pharmacy has closed and the services it it used to provide um but as you will see from what’s included in the in the presentation seven pharmacies have closed um and so myself
And and Dave next to me and colleagues from NHS Devon have had convers ations about whether that is sufficient to enable us or to require us to revise our our pharmaceutical needs assessment in its entirety pharmaceutical needs assessment as I’ve said needs to be produced every three years or within that threeyear
Window if there’s been significant change to to the to the pharmacy situation in in an area we think that the closure of seven pharmacies and the and the consolidation application means there probably has been sufficient change to Pharmacy delivery Plymouth to Warrant us providing an update producing
An updated PNA so that’s why we’ve included this this section on the reasons for this proposal to go early those changes are of a significant extent we believe so what we’d like to do as one of the recommendations later on is for you to consider our proposal
To go early and produce an updated an updated PNA um it’s not massively you know it’s not we’re not going massively early we’re not due to produce another one until September setember 2025 these things take 9 to 12 months to to to produce because one of the things you
Have to do is a 60-day consultation so that eats into a significant amount or takes a significant amount of time so what we’re looking to do is to produce the next PNA by March 2025 in effect start producing it now so that we’ve got something ready in March 2025 we would
Do what we normally do um hopefully and that’s produce something in partnership with um the other public health teams in in De so our colleagues in in in Devon and T Bay what we normally do is is is share the pain I suppose is the way to put it
In the production of the PNA we produce certain bits they produce certain bits we all have a document that’s formatted in the same way and it works really well for NHS Devon because they um they hav’t got to look at three completely differing differing pnas so what we’d
Like to do as I say is is is for you to consider at the end of this whether we whether we’re able to produce whether whether you’re happy for us to go early with the production of the PNA for the reasons I’ve I’ve outlined the significant change that that that that
We are seeing in the city and the significant challenges that that Tony has outlined in the um in in in the health watch report what I just would say is I’ve talked about us producing the PNA jointly with Devon and torbet it’s just worth saying going back to the
Point that Mary made in terms of the Devon Pharmacy strategy that’s being produced that’s a separate thing okay that Pharmacy strategy that’s being produced we will use that to inform the PNA when it’s when it’s published so I think what what Mary was suggesting is that we need a separate session with NHS
Devon to consider our input into that Pharmacy strategy and then what we would do is we would use that Pharmacy strategy to inform plymouth’s PNA but we would we would produce our PNA in Partnership with colleagues in in in Devon and with colleagues in tbet as we have done for
The last however many years I’ve been involved in this lots of years basically so that’s where I’ve brought us up to I think we’re going to move on now and Dave’s going to talk about some of the well the current update people on the current situation to go into a bit more
Detail on some of the things we’ve we’ve talked about already so should I hand the clicker over to you Dave just the right hand button there yeah just to reinforce what Rob said really I think um the health and wellbeing board is quite a different situation for pharmacy
And the others it’s this is you have more responsibility for pharmacy in any other part of the health system and actually you basically hold the me one of the primary mechanisms for the delivery of the pharmacy strategy in your hands so it is really quite important you get involved with Pharmacy
Above and all other the healthc care situations really so I just wanted to go through um the current situ oh CL me sensitive is it um as we as we’ve already talked about um the sector under imp precedented challenge um Financial challenges we talked about Workforce issues we’ve already talked about Supply
We’ve already talked about um and there’s operational things and and workload as well in terms of uh increased levels of activity that are leading to this reduction in Access we talked about um we have seen significant closures in Plymouth it is one of the highest closure rates in the country
It could be up to 20% uh well nearing 20 it won’t quite reach 20% by the spring um I’m not saying there will be more closures but I I don’t from the conversations we’ve been having with the national team we don’t believe the closure stream has finished so uh there
Is an anticipation there will be further closures at a national level whether they will impact on Plymouth that’s difficult to ascertain at this point um in May uh the Department of Health and social care and hsse published the delivery plan around recognizing the need to recover access to Primary Care
And that actually included that the pharmacy first service is one of the one of the solutions to the access to the primary care agenda so it’s quite clear within the Strategic thinking that Pharmacy is going to grow in importance in terms of service delivery and that first point of contact so it’s really
Really important we have a robust infrastructure to deliver that because that’s clearly a national intent the pharmacy will take off a significant chunk of the demand uh coming into the primary care sector um so that’s a real reason when you think about the robustness of the pharmacy
Sector in terms of our opportunities um we probably aren’t maximizing some of our existing Services actually so things like the new medicine service which helps support people when they move to New medicine the discharged medicine service which is um looking at how you manage discharges from hospital and and
Reconciliation of medicines um which is known to have actually a real impact on readmissions and actually L to stay in hospital so some of those things we know that can have an impact on on system demand we probably could do more to maximize the new Services coming out um
Is basically a growth of the existing ones we have which are the cpcs and the GP CPS Services which are Urgent Care Services where um the largely referral from 111 and GP um but the the the new service is going also include walking capability which is a real positive move
Um alongside that there’s things like emergency repeat medicines Etc um but the new thing particularly is around clinical pathway consultations which will occur around sinusitis sore throat uh acuto titis media infected insect bites Ino and shingle so an uncomplicated UTI so the scope is significantly increasing and it will be
Driven out of um a whole number of pgts um which have been printed out and literally that thick uh in terms of the level of governance that go is going over the top of this um so there is potentially significant scope there to to impact on the Urgent Care demand
Coming into the system uh in addition to that there’s a new contraceptive service coming in where pharmac is able to initiate a contraception as well as manage contraceptive Supply which is already in place so again that’s a real positive um uh move forward in terms of
What pharmacy can do and support of The Wider Primary Care sector um there’s also um an opportunity around independent prescribing uh it’s worth mentioning you’re probably aware but uh Community pharmacies uh Community pharmacists will uh as they come out from college now all pharmacists will become in prescribers from 25 26 in
Terms of that cohort so um you know that training around you know you know uh it has become more and more clinical as we’ve gone through the last 10 15 years and that training would involve rotations into practices and acute care Etc to get that independent PR prescribing experience but the as they
Go through college now um is three four and actually in the pre-registration year you’ll see that buildup of clinical experience around ability to prescribe um so it’s embedded in now the undergraduate program that that learning and capability around clinical skills um is far more more in depth than it
Historically has been um so there’s real opportunity here about what we then do with those prescribers that sit particularly across the whole of the pharmacy estate and that will be over and above what I’ve mentioned there about the pharmacy first interventions so he potentially can have a real significant level of support around
Things such as long-term condition management and broadening that Urgent Care intervention agenda so potentially significant scope to um actually um enhance what we can deliver um also we we have a hypertension service that’s being expanded in terms of the number of abpms and actually this is one of the areas
Where technicians will become involved um so that won’t be a Farm sustainably Service in future uh that’s obviously one of the key preventative interventions we can make and expanding the capacity of that will potentially have significant positive benefits for the health system um I’ve mentioned Pharm technician scope that was one
Example above but uh the intent is to grow pharmacy technicians in their capability of of intervening uh around vaccinations all kinds of things so the intention is to grow that their skill base and actually have them involved in more and more of the service interventions um medicine Supply um is
Being centralized so we’re looking to do that in order to enhance efficiency and capacity um and that is part of what was saying John about the ability to actually create space um so the way we’re creating space is actually um automating things that allow us to actually reduce stock space Etc so to
Create more space for other things within the pharmacy sector um greater system linkages are occurring but there’s real opportunity to do more around that linking up potentially with GP practice systems Etc to improve um safety uh and and you know I think there’s real real scope here to improve
Care and improve safety and improve um transfers of care between pharmacies and practices by actually improving that water the system linkages um and utilizing pharmacies in the prevention uh role uh we obviously have Healthy Living pharmacies there is a preventive agenda that we can deliver through pharmacies um there’s a real opportunity
To use Pharmacy to support inequality and uh also uh NH it’ss Devon uh and the icbs we’re looking potentially about setting up a a small team to look at Community Pharmacy resilience and think about how we might exploit the opportunities so real opportunity there so what basically is
Saying here is I appreciate what we talked about in terms of the the um demand capacity issues but there’s huge scope if we can get that right to actually have a a really really strong support to the health sector by utilizing the pharmacy system in terms of uh Pharmacy strategy
That’s being developed at the moment uh NHS uh Primary Care turning into the NHS Primary Care strategy um it’s going to be built on local examples of integrated working but also there’s a significant body of work um which I haven’t bed with but there’s about there’s there’s many
Many documents now around visions of Pharmacy Etc the key and most recent one is the Kings fund of nuffield trust Vision um that’s come out that will be utilized in actually thinking about what we do and how we take committee Pharmacy forward um but part of that uh there’s a
Significant level of Engagement going on um with health and well-being boards and with others and and and actually there’s a significant scope around that about engaging with a whole wide range of uh potential interested parties and from that we’re going to talk take people through the national context of what
Community pharmacies are operating and practicing in um outline the number of community phies in Devon and the changes that are occurring highlight the challenges um and look at some of the good news stories as well and that’s the context of those engagement sessions and it will be developed using uh those
Sessions and the intent is to actually involve health and wellbe Boards in one of those and look at you know the the the stakeholders and and things such as you know what’s happening around Pharmacy service provision what the opportunities and what can we do around those Community Pharmacy services so it’s a real
Opportunity for health and well-being boards to get involved in actually driving and developing the strategy um and the intent is to have that completed by May um just wanted to flag though that it’s really really important in in get engaged in that because um we want to
Utilize the PNA to enable the delivery of that vision for for pharmacy uh working partnership with NHS Devon so what we’re doing around the PNA and what’s happening around the pharmacy strategy are very much linked and and it’ll be really helpful to actually start bring um the bodies together um
With with NHS Devon around this to make sure that we’ve got something that’s integrated coherent and we understand our roles in actually delivering that strategy going forward I think that’s me I I think that’s I mean I guess there’ll be a little bit of discussion but those
Were the the recommendations at the end that we’ve suggested lovely thank you I’m going to bring in Michelle first and then John thank you and thank you for the presentation I I always find things that this quite inspiring and you just see what the future can look like but we’ve
Also seen that the issue that Plymouth had has um and um Pharmacy is a strange thing around um ownership and drive isn’t it so you know I I just even if I think Back to Basics around any Workforce strategy you know what part of the strategy is really looking at that
From a national point of view it’s great that we’re training in Plymouth but have we done any work on how many people are likely to come up to retirement how many pharmacists we actually need do we need the do we know the amount of support support that newly qualified pharmacists
Will need in order to start to take up all of these exciting things um and again the focus on technicians how are we training technicians and how are we supporting them as part of their new role um and it just feels like I sit on the periphery of this as well and it
Feels like we we need something for Plymouth to really really focus on the Plymouth issue and know what we need as well as listening to the what’s happening nationally because I think something special needs to happen here yeah thanks ch um yes we are looking at Workforce we’ve done the the
Uh some work with Simon Fuller around optioneering Etc looking at the future um out to 2035 um the the the we recognize that that from start Point we’ve got a gap but we’ve been looking at what we need to do to plug that Gap looking at what level of international recruitment we
Might want looking at what we can do around particularly accessing uh pre-registration or now called IP students um we think there’s a real opportunity around that because the way that is now going to operate um is going to become far more like Medics um everyone will have to go through the
System called Oro they’ll be um they will be uh uh what’s the word uh they will be uh well numbered Etc in order to get a ranking uh and and they will then go out according to their preferences just as they are with Medics now the reality is is we know the number
Of places potentially going to come offer because of the way the funding is working is going to reduce historically we’ve only got something like 20% of uh the fill rate uh in our area actually is quite as lower than that amongst community pharmacies so we know that
That that our fill rate will probably increase as a consequence so there’s real opportunity around that and then there’s also an opportunity because we’re going to have the new School of Pharmacy down here so we think we can get our our our numbers of uh what is historically called pre-registration
Students up um the question then will be is about what retention mechanisms do we put in place to keep them so so there are things around that we’ve had discussions with Mary around this and around International students as well what that might mean um guarding ptpt which is the technician
Training program it’s a two-year apprenticeship um that rotates around um a a couple of sectors normally in fact a lot of Pharmacy education now is not organization specific it’s increasingly system orientated uh so you will see uh all pharmacists going forward after 25 26 will have to rotate through more than
One sector in terms of their final qualifications um and increasingly seeing that with technicians as as well which is a really positive thing it means we’re training people for the system and and able to work across the system going forward so um we have looked at real planning around this so
We we it’s not straightforward and there’s a lot of work to do but we have plans in place we think um to actually start addressing that there are pinch points particularly in general practice around um the huge burden we’re expecting on them in terms of the training requirement particular around
Placements um but we are looking at that at the moment to see how we can increase that capacity um it’s not straight forward it’s not easy um but um we do have a plan but we recognize there are significant challenges in delivering that plan thank you very much
John thank you David Rob for your presentations two questions really one for Rob and one for Dave for Rob first with all all these pharmacies closing obviously there could be a geographical problem for patients who find it difficult to access a a pharmacy but also I mean particularly with the the
The S is closing and I recently had a text um from Polar Pharmacy saying that they’re going to be closing on Sundays I think as from the 1st of March so what is the out of hours provision the evening provision the extended hours let alone satday days and Sundays what is
The position there because it strikes me there could be a problem um and and for Dave I mean yes all this is adorable but again I don’t see how it’s deliber in a smaller number of surgeries Pharmacies with what appears to be a decreasing number of pharmacies or there may be
Some rationalization when so when pharmacies can merge but you know how deliverable is this and people are now saying well during covid we were asked to save the NHS well perhaps the question should have been the NHS is there to save us and again now we’re talking about pharmacies protecting
Primary care and general practice well I wonder whe this is the wrong way round at the moment and actually whether we’re not ending up the situation where the the tail is wagging the dog your comments would be appre appreciated can I before you come back can I just also
Add in years ago um G um the of doctor Services overnight Etc would often have enough antibiotics or whatever to keep you going till the next morning when a pharmacy was open do you see that that’s wherever somebody goes for that let’s say emergency care overnight particularly that that is going to have
To start happening again so Ed may have to have stuff for say complicated UTI or chest infection or whatever to hand at there rather than waiting till the next day when somebody has to go to far phy I think that links in with what John’s saying and Sunday
Cover um and the geography of that is really important isn’t it because we need we need to remember there are a lot of people that do not drive and how are we going to manage that yes so I think I mean what what what what um Council mone’s highlighted
Is the very reason why we need to do the the PNA sooner rather than later because you know although the the current iteration of the PNA didn’t identify any gaps ac across the city it’s very unlikely that a future version would would would tell the same story for the for the you know
The reasons we’ve heard this morning the you know the seven closures the one consolidation application and a and a reduction in and a reduction in hours and that’s just the situation now we don’t know how things are going to change going going forwards in terms of you know the other thing I appreciate
Obviously is that the next ex iteration of the PNA even if we go early it’s not going to be published until March 2025 which is over 12 months away that’s why it’s so important that that we engage with the development of the pharmacy strategy because through that we might
Be able to change things quicker um you know outside of the PNA process so I think that’s that’s the key thing I would say is you know engage in that and raise challenges and ideas with with the um with NH de as they as they develop
That I don’t if you want to add anything yeah um John you’re very much right to raise the issue our services uh I think we we do have some concerns about that um as a consequence we’ve been um engaging with the adir provider and to bring them into the conversations about
You know what are the risks how do we actually deal with that um is that through some kind of Pharmacy provision or is it through what they do themselves in terms of stocks and supplies available um don’t think we’ve got a definitive answer to that at this point
In time but that that that issue is recognized as a significant risk and and we are engaged in conversations about what we might do about it and that’s the reason why we’re involving those individuals into the discussions about the closures um in terms of actual capacity the difficulty is is to view
Everything as is one and homogeneous system and it isn’t actually there are there are big chunks of Pharmacy that actually can still and all delivering those services so um there’s some real positive examples of of of services delivery going on in in in in some Po in
Places within Plymouth um so some yes have pressures but others have great capacity and can deliver these Services well uh and and we are seeing that and we’re actually seeing um pharmacies putting huge effort into gearing up for the for this new service so I actually think there’s a good chance that it’s
Going to be delivered quite well that doesn’t uh forgo the constraints we have and the pressures that we’re seeing in the system um and and we kind of do need to think about how we do do tackle the cues Etc um but that isn’t uh happening every day in every pharmacy location and
Actually some areas you the access is still positive so I think it’s a mixed picture but I also do think that um the way that our people are engaging with the services that are coming are coming out suggests that we’re potentially going to have quite a good response to
Them um the issue I guess you’re right in highlighting the issue is is going to be the capacity but that there there has to be um actually some kind of funding issue Etc going on with this to enable us to actually ensure that we have enough um people in the place to deliver
Things correctly ly so I I think the conversations with government around the next contract I to said we had a five years flat contract that is coming to an end there are new contract discussions going on and I would hope that that is recognized with a new contract negotiations that actually is really
Really important to create sustainable uh growth within the community Pharmacy sector so that we can uh effectively deliver um the aspirations of government going forward to be the first point of cont Ty of Care thank you now I’ve got jamaa Gary Ruth and Kathy and I’m going to have to
Call a line under that then because we have a little bit time already and we have guests coming in to talk about dementia care so I I don’t want particularly keep them waiting too long um so Jima thank you chair um and through you I think I would say you know I think
Going early proposal is an absolute no-brainer um the I mean what what sanction is there who’s going to be annoyed with us how does it work you know where’s is there where’s the issue with going early the second thing is around the supplementary statements Rob
How many have you done of those in the past have you ever done seven in a year or maybe possibly eight before no I think in the I think in the last the last iteration so the last PNA that um there was maybe one so no we’ve never seen this level of of
Change so I think that’s all more reason to go early because we really need to underline feels a bit of an emergency to me to be honest if you’ve only kind of done one in the past and we’re seven possibly eight so and then my um second question and it’s goes to Michelle’s
Point about Plymouth is experiencing a particular problem um what what work are we doing to support pharmacies that might be on the edge of having to do this especially again looking at the the rent um Le issue relocation you know I don’t know what kind of support
We that there is to support you know where does somebody who’s running a pharmacy go to say look I’m teering here what you know is there something that can be done to support them um to keep going I think there’s quite a delineation isn’t there in in that it’s
Boots wanting to restrict the number of pharmacies they’ve got because they’re not financially viable as against a pharmacy that is finding a problem with rent Etc or am I wrong on that I I I think you’ll find that all pharmacies under Financial stress at this point in time so I think the
Question is an that one and and in the presentation I gave we talked about um us coming together to to create a group looking at Pharmacy resilience um and that will be part of those discussions uh working out what we can do and in what circumstance um though it in terms
Of the statute what NH HS England can do um it is more limited um than it is for a general practice uh so so it will probably be about you know where do we where do we want to actually lay down activity to support the sector um and it
Isn’t remember it’s not just in in the urban sectors we’ve got a problem in broader de we’ve also got um significant risks around uh rural oneoff Farm locations that um would also provide quite significant concerns about what they would mean for population Health if they disappeared thank you
Gary thank you Council as um some really good presentations and conversations today we all know how important pharmacies are inside of communities and I just would Echo something from jamaa before I make a couple of points which is that how do we understand that critical Tipping Point in terms of
Pharmacy services in the city and if we recognize we were approaching that should we what would be our critical actions I think that would be just something that would be really interesting from my point of view I’m I’m looking at your recommendations and I have lots of thoughts so I’m thinking
Item two the answer would be yes I’d be interested in engaging in a bit of the work around the the the strategy but I think for me I wanted to talk a little bit and ask some questions about demand and demand modeling and I’ve looked a little at the
F suitable needs assessment which talks about different types of essential Services you’ve also listed other services that you could start to do but where’s the place which captures that demand over time to see how that profile is changing by the different types of service because I think we’ve heard
Quite a lot today for example supply issues you talked a bit about perhaps Market forces but I’m just wondering where that demand is going particularly when we hear from others around the changing ask of Pharmacy and therefore what we see that looking like yeah through this needs assessment
Period I think that’s a very fair question we we have um a high level understanding of demand looking at demographics and population and therefore what we expect to happen as overall impact on Health Urgent Care Etc um down to the specific service level no we haven’t got that level of granularity
And understanding um so I guess you could argue that’s a gap but it would be quite difficult um process to actually get to that but I understand why you’re suggesting that’s needed I guess and just as as an an example we talk about now in terms of
The primary care offer for people coming to attend pharmacies and to get advice so I’m imagining what we’re seeing is a growth in those numbers and I’m thinking is it important for A needs assessment to be describing the direction of that growth recognizing how hard that might
Be but it feels like if we can’t quite do that um it’s going to be hard for us to know that the workforce planning and the strategy is really going to be ticking off those those issues so I think for me that was why I’m asking I
Think you you you are right and and you know to some extent within the within the PNA we can you know we We There is information at our disposal around like item dispensed per head of population and those sorts of things which are included in it I think the thing the
Thing which to to bear in mind is that the term pharmaceutical needs assessment is maybe slightly wrong because it’s not A needs assessment in the traditional way a pH the PNA is really a control of Entry document so it controls the the entry of new provid providers to to the
Market to to some to some extent and and and it you know as I said it’s used by it’s used by the NHS to to to control to control entry to to of new providers so it’s not a need assessment in the traditional form that you that you might
Have seen one one before um but having said that we do try and include that that information within it in terms of you know items you know prescriptions dispensed per head of population and those sorts of things things and again it’s probably you know one of the good
One of the reasons why it’s fortunate it’s updated every 3 years because um because things change you know the way the way a pharmacy operated three six nine years ago is probably quite is probably quite different now so it does need to be updated to reflect what
Pharmacies do the way they operate the change in yeah I don’t know 15 years ago we already didn’t have many online Pro providers um I work quickly think that how long ago we did online C but um but but you know so the so the pattern of
Delivery is is different now which is as you say why we do need to to update it and include new new variables if you like in in the document whenever they become available to us and your tipping quite questions quite a difficult one in that different bits of the city you can
Look that and say actually I can see how you can spread that workload Etc and other parts um you actually say actually I can see that’s a real problem that we’ve lost too close to each other whatever um I think part of the the question is well is that when we’ve
Looked at this or when the commission has looked at this that the belief is a lot of these Provisions might go online um the reality is we’re seeing actually that is not happening to anything like the extent extent that people believed it to that that people are just moving
Locations because they want that personal care that’s happening at a local level so um it actually you it’s quite difficult to model uh and and though though I have to say when you look at certain bits you can see a scenario whereby um closures overburden the pharmacies next to them and create
You know you can see a situation where it might cause a series of collapses not not actually physical closures but actually them becoming completely overburdened um so yes there is that risk but actually evaluating when it is is quite difficult because the number of variables involved um having said that
You can do some desktop and say I can see we have a problem in some areas when when certain things are put on the table and and I think that’s purpose of why we’re saying what we’re saying there by bringing it forward thank you
Ru so to be to be very brief um I just wanted to very explicitly mention inequalities and how that’s connected with access when we know that some of the pharmacies that are um are closing are in some of those areas where access might be more difficult to the to the
Larger pharmacist those remaining open not just for normal for for our you know everyday pharmaceutical needs but particularly highlighting some of these opportunities where those opportunities are all about identifying early interventions and therefore would be reducing inequalities if we can get them to the right people and so I think it’s
It’s a requirement for all of us to consider when we do engage within the with the pharmaceutical strategy and obviously I am supportive of both those recommendations that we are really thinking about and highlighting those issues around inequality and i’ just like to mention
On that I I think we need to really look at where closures are occurring because given the breadth of services that phes can have if phes aren’t available in areas of inequality then we’re actually building the inequality Gap not reducing it and I think looking at what’s happening
There’s a real risk that that is happening thank you Kathy thank you chair um my question is um to what extent do you actually discuss with local pharmacists your future plans and um get them involved in the consultations yeah so so um the community pharmacies have got evening
Events and actually engagement events so we’ve been engaging with what call the PCN lead so we have uh a nominated lead uh pharmacist for each PCN that engages with the other pharmacies around at PCN level so we’ve already had engagement sessions with them and now we’re having uh online and evening sessions and
Actually a daytime session as well to engage with the wider Pharmacy population um to make sure everyone has an opportunity to input into that strategy development process can just to add to that in terms of the PNA the pharmaceutical needs assessment which is a statement of fact at a point in time
And I think one of the things that that um that I mentioned in the presentation is there a 60-day consultation as part of that um before it before it’s published and obviously all all Pharmacy providers are invited to to comment on that draft PNA um and any any um you
Know and and the responses to the consultation from them and others are are then um reflected upon in the final in the final in the final docum so there’s a 60-day consultation as part of that thank you and Tony I would see healthwatch being one of those essential
People and I know you sit on the is it the pharmaceutical committee isn’t it or something like that but I think to me Health watches is one of those critical people that we need organizations that we need to get involved and making sure that that people know we’re Consulting
About things so to me if you could manage that that would be really good um I guess we are chair I mean there’s conversations going on with the um NHS Devon strategy at the moment and how we get sort of patient experience into that Mary could I just ask part of this
Process we’re talking about you engaging the strategy in the pnas ETC do you want to do that as a Devon uh and torb and P or you want to do it separately I think that would be really helpful to understand sorry I think I that me yes I that’s something
That that we need to disc decide but I think there are certain things I want to do as Plymouth and certain things I want to do as as Devon because that’s important but um rob you you straighten us out on that yeah my I suppose if if I
Was recommending something to to to to you then I would suggest that you do the consultation on the Devon Pharmacy strategy as a Plymouth thing okay Plymouth health and wellbeing board does has a session with the team leading that and you do it from a Plymouth perspective okay that’s what I I think
Is is is the way to go there in terms of the production of the PNA I think we do what we’ve always done and we share the joy and the love of doing it with our colleagues in public health teams across Devon because we do part we lead on parts of
It they lead on parts of it it’s worked really well in the past and I don’t see a reason to to to change that because what it means really is that NHS Devon get get a document for Plymouth a document for Devon a document for tbet they’re structured in the same way and
It makes it just works well so I think that the far the Devon Pharmacy strategy do it as a Plymouth thing but I think the next iteration of the PNA do what we’ve done in the past and we’ll do it we’ll produce a Plymouth specific document but we’ll produce it in with a
Working group that’s got representatives from the other public help teams as well I see no reason to you know digress from from that now Sue you’ve been very quiet there and I I mean I hate you to think we’re ignoring you so is there anything you want to input do you to introduce
Yourself to everybody and say who you are yeah I’m Sue Taylor I’m the chief officer of Community Pharmacy Devon and work very closely with David so I think David’s done an admirable job actually of responding to all the questions I was just going to add in about the
Engagement um with community phaces and with any stakeholder there is also a survey that’s been sent out so when people um join in with a sort of uh think tanks as they’re called around what needs to go in the strategy they’re also invited to complete um an online
Survey as well and that’s gone out to all the community pharmacist in Devon but I support everything that um David said and we work very closely together around um supporting our phaces as well in the network across the whole of Devon thank you Sue and I know you’ve
Been one of those ears that I’ve had to uh sort of go and whisper in several times so I do value your input into that so thank you very much indeed okay team um I’m just conscious of the time now um can I ask you that we have two
Recommendations to accept the proposal to go early with the publication of the next PNA and looking at March 2025 as opposed to September 2025 and then secondly to support and engage with the development of the NHS Devon ICB Pharmacy strategy which in turn will inform a Plymouth um PNA are
You all happy with that jamaa yeah sorry I got confused with the date so March 2025 I know we’ve had the discussion that seems quite a long time away in terms of what’s happening is and I I’m I understand your sorry I read it as 2024 I and I understand around capacity
And getting things done and all the rest of it but actually we might be you know we’ve already got 20% of our phes closing now we might be so much worse off by the time we get to March 2025 is there any reassurance you can give me
Around that sorry before agree to the recommendations that’s my fault because I misread the the Year Rob yeah I mean the trouble if you like is that it takes an inordinate amount of time to do when to produce the PNA it’s normally a 12 Monon lead time to do it when you think
Of things like you know two Monon consultation as well that’s why I think it’s really important that that as a board given the issues that we’ve got in Plymouth that that the board engages with the with the Devon Pharmacy strategy because it might be that we can
Put things in place and make changes to sort the situ to sort out some of this situation that that that you’ve been made very well aware of this morning in advance of the publication of the next PNA because the PNA will literally just say where there are gaps and where there
Aren’t gaps that’s what it does really whereas the pharmacy strategy I think will be the the driver of of of change can I just say then I think as a health and well-being board we need to put a point three which says we are extremely concerned with the number of
Closures of pharmacies within Plymouth and that we will monitor this um I don’t know quite how to finish that off according Rob can you help me with that I mean what I mean we need to not as I say we need to say that we are very
Concerned but I don’t know quite whether we have anything that we can action after that so David or or Rob can you help with that I just I just wondered if you want to involve with that resilience operation that’s going on um that might be the the the mechanism by by which you
Could uh influence outcome you’re happy with that could we add in then um at the very latest March 2025 in the recommendation we could put that into that number two couldn’t we and then make a number three um as I say to to note our not note but to express our extreme concerns
Of of the reduction in the number of community pharmacies within the Plymouth area and the services that they provide and we David the last bit if you can add put that in we’ll engage with the resilience planning that’s going on within Devon ICB any you will support that folks just
Great and just the key point to remember is that the the pharmacy strategy is due for publication in in May May 24 so this coming May so that’s the the thing we’ve really got to influence you know quickly if we if we can from a Plymouth perspective okay so we’re happy with
That third one to pop in there okay all agreed excellent thank you um Chris I’m going to bump you now I’m sorry um if we invite the dementia care people in um because I think they’re more on a time schedule sort of thing so thank you very
Much so David thank you as usual Rob thank you as usual and um we will just have two minutes while we get the people in from the dementia care all right um sue a big big thank you to you we appreciate that and no doubt we will see
You again soon all right thank you two minutes while we get change your seat jar are you all right you do you want that stool B in for your leg I think it’s in the group shall no I we’ll go and get that organized hey start again Louise hello Lise Barnes
CEO of elder tree befriending service Emma Crowther interim head of commissioning for Plymouth city council Kate Smith chief executive of memory matters hi Sarah Coulson lead nurse for elderly care and dementia at dford Nicole Quinn lead dementia advisor Livewell Southwest can I thank you team for coming along
And joining us and um who’s going to lead on it ever thanks so thank you for having us uh join you today we wanted to just as you see come as a bit of a team effort and we wanted to just walk you through a bit of background about the current position
In terms of demena in Plymouth some of the um sort of going back to basics really in terms of the symptoms um and the various services that are available in the city for people we also wanted to present some of the challenges and issues uh that we face as well as how we
Work together as a partnership to try and um do our best for not only those with dementra in the city but their um carers and loved ones as well so if we go on to the uh next slide please oh I got the clicker sorry I’m at the controls here which is
Always always a bad thing so we just wanted to do a really quick summary of prevalence of dementia you’ll all have um be aware in the sort of national and local press um that dementia is a a rising challenge for our society um I’m not going to go through those numbers
One by one but you will see that there are are rising numbers of people um who are being diagnosed with dementia presenting with dementia living with dementia and also that impacts significantly on those those who uh live with them support them and care for them um you’ll see that the the top number
For the uh which is our local data shows that we’re estimating a rise by 2040 to over 5,000 people uh in the city living with denture and the sort of really Stark figure on there really is that one in two of us will be affected by denture in
Somewhere during our lifetime so a really significant challenge for the city in terms of making sure we have the right Services the right support and we’re looking after people as best we can Nicole I think it’s you thanks so the the common early uh symptoms recognized by most people are memory
Loss uh difficulty in concentrating and finding it hard to carry out familiar daily tasks such and getting confused over the correct change while shopping that can often be a a concern to people uh struggling to follow a conversation or find the right word uh being confused about time and and place and mood
Changes and some of the possible diagnosis are Alzheimer’s which is the most common form and probably 60% of uh dementia diagnosises are um Alzheimer’s then vascular uh dementia which um follows up around about 30% and then the other dementia such as Louis bodies front temporal dementia and other rarer
Forms of dementia make up another 10% of those diagnosis there are more than a hundred types of dementia um that’s and often the more rarer the dementia it impacts on younger people um having a RAR dementia who’s who’s pressing me knobs oh thanks so um the process for for people uh coming
In to find out how they uh get this diagnosis because dementia is not a normal part of aging and any symptom changes uh noted should be discussed with the GP and that’s the first point of contact because your GP is going to know um your medical history uh the
Information about you and what other things might be going on in your life that could be mimicking some of the uh symptoms that people might automatically think oh my goodness this is dementia so the gp’s role is to um highlight any areas that uh the person may have control over themselves so it
Could might be um and with the gp’s help so it may be depression anxiety those issues which can impact on uh people’s cognitive ability so going to the GP so he can eliminate all the uh other possible things that are happening which will then once he’s done that and he
Will then uh conduct a mini mental an ace test which is about 30 questions and that will help to clarify for him or her what is actually going on and do they need to take this further sometimes if it’s a very obvious uh dementia and and vascular dementia sometimes falls into
That the ideas of people’s other health conditions can have an impact on that sometimes the GPS will diagnose that themselves but the more complex uh the uh the diagnosis then they will forward to the um Plymouth dementia pathway next so when the uh patients are uh referred into the memory service and the
Nursing teams will be the first first team that they um will meet uh and this is after maybe some complex cases have been taken to uh a multidisciplinary team meeting to get a a a discussion around if things aren’t quite the straightforward and after that then the uh psychiatric nursing team will meet
With the patient and they will carry out a a more in indepth um ace3 which is the adenbrook c E I forgot what the E stands for examination thank you examination so because I’m not clinical H so they will carry that out um that information alongside the information
That the GP is already sent in um and blood tests and a scan that has been done will then be forwarded to the consultant psychiatrist and they will uh meet with the patient and have the discussion bring forward all that information and with their specialist knowledge they will be able to discuss
With the patient what they believe the patient’s diagnosis is and uh and talk about possible uh medication uh it is not a curing medication it is medication that will maybe slow down and it every medication Works differently with every patient so it it is not uh an option
That works for every body all the time but it’s certainly something to discuss and they take into consideration people’s others uh other health conditions as well if the consultant also feels that maybe the um consultant psychologist needs to be involved as well there could be some you know maybe
A couple of meetings that they have with the patient to really clarify and give the patient to the best of their ability that medical teens uh diagnostic uh conclusion and they will also following that appointment they will if people have come with uh or have a diagnosis of
Mild cognitive impairment so it’s not as yet a diagnosis of dementia and about one in 10 people who have mild cognitive impairment will go on to um develop a Dementia in a year so it does raise the the risk uh factor for people but following on from that diagnosis the
People with MCI are encouraged to come to our memory strategy group so that’s a five-week program run by our occupational therapy team and that’s a a program to support them to find strategies information and knowledge that can help them to live well with their diagnosis of MCI if they have a dementia diagnosis
Then they come to to our team uh we’re a non-clinical uh team called the dementia advisor service and after uh initial contact with the patients we also then um in invite them to come along to a four-week education program with a supporter and at that program over the
Four weeks uh we cover my well-being so it’s about uh the uh you’re living with your dementia what the diagnosis means clarifying for people sometimes all the time clarifying for them why the processes are not working as well in the brain as they used to uh helping people to understand that this
Is a disease it’s not something they’ve done it helps clarify for the carers a lot of the time that they’re not being awkward this is a disease and these are uh physical blockages and break you’re breaking down of processes in the brain and we in another week we talk about
Staying me so it’s about how to continue living their life well and uh what impact that dementia diagnosis has had on the patient and also the carer but what support is out there for them including our team and all the teams that uh some of them are here today that
Can provide that advice and support to people to continue to live well with their dementia and week three is all about my well-being so it’s about giving people the knowledge and information about being able to be in control of what they can do in their lives to help them live
Well and sometimes it’s as simple as getting your glasses cleaned uh so that you can actually take in quality information because all the information that comes into US is through our senses so if our hearing aids need a a top up with a prescription if the wax needs
Clearing because if we’re only taking in poor quality information this is going to have an impact on the processes in the brain and sometimes they don’t think of these uh more practical solutions that is in their control and they can make a difference too for themselves and
Then in the fourth week we talk about my future so uh they will all tell us straight away yeah well we’ve got wheels in place and we say well that’s lovely but you’re dead when that happens so that’s really not much use to you living well with your demention so we talk
About plans and putting things in place that they are in control of because often people think that they’re going to lose control but natural fact by informing uh the the um supporters and carers around them of what works for them what makes their day go well it
Puts the patient back in control of how they’re going to live well sometimes it’s through documents like lasting Powers of Attorney sometimes it’s through advanced statements it’s about informing people what’s important to you because if people come in to support they will presume and they will try and
Do from a very good place they will try their best but it might not be what works for the patient so it it’s about informing people how communication is so important and then our team then Contin you through then we don’t discharge from our team and we’ve got 850 on our case
Load at the moment there’s four dementia advisors a an administrator myself and uh apart from running the groups uh every week and we run those groups um four-week rolling basis and continues uh apart from May and December and following on from those because we don’t have the uh luxury of home visits during
Those meetings they’ve got chance to meet the person delivering the group who will also be their allocated dementia advisor so they will have a named person in our service that they can come to and uh and they will carry out with them six monthly reviews so every six months
Whether the people have contacted us because they have a concern they will uh the dementia advisor will be in contact with them and to make that a review that is worthwhile not just a hello how are you doing great bye-bye it’s we complete a dementia plan or the patients and the
Carers complete a dementia plan and that is reviewed every six months with the patients and their carers to see where uh the dementia advisor can provide support and advice and refer on to organizations but also pick up if there are changes and because we’re based in
With the clinical team we can uh go and speak to the uh nursing team the occupational therapy team the psychology team and the consultants and ask questions and so people don’t have to ring round to their GPS they can come straight to us and and chat about what
Concerns they may have we’ll do a bit of digging and then we will take it to the um clinical team and hopefully provide that ongoing support for those patients I’ll stop now you so um the vcsc um I believe plays a really important role um impl in supporting people living with dementia
You know helping enhancing and supporting those statutory Services obviously um memory matters is the prime um vcsd organization to do that but elder tree also supports a significant number of people living with dementia and we work very closely with memory matters to provide a really good joined up approach from the vcse perspective
So just a few um bits of data about what we do so we’re currently supporting um about 200 people living with dementia and their careers um we receive referrals from um anybody really dealing with Dementia um Livewell Southwest memory matters um primary care social prescribers but also from um people
Living with Dementia or their carers their familial carers um we provide weekly contacts either through a social inclusion group or onetoone befriending and the people home whichever is most appropriate we generally Reserve our onetoone befriending for people who are housebound um because we can see the
Benefit of getting them out to a group if they are able to get out of their home so um we have over 90 groups across the city various different activity groups that people living with dementia are welcome to attend any of those but we also have um a specific um dementia
Support program as well um so for those wanting more specialist support um most recently we’ve also recognized the need to support um Dem familial dementia carers um we we recognize going out on our referral visits we assess everybody that comes into us for our referral and
As going out to visits for people with living with dementia we were realizing that the carers needed just as much support as the person living with dementia sometimes even more in some cases and a lot of carers were telling us that they were feeling you know at a
Breaking Point um didn’t know what was going on just needed to talk to someone so as a result of that we’ve um set up a specific we called it breathing space program um in the city we’re in six locations across the city um it’s going
To be 8 from from Spring 24 um and that’s providing two rooms within the same venue so the people living with dementia are supported by a project worker and volunteers and then in the other room completely separately the Dem the carer has some rest bite away from that person living with dementia and
Peer support most importantly they get to speak to people going through the same thing um who can actually you know relate to what they’re going through and offer support um that’s been going really really well it’s been going for nine months now and as I say we’re about
To roll out another two because we we see that that need is is really important um we deliver 48 weeks of provision a year we think it’s really important a lot of people come to us and say how long’s your course it’s not a course people stay with us for as long
As they want to stay with us um so supports regular consistent ongoing and in between group um visits or if it’s a Ono one um people will stay in touch with people via the phone or additional home visits if necessary and appropriate um we provide sign posting advice to
Other organizations as say we work very closely with um memory matters um and live well um and we’ll always escalate sort of any any changes or deterioration to Livewell or adult social care or whoever is appropriate um I know we’re going to deal with this a bit later on
About some sort of challenges and suggestions but um just something to say you know we we’re offering the support um we have got capacity but we really finding that a lot of the referrals coming to us are at the later stages of a person’s Journey with dementia so more
Of the moderate to severe end and actually as a charity um not nonclinicians that’s almost too far for us so what we’d really like to see is more referal some people earlier on in their dementia journey and maybe a preassessment stage as well where we can support them while they’re waiting but I
Know we’re going to cover a bit more of that later thank you hi um so so I’m going to give you a Whistle Stop tour of um memory masses and also I’ve bought a couple of case studies as well for us just to show the
Breadth of the kind of work that we do um so memory matters is the nvcs organization with a so demens focus in Plymouth we’ve been here for well over a decade now um and have provided all our services based on those with a lived experience so carers and people with
Magic will tell us what they want and we will design a service around it um the main stay of one of our um services that we have in um Plymouth is based at um moment’s Cafe so upstairs we have an advice and support Hub which we run
Based on uh donations um we supported last year over 752 families with support a majority of those people have either Fallen not sure where to go for help or are on a waiting list um we run um National Institute of clinical Excellence recommended cognitive stimulation therapy and we run that
Twice a week um in um our Center which is funded by the lottery currently we also have a conscious stimulation therapy plus Group which is a longer day for people with dementia without their carers um and that’s a really interesting thing to think about is that our CST groups are for people with
Dementia and not their carers which is normally the first step into a career having a little bit of time without their loved one um it’s normally for those at a mod moderate um stage but what we find is once they’ve had those 15 weeks of CST the car is go okay so I
Need a bit more so having these two hours off is absolute Bliss thank you very much what else can I have um we also run two memory cafes um we run one on a Monday and one on a Wednesday we have over 50 F people coming along to
Those groups twice a week we run nine dementia friendly activities in our building free for people once a week um and I just want to have a little hint the whole point of moments was to enable people to really understand where they can get help in a non-clinical enol
Enironment um so last year we had well over 54,000 people walking through the door on the back of our menus it says if you need help this is where you can go so that all of those subtle ways of making sure that people understand that there is support and
Help out there um on all our staff are trained downstairs to know exactly what to do when somebody requests that help we share lots of our learning as well so we teach cognitive simulation therapy all over the country um we’re currently um commissioned by Livewell to support some training and behaviors a
Challenge for 100 care homes in the city that’s nearly coming to the end um we’re supporting improving lives on their caring for care as dementia Insight courses for people um who are carers um and we have also set up a young onset Group which we’ve run alongside live
Well in our building I think we had 20 last week um and we run that once a month for people under the age of 66 who have dementia and so there’s quite a lot of stuff going on um the reason that our advice and support center is really
Beautifully sat is because we sat straddling and understanding um all of the services that work along the city that help older people so it might be that we’re referring to um aguk for their um bre fite services or their day Center it might be that we’re referring
To the elder tree for their breathing space veterans groups um memory cafes back to the demena advisor service but really understanding actually that that Livewell have a lot of work to do you know there’s a there’s a lot of work they’re an exceptionally busy service
And our point in that is where we can support we will there’s quite a lot of low-level support that we can do um The Specialist dementia advisor Service as they are once people are diagnosed is really important that it sits with live well within that medical team because
That’s where the crisis is going to happen and that’s where people can be assessed quickly so that’s really important that we get a really well-rounded so I just wanted to talk through a couple of examples of where um the memory matters advice service has been really helpful and we see lots and lots
Of people um who are not just the worried well some people are in deep crisis when they come to us a majority of people will go to their GP quite late when they’ve got memory difficulties it’s been a problem for quite a long time and normally it’s the last thing
That people want to do is go to their doctor and have that faced so when we’re thinking about how do we look after people for longer um by the time people are going to their GP it’s quite late if they’re waiting again for a diagnosis that’s longer still so there’s quite a
Raft of work that we do in the meantime in looking after those people to make sure that they’re waiting well um this uh family that we were working with here um had been part of our um memory Cafe for a little while um and we always knew that the relationship
Was fairly fractious um between the gentleman who had dementia and his wife they’ moved back to Plymouth after living in Spain for quite some time and didn’t really have a support system around them things started to get a little bit fractious in their relationship um and
At one point what happened is that they would come into the Hub regularly almost every day because they didn’t really know where else to go and on one occasion the Cara came in stood in the middle of our Hub and screamed I’m going to kill him he’s stupid I want him out
Of my life and then she hit him at this point some of the the our staff obviously are on hand to support this but it just shows you that actually there’s a real um there’s a real need to be able to unpick what’s okay what’s not
Okay and where’s the risk in this some of the discussions we had with her was if this is happening in public in front of people what’s happening at home he was commenting that he was very frightened and that he didn’t want to go home and that she was hurting him some
Of the issues that we had when we were referring to the safeguarding team was he didn’t have a telephone and she was always with him as the carer on a couple of occasions we had to phone the police on the behalf of the person with dementia because nobody could get hold
Of him nobody would able to call him she wouldn’t let him speak to anybody on the phone this was a perfect example of car breakdown was Absolute Car breakdown um some of the things that we did and obviously we referred back to Livewell and made sure the demential
Advisers were kept informed at every single stage because as managing a risk like this we’re just a social Enterprise so there was an element that actually involving all of the safeguarding team making sure that all our documentation was shared with services so that they all knew what was going on but
Ultimately what we had to do was try and navigate the safeguarding team to have some time with this gentleman on their own one of the other issues in this is when the police were called on one of the occasions the said it’s me I’m really sorry I’m it’s I’ve got carea
Breakdown I’ve got my own problems um and the police actually said actually it’s fine you going home it’s care of a breakdown they’ll be fine and this was all before and we have to unpick all of this we have to unpick and say actually this might be a safeguarding issue this
Might be something that’s going on at home um I’m happy to say that you know after months and months of working with this family um the gentleman in Preston is now very happily living in a care home um and the carer is living with her son um and their lives are much much
Better um that took a long time for us to unpick um and they would never speak to Social Services and they would never speak to the demential advisor service because they didn’t want to get found out that something wasn’t going well go to the next one for
Me um the next one I just wanted to bring up was um a really interesting case of a lady who was um diagnosed with outsider’s disease at 62 um and this lady had been struggling independently to try and manage with a husband who didn’t really understand dementia and didn’t really understand
What was going on with her so he kind of distanced himself from her he was working full-time she had had to give up her job full-time so there were some Financial worries as well because she was no longer working the husband didn’t really realize what was going on until they
Went on holiday and he realized just how impaired his wife had become she kept attending alone to some of our groups and would tell us that he didn’t understand and he didn’t know what to do but that he wouldn’t engage with any Services we kept asking him to
Go back to the demential advisor service and have a conversation and he kept refusing and I think demential advisor service had the real struggle to try and communicate with this family because he wouldn’t engage in it however she was coming to US Weekly and we have this thing about actually having eyes on
Somebody regularly makes such a difference because we get to see where that deterioration happen um this lady was getting lost regularly while her husband was at work and police were involved in bringing her back on multiple occasions she was very anxious and she was very tearful again hopefully with we had saw
Her regularly gave her lots of support and finally actually when our husband was taken into a hospital who actually had his own health challenges um the son found a letter in the house um which had our details on it and he called us he didn’t really know what was going on
With his mom at all because she hadn’t told him um I’m happy to say we managed to support um quite a variety of um support in for him car’s assessments P family support we kept seeing her regularly um and she is now also in a residential
Home but the whole point about all of these case studies is and that trusted relationship is really important it’s really important that people it’s mention their carers find somebody that they can relate to that they can talk to and that they can access quickly because some of these issues come up very
Quickly and and not dealing with them causes unending distress both of these situations um had carers who had difficulty in accessing services but actually with a bit of time to listen and time to unpick and time to investigate it’s a really worthwhile thing to be able to make sure that we
Continue to see them hello I’m just going to cover some of the things that we do up at um University Hospital Kus obviously um if you were to walk around one and four people patients with um have dementia that’s in an acute trust at any one time people don’t actually come into the
Hospital with prop with dementia they come in because they’ got something else so you know they might have had a fall but they have a background of dementia so it’s really important that we’re identifying um all our patients in the beds so we’re working quite hard to make
Sure that everyone’s got um a little dementia flower um on their records and we’re also um using the getting to no le which is very much like the this is is me which is an Alzheimer’s um document to find out as much information as we can about each individual patient so
That we can make their stay um as person centered and as individual as possible we’re working hard with carers um to try and change things so there’s open visiting we signed up to the John’s Campaign which was actually a national campaign many years ago where there was
An incident of a gentleman who was admitted to a hospital we not allowed to know where it was but but um he basically came in with a leg Elser and then came out the other end end of life because that that particular Hospital wouldn’t allow his car is in so they
Didn’t know what he was likes his dislikes and he basically deteriorated so we’ve um we’ve signed up to the John’s campaign so we allow open access to all our carers to come in one please um we’ve also done quite a bit I mean hospitals are quite a frightening place for the general public
To come in but if you have dementia it’s very frightening it’s very busy you walk into dford and it’s like a um airport waiting area isn’t it you know it’s very very busy so we’re trying to improve the environment we’re trying to improve wayf finding we’re trying to make the um
Hospital as nice as we can for our patients um so we’re doing what we it’s um an inhouse what we call a dementia friendly accreditation so Wards and departments can get in touch um with myself and and um we can make lots of improvements for the um each individual
Department and board to make it more DeMent friendly um and we award them with a plaque as shown in the picture there um and that goes outside the water to so that that particular area department is doing have gone out of their way and they’re doing extra things
For people of dementia we’re doing lots and lots of education so we’re linking with um university of Plymouth we run a module um on dementia which started again this week but we all equally every single person that works in dford has level one and anyone that’s patient
Facing has to have level two training and um I don’t ever have any trouble people always Kean to come to that training um we’re doing next please um we’re doing quite a lot to um make our patients um less anxious more calm so we’ve had a lucky we’ve had some
Donations and we’ve um got those cats there um um they can be quite frightly for some people but they don’t work for everyone so we’ve got cats and dogs um we equally recognize that um we’ve got issues with making sure that all our patients are fed properly
Given the right nutrition so we’ve done a lot of work on F making sure we’ got access to finger foods different plates uh you might think why why a plate but actually some patients with dementia can have visual perception issues so a yellow plate on a yellow tray with sweet corns an ideal
But um you know equally a white plate doesn’t help so we’re doing lots of work um we’ve we’ve got a dementia volunteer scheme going at dford now so we’ve got volunteers who are just working with our patients with dementia and they sit with them give them some company meaningful
Activities um and that’s worked really well we have got challenges which obviously are pick on at the end of the presentation lovely so hopefully that’s giv you a bit of a flavor of some of the um services and support that are available in the city the focus genuinely is on how we
Can support people to live well with dementia it’s not a one-way path into uh residential care it’s absolutely Nuance support around individuals to make sure we get it right for them and their families um and to do that our partnership working is really key so a key part of that is the Plymouth
Dementia action Alliance which is a really long-standing group that’s met since 2011 to bring together and is chaired by councilor aspel um and is brings together all the partners in the city that have an interest in in dementia to think together about what are we doing how can we improve what do
We need to be alert to what’s coming down the road in terms of um future needs in terms of dementia both in terms of what we could do differently and what are challenges we anticipate um you have seen around the city the uh work that’s been done by that group around the
Dementia friendly City and the signs in the car parks and things like that so some really tangible examples of that in practice across the across ply so we’re meeting again in two weeks um to sort of regroup again and thinking together about our themes and our work plan for
The year ahead um and you’ll see on the slid some of the things we we collectively think we want to focus on over the next year right the way through as someone with dementia Journey soort the advice and information that’s out there big focus on um timely diagnosis
And support both pre and post di diagnosis thinking right the way through that Journey for carers support how do we support everybody with demential whether they’re um experiencing that at a younger age earlier age more severely less severely how do we listen to people with dementia and their families and
Make sure we build that feedback into our service design um right the way through to you know the sort of very sad end of things that can happen around end of life so really working through together the different steps um and possibilities and opportunities for people with dementia and than you Dad
Kate and then finally last slide our challenges and opportunities so what we did together was we’ve identify excuse me some common areas um and I know others want to chip in on this and no doubt you’ll have some questions for us as well we know we want
To a big challenge for Us is around the demand for dementia services in the city how do we manage waiting list how do we make sure that people are supported well while they’re waiting how do we get that support in as quickly as possible and Kate’s identified people don’t always seek
Support as early as they as they could they are sometimes worried about doing that how do we encourage them how do we make sure that they’re aware of what’s available to them um and that know that they will be looked after how do we reach them really early
In that Journey so that they’re not waiting and deteriorating um in their own pathway and we can get in and wrap around them as best we can very important with our car is how do we really understand and again the case studies that Kate talked through the sheer day-to-day pressures
On people who are caring for someone with dementia how do we better understand that and respond to that so that people don’t get into these terrible situations where they’re they’re at risk and putting others at risk as well sometimes um and understanding our through our some of our Citywide programs around healthy
Aging how do we think as a city about how we respond to dementia and the whole sort of premise of of aging and living well um and improve our approach to those as well don’t if others want to chip in I know some we’ve got lists here
Always lists um so just going back to the first point about the waiting list and assessment um we know that the demential advisers already got a case load of 850 and there’s about 600 I believe I met with Joe Thompson the service manager lead for the memory
Service pass break just this week um um and still of still some of those are waiting for a significant period of time um I’m happy just to share that we’ve um managed to get a very very tiny amount of funding to do a waiting Well Service
Which means that anybody um that is um placed on a waiting list at a certain point will be immediately referred to us so that we can start some work while they’re waiting um to enable them to wait well um like I said it’s very short it’s only a four-month pilot but we’re
Really mindful that of these 600 people that are waiting and continually more um I think Jay’s comment was there was about 50 people a month being being referred to the service so that’s going to continue to go up and of course not all of those will be diagnosed with
Dementia but there’s a fair amount of work that we can do just to try and prevent some of that crisis and some of that um dipping into you know the space where actually they well trying really hard to make sure that they’re seeing all of those people under crisis but I’m
Sure we can do some preventative work in trying to reduce some of that between yes Sarah I know you wanted to ask I just um wanted to say that obviously you know whilst we are doing lots of I would say quite good work at der for to improve our care we have got
A big issue of you know patients arriving and waiting a long time in abanes outside you know we’re one of the it’s been across the news quite a lot but we are the second worst trust ambulance um waights outside and equally I’ve just completed the National
Audit of dementia which is a thing for all the hospitals and our length of stay is 10 days longer than the national average um we have you know and these poor patients are staying in longer than they need to and um the other thing I wanted to bring up is obviously we we’ve
Got a big issue with placement of our patients particularly with very high complex needs um into Care Homes there’s um quite a delay there um in placing these people and the odd patient is unfortunately having to be placed out of County um so you can imagine for
Families having to travel all that way to visit them but equally it’s not ideal being in acute trust for a bit longer so I just wanted to mention that uh and as far as the dementia advisor Services um you know we’re looking at that 650 uh coming down the line so having
Funding for organizations and teams that we work alongside to give those patients um some uh confidence that they’ve not forgotten while they’re on that waiting list to which may end up with them receiving a diagnosis it may not but the fact that you’re on a waiting
List and you just feel left so being able to have experienced teams to give that patient some um ability to wait well as they they call it so uh is really important and obviously Joe Thompson and our team when those numbers do go through the diagnostic process and
Then come down to us that’s something we need to review further down the line we’re collecting the statistics of patients coming in patients going out we don’t discharge in our team unless people go into full-time care or sadly pass away um so our list doesn’t uh decrease it started at
299 in 2018 and we’re now at 850 with the same team so we know that there’s work there to be done so can I say a big thank you for this presentation it’s really been en lightening and certainly it’s something that I think we ought to consider um
Going elsewhere um as as counselors I think we need to be a bit more aware of this um certainly I was involved in 2011 we’re setting up the the alliance and Nicole and I go back way that to then and we have some very happy and
Bizarre memories of that time so uh this this is something that’s very close to my heart I’ve got Michelle with a hand up um and then I’ve seen both Gary and Chris scribbling well so let’s start with Michelle please yeah thank thanks everyone for that presentation it was
Great and as someone who is touched by um dementia within their family I just want to say what we offer in Plymouth is is brilliant compared to other areas um I think we do need to um concentrate and look again at where the funding is and
Where the funding needs to be and I would be Keen to be part of that um and you know I keep in regular contact with several people linked into this not all of you but I would be ke from a cic point of view to make sure that we
Maintain those um conversations to look at how the whole pathway Works um and certainly from a Live Well pure numbers but that’s not what this is about necessarily really really focusing on on how we speed up that diagnosis and changing the way that we do things but
You know we can’t get away from the fact that these people will need long-term support and and the other bit that I wanted to get across just hearing um what Sarah was saying um from a uhp point of view you know it is something that we’re all going to come into
Contact with and there’s just something about you being the experts and having expertise but also almost as a city the city recognizing that that’s part of our population and actually how we how we support and and think about dementia in a very different way to perhaps it’s
Something that happens to people who are very old with a with a gray top knot and it’s just something that it’s part of every day and every family and every community and I don’t know what more can be done than that space either thank you I think it’s I mean
Ruth no doubt will um sort of agree on this it’s something that we’re looking at the Aging well agenda this has got to be an important thing and I I will take exception to the little person in blue at the end of that that is completely contrary to what we’re looking at for
Aging well so I think we’ve got to find a new um whatever you call those things to look for for that so I’m sorry I’m going to criticized for that but that’s that’s a well-known fact that that is the impression of somebody older so we’ve got to change that yeah um Chris
Or Gary did you want to come in at this stage thank you chair um so really interesting presentation and as has been said really great to see the level of support that’s available within plimouth um I do there’s a couple of areas that I think we probably could look to
Strengthen in terms of those links across so things like as you say building that awareness for people at an earlier point and the support offers that are aware already there how we connect that in with the Community Builders program that we’ve got in order to make sure that we’ve got the right
Links there um also the piece around the hospital discharge process so that you rais and Emma our commissioning teams look are looking at this currently aren’t we in terms of the sport offer that’s there um but I think making some of those connections across to the other partners who are supporting individuals
And particularly supporting the care homes in that space is going to be really key um and my final Point as well is just to make the connection across to the uh Devon dementia strategy that’s under development and just making sure that we’ve got the links across and
Pulling the the Plymouth position in as part of that as well so that voice is being heard strongly okay did you want to respond to the particular I think the the strategy both actually um so my ple is please can we have a community builder for older
People we don’t have one in the city we’ve got them for most other sectors but we have an older person’s one if we could have one that would be great um and help us to link in with some of the Thrive work to enable people to start to
Think about living healthily um I went along to the demat um Summit on uh Tuesday I believe um which was really useful actually and also um brought lots of the challenges that Devon as a whole was facing in terms of dementia and I think historically the word was they
Were waiting for a national dementia strategy before they built theirs um I don’t think that’s coming and so it’s nice to see that Devon are actually doing that and I’m happy to keep going to those and bringing some of the information back and sharing it thank you and I think you’ve got a
Lot to input into that not just yeah sitting there quietly no doubt you aren’t sitting there quietly Gary yeah clear my thrat I’m really really interesting presentation and nice to see such a rounded group of people coming to talk about this subject from the voluntary sector all the way through
Up to paid Services because I think it’s it is that hole that helps work to some of these Solutions I would I’m interested in lots of this and I’m certainly going to be coming along to the moment’s Cafe and at some point where I can get it in but I’m just I
Want to talk a bit about this waiting well and diagnosis and what we do at that point and I’m thinking about information and advice Services as well because I’m imagining those are some of the things that all those people who you talked about don’t go to their doctor until very late are
Probably trying to Google or find out a little bit about so I’m just interested more in your thoughts around what we’ve got whether that’s enough for how we kind of develop those things uh we don’t think so we think it’s not clear enough it’s not visible enough there’s some Fant as you’ve
Hopefully heard some fantastic work um we’ve been talking K but how through the action Alliance how do we pull all the information together how do we make it visible how we make it accessible how do you make it interesting to people so that’s a written you’ll have seen on the
Um Alliance slide advice information and guidance quite a dry phrase isn’t it but actually how we bring that to life just to say as well just a bit of a plug for the cafe they make lovely chocolate brownie so should you want cake perfect place to go can I also just add into
That as well is if we don’t know how a care is supposed to know um and actually they’re the ones that should know so as part of the alliance and we are really lucky in the city that actually we all work together um there is plenty of
People with dementia to go around um in terms of how we look after those and actually we’re better when we do it together because that gives people choice and people need Choice um but also to enable people if if the alliance can start to think about actually how
Does that work and we can communicate that out to the public that’s going to help them navigate that at a much earlier time too and Gary I think we really need to get Ellie and the comms team in involved in this whole issue initially um Nicole
The type of scan that somebody needs is it a CT an MRI what type of scan is it h it’s often a CT scan and the doctors are putting those in place sometimes if it’s a more complex diagnosis then an MRI is involved but sometimes an MRI might have
Been done for other health conditions and that can be reviewed and checked as well as well are so in fact the the new um mobile system down at Colin Campbell Court is obviously helping because that’s an an additional CT scan isn’t it within the city so hopefully and I know
GPS can refer directly to that one so it will be interesting to to learn how that that’s going and I think we perhaps need to keep a a check on on how it’s being used and is it being used wisely um to make sure we can get the waiting time
For CT scans down that would be good okay Jamina thank you just asked one of my questions Mary um I um early come you know in my portfolio of children’s early early early EV everything comes back to getting things diagnosed early and um I I I guess I
Want to understand what so the comms thing is one thing we really need to encourage people and I guess you’re kind of scared when you initially think this might be you and you put it off and people tend to do that so I think being more um sharing even more publicly what
Support is on offer is really really important because hopefully that will encourage people to do that I I went on um a a visit to a number of care homes in my ward of of stoke and one of them Parkwood particularly had this um just talking about how the City Works they
Have got corridors these really incredible corridors which are all based on um you know jogging memories and they’re just incredible and I just thought the level of trouble that they were going to to make those places comfortable for people with dementia was was extraordinary and hearing you all
Talk together and you work together I think you know we have a really brilliant um foundations to lightwe I don’t mean that it’s much more than that but the early thing is obviously the of it and U so that you know whatever Journey people have to go on they can
Get support for as long as as as possible um so I would absolutely support anything that we can do comms wise about a reassurance rather than kind of symptoms necessarily but kind of if you think this might be you don’t be scared because actually we have this in place
Or this in place or you might you know um so I think it’s something about making it clear that we we’ve got a lot of support but again taking on what you’re saying in terms of numbers um what we can do to to make that easier
There as well I think I I think your presentation was brilliant and I feel I feel incredibly proud of what the city is doing and I would also um back Kate’s um suggestion around Community Builders because again they could be very good at disseminating information which hopefully could make things a little
Less threatening and and scary for people thank you yes we need to definitely looking that I’ve got Nicole do you want to come back about a particular thing and then I’ll go to yeah um just saying that uh we used to have uh a lot of Education done in
Schools uh around dementia and quite often it’s grandchildren and children starting to have that conversation with parents and grandparents that can help uh reduce some of those fears and concerns and and building that awareness and understanding and you know it’s something I don’t think’s in place at
The moment but a trainer a an educator for uh schools um Council uh properties buildings all that sort of thing shops retail just because we have dementia doesn’t stop us being a a shopper or and that awareness you know it’s almost like a bit of a mystery shop sort of thing um
Back in the the day somebody got a sticker that shot might have changed hands different staff so it’s something that needs to be ongoing and I think that’s building that awareness taking take bringing it into a regular everyday conversation will help people to seek that support and advice at an earlier
Stage we definitely had demena friendly certificates or whatever didn’t we when we first launched so I think that is something to look at and again I think Ruth that’s coming back to to looking at the Aging well thing also I think so that’ be good right Tony thank you chair uh absolutely
Brilliant presentation as far as I’m concerned and it’s great to see how well linked up everybody is um in what you’re delivering and what you’re dealing with I’ve got an offer for you so the offer is we are um just finalizing a report in some work we’ve done with unpaid carers
Across the particularly looking at career isolation and well-being and within that one of the questions um was about the condition of the person that you were caring for so the engagement um was a mixture of survey and some guided conversations at the end of it I can get the team to have
A look and see if there’s anything demena specific but even if not I would have thought the experiences of those carers would be useful just to understand that um and to give an idea we spoke to I think it was survey wise 224 across Devon of which the majority
Were Plymouth by the way um and we’ve done 17 guided conversations of which I think eight were Plymouth based What’s the timing of that just and think about our alliance meetings we could build that in as well yeah I we’re aiming to get it finalized by the end of
The month I think we’re not going to be there if I’m honest because of other competing factions um but certainly um you know in the next month we would want that to be published so can I leave that with Kate and Emma to action that please
That sounds a good idea and Kate is dying to say something I’m sorry um I just wanted to say that um I I strugle borders so I work in Cornwall as well and something that Cornwall did that was really helpful was they engaged Health watch to ask and send questionnaires out
To people at to mention and their carers to ask about their experience and what they’ve done is they’ve used that information it’s called the hear our voice report and but what they’ve done is they’ve used that to inform their strategy going forward so that it’s from the person with lived experience so it
Kind of goes along listening um and listening and informing and shaping services around actually what people people are needing um just want to sh thank you you better get cooking with the brownies that’s all I can say after today anybody else want to come forward
With anything no okay um can I just say thank you very very much um and I’m obviously looking forward to two weeks for for the next adventure friendly thing and I think we need to get pushing on certain things I think we’ve dementia friendly city has sort of
Tailed off slightly I’m not saying the work wasn’t going on behind the scenes but it’s lost its prevalence and and its importance within the city and I think we need to make sure that that’s resurrected because the work that is going on um is absolutely amazing it really is um and
Um I will treasure my visit down to to you Louise down and I know we Sue Eddie and are coming down again um so that’ll be really great but I think I would say to anybody if you want to see what’s going on and what everybody down at Livewell is doing
You know Louise will welcome you with not Livewell sorry um Elder Tre are doing Louise will welcome you with open arms and absolutely anytime anytime yeah um thank you there’s there’s quite a few bits and pieces hasn’t there that’s come out of this and although we just asked
Being asked to note the presentation um there are a few recommendations Elliot and I don’t know if you’ve managed to catch them but one of those is to make sure that I think that we need to be making sure that this links in with the Aging well agenda within Plymouth um and
I think Ruth and I will be very happy to take that on board and I think certainly there has to be a request about exploring again about Community Builders and their understanding of this and whether we can get a specific Community Builder post for um for dementia would be really really great or
Whether there we are we have something so I think Chris that’s something that you we need to work out because it’s a joint thing isn’t it between us and the council and and you at the moment so anything else that anybody wants I mean the comm’s thing we need to make sure
That there is a good communication strategy um about dementia um so but anything else that anybody wants spe specifically to pull jamaa and it’s not a recommendation but it’s just where the eight places are or when there will be eight that you were talking about Louise
Because I think that might be quite good to share with counselors if they’ve got them in their Wards or nearby you’re going to test me now don’t worry I’m not asking you to tell me specifically now but I think it might be quite good to to share that and then my
Final recommendation would be that we need to be making sure that counselors as Community work people need to know more about dementia and um activities that could take place and I think Kate and Emma that’s probably something that I would if we work on over the next
Couple of weeks and and think and bring that to dementia um friendly uh meeting and that needs to really be something that as I say I think councilors need to know and um they can certainly be um pointing people in the right direction and again that
Comes back to also our our website as well uh pum City website making sure we’ve got the right information so there’s some homework for you of quite a few people here but I think that’s that’s what this sort of thing is about on the health and well-being board it is
That well-being of our city and that’s what to me is what’s important um and Gary I suppose the other thing is came out about um that you were saying about 10 days extra stay in hospital and whilst ambulance waiting time for that’s the most difficult thing I
Think for us to solve but I think making sure that we have Care Homes except or whatever in place so I think that’s perhaps a dialogue that we need to have about that as well all right thank you very much indeed thank you team um much appreciated and thank you for your time
Today all right um no doubt Michelle they will be in touch with you and a big thank you to you for your input there and I think we need to follow up on that as well your your suggestions okay Chris I do apologize for sort of doing this but um we need an
Update from NHS Dev please sure thank you chair um and recognizing the time I’ve obviously provided some detail in C terms of some highlights um in a report that’s com out in the pack I think you know so this is the the first of these updates that we’ve delivered into the
Health and wellbeing board and particularly for so well since I’ve been a member um Keen to get some feedback to if it’s a useful level of information to bring into this group um H happy to do so on a continuing basis if it’s useful um you’ll see I’ve stretched it in terms
Of some of the highlights of things that have happened at Devon system level but also with a particular Plum of focus to I think recognizing the particular point of time that we’re in the depths of uh winter and what we knew would be a very challenging winter for the NHS um this
This year I absolutely that underpinned our winter planning process that took place which this group heard about um earlier in the year as we were taking that forwards I think it’s recognize that the hospital in Plymouth and actually hospitals across Devon soon after Christmas the early part of January uh found themselves under
Extreme pressure that coincided with the industrial action that was taking place um and that did result in US entering a period of critical incident what what that means is it enables us to bring a total focus around the hospital systems bring Partners together in different ways and look at how we prioritize
Services for those with the most urgent and emergency needs um and and that process enabled us us to step down from that that status we did see some improvements I think dford has seen a a spike in uh demand since last weekend um and had itself reenter iCal incident
Just just from a Plymouth perspective um we’ve continued to support work with the hospital system in how we um respond to that there’s been some really good progress made around the hospital discharge position so actually there’s number of individuals who are waiting in the hospital um to leave through the
Joint work that we’ve done in our initial winter planning some of the additional resources that we’ put in place jointly between the ICB uh live Well’s involvement in that and from the city council um has seen a big difference and we certainly have better place from a discharge perspective than
We were last winter um but there’s always more we need to do and actually the the pressure in terms of the numbers of people who are um currently within the hospital and the high level of Acuity that they’ve got isly that’s continuing to challenge at the minute um
There is some positives though as well in terms of some of the other programs of work that have been put in place in order to uh support the health system um and the local population there some referenc in there to the virtual Ward scheme for example so that’s some new
Addition capacity to support up to 50 people at any one time in their own home with enhanced rack round support um we also got the acute respiratory infection service and that’s been mobilized and working alongside Primary Care Network a m of primary KS within the city to bring
Some additional um capacity in to support what we know is an area of particular pressure and need um so that that’s a really really quick snapshot in terms of the detail that’s there but happy to take any questions or follow up thank you very much and obviously we are
Very uh aware that uh dord in particular is pretty stressed at the moment and I I think uh we know that everybody’s trying to work hard to sort the but it is a very difficult and traumatic time for anybody um that’s having to go to hospital really isn’t at the moment um
John I know you’ve got something to raise thank you Mar I’ll be brief in view of the time of the meeting but I thought i’ to raise a couple of issues and Tony’s here probably be interested to hear what he might think and whether he has any other input um general
Practice across the city very varied access how you do it how easy it is how accessible it is to patients I mean we all hear this I think Plymouth has a bigger problem or bigger divide than perhaps the rest of Devon um I think fortunately some of the practices on the
West of the city that offer services to the more deprived sections of our population OB actually working better than some of the the others but I mean I went to the GP on Tuesday the whatever it was day after the bank holiday in January uh expected it to be heaving for
A blood test I didn’t really think I need it but I went partly out of Interest I was the only patient there at 20 to 11: in the morning there 56 seats in two waiting rooms a couple of people had just left I was the only patient
There when I left 20 minutes later there were two or three more but you know what is going on because I would have thought that would have been rammed full waiting room well not full it was ridiculous in the old days people are timed better but
People waiting to be you know seen at the desk and asking questions and whatever I mean I just could not believe it I hear this from other people and it isn’t just my experience but that was you know the midm morning the day after the bank Day New Year weekend so are
Patients actually being seen where are the paramedics who are seeing patients the nurse practitioners the far you know it’s not just the GPS so where are the people the staff and where are the patients the end of the week my mother didn’t get a visit on the Friday I think
She should have had Saturday 1111 at 8:30 in the morning she got the visit 28 hours later um numerous calls to 111 across the country wherever the call gets picked up there’s no Central system they don’t know where someone is on the list unless you happen to get one of the
111 providers that is on the same system so whole Saturday had no idea 3 hours call at 12 hours later on Saturday evening yes for paramedic you do need a visit happed at HB 12 on the Sunday Morning by which time I did know it was
Going to happen you know it’s not about my mother she survived it but what is happening in general practice there is no consistency do we really know what’s happening are we being told the right information by the GP Representatives who talk to Devon NHS I wonder today on
The radio all these you know 36 million appointments a month apparently you know meant to be happening well are they all being double counted because the population is being seen at an enormous rate if they are true um some of them are the same people being seen multiple
Times you know what is happening what’s happening with the 111 service which um you know it can’t be just my mother who had a problem that weekend there were no GPS working for it the GP came from ampton on the um Sunday morning I think
She was a GP so you want to raise that whether Tony’s receiving any worrying messages recently um but something is not right and it all starts with General practice it it it you know general practice does not function it puts the pressure on 11999 A&E the minor injuries unit and in
The end it’s deriva that gets the front of it goes pop before been chising Tony anything you wanted to add um because obviously John’s mentioned I I guess from a 111 point of view um we’ve had a look back over the last calendar year on feedback there
We’ve only had 21 pieces of feedback across the whole of Deon but I think there’s a consistency in what that feedback is saying and that is when a call back is being arranged um and the length of time um people are waiting for that call back a couple of them said
They’ve never been called back you know so whether that was a Mis call or whatever and it’s difficult for anybody to go in and look at that without patient details and the timings of it but it does appear that um there when you when the you’ve gone through the triage at
111 that and it’s agreed that you need a clinician call back that those call backs are very um very difficult to predict of when you’re going to get that so if the operator so you should get a call back with an hour and you’re still there 12
24 hours later with no call back it does leave you wandering as a patient or as the patient’s um carer um you know are you going to get any support and and I guess you start automatically thinking it’s a weekend the only place I’m going to get support
From is the Ed um you know so I think there’s there’s factors there in terms of GP access access impl if I would agree with John it is a bit variable between different surgeries and that but generally um from what we’re hearing if you need uh to be seen urgently you do
Get seen within 24 hours now that may be a phone call that may be a video consultation or that may be um uh an appointment face to face um so I think it’s more routine ones where there’s three to four week wait for that to be booked in because of the um availability
I guess of slots and again whether that’s done by a phone call or a video conference or face to face um is there as well I mean I think it’s a question of some non-urgent things aren’t being seen because some Paces will only see things
On the day as if it’s an emergency and for a lot of people it isn’t and I actually wonder whether there’s a lot of stuff death rates Rising for all sorts of reasons covid related and other factors but um you know other patients out there who are just not getting seen
And I think there are with potentially things that could be serious even though they’re not urgent at that moment interesting perception and I think Chris if you could come in I mean it’s two things there isn’t it it’s GP services and 111 and got some sort of
Say in both of that area basically with NHS haven’t you thank you um yeah so John it’s really good um point that you raise um and in terms of the personal experience there um I guess so so picking up the two areas separately so the general practice piece so we’ve been having some
Conversations already through the um local care partnership around what what’s the metrics that we’re looking at in order to understand um the delivery of primary care services within the city is as Tony described if you look just at pure access rates that that tells one story but actually what are the other
Things that we need to look at and I think that that’s going to be really key in terms of understanding that job I’m happy to think about how we Link in and get some put into that as that goes forwards in terms of developing that work locally um in relation to the 111
Ask so so simly very happy to go away and have some conversations with um the patient safety and quality team within the ICB who will be looking at the data that’s available to understand actually what’s currently happening is is this service operating as we would want um
And is there there the things that we can be doing recognizing as you say the uh opportunity lost um in effect if that service isn’t operating in the way that it should do um so so agree that’s absolute priority that we need to Cel that’s I can take back and come back to
You on thank you and if you’d come back to us particularly about the one1 I think that would be very very useful I’ve got Gary then I got Jina I just wanted to first to say thanks to Chris for the report which talks quite a lot about some of the
Things that have been going on and I guess I just wanted to link it then to some of that other conversation in terms of looking forward there are already conversations around aren’t there around some of the work that might need to happen through Primary Care through GP
And it it might be helpful to get that bit of look forward and then for this group to think about some of the things it wants to to see and talk about moving forward I would say there’s a lot of focus through systems around trying to help discharge flow clearly because of
The acute CR clinical needs around that we’ve seen some quite good moves there the eyes are beginning to turn aren’t they around admission avoidance schemes I see virtual Wards on here but also what’s going on out in primary care just to make that link in GP so I just wonder
Whether that might be something that we can think about for future agendas as well we certainly note that thank you um jamaa um it’s a quick quick thing um in terms of asking for feedback on the report the first thing I always look for in anything of this nature is around
Dentistry um there’s no mention of dentistry in it and I just wondered whether I I realized you’re reporting on pressing issues but but most other areas are covered in one way or another so I didn’t know if a paragraph about um dentistry in in each report would be
Helpful Chris can we ask you to add to that that’s a good point I’ll make sure that’s in next time thank you um before I call Michelle in I’m going to just basically say a big thank you to Michelle and and the team that have been running Mayflower medical this last um
Year or so um certainly the service I mean I’ve got to say declare an interest as a as a patient but the service certainly has improved tremendously um and um whilst access to a GP is like the same anywhere else I’ve got to say that the nurses and the paramedic certainly
Down at the surgery that I go to have been absolutely First Rate their service continued all the way through covid and and through all the restrictions and and and certainly it’s been brilliant so from my perspective Michelle please I mean they always know that I I value
Them but you know certainly from me as chair of health and well-being board I would certainly like to um say a big well done and thank you to all of that and it will be an interesting time with the change of of um service so I I I’m
Really quite disappointed that you had to not take part in in the sort of going forward with the contract but certainly understand completely after reading the the report um your your annual report so as I say a big thank you Michelle over to Youk gosh thank you and I I have to
Say it’s um I’m really sad and it’s something that the board didn’t take lightly and we agonized over so it’s something you know we’re very proud of what’s happened and and what the team have have achieved you sort of thrown me a bit there Mary um I just I just wanted
To thank Chris as well what with that report um because it it’s informative but I think it doesn’t quite get the essence of how well and joined up all the systems have been and I think that’s the difference this year so where I agree GP GP is
Variable and you know gaps in GP practices are all over the place but actually the way that Health acute Health Community Health Mental Health social care have all worked together um and to actually look at developing new services and looking at where we can um have the biggest effect and certainly
That prevent that focus on prevention and um the virtual ws and the fact that that’s a an acute and a community offer and just working seamlessly together um but I have to say Qui you are one of the people who really speak up for Plymouth
And the Western system um in that in the ICB and um I just want to thank you in front of all these people to embarrass you even more than Mary has me so thank you thank you and you know Chris yes this is great to have this this Thea on
And and certainly we appreciate that um oversight the oversight framework is not the easiest thing to be working in uh and the financial problems and concerns are there and will be ongoing um and I certainly know that Sarah werson is very adamant that that we’ve got to and Bill
Shields are very adamant that we’ve got to get back to a better situation but it also need with looking at the fact that we need to be providing a brilliant service and and I know you’re you’re trying your best there okay any other questions no lovely thank you Chris um and we look
Forward to the next Report with Dentistry added she says um right we come now to tracking decisions an hour late but never mind we got that thank you chair um so the board will see there’s three tracking decisions in front of you now Mark completed uh and three still in progress
Um one of the ones I draw your attention to each one uh the first one’s been added to the work program so I marked as complete um the second second one is going to take more time to actually fully investigate the issues sever of the bits of information including the
Carer’s request that we requested last time are quite in depth um and so while you’ll see on what page is that page 54 there’s there’s an extensive response there from from em Crowther on behalf of the car’s item um but there is still more work to be done to to analyze the
Statistics um the last thing I draw your attention to is the CPR training for counselors uh which is the last recommendation on your sheet and just to note that the 30th of January is your last opportunity thank you chair thank you anybody want to raise anything about or ask any
Questions no hopefully we can get more interest with the CPR training for counselors because that seemed to be and that was something that was raised in Council wasn’t it so I think probably next Monday I need to remind counselors if they haven’t they’re running out of
Time to do it so we’ll sort that okay um item 12 the work program oops sorry thank you chair um so unusually I’ve managed to to quite prefill this one they are all obviously subject to to review and approval here um but these are all based on what we’ve
Discussed over the past couple of meetings and line up as um due due to come back so an update on the dental task force obviously we had one at the last meeting and at the next one it’s going to been about four months uh the next meeting of the dental task force
Would have taken place so therefore it makes sense to sort bring that back and have a look um Thrive Plymouth next 10 years Ruth I don’t know if that one will be ready for March’s meeting I’ve got it down as available uh yeah I think so perfect thank you um and then
Plymouth Suicide Prevention alel and the last one would be an update on The Vaping uh vaping working group if we’ve held it in time by that meeting thank you yes that vaping one will depend on what government come out with um so yeah John thank you thank you ell what about
The things on the outstanding schedule there’s quite a lot there couldn’t put them all in one meeting but what about the NH is long term plan and Recovery plan doesn’t that link all sorts of things together what what are we doing with that Chris that’s part of your remit
There isn’t it yeah um so so yes we can do and we should do and um actually Gary’s made a point around the local care partnership priorities as we look at how we bring those two things together um which will obviously be shaped by components of that too so we
Could look at bringing those two items at the same time when do we think time wise possibly would might be able to give some update in March might be better for the next one I’m just thinking in terms of some of the other conversations the operating pound comp discussions that
Are underway at the minute and just making sure we’ve got that navigated perhaps before bring it back in and the safeguarding that probably would be useful once the annual report for 23 is ready isn’t it whether we bring the safe something from the safeguarding board later June is um this
Year I think yeah I mean it’ be good to bring it we can just check when they think they’re going to have it available and put just put it into the the following health and well-being board so we’ll link across with the partnership for that and Ruth the annual update from the
Plymouth health determinance research collaborative that will fall into a a pattern as well won’t it um probably the summer for that as well yes yeah that’d be great that’s fine whenever you want really lovely thanks very much indeed okay and I think if anybody’s got any more topics that
They want to bring Tony it would be quite useful to find if you could just give us heads up when you’re going to be doing surveys or talk s a from the comm’s point of view so that we can make sure that we let people know and B
Obviously for for what comes to us because I know you’re very active um with your your reports and it would be interesting to to have sight of them so we’ll keep in touch about that thank you okay um I think that’s it folks thank you very much indeed for your input um it’s
Been been really really useful and I think we’ve got a lot of information and a lot of work done as a health and well-being board um and we just need to pull some of those strings together so thank you all very much for your time much appreciated okay farewell team um online
We will see you soon no doubt U thank you from here all right take care folks um bye