Agenda and minutes

Apologies for absence were received from Councillor Will Harmer, Councillor David Jefferys and Councillor Charles Rideout QPM CVO. 

Apologies were received from Justine Godbeer and Rosalind Luff.

The Chairman was pleased to welcome Councillor Robert Evans who was attending the meeting by invitation and had been nominated to fill the remaining vacancy on the Sub-Committee membership.

Councillor Mary Cooke declared that she had worked for Bromley Healthcare until 2012.

Councillor Judi Ellis declared that her daughter worked for Oxleas NHS Foundation Trust.

Councillor Diane Smith declared that her daughter worked for St Christopher’s Hospice.

Councillor Pauline Tunnicliffe declared that she was a foster carer for the London Borough of Bromley and supported a young person through the ‘Staying Put’ scheme.

Linda Gabriel declared that she was the Chairman of Bromley and Lewisham Mind.

In accordance with the Council’s Constitution, questions to this Committee must be received in writing 4 working days before the date of the meeting.  Therefore please ensure questions are received by the Democratic Services Team by 5pm on Wednesday 7^th June 2017.

No questions had been received.

RESOLVED that the minutes of the meeting held on 16^th March 2017 be agreed.

The Sub-Committee received a presentation from Matthew Trainer, Managing Director for the Princess Royal University Hospital (PRUH) and South Sites and Sarah Middleton, Stakeholder Relations Manager, King’s College Hospital NHS Foundation Trust providing an update on the progress of the Trust and the PRUH Improvement Plan.

Although it continued to be extremely challenging to meet emergency performance targets, there had been significant improvement in the performance of the Emergency Department during April and May 2017.  Referral to Treatment times remained an area for improvement, but overall it had been identified that the quality of care at the PRUH remained very high and that the Trust continued to perform well against key outcomes and safety measures.  Patient experience across the Trust had been reported as being good for 2016/17, and the King’s Way Programme which aimed to increase the quality of services and make them more efficient and productive continued to be implemented.  The review of the Outpatients’ Service was also ongoing and it was planned to improve patient experience, efficiency and productivity through a range of measures including digital transformation.  Six major areas of work had been developed in response to the annual staff survey results which comprised strengthening relationships between staff and senior leaderships, improving support for managers, value and recognition, diversity and inclusion, career and talent development, and health and wellbeing.  Priorities for the coming year included improving access, finance, recruitment, quality and safety and end of life care.  The Trust had delivered a £49m full year deficit in line with the mid-year forecast and had a target of a full-year deficit of £39m for 2017/18. 

In considering the update, a Member was pleased to note the significant improvement in Emergency Department performance in April and May 2017 and underlined the need for this to be sustained.  The Managing Director for the PRUH confirmed that work to manage the usage of the Emergency Department would continue.  Inpatient admissions and bed management remained an area of key focus including regular meetings to review bed availability, and a London Borough of Bexley social worker had been placed in the Transfer of Care Bureau to support Bexley residents to move into more appropriate provision when hospital care was no longer required. 

With regard to a query from a Member about the significant cost of agency staff, the Managing Director for the PRUH advised that there continued to be a significant shortage of skilled staff in some specialist areas, such as dermatology and that this made it difficult to recruit permanent staff.  A range of measures would be used to support recruitment and retention including the block-hiring of housing and relocation packages for doctors where this was cost effective.  The PRUH was working with other hospital trusts across London to set standard agency rates for staff in particular specialisms to help contain agency spend.

Members generally discussed the importance of ensuring that patients received appropriate end-of-life care, particularly in relation to nursing and care homes.  In response to this, the Managing Director  ...  view the full minutes text for item 5.

To Follow.

Natalie Warman, Director of Nursing, Therapies and Quality, Bromley Healthcare and Julie Miller, Clinical Quality Team Manager, Bromley Healthcare presented the Bromley Healthcare Quality Account 2016/17 to the Sub-Committee, which outlined the provision delivered by Bromley Healthcare across the Borough during 2016/17 and quality priorities for 2017-2020.  There was a statutory requirement for all NHS public funded bodies to provide their Annual Quality accounts to NHS England for publication by 30^th June 2017, and for this to contain a supporting statement from the Health Scrutiny Sub-Committee.

The Director of Nursing, Therapies and Quality advised Members that there had been three Care Quality Commission Inspections of Bromley Healthcare’s provision during 2016/17, all of which been rated as ‘Good’.  Feedback on customer experience had generally been very positive and there had been a 25% reduction in the number of complaints made to Bromley Healthcare in the past year.  For 2016/17, Bromley Healthcare had made a commitment to listen to the hard-to-hear community and particularly focused on the views of children with communications difficulties.  This commitment would be carried forward into 2017/18, when it was planned to focus on the views of patients with dementia or lack of capacity.  Bromley Healthcare had continued to work across all key partners throughout the year.  A staff survey had not been undertaken, but a number of measures were in place to support staff including a focus on workplace safety and a debt management initiative. 

In considering the update, Members generally agreed that the Bromley Healthcare Quality Account 2016/17 was an accurate account of service provision.  A Co-opted Member congratulated the Director of Nursing, Therapies and Quality, Bromley Healthcare and Clinical Quality Team Manager for an excellent report.

A Co-opted Member queried what progress Bromley Healthcare had made in becoming ‘Dementia Friendly’.  The Director of Nursing, Therapies and Quality underlined that becoming ‘Dementia Friendly’ remained an ongoing priority for Bromley Healthcare, and that 80% of Bromley Healthcare staff had now completed Dementia Awareness Training.  An emphasis had been placed on the early recognition of dementia to ensure that patients were signposted to the appropriate treatment, and work was also being undertaken to ensure that patients with end-stage dementia received the support they needed, such as the development of life story resources.  Consideration had been given to how the Bromley Healthcare estate environment could be managed to be more accessible to people with dementia, and resources that raised awareness of dementia had been made available on-site including the short film, ‘Barbara’s Story’.  Bromley Healthcare had worked with a range of key partners on the development of the draft Dementia Strategy for Bromley including the Dementia Hub. 

In response to a question from a Member, the Director of Nursing, Therapies and Quality confirmed that GPs were able to refer patients with pressure ulcers in the lower extremities for assessment.  Following assessment, patients were directed to the most appropriate treatment for their needs which could include the Community Nursing Team or Podiatry Service.

RESOLVED that the Bromley Healthcare Quality  ...  view the full minutes text for item 6.

The Sub-Committee considered an update on the Bromley Urgent Care system performance and the evaluation of the schemes commissioned by the Bromley Clinical Commissioning Group (BCCG) during Winter 2016/17.

The winter period 2016/17 had been very challenging with a much higher demand for urgent and emergency care services than in recent years.  A range of winter resilience schemes had been put in place by the BCCG to contribute to the management of pressures.  The BCCG met with all health partners on a regular basis to review the performance of these schemes, and a formal review had been undertaken during Spring 2017, which identified a number of schemes that had been particularly successful.  This included the in-reach (Medical Response) Scheme that had been extended to help manage surges through Easter and the May Bank Holidays and continued to see 5-7 patients a day, and for which a full review had been commissioned to identify further opportunities for the scheme.  The Patient Champion and GP in the PRUH schemes which redirected patients towards primary care and community services had also been extended, and the GP Access Hubs had successfully provided 120 additional primary care appointments per day and would continue to be utilised going forward.  The major contribution of the Transfer of Care Bureau to the success of the winter schemes as an access point and host had been recognised as part of the evaluation process, and a full review had been commissioned to identify further benefits that could be realised through the Transfer of Care Bureau.

The Chief Officer, Bromley Clinical Commissioning Group advised Members that a key area for development in 2017/18 would be the development of a multi-disciplinary approach towards care provision in nursing and care homes, including end-of-life care.  The ‘Red Bag’ scheme had recently been introduced to improve the continuity of care for care home residents during their hospital stays.  There were also plans to build on an existing scheme through which a representative of St Christopher’s Hospice visited nursing and care homes. 

In response to a question from a Member, the Chief Officer, Bromley Clinical Commissioning Group confirmed that the additional primary care appointments available through the GP Access Hubs were allocated on a proportional basis to all Bromley GP Practices based on patient numbers.

RESOLVED that the progress be noted.

The Sub-Committee considered a report providing an update on the early impact of Integrated Care Networks.

In May 2016, a Memorandum of Understanding was signed between Bromley Clinical Commissioning Group (BCCG) and a range of health providers to commit to working together to establish a new model of care within the Borough in the form of three Integrated Care Networks, and to co-design, mobilise and agree delivery trajectories for new pathways within these networks.  The first pathway to be mobilised was the Proactive Care Pathway which had been supported by multi-disciplinary meetings of key health professionals including GPs, the Community Matron and mental health professionals, with over 250 patients supported through this pathway since October 2016.  The BCCG had monitored the progress and impact of the Proactive Care Pathway across the three Integrated Care Networks which demonstrated there had been a positive trend of month-on-month increases in the number of patients identified by their GPs as suitable for the pathway.  Work was being undertaken to capture feedback and case studies from these patients to ensure that the pathway maintained a patient outcomes-focused approach.  Priorities for the next phase of Integrated Care Networks Pathways were being developed through the Bromley System Leaders Programme and four new workstreams were being explored comprising care homes (with a focus on reducing emergency admissions), acute admissions at end of life, integrated therapy services, and integrated heart failure services.

In response to a question from the Chairman, the Chief Officer, Bromley Clinical Commissioning Group confirmed that patients who could benefit from the Proactive Care Pathway were identified by their GPs and referred to the Community Matrons for assessment.  Work to evaluate the outcomes of the Pathway and how patients had benefitted was ongoing and to support this, an information sharing agreement had been put in place across all partners.

The Chairman requested that a further update on the Integrated Care Networks be reported to a future meeting of the Health Scrutiny Sub-Committee.

RESOLVED that the progress made with Integrated Care Networks be noted.

The Sub-Committee considered a report providing an update on developments in the planning and approval of the Bromley Health and Wellbeing Centre project.

The establishment of a third Health Centre within the Borough to complement the Beckenham Beacon and the Orpington Health and Wellbeing Centre was one of the key proposals of the ‘Bromley Out of Hospital Transformation Strategy’, which had been developed jointly by the Bromley Clinical Commissioning Group (BCCG) and the Local Authority.  It was planned that the Bromley Health and Wellbeing Centre would be one of the three ‘hubs’ underpinning the new Integrated Care Networks and would play a key role in providing coordinated care to approximately 100,000 people via integrated services.  It would also offer significant primary care services for Bromley residents, including a Primary Care Access Hub and the relocation of the Dysart Medical Practice.

Members were advised that funding had been secured for the centre from the NHS Executive’s Estates and Technology Transformation Fund in October 2016, following which the Strategic Outline Case had been approved.  The Project Initiation Document was expected to receive formal approval by the NHS Executive shortly and work had started on the next formal project stage of the Post-PID Full Options Appraisal which would identify potential sites for the scheme.  A Multi-Disciplinary Project Board had been established to steer the project which included representation by the Local Authority, and Ward Councillors would also be included in the discussions around the site of the proposed centre.  It was hoped that services would commence at the Bromley Health and Wellbeing Centre following the build and ‘fit-out’ of the centre which had an estimated completion date of 24^th March 2020. 

In response to a question from a Member, the Project Lead, Bromley Health and Wellbeing Centre confirmed that lessons had been learned from the Orpington Health and Wellbeing Centre project and would help ensure the project was delivered efficiently.

RESOLVED that the update be noted and a further update be provided to the Sub-Committee in due course.

Report CSD17068

Members considered the forward rolling work programme for the Health Scrutiny Sub-Committee.

The Chairman proposed that the Task and Finish Group established at the meeting of Health Scrutiny Sub-Committee on 16^th March 2017 to review Bromley’s care offer for people with dementia and their families and carers be reconvened for 2017/18.  This was supported by the Health Scrutiny Sub-Committee and Member nominations were confirmed as Councillor Mary Cooke as Chairman, Councillors Ruth Bennett, Judi Ellis and David Jefferys, and Co-opted Members, Linda Gabriel and Lynn Sellwood.  The Chairman noted that Bromley Healthcare had undertaken a range of work on dementia during 2016/17, and requested that the Task and Finish Group link up with Julie Miller, Clinical Quality Team Manager who was the Dementia Lead for Bromley Healthcare.

The need to appoint two Local Authority representatives to the Our Healthier South East London Joint Health Overview and Scrutiny Committee for the 2017/18 municipal year was discussed by Members and it was agreed to recommend the Care Services PDS Committee appoint Councillor Judi Ellis and Councillor Ian Dunn to the Joint Health Overview and Scrutiny Committee.

A Member requested that an update on how reablement provision across the Borough linked up with mental health services be provided to the next meeting of Health Scrutiny Sub-Committee on 7^th November 2017.

RESOLVED that:

1)  The work programme be noted;

2)  The Task and Finish Group for Dementia Services be reconvened for 2017/18, and for membership to comprise Councillor Mary Cooke as Chairman, Councillors Ruth Bennett, Judi Ellis and David Jefferys, and Co-opted Members, Linda Gabriel, and Lynn Sellwood; and,

3)  The Care Services PDS Committee be recommended to appoint Councillor Judi Ellis and Councillor Ian Dunn as Local Authority representatives to the Our Healthier South East London Joint Health Overview and Scrutiny Committee for the 2017/18 municipal year.

There was no other business.

4.00pm, Tuesday 7^th November 2017

4.00pm, Tuesday 6^th March 2018

The next meeting of Health Scrutiny Sub-Committee would be held at 4.00pm on Tuesday 7^th November 2017.