Agenda and minutes

Apologies for absence were received from Councillor Angela Page and Justine Godbeer.  Apologies for absence were also received from Councillor Aisha Cuthbert and Tim Spilsbury, and Councillor Keith Onslow and Stephanie Wood attended as their respective substitutes. 

Apologies for lateness were received from Councillor Judi Ellis

There were no declarations of interest.

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 Thursday 11^th October 2018

No questions had been received.

In respect of Minute 7: PRUH Improvement Plan – Update from King’s College Hospital NHS Foundation Trust, the Chairman reported that a suggestion by a Member to send a letter to Ian Smith, Interim Chairman, King’s College Hospital NHS Foundation Trust emphasising the need for the continued delivery of the Princess Royal University Hospital Improvement Plan had not been necessary to take forward following the appointment of the Interim Managing Director: Princess Royal University Hospital and South Sites.

RESOLVED that the minutes of the meeting held on 11^th and 30^th July 2018 be agreed.

Laura Badley, Interim Managing Director: Princess Royal University Hospital and South Sites, Shelley Dolan, Chief Operating Officer, Chief Nurse and Executive Director of Midwifery, Eimear Finn, Head of Nutrition and Dietetics, Debbie Hutchinson, Director of Nursing and Sao Bui-Van, Director of Communications, King’s College Hospital NHS Foundation Trust provided an update on progress in a range of areas across King’s College Hospital NHS Foundation Trust.

As Interim Managing Director, Laura Badley had managed the Princess Royal University Hospital through a particularly busy period of increased attendances as well as leading the response to a major incident on the M25.  A permanent Director: Operations had now been appointed for the Princess Royal University Hospital and South Sites and would start in post from end-November 2018.  It was proposed that two Deputy Director posts be created to support the Director: Operations, and any changes to the Trust’s management model would be a decision for the Chief Executive: King’s College Hospital NHS Foundation Trust.

Emergency Department performance at the PRUH had improved during the year with an aggregate performance of 87.9% in September 2018 against 84.9% in January 2018, although this remained below the target of 95%.  Performance against the 62 days from screening target for cancer treatment was 90.9% in September 2018 which was above the target of 90%, and measures were in place to improve the GP referral target for cancer treatment which was currently performing below target as a result of a significant increase in prostate cancer referrals following a highly successful campaign by Public Health England during 2018.  Work was underway to maintain Referral to Treatment times and following an increase in referrals in early 2018, the need to increase endoscopy capacity at the Princess Royal University Hospital had been identified and would be a key priority for capital investment going forward.  A robust recruitment and retention strategy had supported a reduction in vacancy rates across the Trust over the last 12 months with 8.6% of PRUH posts vacant as at August 2018 against 17.8% for August 2017, although there continued to be challenges to recruit consultants within certain specialisms. 

Following King’s College Hospital NHS Foundation Trust being placed in Financial Special Measures by NHS Improvement on 11^th December 2017, a range of work had been undertaken to address the deficit.  The Trust had agreed a control total of £146M deficit for 2018/19 with NHS improvement and as at Month Five 2018/19, the Trust was showing a £5.3M variance against the 2018/19 financial plan which was a result of lower than expected income for specialist services as well as costs relating to locum staff.  The financial position of the Trust was broken down into three divisions which were individually assessed on a monthly basis.  Princess Royal University Hospital and South Sites formed one division and had been identified as contributing £3.1M to the £5.3M variance against the 2018/19 financial plan due to reduced income from maternity services, although this position was expected to improve by the end of the financial year. 

In response to a question from a Member, the Chief Operating Officer, Chief Nurse and Executive Director of Midwifery explained that King’s College Hospital NHS Foundation Trust had been managing the deficit for several years and, as a large Trust with 1700 beds and 1.4M outpatient appointments per year, was severely affected by the level at which NHS tariffs had been set with every procedure funded at a loss of approximately 25%.  Ways to offset this deficit included offering highly complex or specialist procedures which were paid on a per-procedure basis, and private patient and research income.

The Elizabeth and Churchill Wards at Orpington Hospital opened in January 2017, making 38 inpatient beds available to older patients as part of a wider frailty model that aimed to bridge the gap between hospital and home care.  In July 2018, King’s College Hospital NHS Foundation Trust notified the Local Authority that it proposed to close Elizabeth Ward as part of plans to refocus Bromley’s integrated care model towards providing more home-based care which was expected to reduce ‘decompensation’ caused by inpatient care.  This would be supported by further development of Bromley’s integrated care model which included the implementation of the Cardiac Failure Pathway and the repurposing of the Elizabeth Ward as an outpatient facility.  Plans to repurpose the Elizabeth Ward as an outpatient facility had been delayed due to the pressures on the Emergency Department during Summer 2018, and whilst it was still planned to use the Elizabeth Ward as an outpatient facility, a flexible approach would be taken to the use of the space in the short term to ensure that the needs of patients were being met.

In response to a question from a Member, the Chief Operating Officer, Chief Nurse and Executive Director of Midwifery advised Members that the Trust was also impacted by “stranded” and “super-stranded” patients which were those who no longer required hospital treatment but were waiting to be placed in an appropriate setting for their needs.  Examples of “stranded” and “super stranded” patients included those with no fixed abode or no recourse to public funds.  It was also often difficult to find an appropriate care setting for patients with a high level of need.  The number of “stranded” and “super stranded” patients was monitored on a daily basis, and differed from patients affected by Delayed Transfers of Care which had been managed very effectively at the Princess Royal University Hospital over the past year.

The Princess Royal University Hospital served 386,000 meals every year (based on two meals a day – lunch and dinner), with seven hot drinks provided per patient and water jugs replenished twice a day.  Hot and cold menu choices were offered to meet individual nutritional needs based on British Dietetic Association standards, and menus were reviewed twice a year using patient feedback as well as input from nursing teams and Trust dietetics.  A “Red Tray” system was used to identify patients requiring support or encouragement to eat, and the Trust also catered for specific nutrition requests including more finger foods for frail patients, and vegetarian, gluten-free and modified texture choices, with a light meal made available if lunch or dinner was missed due to treatment.  A Dignified Dining Group was convened on a quarterly basis which was responsible for ensuring that a high quality nutrition and hydration offer was consistently and safely delivered to patients and that high quality standards were also promoted in the provision of nutrition and hydration to staff, volunteers and visitors.  Following the Care Quality Commission’s National Inpatient Survey, the Trust was working to implement further improvements including encouraging patients to cleanse their hands before and after eating.  It was planned to develop a “Lunch Club” to enable relatives and friends to eat meals with patients and to introduce John’s Campaign, which gave extended visiting rights for family carers of patients with dementia.  Further information on the unit cost per meal would be provided to Members following the meeting.

In response to a question from a Member, the Head of Nutrition and Dietetics confirmed that patients were supported in meeting their dietary requirements throughout their health journey, both as inpatients and outpatients.  The Trust had recently been successful in a bid to Macmillan Cancer Support that would help inform the way that patients with cancer were supported to maintain their nutrition and hydration, and work was being undertaken with the London Procurement Programme and General Practitioners to reduce local variations in the way that patients were supported with dietary supplements.  Measures had also been put in place to ensure that patients’ nutrition and hydration needs were met whilst they were in the care of the Emergency Department, including the recruitment of additional Healthcare Assistants.

A Co-opted Member underlined the need for a more consistent approach to supporting patients with tracheotomies with nutrition and hydration.  The Chief Operating Officer, Chief Nurse and Executive Director of Midwifery confirmed that this was an area of focus, and that the favoured option was to provide a dedicated ward as well as a mobile team to support patients with tracheotomies.

The Chairman led Members in thanking Laura Badley, Shelley Dolan, Eimear Finn, Debbie Hutchinson and Sao Bui-Van for their excellent presentation which is attached at Appendix A.

RESOLVED that the updates 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 from Mark Cheung, Programme Director: Integrated Care Services and Phil Chubb, Project Leader, Bromley Clinical Commissioning Group.

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 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 which would be able to expand to offer primary healthcare to additional patients.  The Health and Wellbeing Centre would be designed with a flexible layout which could respond to changing needs over time, and more specialist health services such as endoscopy could be delivered where there was an identified need.

Funding had been secured from the NHS Executive’s Estates and Technology Transformation Fund in October 2016 to develop the project, following which the Strategic Outline Case and Project Initiation Document had been approved.  The Post-PID Full Options Appraisal which identified potential sites for the scheme had been approved by the NHS Executive in October 2017, and following a detailed evaluation of a number of site options by the Multi-Disciplinary Evaluation Panel which included Local Authority representation, 32 Masons Hill, Bromley had been identified as the preferred site.  The Outline Business Case was being prepared and would be submitted to the NHS Executive for approval in November 2018, and work was ongoing to develop a comprehensive community engagement plan.  The project was being steered by a Multi-Disciplinary Project Board which had established a Sub-Committee to support effective coordination of the overall site redevelopment and included representation by all key stakeholders. 

In considering the update, the Chairman highlighted that there was a need to secure planning permission for the proposed development, and the Programme Director: Integrated Care Services reported that the scheme had been referred to the Greater London Authority Planners with a review meeting scheduled for 7^th November 2018.  In response to a question from a Member, the Programme Director: Integrated Care Services explained that £3M funding had been secured for the Bromley Health and Wellbeing Centre against an estimated total capital cost of £13M.  A bid had been put in to the NHS for the outstanding balance of the project which was ranked as the top priority NHS scheme in South East London.  Should this not be successful, a number of other options were being explored including seeking investment from key partners including the Local Authority. 

A Member underlined the need for contingency  ...  view the full minutes text for item 24.

The Sub-Committee considered a report providing an update on the Bromley Minor Eye Care Service Pilot Scheme from Mark Cheung, Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group.

In 2015, the Local Authority and the Bromley Clinical Commissioning Group jointly commissioned an eye needs assessment to review services across the Borough.  The outcome of this assessment identified the need for eye care pathways to be improved to alleviate capacity issues and increase access to local services.  The Bromley Clinical Commissioning Group subsequently conducted a comprehensive review of eye care services which led to the commissioning of the Bromley Minor Eye Care Service. The Bromley Minor Eye Care Service was launched on 1^st April 2017 as a two year pilot scheme delivering minor eye care provision.  There were 13 local optical practices participating in the scheme with another four practices due to join the service shortly.  The Bromley Clinical Commissioning Group had commissioned Dr David Parkin to undertake an analysis of the Bromley Minor Eye Care Service during Summer 2018, following which it had been identified that the Bromley Minor Eye Care Service had already made an impact on improving referral quality and reducing inappropriate referrals to ophthalmology services.  Work was underway to further promote the Bromley Minor Eye Care Service to General Practitioners, optometrists not participating in the scheme and Bromley residents, as well as to further develop the service.  The two year pilot scheme would end in March 2019, and the Planned Care team was working to identify how this service could best be delivered into the future.

In considering the update, a Member queried Action Two from the list of actions for the remainder of the pilot scheme.  The Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group explained that this referred to the need to understand the activity undertaken by optometrists participating within the scheme and ensure that practice was consistent across the Bromley Minor Eye Care Service.  In response to a question from another Member, the Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group confirmed that work was underway to identify future delivery options for this service, which could include taking a pan-South East London approach, and that further information would be provided to the Health Scrutiny Sub-Committee when available.

RESOLVED that the update be noted.

Please be advised that this agenda item only includes selected appendices from the Winter Plan. 

The Winter Plan with all appendices can be viewed in the agenda for Health and Wellbeing Board on 27^th September 2018 accessible via this link:

https://cds.bromley.gov.uk/ieListDocuments.aspx?CId=617&MId=6344&Ver=4

The Sub-Committee considered a report providing an update on the development of a Bromley System Winter Plan from Mark Cheung, Programme Director: Integrated Care Services and Clive Moss, Urgent Care Lead, Bromley Clinical Commissioning Group, and Mark Davison, Interim Head of Programme Design (ECHS).

The Bromley System Winter Plan had been developed to provide a framework for health and social care partners within the Bromley system to manage surge and capacity issues at both technical and strategic levels within the local health and social care system during Winter 2018.  A number of objectives had been identified within the Plan which comprised establishing a shared understanding of surge and escalation criteria used across health and social care services, defining a flexible framework for response and defining procedures and processes about escalation in the event of an actual or potential surge and capacity issues.  During surge and escalation issues, the Plan also specified frameworks for informing, coordinating and supporting the health and social care services response to incidents and to actively engage with the public, as well as to provide a mechanism by which issues for joint resolution by partners could be escalated at both a tactical and strategic level.  Winter Resilience Schemes focused on three joint strategic themes which comprised increasing capacity in the work force as well as in service provision, and the integration of services to prevent the need for hospital-based care and streamline discharge processes.  Further Winter System planning had taken place across a wide range of areas including infection control, processes for hospital repatriations, improving ambulance handover workstreams, minor breach reduction work planning and out-of-hospital Borough-based service mapping.  The Bromley System Winter Plan 2018/19 had been considered at the meeting of Health and Wellbeing Board on 27^th September 2018, at which Board Members had resolved to agree the Plan.

In considering the report, the Chairman was pleased to see the move towards increased collaborative working by health and social care partners and underlined the importance of highlighting the contribution of pharmacies to winter planning and service delivery, such as through the flu vaccination service.  Another Member emphasised that the role of domiciliary care provision within winter planning should be realistic in terms of what could be delivered, and the Interim Head of Programme Design (ECHS) outlined work currently underway with providers, key partners and service users to co-design a new model of domiciliary care provision in Bromley that was able to meet the changing needs of service users and be more responsive to service pressures including increased seasonal demand.  A Member queried how performance during Winter 2017/18 had not met national standards, and the Urgent Care Lead explained that this measure related to the operational standard of 95% of patients attending Emergency Departments being seen within four hours and that a number of additional measures had been introduced for Winter 2018/19 to improve performance in this area.  Another Member noted the increasing demand for General Practitioner home visits during winter and suggested the potential for a  ...  view the full minutes text for item 26.

Councillor Judi Ellis and Councillor Robert Mcilveen provided an update on the Our Healthier South East London Joint Health Overview and Scrutiny Committee which had met on 26^th September 2018 to consider the Our Health South East London Programme and the forward work programme of the Joint Committee.  Further meetings of the Our Healthier South East London Joint Health Overview & Scrutiny Committee would be held in February and June 2019.

Councillor Judi Ellis was pleased to announce that she had been appointed Chairman of the Our Healthier South East London Joint Health Overview and Scrutiny Committee for the 2018/19 municipal year.  Councillor Philip Normal of the London Borough of Lambeth had been appointed Vice-Chairman.

RESOLVED that the update be noted.

Report CSD18125

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

The Chairman invited Members of the Sub-Committee to provide details of any other items they wished to discuss at future meetings to the Clerk to the Committee.

RESOLVED that the work programme be noted.

There was no other business.

4.00pm, Wednesday 16^th January 2019

4.00pm, Wednesday 3^rd April 2019

The next meeting of Health Scrutiny Sub-Committee would be held at 4.00pm on Wednesday 16^th January 2019.