Agenda and minutes

Apologies for absence were received from Councillor Robert Evans.

Apologies for lateness were received from Councillor David Jefferys.

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 28^th March 2019.

No questions had been received.

RESOLVED that the minutes of the meeting held on 6^th March 2019 be agreed.

Fiona Wheeler, Acting Executive Managing Director – Princess Royal University Hospital and South Sites (“Acting Executive Managing Director”), Debbie Hutchinson, Director of Nursing – Princess Royal University Hospital and South Sites (“Director of Nursing”) and Sarah Middleton, Head of Stakeholder Relations – 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.

The Acting Executive Managing Director informed Members that the Trust’s four hour target in Emergency Departments had been a struggle to deliver at the Denmark Hill and PRUH sites. However the PRUH had made considerable improvements, and in February reached 70% of the 95% target. The referral to treatment time remained as a priority improvement area for the Trust. The Trust was 77% compliant in relation to the number of patients waiting 18 weeks, but there were considerable problems in meeting the 52 week target. However, work way underway to reduce the backlog of more than 200 patients.

In relation to the Trust’s finances, the Trust’s control total had been agreed with their regulator for 2019/20. The financial position remained very challenging, with a reported deficit of £147m at the end of month nine. The end of year report on the Trust’s financial position was currently being completed and would be shared once it was available. Improving the performance of the Trust and the experiences of patients was difficult in the current financial climate and forward planning for this would be conveyed at future Sub-Committee meetings. In terms of quality, overall the Trust’s performance against patient outcomes remained good, and was in the top quartile for Hospital Standardised Mortality Ratio (HSMR). The Care Quality Commission had recently visited the PRUH and Denmark Hill sites, and the outcome of the inspection was awaited. The Trust was also finalising their quality priorities for 2019/20, which would be published once they were signed off by the Board.

There had been a number of new people welcomed to the Board, including Dr Clive Kay – Chief Executive, Sir Hugh Taylor – Interim Chairman and Nicola Ranger – Chief Nurse and Executive Director of Midwifery. Dr Shelley Dolan was now the Acting Deputy Chief Executive and Bernie Bluhm was Interim Chief Operating Officer for King’s College Hospital, Denmark Hill site. The Acting Executive Managing Director advised members that she was now also a member of the Trust’s Board, as her appointment had been made following the acknowledgment that the PRUH and South Sites needed Board level attention. It was noted that there were a number of Acting and Interim roles, which was to allow the new Chief Executive to consider the structure he would like in place for the governance and management system. Work was ongoing to refresh the Trust’s strategy, and the strategic framework was its current focus. A number of engagement sessions had been undertaken with staff, members and volunteers relating to what they do, why they do it and what they wanted to do in the future.  ...  view the full minutes text for item 44.

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) and Janet Ettridge, Director of Operations – Bromley Healthcare (“Director of Operations”) presented an update on Bromley Healthcare and the Care Coordination Centre.

As of the end of January 2019, Bromley Healthcare was ranked first out of all London providers, and joint second nationally for patient satisfaction, with a 98% rounded average score for patients that responded between January 2015 and January 2019. Bromley Healthcare’s average score of 98% was 1.3% higher than the second ranked provider in London.

The Care Coordination Centre had launched in January 2018, following a pilot in 2017. Services were migrated across during the rest of the year, bringing together all of the administration support. Currently the Care Coordination Centre provided the first point of contact to patients across 35 services, taking 26,000 calls and making 33,000 appointments per month, and drivers were based around ‘doing things the right way’. The Patient / Carer communications team focus was to manage waiting lists, DNAs / UTAs and adhere to patient pathways through the use of live dashboards to provide a consistent patient journey. The aim was to use this process to innovate and ensure that Bromley Healthcare, as part of the wider health economy was ‘doing the right things’ with proactive care coordination and development of patient pathways that reflected best practice and positive outcomes.

The Care Coordination Centre was used to manage the delivery of Key Performance Indicators, of which 20% of their contracts was based on the outcomes and were listed on a live dashboard. At the end of February 2019, 90.7% of Key Performance Indicators were achieved in Adult’s Services and 84.6% in Children’s Services, against the target of 70%. Overall, Adult’s Services achieved higher activity than planned in the first year of the contract, December 2017 to November 2018 being 0.4% above the baseline. For the same period, Children’s Services had overall also achieved higher activity than planned being 21.7% above the baseline.

In the 2017/18 Community Benchmarking, the Adult’s Services had a DNA rate lower than the mean benchmarking rate for twelve out of fourteen services, whilst Children’s Services had a WNB rate lower than the mean benchmarking rate for all six services. Since the establishment of the Care Coordination Centre, there had been a dramatic reduction in waiting times, whilst also ensuring that the right things were done in the right way. This had included the daily audit dashboard which had just been launched, and allowed outstanding issues to be passed on to the twilight team. There was also a bed based dashboard which allowed care gaps to be managed, and highlighted what specific services were needed on a particular day. It also noted the estimated date of a patient’s discharge to ensure that there were no hold ups.

Key messages from the National Audit of Intermediate Care (NAIC) were that patients under Bromley Healthcare were more dependent than the National averages on admission and their outcome was better  ...  view the full minutes text for item 45.

Adrian Dorney, Associate Director – Oxleas NHS Foundation Trust, Lorraine Regan, Service Director – Oxleas NHS Foundation Trust and Helen Smith, Deputy Chief Executive – Oxleas NHS Foundation Trust provided an update outlining some of the new developments in Bromley Adult Mental Health and Older People’s Mental Health Services.

Key highlights included:

-  Following the Care Quality Commission (CQC) Inspection in January 2019, Oxleas NHS Foundation Trust had maintained their ‘good’ rating across the board. The inspection had also recognised elements of outstanding practice in caring for older people on wards with mental health problems and community-based mental health services for older people.

-  There had been full engagement in planning for ‘One Bromley’.

-  There was a new 24/7 Home Treatment Team for people in mental health crisis which would improve the service by reducing the number of admissions, providing support to acute colleagues.

-  There was now a recognised Single Point of Entry which would avoid confusion. Phase 1 had been the establishment of a Single Point of Entry for Oxleas Adult Services. Phase 2 would include Bromley Healthcare, Bromley Well & MIND to establish a Single Point of Entry for the whole Borough.

-  There was a new innovative joint service with the police, Serene Integrated Mentoring (SIM), and an officer had been allocated to work with the Community Mental Health Teams.

-  A small perinatal mental health service had been launched, and a bid had been won to expand the service across all three boroughs. The service in Bromley was located at Queen Mary’s Hospital.

(To follow)

The Sub-Committee received a presentation from Adrian Dorney, Associate Director – Oxleas NHS Foundation Trust (“Associate Director”), Lorraine Regan, Service Director – Oxleas NHS Foundation Trust (“Service Director“) and Helen Smith, Deputy Chief Executive – Oxleas NHS Foundation Trust (“Deputy Chief Executive”) regarding Oxleas proposals to implement the London-wide new model of care for Health Based Place of Safety (HBPoS).

Members were advised that a HBPoS was a safe place in which to assess people who had been detained by the police under section 136 (s136) of the Mental Health Act. The s136 order allowed detention for up to 24 hours, beyond which the person was free to leave or would be admitted to a mental health ward either informally (with their informed consent) or formally detained under the Mental Health Act.

Work was being undertaken by a Pan London Group to develop the ‘Mental Health Compact’ to care for people in crisis. The purpose of the London-wide work was to improve the efficiency and effectiveness of treatment and quality of care for people experiencing mental health crisis along the s136 pathway and the broader crisis care system. The Pan London Group involved cross-partnership engagement with the police, London Ambulance Service and Accident and Emergency Departments (A&E). Its key principles included:

-  Patients being taken to the nearest HBPoS.

-  The prompt transfer to mental health services, if necessary.

-  Dedicated HBPoS staffing, 24/7 to provide the best care and get the best outcome.

-  Physical health competencies to avoid unnecessary A&E referrals.

Currently there were two separate HBPoS sites in the Oxleas NHS Foundation Trust. One was based in the London Borough of Bromley, at Green Park House, PRUH and the second was in Woolwich, at Oxleas House, Queen Elizabeth Hospital. There was one bed at each site, which remained occupied until a person’s care was transferred onwards. During 2018, 86 Bromley patients used the Oxleas HBPoS, equivalent to 1.5 patients per week, and 20% of these patients were taken to Oxleas House. Of the 200 patients admitted to the Bromley HBPoS, only 68 were Bromley patients. Police took people that had been detained to the nearest HBPoS, and this indicated that the majority of patients accessing it were not Bromley residents. Bromley Adult Mental Health Professionals, who were employed by the Local Authority and generally work within the boundaries of the borough, were already attending Oxleas House to assess Bromley patients.

The Pan London Group was proposing to reduce the current number of HBPoS sites in London from twenty to nine, with an interim plan for thirteen sites. The interim plan included two beds based at Oxleas House, which would result in the closure of the bed based at Green Park House. The nine site option would see all nine beds based in Denmark Hill, run by South London & Maudsley NHS Trust. The local view was that a HBPoS needed to be maintained within the footprint of the Oxleas NHS Foundation Trust.

Local services had been  ...  view the full minutes text for item 47.

James Postgate, CCG, Charles Oseghare, LBB Interim Strategic Commissioner (Mental Health) and Kelly Sylvester, LBB Head of Early Intervention, Prevention and Community Services Commissioning attended to provide an update on the Joint Mental Health Strategy.

The LBB Head of Early Intervention, Prevention and Community Services Commissioning informed Members that the first meeting of the Task and Finish Group would take place at 6.00pm that evening. The Chairman thanked the members who had agreed to sit on the Task and Finish Group – Councillor Judi Ellis, Councillor Simon Jeal, Roger Chant, Justine Jones and Lynn Sellwood, and requested that an update be provided to a future meeting of the Health Scrutiny Sub-Committee.

Councillor Judi Ellis, Chairman – Our Healthier South East London Joint Health Overview and Scrutiny Committee provided an update from the meeting on 21^st March 2019.

Members were advised that the Committee membership consisted of Councillors representatives from the London Boroughs of Bromley, Bexley, Lewisham, Lambeth, Southwark and the Royal Borough of Greenwich. Issues discussed at the meeting had included population health and life expectancy and the decisions made to change the configuration of stroke services in Kent.

A presentation had been received regarding urgent and emergency care services in South East London, which had provided advice on where to go and what to consider during an emergency episode. In addition to Emergency Departments, Urgent Care Centres, 999 and NHS 111, GP hubs had been established in Bromley for a while now, offering out of hours appointments. It was hoped that services could be streamlined across South East London, with communications and signage to make residents aware of how to access them.

The next meeting of Our Healthier South East London Joint Health Overview and Scrutiny Committee would take place at the London Borough of Southwark in June 2019. The focus of the meeting would be on mental health provision, including the number of youths and adolescents travelling out of borough to access services.

RESOLVED that the update be noted.

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

As suggested during the meeting, King’s College Hospital NHS Foundation Trust would invite their Chief Finance Officer and Clinical Director to provide presentations on the Trust’s financial position and patient flow at the PRUH.

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

The Chairman advised Members that King’s College Hospital NHS Foundation Trust had provided a copy of their draft Quality Account 2019, which would be circulated following the meeting for Members’ comments. Following a discussion, Members agreed that they would email any comments to the Clerk to the Sub-Committee by the deadline on Tuesday 23^rd April 2019.

RESOLVED that the issues raised be noted.

4.00pm, Tuesday 2^nd July 2019

4.00pm, Tuesday 8^th October 2019

4.00pm, Tuesday 28^th January 2020

4.00pm, Thursday 23^rd April 2020

4.00pm, Tuesday 2^nd July 2019

4.00pm, Tuesday 8^th October 2019

4.00pm, Tuesday 28^th January 2020

4.00pm, Thursday 23^rd April 2020