Agenda and minutes

Apologies for absence were received from Councillor Evans, Justine Jones and Lynn Sellwood. Apologies for absence were also received from Councillor Cuthbert and Tim Spilsbury, and Councillor Onslow and Mina Kakaiya attended as their respective substitutes.

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 February 2019.

One oral question and two written questions were received from Councillors and members of the public and these are attached at Appendix A.

There was no supplementary oral question.

RESOLVED that the minutes of the meeting held on 17^th October 2018 be agreed.

Dr Agnes Marossy, Consultant in Public Health, Bromley Clinical Commissioning Group, attended to present the findings of the Bromley Primary Care Needs Assessment. Dr Marossy had been seconded to the CCG to carry out a Primary Care Needs Assessment.

The aim of the Primary Care Needs Assessment was to describe both the need for primary care, and the needs of those delivering primary care, in order to inform the development of a sustainable model of primary care in Bromley. The Primary Care Needs Assessment had been informed by a Steering Group and a Clinical Reference Group. The Steering Group had consisted of GP Clinical Directors, the Bromley GP Alliance, the CCG Primary Care Team, the CCG Nurse Lead and the Director of Organisational Development, and the Clinical Reference Group had included GP’s (Partners, Salaried, Locums and Trainees), Practice Nurses and Practice Managers.

The Consultant in Public Health had undertaken a number of tasks, including workforce analysis and workforce surveys which identified trends, but the bulk of her time had been spent carrying out public engagement. This had included attending the Practice Nurse Forum, which was attended by around fifty Practice Nurses, and visiting and spending time at forty two of the forty five Practices in the Borough, to get an understanding of how they operated. The work also included engagement with patients and public, including vulnerable groups, and some of this was commissioned out to Healthwatch Bromley.

The results of the public engagement had found that patients were now more accustomed to not seeing the same person each time they visited their Practice. Patients did not feel this was an issue, acknowledging the positive impact of being ‘known’ at the Practice by clinical and non-clinical members of the team, and that a person’s job title was not important as long as they sorted out the patient’s problem. However, certain vulnerable groups, such as those with mental health issues and those with learning difficulties, benefitted from having continuity with one GP. A fundamental issue raised was the length of consultations, as neither doctors nor patients were happy about the ten-minute consultation time. Ten minutes was perceived to be too short. It was highlighted that an older patient may take longer to reach the consultation room, and then may need time to sit and compose themselves before speaking to the GP, would find most of the appointment time had already been used up. Patients also particularly objected to the ‘one appointment, one problem’ policy where it was being implemented.

There had been a number of questions asked when visiting Practices, and one key area of focus had been resilience and how they would continue to manage to provide care if a Partner went on long-term sick leave or retired; if a neighbouring Practice closed; or a new housing development was built close by. Other issues regarding how the Practices recruited and retained their workforce had been highlighted. There had been a number of key outputs, but the main ones to be addressed  ...  view the full minutes text for item 35.

Dr Angela Bhan, Managing Director, Bromley Clinical Commissioning Group provided a verbal update on Diabetes Flash Glucose Monitoring. These were devices for Diabetics to self-monitor their glucose levels, without the need for a pin-prick test. The devices were placed under the skin, and monitored the levels of glucose in the fluid found between cells in the body. This was intended to develop a better understanding of each patient, and was a new way of continuously recording the glucose found in their bloodstream.

Despite there being only a very limited amount of evidence as to the outcomes of their use, these devices were taking off by popular demand. However, there was a cost to the CCG associated with their use, and for the patients in Bromley that were eligible, and most severely affected by Diabetes, this would be at least an additional £250k per year. It was recognised nationally that to provide the devices, the CCG’s funding would be top-sliced and that the devices would be rolled-out gradually.

The Chairman said that a constituent had spoken with her, and questioned why they had not been able to obtain a Flash Glucose Monitoring device, and asked for further information on their availability. The Managing Director, Bromley Clinical Commissioning Group said that information regarding eligibility had not been distributed effectively. This had led to the demand for the devices growing within patient groups that were not eligible to receive them, and also a number of patients obtaining devices when they were not necessarily the most appropriate solution for the individual patient. It was acknowledged that there had not been a cohesive approach, and that there was a need for a patient education programme. It was noted that there was still a need for evidence to gauge the long-term impact of the devices, such as whether they made patients more anxious, and resulted in them constantly checking their glucose levels.

A Member expressed that they felt this was a major step forward, however there were concerns as to what would be done with the data gained from the device, and the implications as to how Diabetes was managed. Some Flash Glucose Monitoring devices could be bought ‘off the shelf’ and the extra demand could lead to patients modifying their own treatment, which could be counter-productive.

Another Member said that she was aware of the devices through a Child Looked After (CLA), and that the definition as to who could, and could not, receive the devices was unclear. It was felt that children were a relevant group of patients to be receiving these devices, especially those that had hospital admissions as a result of their Diabetes, and it could be considered a safeguarding issue if the devices were not provided to them. It was noted that the devices could be particularly helpful for parents dealing with their children ‘midnight eating’, as it would allow them to monitor the child’s glucose levels on their phone. It was requested that Members be provided with a copy of  ...  view the full minutes text for item 36.

Report CSD19029

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.

Moorfield’s Eye Hospital

Dr Angela Bhan, informed Members that Moorfield’s Eye Hospital planned to move to new premises at King’s Cross, for which a consultation had been launched. Members agreed that this was felt to be advantageous for the residents of Bromley as they would benefit from a new and improved building, and a much easier journey by public transport to get to King’s Cross than Old Street. In response to a question, the Managing Director, Bromley Clinical Commissioning Group said that between 700 and 750 patients were referred by Bromley CCG to Moorfield’s Eye Hospital each year.

Treatment Access Policy

The Managing Director, Bromley Clinical Commissioning Group advised Members that there was a revised Treatment Access Policy, which had been produced jointly by the six South East London CCG’s. It was proposed that there would not be a formal consultation on these changes, but instead a period of engagement. A few local changes had been made to the policy to reflect national evidence based interventions and NICE guidance, which included:

-  Stating that micro-suction is suitable for earwax removal

-  Not removing bunions for cosmetic purposes

-  Adhering to the national ‘pause’ on using vaginal mesh surgery for urogenital prolapse

-  Shoulder arthroscopy replaced by decompression

-  Bariatric surgery was now a CCG responsibility, which was a move from being commissioned by NHS England

Meeting with King’s / PRUH

Councillor Jefferys informed members that he had attended the King’s College Hospital NHS Foundation Trust Council of Governors meeting that afternoon. There had been a change in personnel, with Ian Smith’s role as Interim Chair of King’s College Hospital NHS Foundation Trust having ended on 1^st March 2019, and Sir Hugh Taylor being appointed to the post for the next two years. Simon Stevens, Chief Executive Officer (CEO) of NHS England had also taken over responsibility for NHS Improvement, resulting in the body that oversaw finances being under one person.

Sir Hugh Taylor had taken on the position of Interim Chair of King’s College Hospital NHS Foundation Trust alongside his existing role as Chair of Guy’s and St Thomas’ NHS Foundation Trust, but he had been clear that they were two separate hats, and it was not a takeover. He was aware that there were a number of issues at the PRUH, which he was keen to progress forward, and expressed the need for the closest cooperation with Bromley. With regards to the financial situation, it would be a difficult period with challenging budgets, as there was already an in-year deficit of £145m.

The Chairman noted that the PRUH needed to look at the service being provided to residents, as it was felt that changes were needed. Councillor Jefferys responded that staff surveys had highlighted that staff were feeling down beaten and dealing with incidents of bullying and harassment, which meant that morale was not good. A Member said that when talking to people about the PRUH, perception and reality were very far apart. Some services were considered to  ...  view the full minutes text for item 38.

4.00pm, Wednesday 3^rd April 2019

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, Wednesday 3^rd April 2019

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