Apologies for absence were received from Roger Chant and Lynn Sellwood.

The Chairman welcomed Vicki Pryde, Chair of the Bromley Mental Health Forum.

On behalf of Roger Chant, the Chairman passed on his thanks to Debbie Hutchinson, Director of Nursing – PRUH and South Sites for her dedication, care and compassion, and for her involvement in progressive meetings.

There were no declarations of interest.

In accordance with the Council’s Constitution, questions that are not specific to reports on the agenda must have been received in writing 10 working days before the date of the meeting. 

Questions specifically relating to reports on the agenda should be received within two working days of the normal publication date of the agenda. Please ensure that questions specifically on reports on the agenda are received by the Democratic Services Team by 5pm on Wednesday 22^nd January 2020.

One written question was received from a member of the public and is attached at Appendix A.

RESOLVED that the minutes of the meeting held on 8^th October 2019 be agreed.

Meredith Deane, Director of Operations – PRUH and South Sites (“Director of Operations”) and Debbie Hutchinson, Director of Nursing – PRUH and South Sites (“Director of Nursing”) provided an update on the King’s College Hospital NHS Foundation Trust.

The Director of Operations noted the request made by the Sub-Committee for an update on the endoscopy backlog to be provided to the meeting. There was a capacity gap within the Princess Royal University Hospital (PRUH) endoscopy service, which had resulted in a significant backlog of patients on the activity diagnostic (DM01) waiting list, as well as surveillance patients. A comprehensive recovery plan of immediate and medium term solutions was underway, with a focus on bringing waiting times in line with national standards. Capacity was being increased in a number of ways, including:

-  using 30 weekend appointments at King’s College Hospital, Denmark Hill, providing patient transport if required;

-  outsourcing of between 30 and 40 appointments per week to BMI Healthcare, Croydon;

-  support from an 18-week insourcing team to deliver twilight and weekend services at the PRUH;

-  since September 2019, Day Surgery Units had been providing weekend sessions at Orpington Hospital, supported by Vanguard decontamination units.

The Director of Operations advised Members that throughout the recovery programme there had been a continued reduction in the number of patients waiting over six weeks. There had been an issue in regards to outsourcing, with the provider being unable to deliver the 50 appointments initially offered, but overall the position was much improved. In respect of longer term solutions, a business case was being developed for the expansion of the current endoscopy unit, in line with demand and capacity analysis. To maintain standards, a group had been established to explore longer term solutions.

From May 2019, harm reviews were being undertaken for all patients that had been on the diagnostic waiting list longer than six weeks, and all patients on surveillance waiting list with a past ‘due by date’. The current status of this process was that following harm reviews being completed for patients with cancer diagnoses, work was underway validating the cohort of patients whose pathways were delayed and had a diagnosis other than cancer. In response to a question, the Director of Operations noted that this was a huge piece of work, involving around 8,000 patients. It would be difficult to pin-point exactly if patients had come to harm as a result of these delays and they would therefore be looking at the whole clinical procedure.

A Member enquired if a specific “pinch-point” had been identified which had contributed to the delays. The Director of Operations advised that room availability was a key factor. There were currently two endoscopy rooms at the PRUH. However with 14,000 patients per year, plus a 6.5% growth in the number of patients per year, five endoscopy rooms were needed. In response to a question, the Director of Operations said that patients on all pathways were vetted by the clinical team, but they had seen  ...  view the full minutes text for item 25.

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) and Janet Ettridge, Director of Operations – Bromley Healthcare (“Director of Operations”) presented a general update on Bromley Healthcare; proving an overview on performance, new initiatives and programmes; and their focus for 2020/21.

Highlights of the Bromley Healthcare performance for 2019/20 included patient satisfaction of 98.1%, and a dramatically reduced response rate of 6.7%, which was the best across London. The service had monitored 471,000 patient contacts and in Year 1 of the Bromley CCG contract they had met the target for adults, and exceeded the baseline for children by 15.6%.

Members were advised that the staff vacancy rate across all services had reduced to 7.5%. The main area of increased recruitment was Band 5 and 6 nurses, and Bromley Healthcare had also ran an apprenticeship programme. A bespoke Nursing Band 5 Development Programme for newly registered nurses had been implemented, and 20 nurses had been recruited over an eighteen month period.

The Chief Executive Officer noted that £4m of their contract was payable on the achievement of Key Performance Indicators (KPI). Adult’s Services had achieved 89% of KPI’s, and Children’s Services had achieved 92% of KPI’s, both against a 70% target.

In relation to rehabilitation beds, the National Audit of Intermediate Care (NAIC) had identified the service as positively deviant, with patients under Bromley Healthcare being more dependent but having better outcomes, and shorter wait times and length of stay than the national and London averages. This work had been recognised within the industry, and Bromley Healthcare had received the Laing Buisson Rehabilitation Award in November 2019.

One of the new initiatives piloted by Bromley Healthcare had been Telemedicine. The Remote Patient Review Service provided a monitoring cuff, which was worn on the arm of a patient and enabled health care professionals to monitor vital signs (oxygen saturation; respiratory rate; pulse rate; skin temperature; motion; blood pressure), whilst the patient remained in their own home. Health care professionals were able to access and review a patient’s data remotely via the internet (through a secure server) as part of the patient’s ongoing care needs. In response to a question, the Chief Executive Officer noted that this was currently being used to support the service provided. It was suggested that an evaluation of the Remote Patient Review Service be provided to a future meeting of the Health Scrutiny Sub-Committee.

In June 2019, Bromley Healthcare had commissioned a Therapy services productivity analysis. Following the results of the initial analysis, a 17-week improvement programme had commenced within the following areas: Dietetics, Occupational Therapy and Physiotherapy (for both Children’s and Adult’s Therapies) and Falls, Home Based Rehab (removed mid-way through), Neuro Rehab, Respiratory and Home Oxygen Service (Adult’s Therapies). This had involved work such as reviewing activity data to look at historical trends; team engagement; six weekly leadership programme; and reviewing expectations of each banding / role and setting a percentage for patient contact with the Service Leads. It was noted  ...  view the full minutes text for item 26.

The Sub-Committee received a presentation from Adrian Dorney, Associate Director – Oxleas NHS Foundation Trust (“Associate Director”) regarding an update on Health Based Place of Safety (HBPoS).

Members were advised that a HBPoS, or s136 suite, was a safe place in which to assess people who had been detained in the community by the police under section 136 of the Mental Health Act. There had been two separate HBPoS sites within the Oxleas NHS Foundation Trust. One bed was based in Woolwich, at Oxleas House, Queen Elizabeth Hospital and the second bed was in the London Borough of Bromley, at Green Parks House.

Following a PAN London s136 review, in which a mapping exercise had been undertaken, it had been proposed that the current number of HBPoS sites in London be reduced. The HBPoS was part of a comprehensive Mental Health service, and whilst the benefits of scale and simplicity of access from reducing the number of sites were acknowledged, the Oxleas NHS Foundation Trust did not want to see a reduction in the number of beds within their footprint

It was highlighted that the refurbishment of the Oxleas House site would provide up to date facilities, and the best environment possible for this provision. In response to a question, the Associate Director said that this had included seeking guidance from psychiatrists, and visiting other provisions to see the high impact materials being used to keep patients safe.

From 1^st January 2020, a Crisis Assessment Team (CAT) car had been initiated, serving Bexley, Bromley and Greenwich, which was a joint venture between Oxleas NHS Foundation Trust and the Metropolitan Police. It provided a nurse to travel with a rapid response team to s136, or potential s136, cases. The CAT car had been operating during twilight hours, which was when demand was at its highest. A London Ambulance Service (LAS) car, which provided a similar service, was also operating across areas of South East London covered by the Oxleas and South London and Maudsley (SLAM) NHS Foundation Trusts. Members requested that an update on the impact of the CAT car be provided to the Sub-Committee in six months’ time.

In response to a question, the Associate Director said that there were several factors which contributed to the peak time in out-of-hours demand. Local services had been developed, including a crisis service and Crisis Line which were both available 24 hours a day, seven days a week. It was hoped that as a result of more services being provided, fewer patients in crisis would present at Emergency Departments and support suites.

In January 2020, the s136 service had been reduced by one bed, following the closure of Oxleas House for refurbishment, throughout which the s136 suite at Green Parks House would remain functioning. At present, there had not been an adverse demand on impact at Green Parks House. The number of referrals showed that following the temporary closure of Oxleas House, there had not been a striking uplift in numbers attending  ...  view the full minutes text for item 27.

Mina Kakaiya, the Co-opted Member representing Healthwatch Bromley advised the Sub-Committee that feedback received from service users reflected the points raised by the representatives from the King’s College Hospital NHS Foundation Trust.

There was positive feedback in respect of the quality of care, however issues relating to access to appointments and waiting times, were impacting upon this. Work needed to be undertaken to improve systems; respond in a timely manner; and make triage clearer.

It was noted that Healthwatch Bromley was currently in the process of recruiting a member of staff whose role would focus on service user engagement. It was agreed that an item on ‘Service User Engagement’ be added to the agenda for the next meeting of the Sub-Committee.

It was reported that the Portfolio Holder for Adult Care and Health and the Executive Assistant for Adult Care and Health would be meeting with Healthwatch Bromley on a regular basis.

Members considered the forward rolling work programme for the Health Scrutiny Sub-Committee. It was requested that the following items be added:

-  Post-winter follow up on patient flow / discharge – King’s College Hospital NHS Foundation Trust / Bromley CCG

-  Presentation on the Severe Heart Failure End of Life Pathway – King’s College Hospital NHS Foundation Trust / Bromley CCG

-  Evaluation of the Remote Patient Review Service – Bromley Healthcare

-  Update on the Stock Hill Pilot  – Bromley Healthcare

-  An update on the CAT car – Oxleas (July 2020)

-  Service User Engagement – Healthwatch Bromley (April 2020)

RESOLVED that the work programme be noted.

There was no other business.

4.00pm, Thursday 23^rd April 2020

4.00pm, Thursday 23^rd April 2020