Agenda and minutes

The Chairman welcomed Members to the virtual meeting of the Health Scrutiny Sub-Committee, held via Webex.

The Chairman led Members in paying tribute to all the Borough’s residents who had died, either directly or indirectly, from COVID-19; those grieving for them; and all that had cared for them.

Apologies for absence were received from Justine Jones and Lynn Sellwood.

Councillor Jefferys declared that as a clinical volunteer he had been given an honorary NHS contract for the duration of the Coronavirus pandemic. This was currently on hold, but may be restarted.

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 Friday 10^th July 2020.

Please note that all questions will be answered by written reply.

No questions had been received.

RESOLVED that the minutes of the meeting held on 28^th January 2020 be agreed.

To follow

Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites (“Site Chief Executive”) and Debbie Hutchinson, Site Director of Nursing – PRUH and South Sites, provided an update on the King’s College Hospital NHS Foundation Trust.

The Site Chief Executive informed Members that in addition to the PRUH, he was also the lead for Orpington Hospital, Beckenham Beacon and the King’s College Hospital services delivered at Queen Mary’s Hospital – Sidcup.

Reflecting back to late January, early February 2020 the Site Chief Executive noted the harrowing scenes in countries around Europe, of the profound and substantial impact of COVID-19. The approach of King’s College Hospital NHS Foundation Trust in response to the threat of the pandemic was to organise services with a view as to how bad the pandemic could be. There had also been a requirement to be very robust in formalised command actions, which were taken at the highest level of a national incident. It was acknowledged that there had not been a huge amount of permission and communication outside of the organisation.

The Site Chief Executive informed Members that there were around 510 beds at the PRUH, and from the 25^th February 2020 the majority of these beds had rapidly been turned over from their standard use, to be COVID-19 response bed space. COVID-19 patients that had presented at the Emergency Department, had mainly required inpatient admission into acute and general wards, but there was also a number who required higher level care in high-dependency and intensive therapy wards.

Areas of the organisation, and its partners, had needed to change rapidly as part of its response. To increase capacity, other buildings on the campus had been utilised and the day surgery unit, which was on the PRUH site, had been linked by a protective tunnel to allow bedded patients to be transferred across the car park with dignity. A number of services had also been moved out of the PRUH site, to create additional capacity and protect vulnerable patient groups. This had included moving the ophthalmology outpatient’s department to Queen Mary’s Hospital – Sidcup, to allow this space at the PRUH to be used as part of the COVID-19 response. The capacity of the site had also been enhanced for other provision, and additional temporary mortuary capacity had been housed on the PRUH site over the last few months. This was used by the organisation, as well as partners across Bromley.

The Site Chief Executive advised Members that well over 1,200 patients had presented at the PRUH and South Sites and been admitted with defined (not suspected) COVID-19. Sadly, despite all their best efforts, over 240 patients had passed away during the pandemic. King’s College Hospital NHS Foundation Trust had collectively seen more COVID-19 patients than a number of hospitals across the UK, which was largely due to the local demographics of the PRUH and Denmark Hill sites.

The Site Chief Executive stated that he was incredibly proud of all his staff, who had responded beyond  ...  view the full minutes text for item 5.

Dr Angela Bhan, Borough Based Director – South East London Clinical Commissioning Group (SEL CCG) provided an update on the ‘Help Us, Help You’ pilot.

The Borough Based Director – SEL CCG informed Members that 'Help Us, Help You' was the term given to a way of using the NHS 111 service. It was noted that the service had previously been called 'Think 111', and its name was expected to change again. ‘Help Us, Help You’ was a new campaign by NHS England and NHS Improvement, geared around providing same day and emergency care.

As mentioned by the Site Chief Executive – PRUH and South Sites, the PRUH had recently been functioning incredibly well around the 4-hour target and there was an intention to not return to having crowded waiting rooms as this would help to manage patient flow. They were also conscious that a second wave of COVID-19 may occur at the same time as the worst winter pressures, and possibly an outbreak of flu. During this time, they would need to try and protect patients and staff and lower the potential risk of infection.

Attendances at the A&E department and the Urgent Care Centre (UCC), during the pandemic had been 35% lower than at January 2020. However, a gradual increase in attendances was starting to be seen, and there was a need to ensure that the right services were available in the right place, at the right time. The 'Help Us, Help You' campaign encouraged callers to ring 111 to be assessed by a clinician, and then directed to A&E or the UCC by appointment. It was emphasised that this service did not cover those that required help straight away, and they would need to dial 999. The 'Help Us, Help You' service was for people of low risk, assessing the right place for them to get treatment and, for those requiring it, an appointment would be booked at the site they needed to visit. For residents that were shielding, their information would be sent electronically to the UCC or A&E so they were aware if a patient was particularly vulnerable. There was also the potential to be booked to attend the Same Day Emergency Care Unit, which would offer diagnostic tests, and avoid the need to sit and wait in an A&E department. For patients experiencing a mental health crisis, there was also a pathway to improve access to mental health services. The other element of the 'Help Us, Help You' service was to book more patients in directly to appointments with their GP.

The pilot was not yet being run at the PRUH, but several pilots of the service were being run across South East London – Lewisham Hospital, King's College Hospital, Queen Elizabeth Hospital and a standalone treatment centre in Erith. It was noted that the pilots were on going, and it was likely to be an early rollout of what would be implemented. It was stressed that having direct  ...  view the full minutes text for item 6.

The Sub-Committee received a presentation from Adrian Dorney, Associate Director – Oxleas NHS Foundation Trust (“Associate Director”) and Lorraine Regan, Service Director – Oxleas NHS Foundation Trust (“Service Director”) providing an update on the impact of the Coronavirus pandemic.

The Service Director advised Members that the Oxleas NHS Foundation Trust had very much been in ‘command mode’ during the pandemic, and an instant command centre and clinical senate had been established. The governance structure of the Trust had changed, with the executive teams taking part in daily phone calls, and the sending out of bulletins to staff three times a week. The importance of frequent communication with teams had been recognised early on, as staff were understandably anxious.

A PPE hub had been established extremely quickly. The Trust had not been in the position of supplies running out, but there had been a couple of times when stock levels had been low, and mutual aid had been provided by other London hospitals. The implementation of PPE had followed the national guidance, and a steer was given as to how it should be used in mental health settings. It was noted that the PPE experience of mental health staff was quite different – they were not used to working in an environment where PPE was usual, and they had responded remarkably well. The Service Director informed Members that there had been daily monitoring of the workforce, allowing them to have a clear idea of how many staff were off due to COVID-19, and redeployment opportunities were provided to protect vulnerable staff.

The Associate Director informed Members that in terms of community services, work had been undertaken to risk stratify caseloads. This ensured that those service users needing to be were seen face to face, whilst minimising this where possible to protect them. They had also worked to maximise the use of other methods of contact, including telephone and video calls with service users. It was noted that, overall, this had been well received by services users, and the ease of access had reduced the incident of appointment ‘no shows’ during the pandemic.

Essential contacts, either via home visits or within their offices, were carried out adhering to social distancing regulations, and PPE was used in line with the guidance received. As a large number of service users were being seen remotely, fewer were visiting the offices for their appointments, which allowed a safe space to be provided. They had also been able to maintain essential clinics for those service users requiring injections and blood test monitoring. These had been managed by providing service users with timeslots at points when there was the fewest amount of people in the building, allowing them to be seen quickly, and leave.

The Associate Director advised that where possible, partial assessments had been undertaken remotely, doing as much as they were able to so that a backlog of patients did not build up. They were now in a position to just complete the face to face  ...  view the full minutes text for item 7.

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) provided an update on the COVID-19 response by Bromley Healthcare.

The Chief Executive Officer noted that she was lucky to have a fantastic team who, overnight, had risen to the challenge of providing care that they never would have expected. Around 30% of the organisation had been repurposed, with non-essential parts of the service being paused. The skills of these staff members had been looked at, to ensure best fit into a COVID-19 team, and some Care Co-ordination Centre staff had even trained as Health Care Assistants and phlebotomists. The finance team had manned the PPE stock room, and HR staff had been answering calls to the hotline. Executive staff had also been involved, undertaking swabbing and antibody testing. The feedback received from this had been extremely positive, and the cross training had allowed a greater understanding of what other team did – some staff members did not want to return to their roles and would instead retrain in the nursing arena.

The Bromley Community COVID Monitoring Service had been set up in two days and had been established in collaboration with the SEL CCG and GPA. This repurposed community matrons, respiratory nurses, consultant paediatricians and local GPs, who accepted referrals for patients with suspected COVID-19 from the 111 service. They responded within two hours to provide support and daily calls were made to the patient. At the peak of the pandemic, this team was undertaking 100 daily calls, and overall had received 3,000 referrals. The team had also recorded all the clinical information on a daily dashboard, to display what was happening within the service. This provided a safety net, to ensure that patients received their daily calls. Over the last few weeks, the Community Matrons had contacted around 10% of patients that gone through this service to gain feedback – 95% had said they had felt supported, and some lovely comments had been received.

At the beginning of the pandemic, the main concern had been to ensure that all vulnerable patients were able to be seen. There was an increase in hospital discharges, plus a number of new team members, with a range of competencies, following their redeployment into other teams. It was therefore thought to be safer to bring forward the roll out of the Malinko Auto Scheduling Tool. This system allowed the competencies of staff to be matched with the intervention required to be undertaken. It also minimised travel time and ensured that visits happened at the right time. Nurses had been provided with laptops to view GP records during visits, and smartphones to inform patients if they were running late. The aspiration was that by the end of the financial year, patients would be provided with time slots for appointments.

The Single Point of Access (SPA) for discharge had been established with the SEL CCG and Local Authority and was run by repurposed nurses and therapists who looked after patients on a number of  ...  view the full minutes text for item 8.

Mina Kakaiya, Operations Manager – Healthwatch Bromley provided an update to the Sub-Committee regarding their services during the Coronavirus pandemic.

The Operations Manager informed Members that during April, two part time Project Officers had been recruited by Healthwatch Bromley. In line with government guidelines and social distancing measures, the face-to face engagement model for Healthwatch services had been adapted. The core offer of patient engagement during this period had included:

-  Fortnightly online Zoom sessions for the community, individuals, and local groups to share their experiences;

-  Providing a Whatsapp Information and Signposting service to enhance the phone, email and website offer;

-  Regular website news updates (from PHE and NHS England) and a specific COVID-19 information page had been set up;

-  Increased social media platforms to share key messages, provide information and signposting and support local health and care partners in reaching wider audiences;

-  Promoting the patient experience programme; and

-  Promoting the Bromley COVID-19 Volunteer Hub.

Other core service functions had included work being undertaken on the Quarter 4 Monitoring and Patient Experience Report. In total 467 patient experiences had been received, but work had been halted on the 15^th March 2020 due to COVID-19 pandemic. However, the Autism Care Pathway Report 18+ had been completed, and would be published shortly, as had the Healthwatch Bromley Annual Report 2019-2020.

The Enter and View Programme for Quarter 1 had been put on hold, and discussions with commissioners would take place to consider how this would be taken forward in Quarter 2. The research study on domiciliary care had also be put on hold, however a deep dive regarding adult mental health services was planned. In relation to patient experiences, the Operations Manager noted that reviews had been obtained from online platforms including relevant NHS and care home websites. For Quarter 1, 300 views had been captured, however they had not been able to meet their target of 600.

The Executive Assistant for Adult Care and Health asked for more details regarding the number of residents and charities that had engaged in the Zoom sessions. The Operations Manager advised that of the 82 participants, 21 had been residents; 42 were charity representatives; and 19 were Local Authority representatives. It was agreed that the Operations Manager would provide further breakdown of these details to the Executive Assistant for Adult Care and Health following the meeting, and a revised report would be circulated to Members.

The Executive Assistant for Adult Care and Health also asked for clarification of the number of enquiries that were made about lack of access to housing support and housing benefit and how these were taken forward. The Operations Manager advised that this feedback had come out of a Zoom session, referring to two clients with mental health issues and the barriers to accessing the online form and applications. However, more support regarding this had been provided.

The Portfolio Holder for Adult Care and Health noted that it would be helpful to receive further clarification  ...  view the full minutes text for item 9.

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

A Co-opted Member asked if the Sub-Committee would be receiving an update on the Bromley Joint Mental Health and Wellbeing Strategy 2019/20-25. The Chairman noted that this sat with the Adult Care and Health Policy Development and Scrutiny Committee, but she could see no reason why a report of these discussions could not be provided to the Sub-Committee. It was agreed that this would be added to the work programme for 2020/21.

A Member asked when the work programme items marked as ‘to be scheduled’ would be brought to the Sub-Committee. The Chairman said that this would be discussed with partners, and proposals would be brought back at a later date.

RESOLVED that the work programme be noted.

There was no other business.

4.00pm, Wednesday 21^st October 2020

4.00pm, Thursday 14^th January 2021

4.00pm, Tuesday 23^rd March 2021

4.00pm, Wednesday 21^st October 2020

4.00pm, Thursday 14^th January 2021

4.00pm, Tuesday 23^rd March 2021