Agenda and minutes

Contact: Jo Partridge  020 8461 7694

Items
No. Item

1.

APOLOGIES

Minutes:

The Chairman welcomed Members to the informal meeting of the Health Scrutiny Sub-Committee, which was held virtually via Webex.

 

Apologies for absence were received from Councillor Aisha Cuthbert and Marzena Zoladz – Healthwatch Bromley, and Councillor Keith Onslow and Jaime Walsh – Healthwatch Bromley attended as their respective substitutes.

2.

PRESENTATION BY THE CHARTWELL CANCER TRUST

A copy of The Chartwell Cancer Trust’s current brochure can be accessed via the following link:

https://chartwellcancertrust.co.uk/wp-content/uploads/2020/12/CCT-PORTRAIT-A4-Charity-Brochure-Oct-2020-PRINT.pdf

Minutes:

This item was deferred to a future meeting of the Health Scrutiny Sub-Committee.

3.

UPDATE FROM THE SEL CCG

Minutes:

Councillor David Jefferys declared an interest in item 3b due to his role as Chairman of the Association of British Pharmaceutical Industry’s Multimorbidity Action Group, which was working on Long Covid with the National Institute for Health Research.

 

Dr Angela Bhan, Bromley Borough Director – South East London Clinical Commissioning Group (SEL CCG) (“Bromley Borough Director”) informed Members that the presentations (on GP access, Long Covid and vaccinations) provided an overview of how the Bromley team, and wider SEL CCG, had worked to meet the needs that had arisen as a result of the pandemic. It was noted that a large increase in the number of COVID-19 cases was being seen – the number of hospital admissions had also increased, with more than 20 beds currently being occupied by patients with COVID-19 infections, however none of these patients were in intensive care.

3a

GP ACCESS pdf icon PDF 2 MB

Minutes:

Cheryl Rehal, Acting Head of Primary Care, Bromley – SEL CCG (“Acting Head of Primary Care”) provided an update on GP access in Bromley.

 

The Acting Head of Primary Care informed Members that there were 43 GP practices across Bromley (one virtual), which sat within one of the eight Primary Care Networks (PCNs). GP access prior to the pandemic had predominately been via face to face appointments (69%) due to other technology not necessarily being available. It was noted that other providers had come into the marketplace offering video consultations and promoting themselves as being highly convenient and accessible for working age adults. This had effectively “cherry picked” patients that were relatively healthy and left GP practices with the most complex and time-intensive patients, which was de-stabilising to General Practice. This had helped to drive change, and an aim of the NHS Long Term Plan was for every patient in England to have the option to access online and video consultations by 2021.

 

In spring 2020, GP practices had been required to rapidly switch to virtual consultations to protect both patients and staff due to the risks posed by the COVID-19 pandemic. Face to face appointments had been paused wherever possible and GP practices were instead required to operate ‘total triage’, assessing all patients remotely and restricting entry to surgeries for essential in-person care only. Moving through the pandemic, during summer and winter 2020, the focus had been on the restoration of services. Face to face care had been increased – patients were encouraged to seek help for ailments in a timely manner and contact their GP practice for overdue care and screening services. GPs had reported difficulties in reassuring anxious patients that it was safe to visit their surgery, with reluctance being particularly high amongst those who had been shielding and other more vulnerable patients. From spring 2021, General Practice had been “open for business”. The COVID-19 vaccination programme was the main drive and where most of the face to face care had been provided – as the majority of the adult population had now been vaccinated, there would be a multitude of delivery modes by which patients could access clinics. GP surgeries were now expected to permit visits to surgery receptions, and a lower threshold of in-person consultations, where safe to do so.

 

The Acting Head of Primary Care advised that the most recent data regarding GP access was currently on a South East London (SEL) level, however work was being undertaken to extract data directly from GP surgeries to view at a Bromley level. This included:

-  The total appointments in General Practice had risen - across SEL nearly 750,000 appointments were offered in March 2021 compared with 664,000 in March 2020;

-  Patients were receiving an appointment sooner - there were 440,000 same day/next day appointments in March 2021 across SEL (60% of total), compared to 350,000 in November 2019;

-  Face to face appointments had risen since the original lockdown - in March 2021t, 42%  ...  view the full minutes text for item 3a

3b

LONG COVID pdf icon PDF 611 KB

Minutes:

Mark Cheung, One Bromley Programme Director – SEL CCG (“One Bromley Programme Director”) provided an update on the development of Long Covid services in Bromley.

 

The One Bromley Programme Director advised that the recovery time for patients that suffered from Long Covid was extremely varied. Although most patients would make a recovery within 12 weeks, sometimes symptoms could last much longer. It was highlighted that the chance of having long-term symptoms was not related to how unwell a patient had been, and Long Covid could also affected those who had been asymptomatic. The National Institute for Health and Care Excellence (NICE) guidelines defined Long Covid as “signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis”. It was noted that the CCG were also looking at how to support patients still suffering 4 weeks after the onset of symptoms.

 

The range of symptoms was extremely varied and included:

-  extreme tiredness (fatigue);

-  shortness of breath;

-  chest pain or tightness;

-  problems with memory and concentration ("brain fog");

-  difficulty sleeping (insomnia);

-  heart palpitations;

-  dizziness;

-  pins and needles;

-  joint pain;

-  depression and anxiety;

-  tinnitus, earaches;

-  feeling sick, diarrhoea, stomach aches, loss of appetite;

-  a high temperature, cough, headaches, sore throat, changes to sense of smell or taste; and

-  rashes.

 

The One Bromley Programme Director informed Members that symptoms could be experienced individually or in clusters; could overlap; and could change over time to affect different parts and systems of the body. It was highlighted that learning was still being taken from this, but some studies estimated that around 10% of patients could suffer from Long Covid. As the illness was multifaceted, so were the treatments. This would involve a number of specialties including respiratory; cardiology; neurology services; and several therapies. The One Bromley Programme Director highlighted that one symptom of Long Covid was depression and anxiety which required support from colleagues in Mental Health services. It was essential to have an integrated approach to addressing the support provided to patients via the One Bromley partnership.

 

The One Bromley Programme Director advised that a post-COVID pathway was being developed in line with recent national guidance, and in conjunction with the other SEL boroughs to ensure there was a consistent offer. The pathway had four different elements, and patients could go back and forth to whichever was the most appropriate:

-  GP / primary care (patient identification, assessment and investigation);

-  self-management;

-  community services; and

-  acute services (specialist input, hospital services).

 

In GP support / primary care, resources and funding were already in place to support identification and assessment of patients, and a referral form and protocols had been developed. The One Bromley Programme Director noted that a condition stipulated was that face to face appointments were required in order to make a comprehensive assessment. With regards to acute services,  ...  view the full minutes text for item 3b

3c

VACCINATION UPDATE (VERBAL UPDATE)

Minutes:

Dr Angela Bhan, Bromley Borough Director – South East London Clinical Commissioning Group (SEL CCG) informed Members that Bromley, as a whole, was doing extremely well in terms of COVID-19 vaccination uptake. In the 80+ year old cohort uptake stood at over 95% and other age groups were at around 90%. Every care home had been offered vaccinations for residents and staff on several occasions and, following joint efforts, staff uptake had now increased to over 80%. The younger age cohorts (18+) were now being vaccinated – across SEL, 1.2m doses had been administered, 700,000 of which had been in Bromley.

 

The Bromley Borough Director advised that work was being undertaken to improve the difference in uptake between ethnic groups – the reduction in inequality was only between 2-3% but was heading in the right direction. There had also been door to door delivery of postcards with information on the COVID-19 vaccination programme; vaccination passes had been provided to the homeless and those in emergency accommodation; and information pods were located in The Glades Shopping Centre and Lidl – Burnt Ash Lane. In areas of low uptake, such as Mottingham, Penge, Crystal Palace and Plaistow, Local Authority colleagues had been knocking on doors, and this would now be extended to the Crays and Bromley Common. A satellite clinic was also held regularly at the Keston Mosque.

 

Work was now underway to look at the delivery of the booster vaccination, which would take place over a 15-week period, from 6th September 2021 to Christmas. A COVID-19 booster vaccination would be provided to the over 50’s alongside the flu vaccination. The first stage of the programme would be for those aged over 70 years; those living in older people’s care homes; those over 60 years who were immunosuppressed; and frontline health and social care workers. The second stage was for anyone aged over 50 years; those within the ‘at risk’ groups; and household contacts of those who were immunosuppressed. During this period they would also continue to offer first doses of the vaccine to all those that wanted it, and second doses for the younger cohorts.

 

The Bromley Borough Director said that there would be a range of options available for delivery of both the COVID-19 booster and flu vaccinations – through GP surgeries, pharmacies and Mass Vaccination Centres. In Bromley, GP’s had been asked to deliver between 40-75% of the total vaccination activity, and it was highlighted that there would be a need to ensure that this did not impact on access to General Practice.

 

The Chairman thanked the Bromley Borough Director, Acting Head of Primary Care and One Bromley Programme Director for their presentations to the Sub-Committee.

4.

UPDATE FROM KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST pdf icon PDF 188 KB

Minutes:

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

 

The Site Chief Executive informed Members that as of that afternoon, there were 22 patients across the PRUH and South Sites with a confirmed inpatient diagnosis of COVID-19. It was highlighted that there had been a 70% growth in the number of inpatients in the last 30 days. In terms of the age range and ethnicity of patients, there did not appear to be any trends, and it was noted that from the following week far more intelligent COVID-19 data and statistics could be shared with health colleagues across the area.

 

With regards to staff vaccinations, these sat at between 80-83% and, as mentioned previously, healthcare workers would be included in the COVID-19 vaccination booster programme from 6th September 2021. In response to a question, the Site Chief Executive said that the vaccination data provided related to the global number – all staff across the Trust and any sub-contracted staff. When looking at individual professional groups the percentage of uptake was higher. The broad percentage was 80%, but some were as high as 90%, and a breakdown could be provided to Members following the meeting. It was noted that during the COVID-19 vaccination booster programme a further marketing campaign would be undertaken aimed at those staff that were still resistant to come forward.

 

The Site Chief Executive advised that in terms of the recovery of elective surgeries that had been delayed due to the pandemic, the Trust was currently performing over 96% of these as ‘business as usual’. As per national requirements, the Trust would receive funding for anything over 85% – for the first three months of the year the Trust had secured an additional income level of around £12m. Members were further advised that the Trust were hoping to submit a planning application to the Local Authority within the next 8 weeks for the new Endoscopy unit.

 

In response to questions from the Chairman, the Site Chief Executive said that some patients had been waiting a very long time for surgery and treatments – some over a year. However, it was highlighted that this cohort of patients had been clinically prioritised and those with the highest level of priority were receiving treatment in a timely manner. With regards to cancer treatment, the Site Chief Executive noted that the PRUH and South Sites were now performing to the national standard across the majority of cancer markers, including 14 days for referral and 62 days for treatment. The two areas of exception were related to specific drug referral and 28-day fast test. It was agreed that statistics on waiting times and cancer treatment could be circulated to Members following the meeting.

 

On behalf of the Sub-Committee, the Chairman thanked the Site Chief Executive for attending the meeting and providing an update.

5.

UPDATE FROM BROMLEY HEALTHCARE

To follow

Minutes:

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) provided an update on the work being undertaken by the organisation. A copy of the presentation is attached to the minutes at Appendix A.

 

Over the last year, Bromley Healthcare had carried out over 600,000 patient interventions, both virtual and face to face. During the first wave of the pandemic a number of services had been paused or changed, but during the second wave all services had continued. Over 500 laptops had been issued to staff to enable remote working and virtual consultations.

 

The Chief Executive Officer advised Members that COVID-19 related workforce absences had increased in line with local population increases. As at the 12th July 2021, there were 20 staff absences related to COVID-19: 10 staff were self-isolating; 4 staff had recorded a positive COVID-19 test; and 6 staff were suffering from the effects of Long Covid. There were also around 30 staff who had been risk assessed and were required to work from home. 90% of all staff had received at least one COVID-19 vaccination, however this was lower for BAME staff at 78% and they were continuing to work with the staff groups that had the lowest uptake.

 

The Bromley Community COVID Monitoring Service (BCMS) provided a 2-hour response to any patients that were COVID-19 positive. Over the last 7 days there had been 25 referrals into the service, which was an increase from 15 in the previous week. The current case load was 8 patients, which was significantly lower than at the peak of the pandemic when there were 200 patients at any one time.

 

The Chief Executive Officer advised that there were four key quality improvement objectives for 2021/22, as stated in the Bromley Health Care Quality Account:

-  Objective 1: Reduction of avoidable acquired pressure ulcers – this was the highest level of reported incidents across the organisation, for which a working group had been established.

-  Objective 2: Reduce the number of patients who fall whilst under our care and ensure the appropriate interventions have been completed – the majority of falls happened in people’s homes and were therefore unwitnessed and a working group had also been established.

-  Objective 3: To Improve the standard of clinical record keeping – the organisation’s most recent record keeping audit had marked them in the high 80% but they wanted to improve this further, and a standard had been introduced for all records to be updated within 48 hours.

-  Objective 4: Reduce the number of Medicines incidents causing harm.

 

The Chief Executive Officer highlighted that quality underpinned everything that the organisation undertook and there were a number of areas in which it was monitored:

-  Workforce development – a large proportion of the workforce was extremely tired, as they had been working throughout the duration of the pandemic, and Bromley Healthcare were providing them with support. There was also a focus on career pathways and progression, provision of leadership training and  ...  view the full minutes text for item 5.

6.

UPDATE FROM HEALTHWATCH BROMLEY pdf icon PDF 2 MB

Minutes:

Jaime Walsh, Director of Operations for Healthwatch and Engagement Services – Your Voice in Health and Social Care (“Director of Operations”) provided an update to the Sub-Committee regarding the Healthwatch Bromley Quarter 4 Patient Engagement Report.

 

The Director of Operations informed Members that over 600 reviews had been collated during the Quarter 4 period (January to March 2021). On each occasion, patients gave an overall star rating (1-star to 5-star) and provided free text comments. It was noted that due to the pandemic the feedback for this quarter had been collected through online review platforms, telephone engagement, and direct feedback could also be left via the Healthwatch Bromley website. It was highlighted that the majority of review were 4- or 5-star rated, with 78% of the feedback received being positive. There was a much lower number of negative reviews overall which was a theme that continued to be seen in Bromley, however there had been an increase in 1-star ratings. This was a trend seen since the introduction of online and virtual platforms during the pandemic and this would be monitored once they return to face to face engagement.

 

During Quarter 4, a number of comments had continued to be received relating to GP and dental services. With regards to the distribution of positive, negative and neutral feedback, GP surgery services had a larger ratio of negative feedback. This was also seen across other Healthwatch areas and was reflective of some of the challenges and issues discussed earlier in the meeting. The Director of Operations highlighted that Children and Young People – SEND services had received a large proportion of negative reviews. Members noted that it was a concern to see that only 2 out of 36 reviews received for this service had been positive and suggested that this be referred to the Chairman of the Children, Education and Families Policy Development and Scrutiny Committee.

 

A Member enquired if anything could be done to encourage more younger people to provide feedback on services. The Director of Operations said that during Quarter 4 there had been gaps in the overall monitoring data as a percentage had been gathered from online review platforms and therefore they had not been able to collate all the demographic data. It was considered that this could be looked at over the whole year, and the analysis fed into plans for the current year.

 

The Chairman thanked Jaime Walsh, Director of Operations for Healthwatch and Engagement Services – Your Voice in Health and Social Care for her update to the Sub-Committee.

7.

JOINT HEALTH SCRUTINY COMMITTEE VERBAL UPDATE

Minutes:

Councillor Judi Ellis, Chairman – Our Healthier South East London Joint Health Overview and Scrutiny Committee provided an update from the meeting on 30th June 2021.

 

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 Integrated Care Services, vaccinations and the recovery of elective surgery across South East London.

 

With regards to Integrated Care Services, Members had been reassured that the opportunity to scrutinise services, both across London and within individual boroughs, would remain the same. It was noted that Guy’s and St Thomas’ NHS Foundation Trust were piloting hybrid care – this would provide the opportunity of choice for patients, but that care would be led by clinical necessity.

 

Discussions had taken place on the progress of the vaccination programmes and the work undertaken regarding pop-up clinics across South East London, as well as how negative reactions to the vaccine and Long Covid were being dealt with.

 

In relation to the recovery of elective surgeries, Members had been provided with information on the pathways and reallocation of beds following the pandemic. Across SEL, there were 138 patients that had been waiting over one year for operation. These patients were being clinically assessed and brought forward as quickly as possible, with the aim to revert back to an 18-week waiting time. It was highlighted that some of these patients had chosen not to have their operations during the pandemic.

 

The Chairman – Our Healthier South East London Joint Health Overview and Scrutiny Committee said the meeting had provided the opportunity to look at Bromley in the light of other boroughs. Bromley was performing very well, and thanks were extended to the commissioners and leadership within the borough.

 

RESOLVED that the update be noted.

8.

WORK PROGRAMME 2021/22 AND MATTERS OUTSTANDING pdf icon PDF 307 KB

Minutes:

The Chairman informed Members that a request had been received from the SEL CCG to provide an update on Winter Planning at the October 2021 meeting of the Sub-Committee.

 

The Chairman requested that verbal updates also be presented on GP access, Long Covid and vaccinations. It was considered that Members could provide greater value by feeding back the views they received from constituents, in a structured format which focussed on key themes, and developing further communications with the SEL CCG.

 

Members were asked to notify the Clerk if there were any further items that they would like added to the work programme.

9.

FUTURE MEETING DATES

4.00pm, Thursday 7th October 2021

4.00pm, Thursday 13th January 2022

4.00pm, Wednesday 20th April 2022

Minutes:

4.00pm, Thursday 7th October 2021

4.00pm, Thursday 13th January 2022

4.00pm, Wednesday 20th April 2022

Appendix A pdf icon PDF 2 MB