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 Charlotte Bradford – Healthwatch Bromley and Julia Eke – Healthwatch Bromley attended as substitute.

Apologies for absence were also received from Councillor Thomas Turrell and Roger Chant.

Apologies for lateness were received from Councillor Dr Sunil Gupta, Councillor Simon Jeal and Jonathan Lofthouse (Site Chief Executive – PRUH and South Sites: King’s College Hospital NHS Foundation Trust).

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 29^th June 2022.

No questions had been received.

RESOLVED that the minutes of the meeting held on 7^th October 2021 be agreed.

This item was moved for consideration later in the agenda to await the arrival of the King’s College Hospital NHS Trust representatives. In the event, because of an urgent matter, the representatives were not able to join the virtual meeting and therefore the Chairman advised that this item, including the update on scrutiny of maternity services, would be deferred to the next meeting of the Health Scrutiny Sub-Committee. It was requested that King’s College Hospital NHS Foundation Trust provide a short report to Members, particularly in relation to recovery and performance of the Princess Royal University Hospital (PRUH).

A Member noted the reference made at the last meeting to several of the wards at the PRUH being classed as ‘dementia friendly’ and asked for an update as to whether this was now the case for all wards.

The Chairman informed Members that Charles Alexander had been appointed as the new Joint Chairman for Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts, and would take up the role from December 2022. It was suggested that a letter be sent on behalf of the Health Scrutiny Sub-Committee to welcome Mr Alexander into the role.

To follow

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) provided an update on the Bromley Healthcare CQC Action Plan.

The LBB Assistant Director for Integrated Commissioning advised that commissioner assurance arrangements had been presented to Members of the Adult Care and Health and Children, Education and Families Policy Development and Scrutiny Committees in March 2022, following a Care Quality Commission (CQC) inspection which had rated Bromley Healthcare overall as ‘Requiring Improvement’. The Integrated Commissioning Board had oversight of the assurance arrangements and were supporting Bromley Healthcare with their improvements. It was noted that Bromley Healthcare’s services were commissioned by a number of other Local Authorities, and that these authorities were taking part in the assurance arrangements. Meetings were held bi-monthly to receive updates in relation to the assurance arrangements. It was highlighted that, to date, the Integrated Commissioning Board were satisfied with the work being undertaken by Bromley Healthcare.

The Chief Executive Officer advised that Bromley Healthcare had regular engagement meetings with the CQC. The last meeting was held on 5^th April 2022, during which Bromley Healthcare had provided an update on the work being undertaken and the CQC had been content with the progress being made. It was noted that the second engagement meeting, scheduled to take place that week, had been postponed until 24^th August 2022.

The Chief Executive Officer advised that three Divisions had been established – Adults, Children and Young People and Urgent Community Response. Within each Division, the Divisional Directors were accountable for delivering performance targets, whilst the triumvirate of the Divisional Directors, Clinical Directors and Head of Nursing / Head of AHP were responsible for Divisional Governance. A cycle of assurance meetings had been established and the Executive Oversight Committee provided an opportunity for deep dives to be undertaken into areas for further review. In terms of recruitment, applicants for the Medical Director post had been shortlisted, and interviews would take place the following week.

The Bromley Healthcare Programme Management Office (PMO) system was the central repository for all projects and programmes within the organisation. All CQC related projects were identified within the tool – internally, these were  monitored weekly, and monthly via the CQC Sub-Committee. Progress at a programme, project and task level was visible and transparent, along with all project risks and issues. The tool worked on a linear basis, tracking percentage completion against target deadlines at a task level – any tasks potentially at risk were flagged early so that remedial action could be taken if required. Members were advised that an area currently not on track was around the reporting to the CQC – as Bromley Healthcare was a social enterprise it had a different reporting mechanism to that used by NHS Trusts. This had been raised at a meeting with the CQC and was included on Bromley Healthcare’s risk register – guidance was currently awaited from the CQC. It was highlighted that all other tasks were currently on track in terms of progress.

In response  ...  view the full minutes text for item 6.

Report CSD22088

The Senior Commissioning Manager – Urgent & Emergency Care, SEL CCG (Bromley) (“Senior Commissioning Manager”) provided an update on the One Bromley review of winter 2021-22, including recommendations for the Urgent and Emergency Care Transformation workstreams and winter 2022-23 planning. A summary of the review of winter 2021/22 and planning for next winter 2022/23 was presented and is attached at Appendix A.

The Senior Commissioning Manager advised that during winter 2021/22, the system had been under considerable pressure, managing a fourth wave of COVID-19 alongside the usual seasonal pressures having a significant impact on the workforce as well as demand for services. The whole system had continued to run at full capacity for the whole of the winter period. The Better Care Fund (BCF) winter funding provided to the London Borough of Bromley (LBB) £1,069,000 and SEL CCG (Bromley) £669,000 was used to support the system to respond to winter demands across the five key pillars of the 2021/22 Winter Plan. These were:

1.  Increasing system capacity

2.   Data sharing and escalation

3.  Single Point of Access and discharge arrangements

4.  Admissions avoidance 

5.  Communication and engagement

Members were advised that 75% (£808,520) of the Local Authority budget was used to fund additional workforce capacity and Extra Care Housing step down flats all year round, whilst 25% of this budget was utilised to provide:

-  additional therapy and brokerage capacity;

-  7-day working and social admission avoidance resource;

-  mitigate increased financial impact due to the need to undertake increased number of post discharge assessments within 4-weeks national discharge arrangements; and,

-  project management to respond and manage the seasonal pressures.

In response to a question, the Senior Commissioning Manager advised that the Extra Care Housing step down flats were included as they were funded through the BCF winter schemes, however they were provided all year round. The LBB Assistant Director for Integrated Commissioning confirmed that it was normal practice for the funding to be spent in this way.

The SEL CCG (Bromley) funds were allocated in line with what worked and learning from previous years. This included:

-  increasing primary care capacity through additional primary care access hubs appointment slot for Bromley patients;

-  utilising additional NHS England/Improvement funding to set up GP Virtual Assessment Hubs (VAHs) to support with 111 demand and COVID-19 calls – this reduced inappropriate referrals to the urgent treatment centres with, on average, 8.5 patients per day redirected into their own practice or GP Hub appointments, rather than having to attend an urgent treatment centre;

-  additional capacity in admission avoidance teams including Rapid Response (RR) and Rapid Access Therapies Team (RATT);

-  additional palliative care support in care homes;

-  additional clinical capacity across primary care, GP out of hours service and urgent treatment centres during the festive period; and,

-  allocation to support a winter communications and engagement campaigns aimed at both the public and the workforce.

Members noted that proactive public engagement would be key to the success of the  ...  view the full minutes text for item 7.

To follow

The Place Based Director advised that the South East London Integrated Care Board (SEL ICB) was established on 1^st July 2022, and had held its first meeting in public that day to agree governance arrangements, including the overall structure, policies and procedures. There had also been discussions regarding the operating plan and a presentation had been received on children and young people’s mental health services, and the work to be undertaken across the system to increase capacity.

The One Bromley Local Care Partnership had met earlier that day, and it was agreed that a copy of the draft Terms of Reference could be circulated to Members of the Sub-Committee following the meeting. It was noted that the draft Terms of Reference would be reviewed in six months’ time to ensure that they were “fit for purpose”. The Place Based Director advised that a deep dive approach to reporting had been agreed and a system for sharing consolidated financial and performance information would be developed.

The Chairman requested that an update on the SEL ICS/ICB  be added as a standing item for future meetings of the Health Scrutiny Sub-Committee.

RESOLVED that the update be noted.

Julia Eke, Project Officer – Healthwatch Bromley (“Project Officer”) provided an update to the Sub-Committee regarding the Healthwatch Bromley Quarter 4 2021-2022 Patient Engagement Report.

The Project Officer informed Members that over 602 reviews had been collated during the Quarter 4 period (January to March 2022). It was noted that during this period 602 reviews were collected. Overall, based on the star ratings received, 68% of responses received from patients had been positive, 4% neutral and 28% had been negative.

GP services were the most reviewed service during Quarter 4, with positive feedback received covering themes such as staff attitudes and high standards of professionalism from reception staff, nurses and GPs. The areas highlighted for improvement related to administration and booking appointments. With regards to hospital services, a high percentage of the positive reviews had related to appointments and cleanliness, hygiene and infection control. The negative reviews received had related to food and nutrition, however the reasons for this needed to be looked into further. Another area which received a high percentage of positive reviews was dentistry. A Member noted that negative reviews of hospital food and nutrition may relate to portion sizes, or that when feeling unwell, patients may not want to eat the food on offer.

One of the areas highlighted as an issue by patients related to the length of GP appointments and the requirement to only present one symptom, which meant that they were not receiving an overall review of their health.

It was agreed that questions would be collated and provided to the Operations Co-Ordinator – Healthwatch Bromley for response following the meeting.

RESOLVED that the update be noted.

Report CSD22086

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

As suggested during the meeting, the following items would be added to the work programme:

-  ICB/ICS Update (standing item)

-  King’s – scrutiny of maternity services (11^th October 2022)

-  GP Access (11^th October 2022)

-  Winter Planning (11^th October 2022)

-  Update from the London Ambulance Service (17^th January 2023)

In response to questions, the Chairman noted that any updates on the immunisation programme and the performance of preventative services would be provided to the Health and Wellbeing Board, and could be shared with Members of the Health Scrutiny Sub-Committee.

In response to a question regarding the update on Children and Young People’s – SEND, Members were advised that this was likely to be led by the Children, Education and Families Portfolio and would need to be presented to the Children, Education and Families Policy Development and Scrutiny Committee before being reported to the Health Scrutiny Sub-Committee.

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

RESOLVED that the update be noted.

Following a brief discussion it was agreed that the October 2022 meeting of the Health Scrutiny Sub-Committee would be held at 4.00pm, as agreed by the General Purposes and Licensing Committee and endorsed by Full Council. It was proposed that during the October meeting, the timings for the remaining meetings of the 2022-23 municipal year could then be reviewed. 

RESOLVED that the issues raised be noted.

4.00pm, Tuesday 11^th October 2022

4.00pm, Tuesday 17^th January 2023

4.00pm, Thursday 20^th April 2023

4.00pm, Tuesday 11^th October 2022

4.00pm, Tuesday 17^th January 2023

4.00pm, Thursday 20^th April 2023