Agenda and minutes

Venue: Bromley Civic Centre

Contact: Jo Partridge  020 8461 7694

Items
No. Item

13.

APOLOGIES FOR ABSENCE AND NOTIFICATION OF SUBSTITUTE MEMBERS

Minutes:

Apologies for lateness were received from Councillor Simon Jeal and Councillor Thomas Turrell.

 

Apologies for lateness were also received from Councillor Dr Gupta due to a professional obligation.

14.

DECLARATIONS OF INTEREST

Minutes:

Co-opted Member, Vicki Pryde declared that she had undertaken work with both Oxleas NHS Foundation Trust and Bromley, Lewisham and Greenwich Mind.

15.

QUESTIONS FROM COUNCILLORS AND MEMBERS OF THE PUBLIC ATTENDING THE MEETING

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 5th October 2022.

 

Minutes:

No questions had been received.

16.

MINUTES OF THE INFORMAL MEETING OF THE HEALTH SCRUTINY SUB-COMMITTEE HELD ON 5TH JULY 2022 pdf icon PDF 329 KB

Minutes:

RESOLVED that the minutes of the informal meeting held on 5th July 2022 be noted.

17.

UPDATE FROM KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST pdf icon PDF 616 KB

-  General Update (To Follow)

-  Women’s Health Services (Pages 15 - 22)

Additional documents:

Minutes:

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

 

General Update

 

The Site Chief Executive advised that, with regards to elective recovery performance, work was continuing to reduce long waits across all waiting time cohorts in line with the NHS Elective Recover Plan following the backlogs caused by the impact of the COVID-19 pandemic. The London region was the most improved area across the UK – of the five Integrated Care Systems (ICS) in London, South East London was the most improved, and King’s was currently the highest performing of its three Trusts. It was noted that there was still a range of long waiting patients, but King’s was in a good position and continued to progress. Around 13,500 patients were currently waiting for an operation and there were approximately 86,000 patients across the total spectrum, which began from GP referrals. The order book was large, but under control – it grew by around 300 patients per week, which was similar to other Trusts across London. Since February 2022, the PRUH and South Sites had maintained its compliance with the national standard, and less than 1% of patients were waiting more than six weeks for their diagnostic test. The importance of this was highlighted as the quicker the tests were undertaken, the quicker an informed diagnosis could be made, and a treatment plan put in place. It was noted that access for cancer patients had improved – the PRUH performance against the 62-day target was 80% for August, and although below the compliance threshold of 85%, had improved due to the increased speed of diagnostics. For August 2022, 96.2% compliance with the two-week wait standard had been achieved.

 

In response to a question, the Site Chief Executive said that national standard for diagnostic test included endoscopy, but there were different forms of endoscopy referrals. The target for a routine endoscopy to be completed was six weeks from referral, however there was a multitude of pathways. Endoscopies were one of fourteen diagnostic targets – it was noted that the performance against national standards was collective, however information relating specifically to endoscopy performance could be provided to Members following the meeting. The Portfolio Holder for Adult Care and Health said it was positive to see that the six week diagnostics target was being met and enquired if this impacted on the patient pathway for those needing operations. The Site Chief Executive advised that there were around 13,000 patients across the Trust, and 4,000 patients were allocated to the PRUH and South Sites for operative care. These patients underwent a clinical assessment, and their prioritisation was reviewed against the national levels, 1 (most urgent) to 4, on a rolling weekly basis. At any point in time, due to further referrals, they were around 300 patients behind. For patients requiring  ...  view the full minutes text for item 17.

18.

UPDATE ON THE BROMLEY HEALTHCARE CQC ACTION PLAN pdf icon PDF 2 MB

Minutes:

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

 

The Chief Executive Officer informed Members that, around 18 months ago, the organisation had been subject to a CQC inspection, and it was agreed that updates against the improvement plan would be provided to the Sub-Committee on a regular basis. The last regular engagement meeting between Bromley Healthcare and the CQC had taken place in August 2022, and it was considered that positive progress was being made. It was noted that the next engagement meeting was scheduled for the end of November 2022.

 

The Bromley Healthcare Programme Management Office (PMO) system was the central repository for all projects and programmes within the organisation, and provided oversight of every action. 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 assured that the two actions labelled as ‘at risk’ were both on target. In response to a question, the Chief Executive Officer advised that completion percentages were dependent on the programmes themselves – each programme had a number of workstreams, and each action had its own rating.

 

With regards to programmes, the Chief Executive Officer advised that a complete review of the Audit Programme had been undertaken – an Audit Panel was now in place and a number of audits were underway across the organisation. In relation to the Lone Working Programme, there were just two final actions for completion which related to the Standard Operating Procedures (SOP) that were in the process of being updated. The Chief Executive Officer informed Members that, as part of its long-term strategy, Bromley Healthcare had reviewed its values following the pandemic. The strategy would cover the next three-year period, and the engagement process had just commenced. Other programmes included mock inspections led by different services leads, a new app for clinical supervision and a central review dashboard. It was highlighted that a new approach was being taken to record keeping which included spot checks; a planned programme of record keeping; and external assurance provided by KPMG.

 

The Chief Executive Officer noted that a particular area of challenge was recruitment of Health Visitors and District Nurses – to help reduce vacancies, new career pathways had been established in both areas, and the training and development up to Director level was highlighted. Ten newly qualified Band 5 nurses had recently started a bespoke training programme, and a similar scheme would be run in Health Visiting. Members were advised that, in order to utilise capacity, all therapy services had been brought together. By working as one team, the number  ...  view the full minutes text for item 18.

19.

GP ACCESS pdf icon PDF 499 KB

Minutes:

Cheryl Rehal, Associate Director of Primary and Community Care, Bromley – SEL ICS (“Associate Director”) and Dr Andrew Parson, Co-Chair and GP Clinical Lead – One Bromley Local Care Partnership (“GP Clinical Lead”) delivered a presentation outlining the challenges and contribution of General Practice to meeting the health and care needs of Bromley residents. Changes in the way these challenges were met were also highlighted, as well as acknowledging areas for improvement and future intentions.

 

The GP Clinical Lead advised that some of the challenges faced in Bromley included it being the largest, and least densely populated London borough. It had the greatest number of people aged 65 years and older, and residents had a higher life expectancy than the average Londoner. There was also a higher prevalence of complex health conditions compared to neighbouring boroughs in South East London – a greater proportion of people in the borough had long-term conditions, requiring additional care compared to those people with routine and same day needs. This resulted in more GP referrals into secondary care and increased spend on prescribing to support long-term conditions. A Member noted that there was a high prevalence of depression in the borough, compared to neighbouring borough, and enquired if the reasons for this were known. The GP Clinical Lead advised that depression was a condition that increased in prevalence with age, which could account for some of the figure. It was important to note that the data was extracted from GP systems – the data needed to be accurately recorded in order to plan any work to be undertaken. Within PCNs they had developed the role of mental health practitioners to support practices in addressing the needed of patients, the challenge of which had increased since the pandemic. A Member considered that depression could also be related to social circumstances, such as deprivation or loneliness, not just an ageing population.

 

The Associate Director advised Members that there were 43 GP practices across the borough, which formed 8 Primary Care Networks (PCNs) – they worked alongside the GP federation and community pharmacies to provide primary care services to Bromley residents. Practices ranged from small to large in size – some were formed of bigger partnerships of GPs, whilst others were single-handed practices. By collaborating in PCNs, they were able to develop a shared workforce of healthcare professionals, working alongside the GP and practice nurses. As PCNs, general practice was delivering a wider range of clinical care to patients, supporting the out of hospital strategy to better manage acute demand.

 

During the pandemic, GP practices, alongside the wider NHS, had temporarily adjusted how patients accessed its services – since the easing of restrictions, patients could access care in more ways than ever before:

-  GP surgery doors were open for making appointments and seeing clinicians;

-  remote consultations were available, where this suited the patient’s needs; and,

-  online services offered convenience for administrative matters and self-referrals.

 

However, general practice was experiencing continued high demand. This was  ...  view the full minutes text for item 19.

20.

WINTER PLANNING pdf icon PDF 553 KB

Additional documents:

Minutes:

The Assistant Director – Urgent Care, Hospital Discharge and Transfers of Care (“Assistant Director”) provided an update on the proposed One Bromley Winter Plan 2022-23.

 

Members had been provided with a copy of the One Bromley Winter Plan for 2022/23 which described how the system would respond to seasonal pressures, as well as how individual organisations were preparing for winter.  The plan also outlined the financial investment being made from non-recurrent winter monies to support the increase in capacity across the system. Following a request from Members, it was agreed that a glossary of terms would be provided, and is attached at Appendix A.

 

The Bromley Executive Lead – South East London Integrated Care Board (SEL ICB) (“Bromley Executive Lead”) advised that a strong partnership approached had been developed across Bromley in relation to the management of winter pressures. This year they would build on lessons learnt from the COVID-19 pandemic. The Assistant Director highlighted that the 2022/23 winter plan was rigorous and comprehensive, and aimed to deliver on the successful elements of the previous year’s Plan, as well as responding to new emerging needs and system changes. The Plan focused on providing additional capacity to the system at points of expected surges on existing services. The plan was being built on three key pillars:

 

1. Increasing system capacity

- Primary Care

- Admission Avoidance

- Discharge

 

2. Meeting Seasonal Demands

- Respiratory pathways – Adults and Children and Young People

- Christmas and New Year additional capacity

- COVID-19 and Flu vaccination planning

 

3. Information Sharing and escalation

- Winter Intelligence Hub

- System Escalations

- Winter Communications and Engagement

In response to questions, the Associate Director said that staffing issues were the biggest risk, however as a One Bromley system a huge amount of work had been undertaken in relation to recruiting and retaining staff. A range of training and qualification opportunities were available, and this offer was continually being increased. It was emphasised that this risk was being closely monitored, and everything possible was being done across the organisations.

 

With regards to a potential nurses’ strike, the Bromley Executive Lead said that nurses were a key part of the community response, but noted that they were not the only professionals working in this area – patients were supported by a range of staff when they left hospital, such as Health Care Assistants (HCAs) and therapists. If there were additional pressures on the workforce, consideration would need to be given as to how people could be better supported in their own homes. A benefit of the Winter Intelligence Hub was that these issues could be discussed when they were happening, and consideration given as to the alternative ways in which other staff could be used. The Site Chief Executive said that the Royal College of Nursing had balloted its members for consideration of strike action – the ballot opened on 6th October and would run until 2nd November. It was noted that the British Medical Association  ...  view the full minutes text for item 20.

21.

SEL ICS/ICB UPDATE

Minutes:

The Bromley Executive Lead advised that the ICB, a new structure across South East London, was now in place and the second meeting in public would be held the following day. Key areas of focus included:

-  Formulation and delivery of the Annual Plan (including managing elective waiting lists; managing acute pressures; and ensuring an inclusive approach was taken)

-  Development of a strategy for SEL (this was not intended to replace work at a borough level, but would identify areas where value could be added by working across SEL)

-  Winter pressures (significant challenges were expected UK-wide this winter, with flu and increased infections of COVID-19).

 

The One Bromley Partnership would continue to look at the needs of the local population, and these meeting were chaired jointly by the Leader of Bromley Council and the GP Clinical Lead. The Partnership had focussed on improvements to primary care, workforce recruitment and the Winter Plan.

 

The Chairman noted that the excellent system in Bromley was being preserved, whilst further added value was identified.

 

RESOLVED that the update be noted.

22.

HEALTHWATCH BROMLEY - PATIENT ENGAGEMENT REPORT pdf icon PDF 2 MB

Minutes:

Charlotte Bradford, Operations Co-ordinator – Healthwatch Bromley (“Operations Co-ordinator”) provided an update to the Sub-Committee regarding the Healthwatch Bromley Quarter 1 2022-2023 Patient Engagement Report.

 

The Operations Co-ordinator informed Members that 600 reviews had been collated during the Quarter 1 period (April to June 2022). Overall, based on the star ratings received, 71% of responses received from patients had been positive, 5% neutral and 24% had been negative. Dentist, GP and hospital services were the most reviewed services during Quarter 1. The majority of service users found Dentist services to be excellent, and high levels of satisfaction had been recorded across all areas. The negative feedback received was minimal, but related to appointments and staff attitudes. GP practices and hospitals had generally received a good level of satisfaction – again the areas identified for improvement were appointments, communication and waiting times. Other areas that had received positive reviews were pharmacies, COVID-19 vaccination centres and opticians. The Chairman highlighted that patients were dissatisfied in terms of being able to get an appointment, but appeared to be very satisfied once they did so.

 

The Portfolio Holder for Adult Care and Health noted that it was widely publicised in the media that people had difficulties in getting appointments with NHS dentists, and enquired if the data collated differentiated between NHS and private dentists. It was suggested that issues with NHS dental appointments could be discussed at a future meeting of the Sub-Committee. The Operations Co-ordinator said they had recently undertaken a check to ensure that only NHS dentists were listed on the Healthwatch Bromley website for collecting feedback.

 

With regards to information on demographics, it was noted that Healthwatch Bromley were looking to find new ways to engage with individuals – over the last few months they had been trying to reach out to the Gypsy-Roma Traveller community, which they were aware would take some time. The demographics of patients providing responses had changed over the last six months, and they were trying to broaden their engagement to speak to those who may not normally have a voice. 

 

A Member noted that there that been a reduction in the feedback relating to Urgent Care, and questioned if this made it difficult to understand how this area was performing. The Operations Co-ordinator advised that they were a small team with limited resources, and relied heavily on volunteers to help gather feedback – they had ambitions to engage as widely as they could across the borough, but this was limited by capacity. An area of focus had been mental health – this was a sensitive subject matter so there were always areas that needed to be taken into consideration. They had been looking at the overall patient experience programme and how it could be developed in terms of the questions asked. It was hoped that the new forms being used would allow them to collect data that was beneficial to the borough.

 

In response to questions regarding the methodology for collecting data, the Operations Co-ordinator  ...  view the full minutes text for item 22.

23.

WORK PROGRAMME 2022/23 AND MATTERS OUTSTANDING pdf icon PDF 318 KB

Minutes:

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:

 

- GP Access (standing item)

- King’s – patient handover (17th January 2023)

- Winter Planning (17th January 2023)

- Dental appointments (TBC)

- Update from Oxleas NHS Foundation Trust (TBC)

 

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

 

A Member noted that some of the reports presented had been quite lengthy and suggested that presenters could provide an executive summary or highlights slide.

 

RESOLVED that the update be noted.

24.

ANY OTHER BUSINESS

Minutes:

There was no other business.

25.

FUTURE MEETING DATES

4.00pm, Tuesday 17th January 2023

4.00pm, Thursday 20th April 2023

Minutes:

4.00pm, Tuesday 17th January 2023

4.00pm, Thursday 20th April 2023

Appendix A pdf icon PDF 446 KB