Agenda and minutes

Apologies for absence were received from Councillor Tony McPartlan and Charlotte Bradford (Healthwatch Bromley), and Councillor Ruth McGregor and Katie Barratt (Healthwatch Bromley) attended as their respective substitutes. Apologies for absence were also received from Councillor Dr Sunil Gupta.

Apologies for lateness were received from Councillors Thomas Turrell and Alison Stammers.

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 11^th January 2023.

No questions had been received.

The minutes were agreed subject to the following amendments in relation to item 17: Update From King's College Hospital NHS Foundation Trust:

-  the first sentence of the second paragraph being amended to read: “…with regards to elective recovery performance, work was continuing to reduce long waits across all waiting time cohorts...”.

-  the third sentence of the eleventh paragraph being amended to read: “…final plans for the £20m cancer endoscopy unit…”

The Chairman noted that a number of the matters outstanding from previous meetings would be considered during the meeting. Members were advised that it had originally been requested that a representative from the London Ambulance Service (LAS) attend the meeting to provide an update, however due to strike action and heavy demand, this had not been possible. The Chairman highlighted that, as several requests had been made to the LAS asking that they deliver a presentation to the Sub-Committee, he would be writing to formally request attendance at the meeting on 20^th April 2023.

RESOLVED that the minutes of the meeting held on 11^th October 2022 be agreed.

To include an update on the London Ambulance Service (LAS)

To follow

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 noted that, speaking as a subject matter expert through his role as Gold Command rather than LAS representative, he was aware that, across London, the LAS had experienced recent challenges relating to the physical handover of patients to Emergency Departments (ED). Within the South East London region, the PRUH had been particularly challenged. There were six hospital sites across London which were identified as being the most challenged, one of which was the PRUH, and an additional £1m of direct funding had been received before Christmas to implement improvements. This included the improvements relating to the speed of offloading patients brought in by ambulance, and co-ordination and flow. This funding had been used to create a larger handover environment at the PRUH, allowing space for 10 ambulances to offload patients at any point in time – this  was a threefold increase from the previous capacity. The Site Chief Executive emphasised that, despite this being a difficult issue, the interaction with the LAS had been good and they had worked with the PRUH to implement as much improvement as possible.

Members were advised that a wider piece of work, affecting all 23 EDs across London, had also been undertaken to refine procedures for handover. It was noted that handover times at the PRUH had improved rapidly over recent weeks. The two category markers were the number patients which took more than 30 minutes to handover, and the number taking over 60 minutes to handover – these markers were now back down to single digits over a 24-hour period. In response to a question, the Site Chief Executive advised that these handover markers related to the patient being brought into the hospital building, taken off an ambulance trolley and the ambulance crew being available for release. It was noted that the ambulance crew were responsible for indicating to LAS control that they were available for their next 999 call. The Site Chief Executive said the PRUH was able to support the rapid offloading of patients. There was a protocol in place for the immediate release of ambulance vehicles, if required, and they were confident that this could continue to be managed.

In response to questions, the Site Chief Executive advised that a number of changes had been made throughout the hospital, and with partners, in relation to improvements in offloading patients – a larger offloading space had been established but steps had also been taken to create ‘positive flow’. For example, if an inpatient ward had 20 beds, which were full, hospitals had been moving one further patient to the ward approximately 4 hours ahead of another patient being discharged. This was known as ‘plus 1-ing’ and was used to create an earlier flow out of the ED.

The Chairman enquired if there was any guidance for residents in terms of safely parking and  ...  view the full minutes text for item 30.

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 Bromley Healthcare was commissioned by the Integrated Commissioning Board (ICB), to whom they were accountable for their performance. As previously reported, following the CQC inspection that resulted in assurance arrangements being put in place, regular meetings had been held in relation to the progress being made against the action plan, which had been put in place in spring 2022. 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. It was highlighted that, overall, the ICB were very satisfied with the work being undertaken by Bromley Healthcare and positive feedback had been received from the CQC. The ICB felt assured that Bromley Healthcare were doing what was required, and at a sufficient pace.

The Chief Executive Officer informed Members that, since that last meeting of the Health Scrutiny Sub-Committee, regular meetings with commissioners had continued to take place. There was also regular engagement meeting between Bromley Healthcare and the CQC – the last one had taken place in August 2022, and it was considered that positive progress was being made. It was noted that an engagement meeting had been scheduled for the end of November 2022, however this had been stood down and an alternative date was in the process of being arranged.

Areas of focus had included work on clinical governance, and a Chief Medical Officer and two Clinical Directors had now started in post. The Chief Executive Officer advised that there was just one area of the plan which still had actions outstanding, which related to lone working. Work was being finalised to ensure that staff across the organisation had a lone working device, which it was noted had been delayed due to connectivity issues in certain parts of the borough. Another area of continued focus related to record keeping – their Board had been provided with an update on the various workstreams and an external audit was just about to commence. For all of the key workstreams, Bromley Healthcare had tried to include external assurance, provided by KPMG, and the results were anticipated to be received by the end of March 2023. The Chief Executive Officer said that over the last year, Bromley Healthcare had focussed internally, to ensure that they were doing the basics as well as they possibly could. Bromley Healthcare was now looking at its strategy and over the last three months had put a development process in place, working alongside Kaleidoscope Social Enterprise, to engage with partners, patients and staff. These responses were now being consolidated, and incorporated into the new strategy.

With regards to partnership working, Bromley Healthcare had not been directly impacted by the recent strike action. The only union that had been balloted within the organisation was the Royal College of Physiotherapists, and  ...  view the full minutes text for item 31.

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 progress towards improving the experience of accessing primary care services; data on demand and activity in general practice in Bromley; and transformation initiatives in train to improve access in Bromley.

The GP Clinical Lead advised Members that there had been some unexpected challenges faced in primary care, particularly in relation to the increased prevalence of Strep A, a potentially fatal condition which could put children at risk, and scarlet fever. This had an unprecedented effect on demand as it coincided with a high prevalence of other viral respiratory illnesses. There had been a huge demand for medical attention and the prescription of antibiotics had put pressure on pharmacies. In terms of winter pressures, the GP Clinical Lead advised that services had been particularly busy this year and it was noted that strike action could have a knock-on effect to primary care.

With regards to the data on appointments, the GP Clinical Lead informed Members that general practice appointment delivery continued to rise, and was returning to the pattern seen pre-pandemic. It was noted that NHS Digital had recently published ‘experimental’ GP appointments data. It was highlighted that, although it provided a picture, the data did not include all types of appointments, nor did it include related clinical activity. There was still some data quality issues to be resolved, and therefore it did not currently match directly with the practice or ICS data on appointment numbers.

In response to questions, the GP Clinical Lead advised that the graph on page 49 of the main agenda pack showed the number of appointments (rates per 1,000 patients) offered at the 43 GP practices in the borough during October (blue lines) and November 2022 (orange lines). It was noted that a number of practices appeared to have offered more appointments during October, compared to November, which may be due to the data counting extra flu vaccinations clinics that were delivered. The GP Clinical Lead said that the capacity of a practice was constrained by the number of appointments offered – demand generally continued to outstrip capacity everywhere, so it was therefore unusual to have unfilled capacity. The difficulty with the data was that it was how appointments were being coded and work may need to be undertaken with practices in term of how this married up. With regards to small versus large practices, the Associate Director advised that by using the rates per 1,000 patients they had tried to take account to ensure that the size of the practices was not misrepresented. The Member further questioned if there was a data set available to see how quickly patients were being seen. The GP Clinical Lead advised that a data set was being put together by NHS Digital to look at how far in advance patients had booked  ...  view the full minutes text for item 32.

To follow

Report ACH23-007

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.

In relation to how the system had faired over the Christmas and New Year period, 23^rd December 2022–4^th January 2023, there had been 591 more attendances at the PRUH ED, compared to the same period last year, totalling 4,497. However there had been 173 fewer LAS ambulance arrivals (totalling 697), with two peaks occurring on Christmas Eve and the 4^th January 2023, which was not in line with previous years. This was believed to have been impacted by Strep A and a number of viruses circulating, causing the run up to Christmas to be incredibly busy. The Assistant Director noted that the numbers attending, and the acuity of patients, had remained consistent – even though patients were not necessarily travelling to hospital by ambulance, those who were very sick were getting to the hospital to receive the care they needed. There had been sustained pressure over the two-week period however, following the national press coverage prior to the last bank holiday (2^nd, 3^rd and 4^th January 2023), there had been a dip in the number of attendances at the UCC.

The Bromley@Home Service, which supported patients at home and in the community, had mobilised before Christmas – it had experienced high activity and was continuing to grow. There had been 31 more ward admissions at the PRUH, and 24 fewer discharges, compared to previous years – this pattern of high admissions versus low discharges had continued over the whole period. The Assistant Director advised that staffing had been one of the main challenges reported over the Christmas period – this had been due to COVID-19 and viral infections circulating. There had been some issues related to the overspill following industrial action, and staffing within the acute setting had been particularly difficult on some of the strike days.

The Assistant Director considered that the work put into planning for the Christmas and New Year period had been extremely beneficial. There had been an additional 754 GP appointments provided over this period; Bromley Healthcare’s GP out-of-hours service had provided a significant amount of support to the 111 service; Bromley Healthcare’s community response services had made visits to patients, allowing them to stay at home; and the Adult Social Care provision had arranged for guaranteed domiciliary care capacity. The voluntary sector had seen a significant amount of patients over this period, particularly in response to the cost-of-living crisis and ensuring they returned to safe homes. There was enough capacity throughout the discharge services, but the challenge had been to get patients fit and ready to be discharged.

The Chief Executive Officer – Bromley Healthcare said that another key service related to admissions avoidance had been Urgent Community Response – they had a target to see 70% of patients within two hours, in order to keep them out of hospital.  ...  view the full minutes text for item 33.

The Bromley Executive Lead advised that the ICB, a new structure across South East London, was now in place. Key areas of focus included the development of an ICS Strategy – this work had been ongoing, and pulled together the Joint Strategic Needs Assessments (JSNA) from each of the six boroughs. The document identified five priorities:

-  prevention and wellbeing;

-  ensuring there was a good start for all children;

-  provide the best services for children and young people with mental health needs;

-  provide the best services for adults with serious mental health needs; and,

-  primary care and looking after people with long-term conditions.

Members were advised that the ICB had been provided with planning guidance from the NHS, advising areas to be worked on over the next couple of years. This provided a number of targets, which indicated a return to business as usual, recognising that the NHS was now in a different place. For example, the A&E waiting times target had previously been for 95% of patients to wait no longer than 4 hours to be discharged/admitted, which had now been reduced to 76%. There were also targets for the ambulance service to improve on its response times; community services to see a percentage of patients within 2 hours; reducing unnecessary GP appointments (streamlining access/increasing the number of additional roles); and reducing elective waiting lists (increase access to diagnostic services).

With regards to the workforce, the Bromley Executive Lead noted that there were a number of recruitment and retention schemes in place, both nationally and locally for all staff, and there were requirements to enhance these arrangements. It was highlighted that there was also a need to consider the services provided for people with a learning disability, and to reduce inequalities across the board.

Members were advised that the responsibility for commissioning community pharmacies, dentists and optometrists would return to the ICB from April 2023.

RESOLVED that the update be noted.

The Sub-Committee received the Quarter 2 Patient Experience Report for Healthwatch Bromley, covering the period from July – September 2022. Healthwatch was created by the Health and Social Care Act 2012 to understand the needs, experiences and concerns of people who use health and social care services and to speak out on their behalf. Healthwatch Bromley had a duty to gather and publish the views of patients and service users in the borough. To fulfil this duty, a comprehensive patient experience data collection programme was operated. Annually this yielded approximately 2,400 patient experiences.

It was agreed that Members of the Health Scrutiny Sub-Committee could email any questions to the clerk would collate them and provide to the Operations Co-Ordinator – Healthwatch Bromley for response following the meeting.

RESOLVED that the update be noted.

The Chairman advised that an informal virtual meeting of the South East London Joint Health Overview and Scrutiny Committee had been held on 1^st December 2022, attended by representative from the six boroughs. The next meeting was scheduled for 19^th January 2023, feedback from which would be provided to Members of the Sub-Committee at the April meeting.

RESOLVED that the update be noted.

Report CSD23002

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:

- Update from the London Ambulance Service (20^th April 2023)

- King’s – CQC Inspection of Maternity Services (20^th April 2023)

It was noted that a further item had been added to the work programme regarding an update on the review of joint working arrangements between Oxleas NHS Foundation Trust and the London Borough of Bromley. 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.

Members were provided with the proposed Health Scrutiny Sub-Committee meeting dates for the 2023-24 municipal year.

Following a brief discussion, it was agreed that the clerk would email the list of proposed dates. Members of the Health Scrutiny Sub-Committee and health partners would be asked to provide feedback if any of these proposed dates cause a particular problem, and a different start time to 4.00pm would be preferred (either 1.30pm or 7.00pm).

RESOLVED that the update be noted.

4.00pm, Thursday 20^th April 2023

4.00pm, Thursday 20^th April 2023