Agenda and minutes

Apologies for absence were received from Councillor Mark Brock and Councillor Aisha Cuthbert attended as substitute.

Apologies for absence were also received from Councillor Dr Sunil Gupta and Roger Chant.

Apologies for lateness were received from Councillor Thomas Turrell.

Co-opted Member, Vicki Pryde declared that she had undertaken work for Oxleas NHS Foundation Trust.

Councillor Stammers declared that she was Chair of the Patient Participation Group (PPG) for The Chislehurst Partnership.

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 14^th April 2023.

No questions had been received.

RESOLVED that the minutes of the meeting held on 17^th January 2023 be agreed.

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 on GP access.

With regards to the demand and capacity for appointments, the Associate Director highlighted that, as requested, data had been provided in relation to how long patients were waiting for appointments. This data, which was subject to quality improvements, indicated that the majority of appointments were within 1-14 days. There was a small percentage (10-15%) of appointments that passed this point – however this was expected as there would be patients that required routine care or follow up appointments, and would continue to be actively monitored. It was noted that there were data quality issues as practices recorded their data in different ways – national guidance had recently been issued in terms of coding, and it was anticipated that locally, and across the country, a standardised mechanism would be used for consistency and like-for-like comparison. A Member said that the challenges were acknowledged, but not as much granular data had been provided as hoped for – it was questioned if GP practices were performing well and if patients were getting appointments when they wanted them. The GP Clinical Lead said that the ask of GP practices was to respond to patients at the first request; offer patients an appointment within 2 weeks; or, where appropriate, see them on the same day. Some of these requests were based on ‘perceived need’, as opposed to ‘perceived want’. The Associate Director advised that, at the next meeting, they could provide data broken down into smaller periods of time. They could not provide data in terms of what a patient wanted, but the national GP patient survey data could provide a sense of whether patients were happy with the timing of the appointment offered. In response to a further question, the GP Clinical Lead noted there would be a limit to what could be demonstrated in terms of meeting accessible choice. The ‘Did Not Attend’ (DNA) deep dive indicated that most of these people were working age adults, and consideration may need to be given as to what options were available for appointments. In terms of more than 15 days, the GP Clinical Lead highlighted that patients had to be allowed to book appointments further ahead and some patients would require follow-up appointments. The Portfolio Holder for Adult Care and Health noted, that in terms of patients getting the appointment that they wanted, the expertise of the practice manager and clinicians needed to be taken into account to prioritise those with the most urgent needs.

The Associate Director informed Members that DNA rates had been published in February 2023 by NHS Digital, which was the first set of data available in recent months. Again, there were limitations in terms of data quality, but this was something that was expected to improve. In Bromley, the percentage of  ...  view the full minutes text for item 44.

To Follow

The Chairman welcomed Christine Masson, Bromley Group Manager – London Ambulance Service, Graeme Marsh, System Partnership Transformation Manager – London Ambulance Service and Darren Farmer, Director of Ambulance Operations – London Ambulance Service to the meeting to provide an update on the London Ambulance Service (LAS).

The Bromley Group Manager informed Members that the focus of the LAS in Bromley was moving towards ‘team-based working’, where a group of staff worked together all of the time. This allowed the staff to form a better bond and increased the face-to-face interaction with managers, which provided opportunities to communicate important information. At the sites where team-based working was already in place, there had been a reduction in sickness absence which impacted on better ambulance provision. It offered a robust opportunity to communicate local messaging in terms of the capacity available at hospitals. It also provided an increased opportunity to undertake operational workplace reviews where the team of managers were completing ride outs with ambulance crews. This helped to improve the quality of service provision, identifying best practice and areas of learning. The clinical supervision allowed the discussion of both failed and successful referrals and how they could be improved. They were currently participating in a feedback trial with Lewisham. The System Partnership Transformation Manager advised that this was a system to support crews, providing feedback on what had happened to a patient in order to aid their knowledge and learning. This trial would be rolled out much further, with the software implemented at multiple hospital sites across London.

In terms of recruitment, the Bromley Group Manager advised that there had been a pan-London focus on training and recruiting more clinicians, call handlers and dispatch staff. This would allow the patient waiting times for an ambulance to be kept as safe as possible, and the most urgent patients prioritised. As a service, the LAS had recruited more than 900 front line ambulance staff and 400 call handling staff (111 and 999 provisions) – an increased workforce meant that there were more people available to respond to patients. The vacancy rate in Bromley had reduced, from 18% at the end of 2022, to currently just over 6%. A number of trained paramedic staff had been lost to PCNs provisions as they provided an opportunity for staff to not work unsociable hours, which was particularly attractive to those staff with families. Looking ahead, they aimed to recruit more than 1,400 frontline staff as part of the 2023-24 improvement programme to meet the levels of demand across London. The LAS had continued to work with colleagues in other blue light services, and in November 2022 had participated in a live multi-agency major incident exercise – this allowed crews and managers to put their response to a major incident into practice.

In response to a question regarding recruitment of St John’s Ambulance Cadets, the Bromley Group Manager advised that the LAS did not have a programme whereby they asked staff to volunteer to help out with the  ...  view the full minutes text for item 45.

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, with regards to the end of year position for elective care, King’s had eradicated the list of patients waiting over 104 weeks for treatment. It was noted that if industrial action had not taken place in recent weeks, the list of patients waiting over 78 weeks would also have been eradicated. There were 13 patients that had been carried over into the new financial year and had since received treatment. The Trust continued to make strong in roads – King’s had been in national press, listed as one of the top 5 hospitals in the country for the volume of activity undertaken over the last year to address backlogs created by the COVID-19 pandemic. Elective operative activities were continuing at pace.

With regards to emergency performance, Members were informed that the overall challenges at the PRUH continued. They were continuing to work with both national and regional colleagues on several initiatives, including ambulance offloads and the Urgent Care Centre (UCC) provider. It was noted that over the two years, since the start of the pandemic, the average attendance age at A&E had increased by 10 years – they were seeing significantly more mature patients, who were often in a higher state of compromise. The London region were working with the PRUH to explore this epidemiological shift and further information could be provided at future meetings of the Sub-Committee. The Chairman agreed that these statistics were staggering and considered that a deep dive was needed to gain an understanding of the change in dynamics.

In terms of diagnostics, the Trust continued to perform highly and remained one of the top 15 hospitals in the country for the speed at which patients were seen. With regards to cancer services, South East London continued to be the second highest performing cancer alliance in the country. It was noted that King’s had finished the last financial year ahead of the trajectory for recovery.

The Site Chief Executive advised that the link bridge on the PRUH site had been completed and they were currently going through a capital planning round for future developments. Later this year a second MRI unit would be opened, which would further accelerate elements of emergency care. As previously mentioned, the funding to expand the bed base was still to be confirmed – if taken forward, there could be an increase of around 32 beds and a capital value of £5.5m investment.

Members were informed that a CQC inspection had taken place at the PRUH in late 2022 – the actions taken from the maternity services review had been fully executed and accepted. It was noted that the latest patient satisfaction statistics for maternity services at the PRUH had seen a marked uptick in recent weeks.

With regards to maternity services at the PRUH, a Member enquired if the reasons  ...  view the full minutes text for item 46.

Report ACH23-019

The Sub-Committee considered a report providing an update on the review of joint working arrangements between Oxleas NHS Foundation Trust and the London Borough of Bromley.

The Assistant Director for Integrated Commissioning advised that for the purposes of delivering local community mental health services, the London Borough of Bromley and the Oxleas NHS Foundation Trust had been the two parties to a Partnership Agreement since December 2004. Through this arrangement, 25 of the Council’s social care staff were seconded to the Trust’s community mental services as part of a pooled fund for the provision of the community mental health services and to deliver the statutory Care Act responsibilities on behalf of the Council. These partnerships arrangements were subject to a review in 2021, with an action plan being implemented from 2022. The report provided details of the outcome of this review and progress made against the action plan. Overall, feedback was positive and in the coming months a new action plan would be developed to progress things further.

The Service Director – Adult Community Mental Health/Adult Learning Disability (Oxleas NHS Foundation Trust) highlighted that a key aspect had been the high level of engagement from the staff. It was considered that staff who were seconded often felt that they did not fully fit in to either organisation, but there had been extremely positive engagement from staff. In terms of the reviews, they recognised their own contributions and felt the recommendations were a good reflection of their input. The staff had also been involved in the co-production of the action plan, which had increased their motivation. This had increased morale within the team, which supported recruitment and retention.

A Member noted that one of the commitments stated in the report related to a co-production process – however there was no reference to this in the action plan provided and it was therefore not clear if this had been tracked. The Assistant Director for Integrated Commissioning advised that the engagement action included related to the co-production work. Oxleas already had well-developed arrangement in place for co-production with service users. This had not been extended to this partnership approach, but it had been agreed that community mental health teams would be providing input. The next steps would be to develop plans for engagement and co-production activities. The Member asked that a summary of the arrangements in place be provided following the meeting.

The Chairman thanked the Assistant Director for Integrated Commissioning and Service Director – Adult Community Mental Health/Adult Learning Disability (Oxleas NHS Foundation Trust) for their update to the Sub-Committee.

RESOLVED that the progress being made following a review of the joint working arrangements between the London Borough of Bromley and the Oxleas NHS Foundation Trust be noted.

To Follow

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

The Director for Adult Social Care noted that, over the last year, the Sub-Committee had received a number of updates from Bromley Healthcare regarding their CQC inspection. Members were advised that the CQC were now satisfied with the progress that Bromley Healthcare had made and the questioning around the findings from the inspection could be closed down following this meeting.

The Chief Executive Officer informed Members that an internal Sub-Committee had been running over the last year. Representation included the LBB Director of Children’s Services and the ICB Director of Quality, who had been ‘critical friends’ that provided helpful challenge. It was considered that Bromley Healthcare was now at the stage where all actions had been completed, barring clinical competencies – this was an ongoing, long-term piece of work around establishing a system which acted as a central repository.

Bromley Healthcare had recently internally launched its new strategy. The process had been undertaken over the last 6 months, gathering feedback from staff and commissioners, and it was suggested that an update be provided at a future meeting of the Sub-Committee.

Members were informed that a recent Ofsted inspection had taken place at their Hollybank children’s services – the provision had been rated as ‘good’ overall, as well as in all three domains, with just two minor recommendations.

The Chairman thanked the Chief Executive Officer and Chief Nurse for their update to the Sub-Committee.

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 5^th April 2023. During the meeting the proposals for the new delivery of paediatric oncology services in South East London were discussed, moving them into the Evelina London Children's Hospital which was part of Guy's and St Thomas' NHS Foundation Trust. With regards to the significance and impact of the proposed changes, it was considered that for Bromley this was minimal, as they were already outside of the borough – however other boroughs would be more severely impacted as they were closer to the current delivery centres. It had been agreed that a formal review of the decision be undertaken by June 2023.

The future work programme of the formal meeting was discussed – it was agreed that the Committee would meet in-person four times a year, and a further four times virtually. The key element would be to look at the operations of the SEL ICB and ICS, focusing on the issue of inclusivity for health care and the preventative agenda. It was noted that a copy of the minutes of the meeting would be circulated once available. In response to a question, the Chairman noted that oversight of the work programme was likely to be fed back to both the Health and Wellbeing Board and Health Scrutiny Sub-Committee.

RESOLVED that the update be noted.

Report CSD23057

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:

-  Bromley Healthcare Strategy (19^th July 2023)

-  Update from the London Ambulance Service (19^th September 2023 / 24^th January 2024)

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 prior to the pandemic there had been a useful programme of Member visits and enquired if there were plans for this to be reinstated. The Chairman agreed that the visits had been extremely valuable, however the timing of them needed to be right. The Portfolio Holder for Adult Care and Health advised that this had been raised at the Adult Care and Health Policy Development and Scrutiny Committee. There had been some concerns around the infection control measure that needed to be taken in care homes, however the LBB Assistant Director Strategy, Performance and Corporate Transformation was looking at taking this forward.

RESOLVED that the update be noted.

The Chairman noted that this was the final Health Scrutiny Sub-Committee meeting of the municipal year and thanked Members, Co-opted Members, officers and health partners for their contributions throughout the year.

RESOLVED that the issues raised be noted.

4.00pm, Wednesday 19^th July 2023

4.00pm, Tuesday 19^th September 2023

4.00pm, Wednesday 24^th January 2024

4.00pm, Wednesday 20^th March 2024

4.00pm, Wednesday 19^th July 2023

4.00pm, Tuesday 19^th September 2023

4.00pm, Wednesday 24^th January 2024

4.00pm, Wednesday 20^th March 2024