Agenda and minutes

Health Scrutiny Sub-Committee - Tuesday 5 September 2023 4.00 pm

Venue: Bromley Civic Centre

Contact: Jo Partridge  020 8461 7694

No. Item




Apologies for absence were received from Councillor Charles Joel and Co-opted Member, Stacey Agius.




Councillor Stammers declared that she was Chair of the Patient Participation Group (PPG) for The Chislehurst Partnership. It was requested that this declaration be added to the minutes of the last meeting.



In accordance with the Council’s Constitution, members of the public may submit one question each on matters relating to the work of the Committee. Questions must have been received in writing 10 working days before the date of the meeting – by 5pm on Monday 21st August 2023. 


Questions seeking clarification of the details of a report on the agenda may be accepted within two working days of the normal publication date of the agenda – by 5pm on Wednesday 30th August 2023.


No questions had been received.



Additional documents:


The minutes were agreed subject to Councillor Stammers declaration that she was Chair of the Patient Participation Group (PPG) for The Chislehurst Partnership being added.


RESOLVED that the minutes of the meeting held on 20th April 2023 be agreed.



Additional documents:


The Chairman welcomed Julie Lowe, Site Chief Executive Officer, King’s College Hospital (“Site Chief Executive Officer”) to the meeting to provide an update on the King’s College Hospital NHS Foundation Trust.


The Site Chief Executive Officer introduced Angela Helleur to the Sub-Committee, and advised Members that she would be taking up the role of Site Chief Executive – PRUH and South Sites from 18th September 2023.


The Site Chief Executive Officer advised that all performance had been significantly affected by industrial action. With regards to elective recovery, the NHS was focussing on reducing the number of the longest waiters. There were no patients at the PRUH, or across the Trust, who had been waiting over 100 weeks – there was a small number of patients around the 78-week mark, but these generally tended to be patients that needed operations undertaken by a specialist consultant/team. The total waiting list continued to grow which was mainly due to industrial action reducing capacity. Diagnostics waiting times had increased slightly and there was a particular issue related to ultrasounds (not maternity), but they were reasonably confident that this could be resolved. Overall they were doing well in terms of elective recovery, but it would take a long time to address.


With regards to cancer diagnostics, the PRUH’s response to the 2-week wait referral had always been around the 90% target – it had dipped significantly but they were starting to recover this position. It was noted that the PRUH had always struggled with the 62-day referral to treatment time, but this was recovering slightly. It was complicated as patients were often treated in multiple hospitals. In response to a question, the Site Chief Executive Officer said that cancer targets were changing, with the attention being on the 28-days to diagnosis target, which the rapid diagnostics centres focussed on. Patients would be moved to other locations if it was the best way to get them seen quicker. There had been an increase in potential cancer referrals across Trust over the last year or so – the reasons for this were not fully known, but it was not just due to delays caused by the pandemic.


The Site Chief Executive Officer informed Members that emergency performance had been less affected by industrial action. Attendance at the PRUH had fluctuated, with a dip in January and February 2023 being an unusual occurrence. It was noted that the national standard was now 76% and reflected the fact that lots of patients were treated in the Emergency Department (ED), receiving same day care and going back home. The PRUH continued to struggle with some longer lengths of stay and long waits for beds. With regards to mental health patients, the average wait times had slightly reduced, but some patients were waiting a very long time in ED (1 in 20 waited more than 2 days) – this was a difficult situation for the patients, their families and other patients in the ED. A Co-opted Member enquired if there  ...  view the full minutes text for item 5.


GP ACCESS pdf icon PDF 1 MB


The Chairman welcomed 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”) to the meeting to provide an update on GP access.


The Associate Director advised that the national GP Patient Survey results showed a downhill trend, however Bromley was not out of sync and was performing strongly in a couple of areas. In terms of the actions being taken, there was already a focus on improving phone experience, and it was noted that the allocated funding was still awaited to start the switchover process. Another area of continued focus was the overall experience of making an appointment and they were expanding the number of directly bookable appointments to relieve the pressure on phonelines. It was also hoped that the introduction of new websites would reflect a better score next year.


With regards to GP appointments in Bromley, the Associate Director highlighted that the data set was limited. The categorisations were relatively new, and the fluctuations related to improvements in the coding of the data. It was hoped that the reliability of the data would improve throughout the year. The GP Clinical Lead advised that generally there was a wide and broad range of access to primary care teams, however they needed to find a mixture of ways to provide access for patients. With regards to relieving pressure on telephone lines, it was highlighted that the use of e-consults was increasing, and websites were becoming clearer and more consistent. It was noted that repeat prescriptions created a lot of traffic. Members were advised that there was now a new national target of 14-day access, with 85-90% of appointments being offered within two weeks. It was highlighted that the percentage on the graph would not continue to rise as some follow-up appointments needed to be booked further into the future. The GP Clinical Lead informed Members that there were expanding roles within general practice. This had been a success story in a number of ways, with an increase in the number of roles employed through the primary care networks (PCNs).


In response to questions, the Associate Director said that practices were trialling different things to get the process run smoother, manage demand and ensure the patients who needed to see their GP were seen. A GP was currently working as the lead, focussing on digital triage and improving flow – they were looking at how they could support individual practices on the ground. There was a national expectation that practices would adopt the Modern GP Access model, having an upfront triage for every patient that contacted the practice to ensure they were being seen by the right professional. However, there would not be a single model as there were differences in how practices worked. The GP Clinical Lead said there was an expectation that practices were using new ways of working, but demand had risen greatly. The  ...  view the full minutes text for item 6.




The Chairman welcomed Iain Dimond, Chief Operating Officer – Oxleas NHS Foundation Trust (“Chief Operating Officer”) and Lorraine Regan, Service Director, Adult Community Mental Health/Adult Learning Disability – Oxleas NHS Foundation Trust (“Service Director”) to the meeting to provide an update on acute mental health pressures, community mental health within Bromley and the ‘Right Care, Right Person’ approach.


With regards to acute mental health pressures, the Chief Operating Officer advised that they were continuing to see considerable pressure across South East London, however the pattern of demand differed between the two providers (Oxleas and South London and Maudsley (SLaM)). Generally the Oxleas data showed a reduction in the number of people attending Accident and Emergency (A&E) in a mental health crisis. However, those that then required admission were waiting longer than they needed to – this was due to problems with flow and pressures within the acute bed system. It was noted that a recovery programme had been agreed, focussing on purposeful admissions and reducing delayed transfers of care. This work was underway, and an update could be provided at a future meeting of the Health Scrutiny Sub-Committee.


The Chief Operating Officer informed Members that as mental health demand was having an impact on A&Es across South East London, the ICB had commissioned a report from an external consultancy, Carnall Farrar. The conclusions had now been circulated to the ICB Executive – Oxleas and SLaM had drafted a response to this and would take forward any additional actions.


In response to questions, the Chief Operating Officer said that the trend being seen across the three boroughs was a gradual reduction in the number of people presenting in a mental health crisis at A&E – however, a greater proportion of those attending were unwell and need hospital admission. Due to the pressure on beds some were waiting longer than they should following the decision to admit them being taken. It was considered that fewer people attending in a mental health crisis was evidence that the decision taken by the Trust to invest more into community mental health was paying off. Data was collated regarding whether those attending in crisis were known to community teams; had been known to community teams; were waiting to see community teams; or were completely new – the data suggested that the majority were under the care of Oxleas, or waiting to come into their care. It was noted that part of the work being undertaken was to look at doing more to identify signs of relapse, and if someone was in crisis were their opportunities to do something different.


The Service Director advised that there had been a huge increase in demand for community mental health services since 2019 – this was impacted by both the COVID-19 pandemic and social circumstances. Referrals had increased significantly from 220 per month, pre-pandemic, to the current level of 400 per month. This activity meant that they were managing around 1,500 patients per month, which was an  ...  view the full minutes text for item 7.


WINTER PLANNING 2023-24 pdf icon PDF 494 KB

To follow

Additional documents:


The Sub-Committee consider a report outlining the ONE Bromley Winter Plan 2023-24.


The ONE Bromley system developed a Winter Plan each year which described how seasonal pressures would be mitigated and managed locally. The Winter Plan built on learning from previous years, and responded to any new national policy change and local system changes since the previous plan. The co-ordination and delivery of a joint Winter Plan placed Bromley in a strong position to respond effectively to the changeable position through winter. The joint plan set out how local services would be arranged, expanded, flexed and work together to meet the pressures experienced throughout the period and manage risk as a system. Through this residents would be supported to make the most cost-effective and sustainable use of joint resources, while enabling better outcomes and ensuring they were able to provide services for our most vulnerable.


The Associate Director – Urgent Care, Hospital Discharge and Transfer of Care Bureau, SEL ICB (“Associate Director”) advised that the 2023-24 Joint Winter Plan described how health and care services across Bromley would organise themselves and work together to ensure local residents were able to access the services they needed and stay well throughout winter. The Plan was set out in two sections:


Section 1 – described the work that would take place before winter to reduce risk to vulnerable residents; and,


Section 2 – described, under the 3 pillars of winter planning, the activity that would take place during winter to increase capacity across key health and care services, manage the impact of seasonal pressures and viruses and maintain oversight to manage the system throughout.


Engagement with a wide range of stakeholders had taken place to inform the Plan with specific, special interest working groups set up around key themes to develop the plans in these areas. Workforce engagement had also taken place throughout the development of the Plan including engagement of primary care, community health providers, social care workforce and providers and the voluntary sector.


In response to questions, the Place Executive Lead – SEL ICS (Bromley) (“Place Executive Lead”) said that the winter in Australia had been quite severe, but not as bad as last year – this was often a good predictor of what would happen in the UK. There were some COVID-19 variants of interest in circulation and the flu and COVID-19 vaccination programmes had been brought forward to start the following week. The flu vaccination could be purchased, but this was not the case for COVID-19 vaccinations – to receive the vaccine residents needed to be in one of the eligible groups, 65+ and those who were clinically vulnerable. The schools flu vaccination programme would also start in the next week or so, with an increase in the number of school years that would be vaccinated. In terms of advice relating to COVID-19, the Place Executive Lead said that the national guidance was to take sensible precautions if you felt unwell, but there was no requirement to isolate or  ...  view the full minutes text for item 8.



To follow

Additional documents:


The Place Executive Lead advised Members that the update presented had been prepared by North East London ICB on behalf of South East London ICB. From April 2023, ICBs in London had taken over the commissioning of community dental services from NHS England and a central team was located for the whole of London in NE London ICB.


There were 42 providers of high street dental services in Bromley, which had a mixture of contracts. The relationship between dental providers and commissioners was not as close, with no support being provided in terms of premises. There was testing to ensure that providers were adhering to infection control standards. Across the country, people were finding it difficult to access general dental services on the NHS – patients were not obliged to register at a dental practice, and could go to any practice they wished (NHS or private). There were a number of practices in Bromley that offered normal and emergency dental service – it was up to the practice themselves if they accepted a patient. Emergency dental services were also provided at King’s and Guy’s.


The team at NEL ICB were looking at how they could expand access to dental services. The impact of the COVID-19 pandemic had been significant – at the beginning local practices had not been seeing patients at all, and then the numbers they could see were restricted due to preventing the spread of infection. An area of concern was children and young people, who were not accessing dental services as early as they would like. Bromley had the best level of dental health compared to other boroughs – however they wanted to ensure that the most vulnerable populations had good access to dental services.


RESOLVED that the update be noted.




The Place Executive Lead advised that work was underway across South East London to implement the priorities of the Integrated Care Strategy – improving health; providing better quality services; and reducing the need for acute services. This would incorporate a number of elements, including improving mental health services; ensuring the best start for children and families; and improving the management of long-term conditions.


Bromley also had its own strategy, through the Health and Wellbeing Board, and work was already underway in relation to improving access to general practice; manage long-term conditions; and reduce waiting times for children and young people to access CAMHS.


This work was running parallel to the management cost reductions review – this was a requirement following a review of ICBs to look to reduce the amount spent on management. In response to a question, the Place Executive Lead advised that this process had commenced, and money had been made available to reduce inequalities – increasing vaccine uptake and providing services for the homeless and asylum seekers. The savings made from the management cost reduction would go into direct patient care.


The Chairman thanked the Place Executive Lead for the updates to the Sub-Committee.


RESOLVED that the update be noted.




The Sub-Committee received the Quarter 4 Patient Experience Report for Healthwatch Bromley, covering the period from January – March 2023.


The Operations Co-ordinator, Healthwatch Bromley (“Operations Co-ordinator”) advised that the Patient Experience Report had changed significantly this year – it provided a snapshot view of the feedback gathered from patients across the borough. 60 face to face visits had been carried out, and they were trying to increase this figure each month as they gained a larger pool of volunteers. During the autumn a research study would be undertaken, and a survey would run alongside the standard feedback form.


With regards the Quarter 4 report, the Operation Co-ordinator highlighted that the most responses were received in relation to hospitals and GPs. This was partly due to local partners allowing Healthwatch to go in and talk to residents – most of the feedback was gathered in-person, so they were visiting hospitals and GP practice regularly.


Members were advised that a yearly comparison had been undertaken at the end of Quarter 4. There had been an increase in the percentage of people sharing positive feedback about GPs over the year, and negative experiences relating to hospital services had increased when compared to the previous quarter. Experiences related to dental services had continued to be extremely positive. Positive experience of community health services had also increased compared to the previous quarter.


The Chairman thanked the Operations Co-ordinator for her update to the Sub-Committee.


RESOLVED that the update be noted.




The Chairman informed Members that the South East London Joint Health Overview and Scrutiny Committee had met in-person on 6th July 2023, and mainly procedural items had been discussed. There had also been a presentation from NHS England on the proposals for the reconfiguration of children’s oncology services and a public consultation would be launched shortly. Once this had taken place, the finding would be shared.


It was noted that the next meeting would take place virtually on 19th September 2023. It was intended that future meetings would be a mix of virtual and in-person.


RESOLVED that the update be noted.





Report CSD23105


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 Oxleas NHS Foundation Trust (21st November 2023)

-  Postpartum Haemorrhage – King's College Hospital NHS Foundation Trust (21st November 2023)


In response to a question, the Chairman confirmed that an update from the London Ambulance Service would be presented at the meeting on the 30th January 2024.


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.




There was no other business.




4.00pm, Tuesday 21st November 2023

4.00pm, Tuesday 30th January 2024

4.00pm, Tuesday 12th March 2024


4.00pm, Tuesday 21st November 2023

4.00pm, Tuesday 30th January 2024

4.00pm, Tuesday 12th March 2024