Agenda and minutes

Health and Wellbeing Board - Thursday 8 December 2022 2.30 pm

Venue: Bromley Civic Centre

Contact: Jo Partridge  020 8461 7694

No. Item




Apologies for absence were received from Councillors Chris Price and Thomas Turrell and Councillors Ruth McGregor and Kira Gabbert attended as their respective substitutes. Apologies for absence were also received from Councillor Will Connolly, Rachel Dunley and Jim Gamble.


Apologies were received from Jonathan Lofthouse (Site Chief Executive – PRUH and South Sites: King’s College Hospital NHS Foundation Trust) and Debbie Hutchinson (Site Director of Nursing – PRUH and South Sites: King’s College Hospital NHS Foundation Trust) attended as substitute.




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 Friday 2nd December 2022.


Two questions had been received from a member of the public for written reply and are attached at Appendix A.



Additional documents:


The Vice-Chairman noted that at the last meeting a statement had been provided in relation to monkeypox and asked for a further update. The Director of Public Health advised that in recent weeks there had only been one case of monkeypox, that was not linked to previous cases, and this had not been in Bromley.


RESOLVED that the minutes of the meeting held on 9th June 2022 be agreed.




The Chairman welcomed Lindsay Pyne, Head of Adult Therapies – Bromley Healthcare (“Head of Adult Therapies”) to the meeting to provide an update on the Falls and Fracture Prevention Service.


The Head of Adult Therapies noted that a presentation had been delivered to the Board back in February 2022 – since then the team had expanded and all areas were back to full capacity. Falls Therapy Clinics were open and home visits for initial assessments were taking place – it was highlighted that the Falls Consultant Clinic was now also in a permanent location.


The Head of Adult Therapies advised that the Falls and Fracture Prevention Service received, on average, 90 referrals per month, which was an increase of 10% in the last year. It was noted that an increase in referrals had been anticipated following the pandemic and other background services had taken on some of these patients. At present, the caseload of the service stood at around 320 patients which did not include the caseload of the Fracture Liaison Nurse. The waiting time was approximately 12 weeks, depending on the pathway patients were referred through. Outcomes for patients remained the same and were measured by Therapy Outcome Measures (TOMs) and Tinetti. Patient feedback was gathered through the Friends and Family Test, and was extremely positive with 99.5% of respondents recommending the service. Board Members were advised that TOMs were completed during an initial assessment and again at the end of an intervention to determine if improvements had been made in four areas, in line with the International Classification of Functioning, Disability and Health: Impairment, Activity, Participation and Wellbeing. Tinetti was also an outcome measure used predominantly by physiotherapists to assess a patient's gait and balance and provided a score on completion which could be compared pre and post intervention to determine progress/improvement.


The Head of Adult Therapies informed Board Members that all referrals to Adult Therapy teams were filtered via the Single Point of Access (SPA). If a referral was considered to be urgent, or required a quick response to ensure safety and reduce risk of attendance at an Emergency Department (ED), it was passed to the Rapid Access to Therapy Team (RATT). The RATT assessed patients in their own home within 2 hours, 24 hours or 2 days, and then provided equipment/intervention and referred them on for ongoing falls specific intervention. In terms of referrals for ongoing assessment and interventions to the Falls Team, work was underway to with other teams to ensure that referrals were streamlined, and unnecessary duplication reduced.


With regards to the prioritise of the Falls Team, work had been undertaken in relation to the roles and capacity expectations within the team, such as upskilling assistant practitioners to complete non-complex assessments, and streamlining and simplifying the assessment process. The team’s workstreams had been considered in line with some of the national data and models in place, and focussed on:

-  multifactorial assessment and investigations;

-  rehabilitation;

-  home environment and safety;

-  vestibular;

-  ...  view the full minutes text for item 18.



Additional documents:


Report ACH22-050


The Board considered a report providing an update on the planning and actions being taken by the ONE Bromley partnership to respond to winter demands.


The ONE Bromley Winter plan brought together all actions being taken by ONE Bromley organisations to respond with additional pressures felt on the health and care system during winter. The report was based around the following pillars:


1. Increasing system capacity;

2. Meeting seasonal demand; and,

3. Information sharing and escalation.


In addition, the Winter Plan also outlined key actions and risks for each individual organisation.


The Associate Director – Urgent Care Hospital Discharge and Transfer of Care Bureau (“Associate Director”) noted that Strep A was currently receiving a significant amount of media attention. In response to this, primary care, acute colleagues and specialist paediatric medicine had been brought together in Bromley. Additional specialist GP Hubs had been provided in the community, specialist paediatric capacity had been added in the non-urgent treatment centres, and three extra paediatric beds had been put into the acute sector. A webinar would be held the following day for primary care colleagues regarding diagnosing, responding to Strep A and prescribing, and access to the Consultant Connect system was also being increased in response to demand.

In relation to attendance and admission avoidance, the Associate Director highlighted the One Bromley @Home service – this provided a virtual bed offer to support acutely unwell respiratory, frailty, Intravenous Antibiotics (IVABs) and palliative care patients to receive care in their own home. The patients remained under the care of a consultant, and their supporting team, who provided treatment and interventions to prevent hospital admission. There was a huge amount of evidence in relation to this model and the progress made in Bromley had been very impressive.


Effective winter communication and engagement was another area of focus which aimed to support the general public to understand how best to access services. The ‘Winter Services Directory’ had been delivered to all households in Bromley and described the services that were available to support patients. There were QR codes included which could be scanned to take the reader to the relevant section of the NHS website. The One Bromley ‘Making a Difference Together’ bulletin would be utilised to support a system wide communication and engagement plan – maintaining and providing two-way communication on winter pressures, updates on winter schemes and capacity, and supporting the workforce. There was also a significant piece of work being undertaken in relation to staff wellbeing and ensuring that they remained healthy and well.


Debbie Hutchinson, Site Director of Nursing – PRUH and South Sites (“Site Director of Nursing”) highlighted that lots of work was being carried out across partner organisations. In the acute sector they were looking at the various pathways within the hospital, with specific work taking place in relation to the same day emergency care pathway. There were ambulatory-type areas which patients could be referred to, from the ED or community, to receive care in a  ...  view the full minutes text for item 19.



To follow


Report ACH22-049


The Board considered a report outlining the additional hospital discharge funds for 2022-2023.


The Assistant Director for Integrated Commissioning informed Board Member that the government had provided additional winter funds to local authorities and the NHS to respond to pressures over this winter. Bromley had been allocated £2.3m by NHS England (NHSE) through a direct grant to LB Bromley and an additional allocation to SELICB, which in turn had been delegated to Bromley. It was a condition of the grant, which needed to be spent by the 31st March 2023, that the Local Authority and NHS funds be pooled as part of the local Better Care Fund (BCF) – the spending of the grant had to be approved by the Health and Wellbeing Board.


The report provided a summary of the grant conditions and local priorities for spend and made proposals on approving the spending plans prior to their submission to NHSE on 16th December 2022. This was to be made through a NHSE template whereby the planned spend was set against headings in line with BCF objectives. Fortnightly activity reports would be required, setting out what activities had been delivered in line with commitments in the spending plan – the first of these would be submitted at the end of December 2022. A final spending report would be provided to NHSE, as part of the end of year BCF report, by 2nd May 2023.


The Assistant Director for Integrated Commissioning said that it was proposed for the funding to be used to provide additional capacity, community equipment and auxiliary care. Further support would also be provided to care homes, mental health discharge and additional beds would be commissioned across South East London.


In response to a question, the Assistant Director for Integrated Commissioning advised that there was a fund available to ensure that people’s homes were ready for them to be discharged in to. The Associate Director said that this fund covered a range of things, such as heating, water and food, and could be bolstered with this funding. The voluntary sector was very good at accessing various grants and further capacity could be provided to gather the resources available.


The Assistant Director for Integrated Commissioning highlighted that, with the Board’s permission, it was proposed that the Chairman of the Health and Wellbeing Board, in consultation with the Portfolio Holder for  Adult Care and Health, approve the planned spend report to NHSE in time for the deadline of 16th December 2022. It was noted that the plan would be presented to the next meeting of the Board as part of the regular BCF reports.


RESOLVED that the Chairman of the Health and Wellbeing Board, in consultation with the Portfolio Holder for  Adult Care and Health, approve the planned spend report to NHS England in time for the deadline of 16th December 2022.



Additional documents:


Report ACH22-052


The Board considered a report outlining the learning that had been taken from the COVID-19 vaccination programme.


The COVID-19 virus had disproportionately affected certain groups and there had been variations in the take up of the vaccination programme. The presentation provided a review of uptake of the COVID-19 vaccine in specific groups and identified some of the lessons learnt from the vaccination programme. Key themes emerging from the programme had helped to shape the current COVID-19 booster and flu programmes. The report also examined key elements such as ethnicity, age, and a number of other factors, that had resulted in lower uptake of the vaccine in certain groups. Whilst there was still a lot of work to be done, the One Bromley Partnership approach, together with the incredible voluntary workforce, had resulted in some good outcomes for the vaccination programme. The Inequalities Taskforce was set up as a joint venture between the London Borough of Bromley and the CCG (Bromley) and had helped to develop relationships and engagement with certain community groups.


The Bromley Place Executive Director: NHS South East London (“Bromley Place Executive Director”) highlighted that some of the learning and insights had included:

  • Standard models of access were useful for the majority of people but not all. The Mass Vaccination Centre worked well, with a satellite model in GP surgeries and community pharmacies.
  • A community space (like the Civic Centre) which could be open for long hours and has associated car parking, was very attractive and easily accessible for members of the public.
  • When outreach clinics and pop-up sessions, such as the one located in the Keston Mosque, were run they needed to be accompanied by strong communications and community involvement.
  • Trusted community voices were needed to engage effectively with those who had concerns and were uncertain.
  • Certain groups in the community needed very targeted arrangements for vaccination, such as those with learning disabilities and the homeless.
  • Uptake was lower in pregnant women and young people and more needed to be done to support and encourage specific groups to be vaccinated.
  • Walk-in services were essential for those who may not get the vaccine otherwise.
  • In Bromley, a number of volunteers had supported the vaccination centres, and this had proved to be a very successful partnership model.


In terms of communications and engagement, the Bromley Place Executive Director noted that localised promotion (local faces, names and places) had more impact amongst lower uptake groups. There was also a need to ensure that communications were targeted at the people to be vaccinated, such as pregnant women and their families. It was highlighted that local political engagement with promotion of key messages had also been extremely helpful.


RESOLVED that the update be noted.




Report ACH22-047


The Board considered a report providing a summary of the current work of the Integrated Commissioning Board (ICB).


The ICB provided leadership, strategic oversight and direction for all health and social care integrated commissioning programmes and processes undertaken jointly by Bromley health and care partner agencies. Its key responsibilities included:

-  Leading and directing arrangements for integrated commissioning of health and social care within the borough of Bromley;

-  Supporting the work of the Health and Wellbeing Board in delivery of the key priorities identified in the Health & Wellbeing Strategy;

-  Overseeing the management of joint resources that enabled effective integrated commissioning programmes;

-  Producing a Local Plan, which allowed the Council and the South East London Integrated Care Board (SELICB) (Bromley) to draw down the Better Care Fund (BCF);

-  Develop a co-ordinated approach to managing and developing the local provider market across health and care services; and,

-  Ensuring the SELICB (Bromley) and the Council were well positioned to meet the emerging requirements from legislation, national/regional policy or best practice guidance.


The Assistant Director for Integrated Commissioning highlighted that, over recent months, the work of the ICB had focussed on winter planning and a project to recommission Mental Health Recovery & Rehab/Support & Accommodation which supported rehabilitative accommodation schemes for residents being discharged hospital.


In response to a question regarding the joint infrastructure to expand Personal Health Budgets, the Assistant Director for Integrated Commissioning advised that this was an NHS system, similar to the Local Authority’s Direct Payments, and people were given money to purchase the direct services they required. The Local Authority and ICB had created a joint team to administer the scheme, which was more cost efficient. In terms of the cost of the care, each organisation would only pay for the care they were responsible for.


RESOLVED that the update be noted.



Additional documents:


Report CEF22067


The Chairman noted that apologies had been received from the Independent Chair of the Bromley Safeguarding Children Partnership, however a video providing an overview of the Annual Report had been circulated to Board Members prior to the meeting.


The Annual Report had been provided in a different format this year – there had also been a series of one-off presentations which allowed certain items to be brought forward as individual reports. The Chairman advised that any questions could be sent directly to the Bromley Safeguarding Children Partnership Manager for response.


RESOLVED that the Bromley Safeguarding Children's Board Annual Report 2021/22 be noted.



Additional documents:


Report ACH22-051


The Bromley Place Executive Director shared some highlights regarding the improvements and impact of collaborative working in health and care services 2020–2022. These included:

-  A GP had developed a bar coding system to enter details which enabled flu clinics to run efficiently during the pandemic.

-  Phlebotomy services had been extended - blood tests were available in some GP practices, a home service was provided for the housebound, and walk-in services and booked appointments were available in a range of community clinics.

-  Homeless healthcare clinics – this had been a partnership approach to provide a wide range of healthcare services in safe environment. This work had won a national Innovate Award for innovation in helping address health inequalities.

-  Integrated Mental Health Services – a new adult mental health hub was providing a single point of access for community mental health services.

-  There had been a joint approach to an all-age autism strategy which aimed to ensure equality of access to universal services.

-  Primary care improvements included expanding primary care team with pharmacists, physio, mental health and paramedics; and appointment options from more locations with flexible virtual access.


The Chairman highlighted that the innovations made within these areas had made a big impact. These comments were echoed by the Portfolio Holder for Adult Care and Health, who noted that the changes would make a huge difference to local residents. Thanks were extended to the Bromley Place Executive Director, and staff across the system, for the work undertaken.


RESOLVED that the update be noted.




The Director of Public Health informed Board Members that, this year, the Annual Public Health Report was in the format of a ‘bugs’ calendar and copies had been provided. The calendar included information relating to various bugs and public health messages, and would be sent to schools in the borough.


RESOLVED that the update on the Annual Public Health Report be noted.



The briefing comprises:


  • Better Care Fund and Improved Better Care Fund Performance Update
  • Healthwatch Bromley - Patient Experience Report Q1 2022/23
  • Healthwatch Bromley - Patient Experience Report Q2 2022/23


Members of the Health and Wellbeing Board have been provided with advance copies of the briefing via email.  The briefing is also available on the Council’s website at the following link:



The Health and Wellbeing Board Information Briefing comprised three reports:


·  Better Care Fund and Improved Better Care Fund Performance Update

·  Healthwatch Bromley - Patient Experience Report Q1 2022/23

·  Healthwatch Bromley - Patient Experience Report Q2 2022/23


RESOLVED that the Information Briefing be noted.



Additional documents:


Report CSD22138


The Board considered its work programme for 2022/23 and matters arising from previous meetings.


The Chairman noted that items had been suggested following the workshop on the new Health and Wellbeing Strategy, which had taken place prior to the meeting. This included discussions on issues such as vaping and the presentation of the Children’s JSNA, for which it was suggested the Children’s Executive Board and Bromley Youth Council be invited to attend. An update on the new Health and Wellbeing Strategy would be provided at the February 2023 meeting, with the final document hopefully being presented in March 2023.


In terms of matters outstanding, the Chairman advised that a meeting of the Brain Health Task and Finish Group would be convened in the new year.


RESOLVED that the work programme and matters arising from previous meetings be noted.




The Chairman informed Board Members that new guidance had been received from the Department for Health and Social Care regarding the role of Health and Wellbeing Boards. There had not been any statutory changes, but it reflected the amendments to the Health and Care Act 2022 and set out how the Health and Wellbeing Board would interact with the Integrated Care Board. It was noted that the implications of this were being reviewed by the Legal Department and commentary would be circulated to Board Members in the coming weeks.


RESOLVED that the update be noted.



1.30pm, Thursday 2nd February 2023

1.30pm, Thursday 30th March 2023


The next meeting of the Health and Wellbeing Board would be held at1.30pm on Thursday 2nd February 2023.

Appendix A pdf icon PDF 184 KB