Agenda and minutes

Apologies were received from Councillors Charles Rideout and David Jefferys.

The Chairman thanked the Shadow Health and Well Being Board for setting the direction for the full board.

He explained that the board would change and evolve in time in collaboration with stakeholders.  He wanted to ensure that the residentss of Bromley received the best service.

Councillor Diane Smith declared an interest as a member of the Board of Governors of Bromley healthcare.

In accordance with the Council’s Constitution, questions to this Committee must be received in writing 4 working days before the date of the meeting.  Therefore please ensure questions are received by the Democratic Services Team by 5pm on 24^th May 2013.

3 questions were received from Ms Soulis.  The questions and answers are appended to these minutes.

The Chairman thanked the Shadow Health and Well Being Board for setting the direction for the full board.

He explained that the board would change and evolve in time in collaboration with stakeholders.  He wanted to ensure that the residents of Bromley received the best service.

The chairman explained that the schedule would be an on-going piece of work.

The timings for the relevant deadlines and other general information would be provided by the clerk.

The Board would look at the strategy and items for consideration would likely arise from this. 

The briefing comprises:

• Draft Integrated Commissioning Plan 2013-2016
• Bromley Joint Strategic Needs Assessment 2012

Members and Co-opted Members 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:

HWBB Information Briefing 300513

Printed copies of the briefing are available on request by contacting the Democratic Services Officer. helen.long@bromley.gov.uk 

Dr. Andrew parsons gave a short presentation on the Joint Strategic Needs Assessment (JSNA) and the Clinical Commissioning Group Strategic Plan.

The Chairman asked how people in need were identified.  In response

Dr Bhan explained that it was the people in greatest need and they were indentified through the JSNA.  She added that the mortality rates were higher in areas of deprivation and a low level of immunisation and screening. These people were reached through the Primary Care team.  In North West Bromley there was a higher rate of stroke and therefore the management of GP’s to indentify patients to prevent stroke. 

Other services were being considered as to how to identify these people such as voluntary and community group. She added that the JSNA was key to supporting people in deprived areas.

Councillor Adams reported that he had a number of residents who felt they had been discharged too early, usually from a London hospital, and he asked how the CCG would influence.

In response Dr. Bhan said that is people were feeling like this it indicated that things had not been explained to them correctly and so patient communication was an issue.  In addition she added that patient re-admission was slightly higher in Bromley and therefore it was important for people to be discharged appropriately. There also needed to be community support to ensure patients felt adequately supported.

Dr Parsons added that it was important there was communication with 2^nd tier health professionals to identify key risks such as changes in medication. There also needed to be better community medicines monitoring.

Board Members commented that GP’s were notorious for “doing their own thing” and wanted to know how the CCG would control this.

In response they were informed that the GP’s contracts and performance monitoring but this was under the jurisdiction of NHS England and not the CCG.  However there were lots of measures monitored by the CQC which monitored the outcomes.  The CCG had an interest on the overall impact of care.  It would also look at discrepancies in referral and management of cases. GP’s received feedback on how they have performed against the targets in Prescribing, referral pathways and new ideas.

One member queried the the number of residents in Bromley appeared to be less than the numbers of people registered with Bromley GP’s.  It was explained that this was due to the fact that Practices had to pick up non-residents in their area.

The CCG had to ensure that a service was provided for all registered patients including out borough residents.  However if patients resided in another authority and needed social care this would be referred to the “home” borough.

In relation to the Elderly, Councillors reported that pre-retirement employees received advice on finance but not health and wondered if there was another way of ensuring the elderly planned for old age.

Dr Bahn explained there was a work stream that addressed this and asked GP’s to identify patients with the greatest need and  ...  view the full minutes text for item 5.

This Item to follow

Dr Bhan reported that the Proactive Management and Integrated Services for the Elderly (ProMISE) programme had used the JSNA as its basis and was a co-ordinated response to meeting the needs of a vulnerable group. The aim was for early intervention and prevention. The aim was to maintain healthy individuals by good management of diseases and better case management an earlier stage. 

It was recognised “joined up” care provided the best care packages.  Bromley Healthcare had started a pilot where the borough was split into 9 areas so that community services could support GP practices to deliver integrated care packages.

It was noted that the report currently contained high level indicators and that low level indicators would provided at a future date.

The Board them agreed 3 areas to consider in more detail:

• Diabetes
• Case Management
• Integrated Management

Under the ProMISE programme the council was the budget holder so a request to the Executive would be needed for money to be drawn down.

This item is included in the Information Briefing

Copies of this item will be sent to all the members of the HWBB.

Copies can also be obtained on the Bromley website using the following link:

HWBB Information Briefing 300513

Or by contacting the Clerk, Helen Long 020 8313 4595.  helen.long@bromley.gov.uk.

It was explained that it was the role of the New Board to ensure the JSNA published ad that it informed the HWB strategy.  It was a document that would continually change as new information was added.

There would be more detailed assessment of different areas and provide analysis that would support the JSNA.

The Chairman asked how the JSNA would be used to set the local strategy. In response Dr Lemic explained that a simple process would be used to decide what priorities to include.  For example they would consider diseases that were a “high burden” such as diabetes. Priorities would be identified and a development plan produced and giving measured outcomes.

The Board were assured that the data collected would be used; census data, mortality rates, GP data all gave a good understanding of the local needs of the borough. Dr Lemic said the value of the JSNA was if all the information was collated it would identify the prioritised where more investment was needed.  An example was used of special needs children who would have 3 budgets supporting, therefore it was important to have “joined up” working.

Members noted that the statistics in the report were shown as a percentage and they asked if actual could be given.  It was agreed that although they were contained in the main document they would also be included in the summary.  It as noted that the statistics were estimated so were not precise. 

Members asked about health checks for adults with learning difficulties. They were informed that the CCG were working on this and taking action.  There had been a local enhanced service to encourage GP’s. Part of the Problem was that practices didn’t have a register so were reluctant to undertake the checks.

The Chairman agreed that it was the Boards role to decide which areas they wanted to work on in detail. 

• Management of the Health and Wellbeing Strategy - going Forward
• Term of Reference

None

The next meetings will be held on:

The dates of the future meetings are:

• Monday 29^th July 2013 (moved from Thursday 25^th July)
• Thursday 26^th September 2013
• Thursday 28^th November 2013
• Thursday 30^th January 2014
• Thursday 20^th March 2014
• Thursday 22^nd May 2014