Agenda and minutes

Apologies were received from Councillor John Getgood and Councillor Peter Fookes acted as his alternate and from Dr Andrew Parson and Dr Mandy Selby acted as his alternate.

The Minutes were agreed subject to the following amendments:

Page 3: Meredith Collins is not a doctor

Page 5: National Insurance Numbers should be corrected to NHS Patient Record Numbers.

Page 7: FLO is a telephone messaging system

RESOLVED that the minutes of the meeting held on 28^th November 2013 are approved.

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 Friday 24^th January 2014.

Three questions were received from Ms Sue Sulis and the questions and answers are appended to these minutes.

Andrew Spears, Youth Council Chairman and Laila Khan, Youth Council Vice-Chairman addressed the Board. The Board viewed the short film that Bromley Youth Council (BYC) had produced for the launch. The film can be viewed at:

http://www.youtube.com/watch?v=Eq31G4F3MLE.

Mental Health was identified as the key priority issue at the Youth Council’s manifesto event in March 2013 and the Board was provided with a summary and an update on the BYC’s campaign on mental health. The campaign aimed to break the silence amongst young people about mental health issues and to raise awareness amongst young people of the services available to offer support.

Each year the Youth Council hosted a youth manifesto event, to which all borough secondary schools and colleges were invited to send representation. It is planned, delivered and evaluated by youth councillors and supported by youth support work programme staff. Key decision makers in the borough, including elected Members, officers and service managers were invited as guests, to listen to the views and concerns and answer questions from young people either living, being educated or growing up in Bromley. The outcomes from this event contributed to and completed the BYC Manifesto for the forthcoming year.

At the manifesto event in March 2013, 81 young people from 15 schools and colleges identified their priority issues as a mandate for the Youth Council. Mental health was identified as the key issue. BYC applied and were awarded funding to support this campaign from Bromley Public Health and thanked Dr Ade Fowler, Dr Jenny Selway and Bromley Y for the support they have given to the campaign.

The official launch of the campaign was 10^th October, ‘World Mental Health Day’. BYC ran a stall and a ‘green’ ribbon campaign and alongside this they launched their leaflet and film. The Youth Council had discussions with 628 young people and 239 adults about mental health and wellbeing and distributed over 1000 green ribbons. 

The Board was able to consider the mid-term progress report and were informed that an End of Year Report looking at the impact of the campaign and reporting individual and group outcomes and achievements would be available from March 2014.

The Chairman thanked the representatives for the “powerful” film and expressed surprise that mental health was such an issue for young people. 

The Board was informed that the information produced by BYC had been distributed to GP’s in key areas. They recognised that the film and leaflet could not reach all young people.

Members requested copies of the information collated as a result of sending out questionnaires during the consultation process.  These findings had been presented at the “Bromley Crime Summit” held on 28^th September 2013.

BYC Members had also worked with Sue Southon to increase volunteering amongst young people. The youth workers were keen to get involved with community schemes and welcomed suggestions by Members.

One Member of the Board noted that in the past the statistics for crimes against the under  ...  view the full minutes text for item 47.

The briefing comprises:

• Bromley Annual Public Health Annual Report 2013 – “Top Body, Top Mind”
• Bromley Safeguarding Children Board – Annual Report

This item is for information only but will be included as an agenda item for discussion at the March meeting.

·  Joint Strategic Needs Assessment

This item will be included as part of the information briefing at each meeting

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:

http://cds.bromley.gov.uk/ieListMeetings.aspx?XXR=0&Year=2013&CId=559

Printed copies of the briefing are available on request by contacting the Democratic Services Officer.

There were no questions received on the briefing prior to the 24 hour deadline.

Following the presentation given at the previous Health and Wellbeing Board (HWB) meeting the Director had prepared a report which outlined a proposal for the joint use of the Better Care Fund (BCF), previously referred to by the Department of Health as the Integration Transformation Fund (ITF).  The intention of the fund was to support an increase in the scale and pace of integration between health and social care and provide a mechanism for promoting joint planning for the sustainability of local health and care economies against a background of significant savings targets right across the system. 

In addition to the overarching integration agenda a number of national conditions and measures are attached to the fund designed to move resources across the system towards prevention and short term care interventions and away from high cost care packages in residential or acute settings.

Locally the Chairman of the Board and Directors from both the Local Authority and Bromley’s Clinical Commissioning Group were proposing to use the Fund to:

• Fund services that came under the banner of ‘short term interventions and preventative services’ in the community in order to mitigate the pressures on long term care packages and admissions into secondary care that were putting considerable financial strain on the Health and Care system as a whole;
• Include services that helped both Health and Care deliver against some of their respective legislative duties as set out in the Health and Care Act 2012 and the Care Bill (currently going through parliament and likely to become an Act in 2014);
• ‘Clean up’ historical joint funding arrangements moving existing joint funded community services into a pooled budget of which the BCF would make up a core component.

Access to the BCF was dependent on agreement of a local 2-year plan for 2014/15 (the planning year) and 2015/16 (first full year).  The plans had been first agreed jointly by the Local Authority and Bromley’s Clinical Commissioning Group and authorised by their respective Executives.

A template has been produced nationally for local areas to complete their submissions to NHS England. This template had been completed locally and attached to the report for the Board’s consideration.

The final sign off required before the Local Plan could be submitted to NHS England needed to be provided by the Board. One of the critical responsibilities for HWBs, as set out in the Health and Care Act 2012, was to encourage joint working and integration in their locality wherever there were clear benefits to the local population. The BCF provided a vehicle that could be used to sustain and accelerate this agenda as well as support the creation of a pooled budget.

The timetable for submission was very tight and Bromley’s submission had to be with NHS England by 14^th February. The final deadline was 4^th April 2014 which gave officers time to finalise the indicative budgets.

The Board requested an outline setting out how the funding could be used.  One of the areas of change would be  ...  view the full minutes text for item 49.

Officers provided a report which gave the Board an opportunity to review the current Health and Wellbeing Strategy and begin the development of the future Strategy. The Strategy would underpin the Board’s work programme and communication and engagement Strategy (both covered in items on elsewhere on the agenda).

The current Health & Wellbeing Strategy commenced in 2012 for three years; it was agreed as part of the development that there would be an annual refresh of the data and priorities to reflect the latest evidence from the JSNA and monitoring reports.  It was also the opportunity to outline current drivers especially as the Health and Social Care areas changed and became more fully integrated.

Board Members noted an update on each of the nine priorities with  summary of the main achievements over the last two years, a red, amber and green rating (RAG) based on the progress against the three year outcomes and finally a summary of the planned actions for 2014/15. This was currently being finalised with key partners including the Council, Bromley CCG and third sector partners. It was planned that during 2014/15 all nine priorities would be monitored and reported to the HWB during the course of the year.

The Strategy developed in 2012 outlined the proposed changes in both health and social care organisations, these changes had now been implemented in part and in relation to further integration these plans had become more developed locally. The evidence base of the 2012 version of the Strategy had also been updated to reflect the 2012 JSNA and other more up to date sources. This document would be finalised and circulated for sign off at the HWB March meeting, with February being used to collate feedback and comments on the content of this refreshed Strategy.

It was planned that work on the 2015 – 18 Health and Wellbeing Strategy will begin as soon as the 2013 JSNA was presented for sign off by the HWB (September 2014). A facilitated HWB workshop where the potential areas to be considered as priorities in the future Strategy, the draft Strategy would be developed for engagement events early in 2015 for launching and implementation from April 2015.

The Chairman was pleased to see the ratings included in the Strategy,  this was one of the suggestions from the Board’s “Away Day” in October.

Councillor Jefferys felt that close attention needed to be paid to the wording and detail and that the issues contained needed to be cross referenced.  He was aware that in relation to obesity and diabetes there are a number of other issues, in the instance of these two medical conditions he would expect to see the prevalence rise to indicate that patients are being indentified.  There were a number of other areas he would like to discuss and it was agreed that these discussions would take place outside the meeting.

Dr Lemic explained that the document being presented was the summary document and the full plan contained details on priority areas  ...  view the full minutes text for item 50.

At the last meeting the Board, whilst considering the importance of communicating the ProMiSE programme to residents, had requested a report from Bromley’s communication team.

Officers presented a report which outlined a draft Communications and Engagement Strategy to manage communications relating to local health and wellbeing issues following government health reforms. It included managing messages emanating from the work of the HWB, those relating to the Council’s new Building a Better Bromley priority of ‘A Healthy Bromley’ and those relating to the Council’s public health responsibilities.  Such an approach would also cover messages reflecting the Council’s and the Bromley Clinical Commissioning Group’s business objectives concerning the further integration of health and social care services, particularly work relating to the Better Care Fund and the Proactive Management of Integrated Services for the Elderly (known as the ProMISE programme).

Members were informed that a number of the “building blocks” were already in place and work was underway to raise awareness of the Board.

RESOLVED that

1.  the draft communications and engagement Strategy including the overarching objectives and messages is endorsed;

a communications and engagement plan is developed informed by a communication structure of target audiences and the Strategy’s objectives and messages.

The Board was provided with an update on the development activity that had taken place with Members of the HWB. Further proposals were also outlined in order to progress Member development. The report suggested a continuing development and engagement programme, the development of ward-based profiles benchmarked alongside Bromley as a whole to give all elected Members a better understanding of health and wellbeing of residents locally in their wards and suggested a series of GP practice visits to be arranged for Board Members and elected Members to broaden the understanding of how the NHS operates in that sector.

Board Members questioned if the ward summaries would be for all Ward Members or just those on HWB.  In response the Chairman said that it was his intention to provide this information to all Ward Members. He also encouraged Members to get involved as he noted that the public liked to see Ward Members showing an interest in local priorities.

The Board also raised concerns about drawing comparisons across the ward profiles or any kind of “ranking” as these sorts of measures could be problematic. In addition it was felt that the Board should be looking for particular problems such as difficulty with access for certain groups. They were assured that the GP data and ward profiles would not be used to compile a “league table”.

The Board welcomed the suggestion of visiting GP practices and were keen that this was broadened to cover visits to other sites such as hospitals.  Officers confirmed that discussions were taking place with the CCG and it was hoped to extend the visits to other area in due course.

RESOLVED that it is noted that The Development & Engagement Programme will be led by the London Borough of Bromley, with required input and leadership from partner organisations including the CCG, Healthwatch and Community Links Bromley for specific actions.

The meeting scheduled for 22^nd May would be re-scheduled after the 4^th June 2014.  The Board would be advised of the revised date in due course.

None

Date of Next meeting: 

Thursday 20^th March 2014

The meeting scheduled for Thursday 22^nd May 2014 will need to be changed, an alternative date will be need to be considered at the meeting.

Thursday 20^th March at 1.30pm.

Please note that this item will be considered as the first item on the Health Scrutiny Sub Committee Agenda. That meeting starts at 3.30pm.  Board Members will be joined by their committee colleagues for this item.  After which Board Members can leave whilst the Scrutiny committee continues with its agenda.

This item will include:

• Winter Pressures Update;
• Outcome of the meeting with Monitor in November;
• Outcome of the recent CQC inspection;
• Joint working to improve outcomes;

For consideration of this item the Board was joined by colleagues from the Health Scrutiny Sub-Committee (HSSC).

The Chairman of the HSSC made a statement: 

I was greatly disappointed to learn on Monday morning that a summit had been arranged for today that Kings’ would be attending and they would not therefore be present here to address this committee and members of the public to allay their concerns regarding The PRUH.

Staff here notably Angela Buchanan, did their utmost at this incredibly short notice to try and accommodate the meeting here at The Civic Centre, so that both Agendas’ could be addressed. Kings’ refused our efforts.

Staff in Care Services are already faced with an extremely heavy workload and it is not right that they had to spend valuable hours dealing with something that could have been avoided. I understand that the Portfolio Holder drew the date of today’s meeting to their attention as early as 17^th January 2014.

If we are going to successfully work together and give confidence to the residents of Bromley with regards to the health service, we need reassurance from Kings’ that this situation will be avoided in the future.

Moving forward, we need Kings’ to provide a full update on the impact their plans/changes have had on The PRUH, especially with regard to A&E performance and trolley breaches.

I am not prepared to spend valuable resources convening a separate meeting, so would ask with plenty of notice that all parties’ concerned attend the next Care Services PDS on March 11^th to provide this in a special item

I will be writing to Kings’ to express the views of this committee regarding this meeting.

The Board and Members of the Health Scrutiny Sub-committee had raised concerns regarding the performance of the Accident and Emergency Department at the Princess Royal University Hospital (PRUH) for some time.  The performance at the Hospital over the last quarter had been at levels below the agreed performance level, with some very significant daily and weekly fluctuations.

There were various steps in place to help improve the performance in order that it was brought back in line with the agreed trajectory.  The CCG presented a briefing paper outlining, broadly the position in line with the trajectory in the previous quarter, highlighting some of the causes for the decline in performance in the previous quarter as well as describing current and planned actions.

Dr Bhan, from the CCG addressed Members. She had conveyed Members feelings about King’s failure to attend and apologised that the situation had arisen.

She reported that the target for A&E patients was that 95% of patients should be in the department for no longer than 4 hours before they are either moved to a ward or discharged. This would only be achieved if all departments were functioning efficiently.

Dr Bhan then outlined the previous history of the PRUH prior to the takeover by King’s. However even after the takeover the performance of A&E  ...  view the full minutes text for item 56.