Agenda and minutes

Apologies were received from Harvey Guntrip, Lorna Blackwood, Jim Gamble, Hannah Norgate and Councillor Stephen Carr.

Councillor Ruth Bennett declared an interest as her husband sat on the Mytime Board.

Councillor Evans referred to Minute 114 which was the Primary Care Co-Commissioning Report. He referenced the sentence ‘However, some people had been brought back to south east London to assist’ and requested some clarification concerning this. Dr Bhan explained that this was a reference to former employees of the Primary Care Trust who had been seconded to assist the CCG in activities such as intervention and monitoring.

RESOLVED that the minutes be agreed as a correct record.      

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 5.00pm on March 24^th 2017.

Written questions had been received from Mrs Susan Sulis, Secretary of the Community Care Protection Group.

The questions and the written answers are appended to the minutes.

CSD 17032

The Board noted the HWB Matters Arising and Work Programme report.

It was anticipated that the matter of ‘Falls’ would be discussed at the June meeting.

It was noted that the letter from the HWB to NHS England concerning the problems faced by local pharmacies had not been drafted. It was anticipated that the letter would be drafted shortly.

It was noted that Bromley CCG had been awarded full delegation of primary care commissioning.

It had been resolved previously that enquiries be made to see if a phlebotomy clinic could be hosted at Bromley Civic Centre. The update concerning this was still required. 

RESOLVED that

(1) the letter from the HWB to NHS England concerning the problems faced by local pharmacies be drafted

(2) the Board is updated with the outcome of enquiries to see if a phlebotomy clinic could be hosted at Bromley Civic Centre

The Transforming Care report was drafted by Sonia Colwill (Director of Quality and Governance-Bromley CCG). The verbal presentation on the report was given by Andrew Royle (LBB Strategic Commissioner--Disability Services). The purpose of the report was to provide an update concerning those patients that fulfilled the requirements for the Care and Treatment Review.

The Board heard that there had been an increase in the number of children being referred into the Transforming Care Programme. This was a risk to both the CCG and LBB in terms of increased cost pressures as they turned 18 and needed to access adult health and care services.

Patients had to meet the relevant criteria to be accepted onto the Transforming Care Programme. The patient would have an inpatient bed either for mental health and or for behavioural health care needs AND also would have learning disabilities or be on the autistic spectrum disorder.

The CCG had a mandatory obligation to report upon these patients, and would be held responsible for outcomes by NHS England. As of 10^th March 2017, LBB had nine patients that fell within the Transforming Care Criteria.

The Vice Chairman asked why nothing was listed on the report under the heading of ‘Financial Implications.’ Mr Royle responded that this was because the financial risks were not quantifiable.

The Chairman suggested that it may be a good idea if the report was seen by the Care Services PDS Committee, but this was not a formal resolution of the Board. 

RESOLVED that the Transforming Care report be noted.

Dr Bhan informed the Board  that full delegation of commissioning to the CCG had now been granted. The term ‘co-commissioning’ would be obsolete going forward. It had been agreed that the CCG would need extra staff to help with the additional work involved, now that full delegation had been achieved. This being the case, it had been decided that some staff would be seconded from NHS England to assist. Dr Bhan mentioned that six south London CCGs worked collaboratively to share resources. A team was being established to take care of routine business administration functions. 

Dr Bhan explained that the NHS would continue to manage complaints and the appointment of individual GPs. A Primary Care Team was being developed, and this would be managed by Jessica Arnold (Head of Primary and Community Care-Bromley CCG). The seconded team from the NHS would be managed by Southwark CCG, based at Skipton House. A Memorandum of Association (MOU) had been formulated between all of the six south London CCGs. There was also an MOU agreed between Southwark CCG and NHS England.

New protocols would be developed to deal with conflicts of interest. A Primary Care Committee had also been set up and was meeting on 4^th May. Underneath the Primary Care Committee would sit a steering group and a clinical referral group. The membership of the Primary Care Committee would be the same as the Joint CCG Committee, with additional representation from the Local Medical Council (LMC). The final structure of the combined operating model would be decided in due course.

Dr Bhan informed the Board that the CCG had recently received their finalised budget allocation, and this was less than had been anticipated.

Dr Bhan reflected on some of the advantages of the new delegated structure:

·  The improvement of Care Pathways

·  Sensitive and specific work could be undertaken with GP practices

·  Better monitoring of GPs, leading to better quality GPs

·  The development and improvement of GP Practices

·  CQC visits to GP surgeries would be programmed in-this was something new for GP surgeries

Dr Bhan notified the Board that one practice in Bromley had been rated as inadequate. She continued that there was currently a lack of GPs and Practice Nurses, and so the CCG had to consider what they could do to provide support in these circumstances. Councillor Evans asked what was wrong with the practice that had been found to be inadequate. Dr Bhan explained that this was to do with the organisation of the practice—issues such as systems, processes and training, but was not related to the provision of care and treatment.

The Chairman acknowledged the complexities involved, but was hopeful that delegated authority would assist with the integration process. He stated that this was a major change in healthcare provision. The Board noted that Dr Agnes Marossy was being seconded for an 18 month period to work with Bromley CCG. 

Dr Lemic commented that LBB was only a small commissioner, but had previously liaised with NHS England. Now  ...  view the full minutes text for item 134.

The Sustainability and Transformation Plan (STP) update was provided by Dr Bhan.

A Committee in Common was discussing the feasibility of three orthopaedic centres of excellence being developed in the south east instead of two. It was hoped that clarification around this would be achieved by the end of April. Community based care was developing around London. LBB was the leading borough in delivering ‘8-8’ care. This was being delivered by the Bromley GP Alliance. The Board heard that a new mental health group was being formed, and good developments were being made in renal and cardiac services. It was also the case that a review of estates was ongoing.

Dr Bhan and Dr Parson were engaged in the STP in different ways, and Dr Parson was leading on the development of clinical programmes. It was noted that there was an engagement gap that existed between the CCG and with local authorities and the public; the CCG were keen to support and develop engagement.

The Chairman was impressed with the energy and creativity that was being put into the process of developing the STP. 

RESOLVED that the update on the STP plans be noted.

The CAMHs Transformation Plan update was written and presented by Daniel Taegtmeyer from Bromley CCG.

The Board was asked to note the outcomes arising from the first two years of the CAMHs Transformation Plan Implementation. The Board was also asked to note the proposed road map to implementing the full transformation by 2020. It was noted that the CAMHS Transformation Plans refresh had been developed collaboratively between the CCG, LBB and delivery and service sector partners.

Mr Taegtmeyer informed the Board that data indicated that:

·  Improved experiences and outcomes were being reported

·  More children and young people were entering the system now than ever before

·  More young people were now getting their needs met earlier

·  Fewer children and young people were needing to be referred onto specialist community CAMHs

·  Referrals were coming  from wider sources

·  The majority of children and young people (CYP) were having their needs met in 6 sessions

·  Presentations to A&E by children in crisis had remained stable

·  Admissions to specialist hospitals had fallen by 36% in the last two years

However, it was still the case that too many young people were presenting in crisis, too many admitted to specialist hospitals and too many had been referred to the Eating Disorder Service. 

Mr Taegtmeyer referred to the ‘Future in Mind’ report that was published by NHS England in March 2015. The report can be accessed via the following link: https://www.england.nhs.uk/blog/martin-mcshane-14/

‘Future in Mind’ (FIM) was a five year project running from 2015 to 2020. The aim of the project (which was supported by NHS funding) was to improve the wellbeing and mental health of CYP. Bromley CCG would receive £660.000 over this period to support the work locally.

The Board heard that the CAMHs Transformation Plan allocations for 2015-2016 to 2017-2018 were:

·  Specialist eating disorder service

·  Investment in the co-production programme

·  Investment in a Tier 2.5 capacity initiative via a single point of access

·  Autism support

·  ASD/Complex Communication Disorder Diagnostic Service

·  Investment in a School Resilience and School Responder Service

·  Investment in a Tier 3 Capacity Initiative

·  Investment in Bromley Y electronic data systems

·  Waiting times initiative

·  Health and Justice Capacity Initiative

·  Youth Mental Health First Aid

Note--Bromley Y is a long established local charity offering free therapeutic support to young people between the ages of 0 - 18 years.The link to their web page is:  https://www.bromleywellbeingcyp.org/about-us

The Board were informed that as a result of these allocations, patients had experienced a step by step improvement and greater accessibility to better quality services, and so more CYP had been able to have their emotional and mental health needs met earlier, and with quicker responses. School staff were now reporting more confidence in managing crisis presentations in schools. It was hoped that improved data collection and analysis would improve the commissioning of mental health services.

The Chairman and Dr Parson thought that the report was good news, and Dr Parson asked if there had been any change in the age range of the children and  ...  view the full minutes text for item 136.

This report was presented Alicia Munday (ECS Programme Manager) as Denise Mantell, was on leave.

The report was presented to the HWB following on from the Adult Services Stakeholder Conference that had been held in November 2016. The report outlined the action plan that would drive the Social Inclusion Campaign. The campaign included the development of a social isolation resource on Bromley My Life, a Social Awareness Week and work by partners to assist people who were experiencing social isolation. 

The Chairman was pleased with the report and thought that it was very positive.

RESOLVED that

(1) the action plan be agreed and that  members of the Board promote the required actions within their individual agencies

(2) the Board receive an update on the Action Plan prior to the awareness week in the Autumn

A review of phlebotomy services in hospitals had just been completed.

Three phlebotomy hubs were working across Bromley. These were located at Orpington, Penge and Bromley Town Centre. Places had not been filled as quickly as anticipated. The model seemed to be a good option. It was also the case that an anti-coagulation service was being developed.

RESOLVED that an update be brought to the Board in six months.

The Presentation from Bromley Mytime was delivered jointly by:

·  Adam Smith—Leisure Division Manger

·  Jason Stanton-Operations Director

·  Debra Weekes—Partnership Manager

·  Ann Wilbourn-Prime Time Manager

The Board heard that Mytime Active invested over £418,000 to make improvements to the Spa changing rooms, the West Wickham changing rooms and the soft play area at the Walnuts Leisure Centre. It was also noted that they had secured an additional £156,535 of external funding to deliver a range of community programmes. This was all part of a commitment to invest locally.

Mytime was committed to supporting under represented groups to become more active, with 59% of people benefiting from a discounted membership fee. Mytime hoped that they would be able to support LBB in some way in terms of strategy and direction.

The Board heard that Mytime was just coming to the end of a three year project with Sport England. A Bid had been submitted to raise funding that would provide more activities for older people.

The Board were provided with details of the ‘My Future Project’ that was taking place on the Ramsden Estate as it had been identified that more activities were required for young people on the estate. Free sport and dance activities had been provided since 2008. Another project that was mentioned was Artstrem, where work had been undertaken with Bromley College and other partners. This had been described as a ‘model of good practice’ by the Arts Council England. 

Schemes for adults who were not active and had medical issues were also being run, this was part funded by the CCG. Two of these schemes were ‘Heart Start’ and ‘Fresh Start’. Individuals engaged on these schemes reported that they remained largely more active after completing the schemes. Just over half of them also reported an increase in self-esteem. Mytime were ambitious to increase the number of people engaged, and would be happy to work with LBB to increase service provision. It was noted that they also ran a stroke prevention programme.

A full range of services was also offered to older people that were aged 60 and over, including those with learning disabilities. The services aimed to break the problems associated with isolation and to promote independence. This was achieved by running 80 classes per week in ten sites across the Borough. A new programme being developed in conjunction with MENCAP was planned for after Easter.

The Chairman enquired what LBB could do to assist. Mr Smith responded that Mytime was looking to create self-sustaining pathways. He asked that the Board think of the services that they provided, and engage with them. He asked that GP’s promote the Fresh Start and Heart Smart programmes.

Colin Mclean noted the social prescribing element and cautioned against duplication.

Cllr Bennett enquired how much could be done practically to assist the frail elderly. The response was that some sessions were specifically designed for people with disabilities and for people who were nervous in the water. The relevant adjustments could be made, and instructors  ...  view the full minutes text for item 139.

The report provided an overview of the third quarter performance of the Better Care Fund for 2016/17, for both the expenditure and activity levels to the end of December 2016.

The report was presented to the HWB as it was the second performance report on the Better Care Fund 2016/17, and the Board needed to be kept informed of the position of the pooled fund and the progress of the locally agreed Better Care Fund schemes.

The Board was being asked to note the report and the latest financial position, performance and progress of the Better Care Fund Schemes.

Dr Bhan updated the Board and commenced by stating that more equipment had been provided for care homes. More care was being provided for those patients that were leaving hospital. The success of the Dementia Hub was noted.

Projects had been developed to increase support to care homes.  A rapid response service had been developed to provide an alternative to the 999 service.

Another scheme that had been developed was the ‘red bag’ scheme.   

When a care home resident needed to go into a hospital, a red bag was packed for them. It contained their details, vital information about their health conditions, supplies of medicine, and a change of clothes for when they were ready to be discharged. It would also include their care passport. This had succeeded in reducing the average time of stay in hospital for elderly people from 12 days to eight days.

Resources were also being used to support the Transfer of Care Bureau (TOCB). A formal review of the TOCB was being undertaken as there had been issues around services connected to the TOCB not integrating properly.

The Chairman stated that the HWB had a statutory duty to sign off BCF funding.

Cllr Dunn referred to page 4 of the report that referenced delayed transfers of care. The report stated that there had been 2385 delayed transfers of care in quarter three, and that Bromley had not achieved the number of planned reductions for that quarter. Cllr Dunn queried how the delayed transfer of care numbers could be valued. It was agreed that this was a matter that could be looked at in the June meeting.

RESOLVED that the value of delayed transfers be looked at in the June meeting.

This item was deferred to the June meeting.

No emerging issues had been identified by members for consideration.

A paper had been written for the attention of the Board by Daniel Knight (Interim Project Manager-Bromley CCG).

The Board heard that the ‘Proactive Pathway’ had been mobilised at the end of October 2016 and good progress has been made with weekly integrated Multidisciplinary Team meetings (MDTs) now happening across all three networks. Since the last report to the Health and Wellbeing Board in November 2016, the CCG had received a report from providers on the first 100 patients to go through the Proactive Care Pathway. It was too soon to assess the full impact of the pathway; there had been positive case studies. A dashboard was being developed to monitor patient activity before and after the patient entered the Proactive Pathway; this dashboard would be monitored via the ICN steering group. An independent quantitative and qualitative evaluation of the ICN Proactive Pathway had been commissioned by the CCG and was being undertaken by the Health Innovation Network (HIN), with a final report expected to the CCG in July 2017.

Some delay against the plan had been experienced due to a slippage in recruitment. Dr Bhan stated that a recovery plan was in place.     

A new Frailty Unit had been developed which had made a significant positive impact on care pathways. Dr Bhan stated that she would like to get colleagues from social care more involved.

RESOLVED that an ICN update be brought to the meeting in September.

The Board noted the briefing report.

The Board was informed that a draft PNA would be presented to members for consideration in September. This would be followed by a 61 day consultation period.

RESOLVED that a draft PNA would be presented to the Board for consideration in September.

An update on the TOCB was provided in the BCF update.

No other business was discussed.

The date of the next meeting is 15^th June 2017.

The next meeting is scheduled for  Thursday 15^th June 2017 at 1.30pm.

The meeting will take place in Bromley Civic Centre.