Agenda and minutes

Apologies for absence were received from Councillor Stephen Carr, Councillor Mary Cooke, Councillor Angela Page and Councillor Diane Smith. 

Apologies for absence were also received from Janet Bailey, Jim Gamble and Lynn Sellwood.

Apologies for lateness were received from Councillor Judi Ellis.

Harvey Guntrip declared that he was a Lay Member of the Bromley Safeguarding Adults Board.

RESOLVED that the minutes of the meeting held on 30^th November 2017 be agreed.

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 Friday 2^nd February 2018.

No questions had been received.

The Chairman was pleased to welcome Professor Cameron Swift, a world expert on falls and a member of the NICE Falls Clinical Guideline Group and Quality Standards Advisory Committee and Dr Laura Austin Croft, Public Health Speciality Registrar to the Board to provide an update on the Falls Task and Finish Group.

A paper recommending that a Falls Task and Finish Group be convened to investigate the number and types of falls affecting Bromley’s older population had been considered at the meeting of the Health and Wellbeing Board on 7^th September 2017 where it had also been agreed that Professor Cameron Swift be approached to chair the investigation.  A range of work had subsequently been undertaken to scope the review, including initial data analysis and it was proposed that the Task and Finish Group focus on assessing falls practice in Bromley including collaborative working by health and social care partners.

Professor Cameron Swift advised Members that the review would be informed by the strong evidence base available around falls, and that the Task and Finish Group would bring together all stakeholders to identify how to develop falls practice in the current climate of closer integration between health and social care.  A Board Member highlighted the potential for the work on falls to link in with Integrated Care Networks.  Another Board Member recognised that loss of confidence following a fall was a key issue in supporting people to regain their independence.

The Chairman requested that the Falls Task and Finish Group provide an interim report to the next meeting of the Health and Wellbeing Board on 29^th March 2018.

RESOLVED that the update be noted.

An update on Primary Care Commissioning was provided to the Board by Dr Angela Bhan, Chief Officer: Bromley Clinical Commissioning Group and Dr Andrew Parson, Clinical Chairman: Bromley Clinical Commissioning Group.

Following the withdrawal of Care Quality Commission registration from two partners of a General Practice in Orpington, a caretaking arrangement had been put in place to sustain continuity of care for the practice’s patients and avoid destabilising neighbouring General Practices.  It was expected that the caretaking arrangement would be in place for approximately 18 months during which time a longer term strategy would be agreed.  Good progress had been made in establishing two Health and Wellbeing Centres within the Borough with building works on the shell of the Orpington Health and Wellbeing Centre nearing completion and discussions underway to develop a joint approach to the proposed Bromley Health and Wellbeing Centre.

The Clinical Chairman: Bromley Clinical Commissioning Group was pleased to announce that co-production work to engage communities in developing the future of Bromley wellbeing services continued.  This included the future design of emotional wellbeing and health services for children and young people, for which a questionnaire had been provided to children and young people across the Borough with over 2,000 responses already received.  A series of Bromley Co-production Community Fun Day events would be held on 14^th-16^th February 2018, and Board Members were invited to become involved and to promote the events through their local networks.

RESOLVED that the update be noted.

Report CSD18039

The Board considered the work programme and draft Terms of Reference for the Integrated Commissioning Board.

The Integrated Commissioning Board had been jointly established between the Local Authority and Bromley Clinical Commissioning Group to lead on all jointly commissioned and integrated activity, replacing the Joint Integrated Commissioning Executive and Integrated Health and Social Care Board and combining the functions of both.  The work programme for the Integrated Commissioning Board had been compiled following a series of discussions with leaders and senior commissioning colleagues across both partner organisations, and draft Terms of Reference had also been developed.

In response to a query from a Member, the Interim Director: Programmes (LBB) confirmed that the Bromley Clinical Commissioning Group and Local Authority would work closely to develop jointly commissioned and integrated activity, and that any proposed course of action would have to be agreed through the Governance process of both organisations before being progressed.

In considering the Integrated Commissioning Board’s work programme, the Vice-Chairman asked for clarification on Action 4.2 within Theme 4: Care Homes, which requested work be undertaken on a Local Authority strategy to procure a nursing home in the Borough.  The Interim Director: Programmes reported that this action related to developing a basic business case to explore whether the proposal was feasible and that there were no plans to progress to a more in-depth investigation at this stage.

The Chairman highlighted the Health and Wellbeing Board’s accountability for a number of areas within the Integrated Commissioning Board’s work programme and requested that the minutes of the Integrated Commissioning Board be provided to future meetings of the Health and Wellbeing Board as a Part 2 (Exempt) item.  It was also requested that a Part 1 (Public) report outlining the work of the Integrated Commissioning Board be provided to the Health and Wellbeing Board at six monthly intervals.

RESOLVED that the Health and Wellbeing Board endorse the work programme and Terms of Reference for the Integrated Commissioning Board.

An update on the Mental Health Strategic Partnership was provided to the Board by Harvey Guntrip, Lay Member: Bromley Clinical Commissioning Group who advised Members that mental health continued to be an area of key focus and would be discussed in relation to a number of agenda items at the meeting.

RESOLVED that the update be noted.

Report CSD18036

The Board considered a report providing an update on Delayed Transfers of Care.

At the meeting of Health and Wellbeing Board on 30^th November 2017, it had been reported that the average Delayed Transfer of Care for the beginning of October 2017 was 3.13 beds per day, which represented a significant improvement on the previous month and on the same period in 2016.  Discharge performance at the Princess Royal University Hospital had continued to improve month on month, even despite significant winter pressures.  Between August and December 2017, a total of 937 bed days had been saved with 374 bed days in December alone, which was the equivalent of an additional ward of 12 beds made available during one of the most pressured months of the year.  There continued to be an ongoing issue with national published data which varied significantly from locally reported performance.  Following the escalation of this concern to NHS England, a new process had been introduced and national published data would now be provided to the Director: Adult Social Care for sign-off prior to publication, which was expected to resolve the issue.

In considering a query raised by the Vice-Chairman in relation to the Winter plan, the Director: Adult Social Care explained that the use of community equipment supported timely discharge from hospital.  The Local Authority had agreed a contribution of £600k towards the £1.2M Community Equipment Contract for 2017/18 with no further cost liabilities, and this was monitored closely by the Local Authority’s Contract Team.  A Member underlined the need to monitor the recuperation of patients following hospital discharge, and the Director: Adult Social Care confirmed that a robust assessment process was in place to ensure all former patients received support through an appropriate discharge model.

RESOLVED that the update be noted.

Report CSD18037

The Board considered a report providing an update on the current position on childhood obesity in Bromley and outlining different programmes and initiatives addressing the problem.

The level of childhood obesity in Bromley was one of the lowest in London; however it had been identified by the National Childhood Measurement Programme that the percentage of children in Bromley schools who were obese doubled between the first year and last year of primary education.  In 2016/17 over 20% of children in Reception year were identified as being obese which increased to 31% in Year 6.  The prevalence of obesity was far more apparent in deprived wards in the borough and it had been identified that vulnerable children were significantly more at risk of childhood obesity than the general population.  A number of initiatives were in place to support a healthy weight for Bromley children including the promotion of breastfeeding, the Healthy Schools London Scheme, Bromley School Games, and cycle training through Bromley’s Road Safety Unit.  A Healthy Early Years’ Programme was being developed across parts of London which could be introduced in Bromley if successful.  The Local Authority had recently participated in a London-wide Childhood Obesity Thematic Review which had identified a whole system approach as the best way forward to help children manage a healthy weight in London.

In considering the update, the Chairman emphasised the importance of working holistically to promote healthy lifestyles, and was working with the Portfolio Holders for Environment and Education, Children and Families to develop cross-Portfolio workstreams, such as the increased use of parks.  Measures had been incorporated into Bromley’s draft Local Plan to restrict planning permission in establishing new businesses near schools in the A3 (Café/Restaurant) and A5 (Takeaway) categories, and a sugar levy on the soft drinks industry would come into force on 1^st April 2018 with the funds raised expected to contribute towards healthy lifestyles programmes for children and young people. 

A Board Member underlined that a ‘whole family’ approach was needed in promoting healthy lifestyles.  Another Member suggested that schools should focus on teaching pupils how to prepare simple, healthy meals.  With regard to infant health, a Member commented that measures to promote the benefits of breastfeeding should include mixed feeding which could help some women to sustain breastfeeding for longer.  In relation to this, another Member suggested that a programme should be developed to support parents and carers with weaning their infant, which was a key transition point.

The Chairman requested that further updates on progress to deliver Healthy Weight Bromley: Children and Young People be reported to the Health and Wellbeing Board on a six monthly basis.

RESOLVED that the update be noted.

Report CSD18038

The Board considered an update on the performance of the Better Care Fund 2017/18 up to the end of December 2017, including expenditure and activity levels.

The Better Care Fund was a programme spanning the NHS and the Local Authority which aimed to join up health and care services to support people to manage their own health and wellbeing and live independently in their communities for as long as possible.  Developed by the Local Authority and Bromley Clinical Commissioning Group, Bromley’s Better Care Fund 2017-19 Local Plan had been endorsed by the Health and Wellbeing Board at its meeting on 7^th September 2017 and formally approved by NHS England on 27^th October 2017.  The Better Care Fund allocation for Bromley for 2017/18 was £22.1M which was being used to fund a number of locally agreed schemes including additional capacity for Reablement Services, the Dementia Universal Support Service, Health Support for Care Homes and Extra Care Housing and Early Intervention and Self-Management schemes to support people to maintain their independence in the community for longer.  Schemes providing carer support services and community equipment were also funded and the Local Authority and Bromley Clinical Commissioning Group would continue to work towards the increasing integration of health and social care.

In response to a query from the Vice-Chairman, the Director: Adult Social Care confirmed that the plan for Bromley Healthcare to take over the delivery of the Reablement Service was not now going ahead, but that service provision going forward would not be affected.  Work was underway with key partners and service users to identify how the Reablement Service could be best delivered in future. 

Another Member queried whether there were issues around recruiting qualified staff to the Reablement Service.  The Director: Adult Social Care reported that work was ongoing to ensure the right measures were in place to attract and retain qualified social care staff, including flexible working and continuous professional development, although social care remained a challenging area in which to recruit high quality staff due to competition from other providers and seasonal work.  The Chairman underlined the need to work in partnership with social care providers to support the recruitment and retention of skilled social care staff, including EU Nationals who might be uncertain about their right to work in the UK.

RESOLVED that the report be noted.

The draft Joint Strategic Needs Assessment 2017 is available on the Council’s website at the following link:

http://cds.bromley.gov.uk/ieListDocuments.aspx?CId=559&MId=6308&Ver=4

Report CSD18036

The Board received a presentation from Helen Buttivant, Consultant in Public Health on the draft Joint Strategic Needs Assessment 2017.

The Local Authority and NHS Primary Care Trusts had a statutory requirement to produce a Joint Strategic Needs Assessment which aimed to develop an understanding of the current and future health and wellbeing needs of the population to support the setting strategic priorities in the short and longer term and to inform local commissioning across health and social care.  The Bromley Joint Strategic Needs Assessment 2017 explored factors affecting health and wellbeing of the Bromley population which had identified a number of key issues including the increasing population as well as specific issues around infant mortality, the prevalence of diagnosed depression and concerns around the rates of self-harm, suicide and drug misuse across the Borough.  It was proposed that a comprehensive evaluation of the Bromley Joint Strategic Needs Assessment be undertaken to review the structure, process and outcomes of the report to ensure it was fit for purpose and capable of answering the complex commissioning questions of the future.  The Joint Health and Wellbeing Strategy would also be reviewed concurrently to this evaluation to inform the publication of a refreshed strategy later in the year.

In considering the report, the Chairman identified the common links between some of the key concerns highlighted in the Joint Strategic Needs Assessment including mental health issues, drug misuse and alcoholism.  Another Member noted the issue of so-called “legal” highs which were a significant concern, particularly in relation to the 15-24 year age group which had an estimated prevalence of drug misuse that was higher than the London and National averages.  The Member underlined the importance of ensuring families were aware of the dangers of drug misuse, and additional information relating to legal highs would be provided to Members of the Health and Wellbeing Board following the meeting.

In discussion, Members expressed concern around the increase in infant mortality rates during the past two years and requested that further analysis be undertaken to explore this issue in more detail, with the outcome of this analysis to be reported to the next meeting of the Health and Wellbeing Board on 29th March 2018.

The Director: Public Health announced that the Joint Strategic Needs Assessment Steering Group would be holding a workshop on 16^th April 2018 to consider the proposed review of the Bromley Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy, and that all Board Members were invited to attend.  A Member suggested that mental wellbeing be included as a key theme for the future Joint Strategic Needs Assessment model.

The Chairman led Members in thanking Helen Buttivant for her presentation which is attached at Appendix A.

RESOLVED that:

1)  The draft Joint Strategic Needs Assessment 2017 be approved.

2)  An evaluation of the Bromley Joint Strategic Needs Assessment be undertaken to review the structure, process and outcomes of the provision of the Joint Strategic Needs Assessment; and,

3)  A review  ...  view the full minutes text for item 49.

The Pharmaceutical Needs Assessment is available on the Council’s website at the following link:

http://cds.bromley.gov.uk/ieListDocuments.aspx?CId=559&MId=6308&Ver=4

The Board received a presentation from Vanessa Lane, Director: Webstar Lane on the draft Pharmaceutical Needs Assessment and the Pharmaceutical Needs Assessment Supplementary Statement.

The Pharmaceutical Needs Assessment recorded the assessment of the need for pharmaceutical services within a specific area which was required for NHS England to consider applications to open a new pharmacy, move an existing pharmacy or to commission additional services from a pharmacy.  The Health and Wellbeing Board had established the Pharmaceutical Needs Assessment Steering Group to oversee the development of the new Pharmaceutical Needs Assessment and a public consultation had also been undertaken between October and December 2017.  The updated Pharmaceutical Needs Assessment proposed minor changes in existing provision of NHS Pharmaceutical Services and set out a vision for future provision of Community Pharmacy as High Street Neighbourhood Clinics that would offer a combination of NHS, social care and privately funded clinical services.  The Health and Wellbeing Board was requested to approve the draft Pharmaceutical Needs Assessment and the Pharmaceutical Needs Assessment Supplementary Statement.

The Chairman led Members in thanking Vanessa Lane for her presentation which is attached at Appendix B.

RESOLVED that the Pharmaceutical Needs Assessment and the Pharmaceutical Needs Assessment Supplementary Statement be approved.

An interim update on the Building a Better Bromley Communications Group was provided to the Board by Susie Clark, Communications Executive.

The Building a Better Bromley Communications Group had been established to support the delivery of the Borough Officers’ Strategic Partnership Forum priority areas, including those relating to health.  Work was underway with Public Health to develop a communications plan for the key messages of the Joint Strategic Needs Assessment, which could include fact sheets. Communications with schools had also been reviewed, following which a twice-weekly circular had been introduced.  Increased use was being made of social media to communicate key initiatives, particularly to young people.

In considering the update, the Chairman underlined the importance of continuing to promote positive messages to Bromley residents and requested press releases be issued to highlight recent work by the Board relating to social isolation in Bromley, positive measures on living healthily and the Falls Task and Finish Group. 

RESOLVED that the update be noted.

Report CSD18002

The Board considered its work programme for 2017/18 and matters arising from previous meetings.

A number of items were added to the forward rolling work programme for the Health and Wellbeing Board as outlined below:

·  Falls Task and Finish Group Interim Report (March 2018)

·  Presentation on Bromley Third Sector Enterprise and Bromley Well (March 2018)

·  Outcome of Review into Infant Mortality Rate (March 2018)

·  Integrated Commissioning Board Update (September 2018, and at 6 monthly intervals)

·  Healthy Weight Bromley: Children and Young People Update (September 2018, and at 6 monthly intervals)

·  Integrated Commissioning Board Minutes (standing Part 2 (Exempt) item: all meetings)

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

There was no other business.

1.30pm, 29^th March 2018

The next meeting of the Health and Wellbeing Board would be held at the earlier time of 1.00pm on Thursday 29^th March 2018.

RESOLVED that the Press and public be excluded during consideration of the items of business listed below as it was likely in view of the nature of the business to be transacted or the nature of the proceedings that if members of the Press and public were present there would be disclosure to them of exempt information.

RESOLVED that the minutes of the meeting held on 30^th November 2017 be agreed.