Agenda and draft minutes

Venue: Bromley Civic Centre

Contact: Kerry Nicholls  020 8313 4602

Items
No. Item

31.

Apologies for Absence

Minutes:

Apologies for absence were received from Councillor Mary Cooke and Councillor Judi Ellis.  Apologies were also received from Janet Bailey, Dr Angela Bhan and Jim Gamble QPM, and Carol Whiting, Mark Cheung and Kerry Davies attended as their respective substitutes. 

 

The Chairman welcomed Isobel Cattermole, Independent Chairman: Children's Service Improvement Governance Board to the meeting as an Observer.

32.

Declarations of Interest

Minutes:

There were no declarations of interest.

33.

Minutes of the Meeting of Health and Wellbeing Board held on 19th July 2018 pdf icon PDF 123 KB

Minutes:

RESOLVED that the minutes of the meeting held on 19th July 2018 be agreed.

34.

Questions by Councillors and Members of the Public Attending the Meeting

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 21st September 2018.

Minutes:

No questions had been received.

35.

Childhood Obesity and Promoting Exercise and Healthy Weight to Children and Young People pdf icon PDF 76 KB

Minutes:

Report CS18178

 

The Board considered a report providing an update on the current position on childhood obesity in Bromley and outlining the different programmes and initiatives in place to target 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 and last year of primary education.  A number of initiatives were in place to support Bromley children to maintain a healthy weight including the promotion of breastfeeding, the Healthy Schools London Scheme, Bromley School Games and the Daily Mile.  Families of Bromley children assessed as being outside the healthy weight range were signposted to Change4life online NHS resources to support them to make healthy changes to their lifestyles, and severely obese children were offered an appointment with a children’s dietician and could access drop-in dietetic clinics for further advice and weight checks.  A new regional awards scheme, ‘Healthy Early Years London’ had recently been launched to support and recognise achievements in child health, wellbeing and education in Early Years settings, and 110 Early Years settings in Bromley had already registered for the scheme. 

 

In considering the update, the Chairman highlighted that an holistic approach should be taken to addressing childhood obesity and that more could be done to embed positive schemes such as the Daily Mile in schools as well as to develop ways in which measures to improve the health of children and young people could be carried forward to their family and friends.

 

A Member noted work by Bromley’s Road Safety Unit to promoted active travel and asked how this had impacted car usage by families and whether there were safety implications to increasing cycling by children and young people.  The Children and Young People Programme Lead, Public Health confirmed that families were supported to make informed decisions about how they travelled and that there was a high uptake of the ‘Bikeability’ cycling safety scheme by schools which trained children to be confident cyclists.  Another Member observed the importance of partners delivering a coordinated response to childhood obesity and not duplicating provision.  In response to a question from a Member, the Children and Young People Programme Lead, Public Health outlined a range of healthy and active lifestyle activities that were accessible outside the school environment including cooking sessions and physical activities, a number of which were targeted towards areas of deprivation.  Further information on work to promote active travel by Bromley’s Road Safety Unit and schools would be provided to Board Members following the meeting.

 

A Member queried how the healthy lifestyle needs of hard-to-reach groups were being identified.  The Children and Young People Programme Lead, Public Health reported that a range of work was undertaken with different groups across the Borough, including young carers.  Work was also underway to build relationships with the gypsy traveller community that would include a health and wellbeing focus.  The  ...  view the full minutes text for item 35.

36.

Local Child and Adolescent Mental Health Service (CAMHS) Transformation Plan 2018/19 Refresh pdf icon PDF 93 KB

Minutes:

Report CS18179

 

The Board considered a report from Nazmin Mansuria, Senior Commissioning Manager, Bromley Clinical Commissioning Group on the local Child and Adolescent Mental Health Service (CAMHS) Transformation Plan 2018/19 refresh.

 

The refreshed local Child and Adolescent Mental Health Service Transformation Plan 2018/19 proposed a continuation of the key transformation aims and vision as set out in the initial Local CAMHS Transformation Plan 2015 that had been jointly developed with the Local Authority and delivery and sector partners, and confirmed in a subsequent Plan refresh in 2017.  The key areas of focus comprised building capacity across the system to cope with increasing demand, improving accessibility to services and the quality of the service offer across early intervention and specialist community CAMHS, and demonstrating a commitment to co-producing the future system and referral and care pathway design.  The Plan refresh for 2018 set out the changes and improvements achieved in transforming local emotional wellbeing and mental health services and also provided a range of evidence showing the impact made by the system by the allocations of Transformation Plan investments and oversight on improved outcomes and learning.  The local strategic ambitions within the plan continued from previous years and included to co-design and co-produce children and young people’s emotional wellbeing and mental health referral and care pathways to respond to need, to exceed the national target of 35% of those with mental health needs accessing appropriate evidence-based treatment and support at the right time and to ensure that waiting times were kept within clinically appropriate time frames.  Other aims included collaborating with schools, the voluntary sector and health providers to prevent need and support communities to keep well, and to develop a workforce capable of delivering planned new services.  The Senior Commissioning Manager, Bromley Clinical Commissioning Group reported that Bromley had been one of 40 areas invited to apply to participate in a Trailblazer programme to be launched in 2021, and that Bromley’s plan to develop a platform within schools to identify pupils with mental health needs and assist them in accessing appropriate support would be submitted for evaluation shortly. 

 

It was a requirement for the Bromley Clinical Commissioning Group and its partners to complete a local CAMHS Transformation Plan refresh for 2018/19 for submission for assurance purposes to NHS England.  The allocation of additional resources for the delivery of the CAMHS Transformation Plan in 2018/19 was dependent on the endorsement of the Health and Wellbeing Board.  As the submission date to NHS England was 31st October 2018, it was proposed that the Transformation Plan be approved via a Chairman’s action following full consideration by the Health and Wellbeing Board.

 

In considering the report, the Chairman noted that recent changes to the Bromley system, including to referral pathways, had driven an increase in the number of evidence-based treatment plans in place to support the individual mental health needs of children and young people.  In response to a question from a Member, the Senior Commissioning Manager, Bromley Clinical Commissioning Group confirmed that  ...  view the full minutes text for item 36.

37.

Joint Strategy for Ageing Well in Bromley (Verbal Update)

Minutes:

An update on the Joint Strategy for Ageing Well in Bromley was provided to the Board by Mark Davison, Interim Head of Programme Design (ECHS).

 

The development of the Joint Strategy for Ageing Well in Bromley was being informed by a comprehensive engagement process undertaken during Summer 2018 that had included online and hard copy surveys, face-to-face engagement sessions with existing groups and an open meeting for all Bromley residents.  The consultation had been focused around four outcome statements comprising:

 

1)  I socialise, participate and make my own choices;

2)  I feel healthy and can get the health and care services I need when I need them;

3)  My home meets my aspirations and needs; and,

4)  I am safe and I feel safe and I trust the people around me.

 

The responses to the engagement process were now being evaluated, but initial analysis suggested that whilst responses to the four outcome statements had largely been positive, there were a number of issues including barriers to accessing leisure activities, access concerns with health and care services (particularly General Practitioners) and difficulties faced by those with caring responsibilities.  Issues had also been raised around the lack of housing available in the Borough for those who wished to move to more suitable accommodation and the value of a visible police presence on the streets in helping older people to feel safe.

 

In response to a question from a Member, the Interim Head of Programme Design (ECHS) confirmed that as the survey had been designed locally, it could not be compare on a like-for-like basis with other local authorities, but that it might be possible to make a comparison across similar themes.  The Member suggested that the Local Authority could do more to support older people seeking to move into accommodation more suitable for their needs, such as extra care housing schemes.  A Member was concerned to note the level of social isolation identified by the engagement process, and highlighted the importance of engaging with hard-to-reach groups who were less likely to participate in activities or events.

 

RESOLVED that the update be noted.

38.

Draft Health and Wellbeing Strategy pdf icon PDF 54 KB

Additional documents:

Minutes:

Report CS18180

 

The Board considered a report outlining a review of the methodology of the Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JHWS) undertaken during 2018.  This included the addition of new priorities for the Joint Health and Wellbeing Strategy agreed at the meetings of the Health and Wellbeing Board on 7th June 2018 and 19th July 2018.

 

In considering the draft Joint Strategic Needs Assessment 2017 at its meeting on 8th February 2018, the Health and Wellbeing Board agreed that 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 that a review of the Joint Health and Wellbeing Strategy be undertaken to inform the development of a new strategy.  This work had now been completed with new methodologies developed for both the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy.  The draft Bromley Health and Wellbeing Strategy provided a structure for the new document and outlined a proposed process for developing action plans for each of the ten identified priorities, as well as a process by which progress on the action plans could be reported to the Health and Wellbeing Board.

 

In response to a question from a Member in relation to Priority 1 - Cancer, the Director: Public Health confirmed that there were plans to target areas of high deprivation where smoking and alcohol use were known to be higher, and that this included work to integrate with local Primary Care services.  It was the first time that cancer had been included as a priority in the Health and Wellbeing Strategy and this was as a result of it overtaking cardiovascular disease as the major cause of death in the Bromley population.  The Member also raised a concern in relation to Priority 7 – Adults with a Learning Disability who Live in Stable and Appropriate Accommodation, and the Director: Public Health advised that a range of work would be undertaken with partners including the Housing Service to explore this issue and develop an action plan, and that regular updates would be provided to Health and Wellbeing Board as this work was progressed.  The Member highlighted Priority 9 – Youth Violence and observed that perceptions of youth violence appeared to differ between younger and older Bromley residents.  With regard to Priority 6 – Statutory Homelessness, another Member suggested that more could be done by the Board to explore the health and wellbeing implications of homelessness, and the Chairman noted that Housing came within the remit of the Renewal, Recreation and Housing Portfolio but that reports relating to homelessness and its impact on health and wellbeing would be provided to the Board where appropriate. 

 

The Chairman led the Board in thanking the Director: Public Health and her team for their work in developing the Health and Wellbeing Strategy.  The Health and Wellbeing Strategy would be provided to the next meeting of the  ...  view the full minutes text for item 38.

39.

Update on Delayed Transfers of Care Performance pdf icon PDF 173 KB

Minutes:

Report CSD18185

 

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

 

The performance of Delayed Transfers of Care at the Princess Royal University Hospital had continued to improve.  Positive results had been attained each month during Quarter 1 2018/19, and Delayed Transfers of Care had reduced from a total of 139 total bed days in June 2018 across all areas compared to 490 bed days for June 2018.  This represented a total of 351 total bed days saved compared to the previous year.  The work of the Mental Health DToC Partnership Group had supported a significant reduction in Delayed Transfers of Care in Mental Health Acute Trusts from an average of 250 delayed days per month in Quarter 3 2017/18 to 127 delayed days per month for Quarter 1 2018/19.  Nationally, for 2018 (year to date), Bromley had been responsible for 756 bed days at an average of 8.3 beds per day. This compared to 1484 bed days (or 16.3 beds per day) for the same period in 2017/18, which was a reduction of 50.9%.  Within the South London region, Bromley had moved from being the worst performer to the second strongest performer.  A revised methodology had recently been agreed nationally by which Delayed Transfers of Care targets would be set centrally.  When calculated using NHS England’s national published objective, Bromley’s target for 2018/19 was 12.5 bed days compared to 10.31 bed days for 2017/18.

 

In response to a query from a Member, the Associate Director: Urgent Care, Discharge Commissioning and Transfer of Care Bureau clarified that Delayed Transfers of Care bed days attributable to Bromley referred to Bromley residents, included those admitted to hospital outside the Borough.  A Member emphasised the need to publicise the significant improvement in Delayed Transfers of Care performance.

 

The Chairman led Members in thanking the Associate Director: Urgent Care, Discharge Commissioning and Transfer of Care Bureau and all other partners for their excellent work in improving Delayed Transfers of Care performance. 

 

RESOLVED that the update be noted.

40.

Bromley System Winter Plan pdf icon PDF 69 KB

Additional documents:

Minutes:

 

The Board considered a report outlining the Bromley System Winter Plan.

 

The Bromley System Winter Plan had been developed to provide a framework for health and social care partners within the Bromley system to manage surge and capacity issues at both technical and strategic levels within the local health and social care system during Winter 2018.  A number of objectives had been identified within the Plan which comprised establishing a shared understanding of surge and escalation criteria used across health and social care services, defining a flexible framework for response and defining procedures and processes about escalation in the event of an actual or potential surge and capacity issues.  During surge and escalation issues, the Plan also specified frameworks for informing, coordinating and supporting the health and social care services response to incidents and to actively engage with the public, as well as to provide a mechanism by which issues for joint resolution by partners could be escalated at both a tactical and strategic level.  The South East London Sustainability and Transformation Plan required Local Accident and Emergency Delivery Boards to submit a winter assurance plan to NHS England for their areas, and the Health and Wellbeing Board was requested to support and challenge the local system to ensure that all elements within the report were delivered and that the local system worked together to respond to the challenging seasonal demand.

 

In response to a question from a Member, the Urgent Care Lead: Integrated Commissioning, Bromley Clinical Commissioning Group confirmed that recruitment was underway to support the delivery of the Bromley System Winter Plan.  A Board Member underlined the importance of Local Authority, health and social care professionals being vaccinated against flu.

 

Further updates on the Bromley System Winter Plan would be reported to the meetings of the Health and Wellbeing Board on 31st January and 21st March 2019.

 

RESOLVED that the Bromley System Winter Plan be agreed.

41.

Better Care Fund and Improved Better Care Fund 2018/19 Q1 Performance Report pdf icon PDF 485 KB

Minutes:

Report CSD18184

 

The Board considered an update on the performance of the Better Care Fund and Improved Better Care Fund during Quarter 1 2018/19, 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.  The Improved Better Care Fund was an additional funding element added to the Better Care Fund for a three year period from 2017/18 providing further investment in adult social care services.  In the Spring Budget 2017 the London Borough of Bromley was awarded an IBCF Grant of £4.2M in 2017/18, with grant funding of £3.4M and £1.7M to be provided in 2018/19 and 2019/20 respectively.  During 2018/19, the Better Care Fund was being used to fund a number of locally agreed schemes which supported a reduction in non-elective admissions, delayed transfers of care and the rate of permanent admissions to residential care, as well funding reablement and rehabilitation services that supported older people to remain living independently in their own homes following hospital discharge.  Schemes funded through the Improved Better Care Fund had been developed to meet adult social care needs, reduce pressures on the NHS and support the local social providers market.

 

In considering the report, a Member highlighted an Improved Better Care Fund budget allocation of £1,566k for Care Homes Investment Options Appraisal for which there had been no allocated spend.  The Interim Director: Programmes explained that this related to work exploring whether it would be cost effective for the Local Authority to establish a care home within the Borough, and that an outline business case was being developed to identify if the proposal was feasible.  If this was the case, the budget for this workstream would be allocated towards the necessary works to take forward the project.  A Board Member noted that there was also a budget area for Market Development and Support with an Improved Better Care Fund budget allocation of £130k for which there had been no allocated spend.  The Interim Director: Programmes confirmed that this referred to a joint project by the Local Authority and Bromley Clinical Commissioning Group to support the development of a stronger, more integrated market for care homes in Bromley and through which three workstreams comprising Strategy, the Health and Social Care Offer and Quality were being progressed. 

 

The Chairman requested that updates on the Care Homes Investment Options Appraisal business case be provided to Adult Care and Health PDS Committee when available.

 

RESOLVED that the performance and progress of the Better Care Fund and Improved Better Care Fund schemes, as well as the financial performance for Quarter 1 2018/19 be noted.

42.

Integrated Commissioning Board Update pdf icon PDF 120 KB

Minutes:

The Board considered an update on the work of the Integrated Commissioning Board.

 

The Integrated Commissioning Board had been developed to support the Local Authority and Bromley Clinical Commissioning Group to work more closely together in relation to commissioning activities.  It was not a decision making body but provided an opportunity for both organisations to work in a more collaborative way and to monitor work streams being progressed. 

 

A Member requested that future updates to the Health and Wellbeing Board include both the target and delivery date of each workstream to support better scrutiny.

 

RESOLVED that the update be noted.

43.

Implementation of the Recommendations of the Falls Task and Finish Group (Verbal Update)

Minutes:

The Sub-Committee considered an update on the implementation of the recommendations of the Bromley Task and Finish Group by Mark Cheung, Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group.

 

The Falls Task and Finish Group had been convened by the Health and Wellbeing Board to investigate the number and types of falls affecting Bromley’s older population and consider falls prevention work in Bromley, including assessing the level of collaboration across primary, secondary, community and social care providers.  The review was chaired by Professor Cameron Swift and a range of work had been undertaken including data analysis to establish falls epidemiology in the Borough and meetings with primary, secondary, community and social care partners.  The final report of the Falls Task and Finish Group had been considered at the meeting of Health and Wellbeing Board on 19th July 2019.  The Board had supported the recommendations of the final report including improving data management and systems, data sharing to identify a strategy to reduce falls in the Borough, increased case identification and referrals to prevention services, workforce development and collaboration across services.  The Board had also requested that final report of the Falls Task and Finish Group be presented to the Integrated Commissioning Board and that a Bromley Joint Working Group be established to take forward the recommendations of the review within a specified timescale.

 

The final report of the Falls Task and Finish Group, which included a proposal that a Bromley Joint Working Group be established to take the recommendations forward within a specified timescale, would be presented to the next meeting of the Integrated Commissioning Board on 1st October 2018.

 

RESOLVED that the update be noted.

44.

Update on Phlebotomy Services (Verbal Update)

Minutes:

The Sub-Committee considered an update on changes to phlebotomy services in Bromley by Mark Cheung, Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group.

 

In early 2018, King’s College Hospital NHS Foundation Trust had notified the Bromley Clinical Commissioning Group that it wished to reallocate the space used for the walk-in phlebotomy service at the Princess Royal University Hospital to other services from 1st October 2018, and requested that the Bromley Clinical Commissioning Group commission this service from different provider.  To enable this change, additional phlebotomy capacity had been added to the 28 General Practices across the Borough that delivered phlebotomy services as an ‘enhanced service’ and the walk-in phlebotomy services at the Beckenham Beacon and Orpington Hospital sites would continue to operate.  The Princess Royal University Hospital would continue to provide phlebotomy services for Inpatient and Outpatient services as well as children’s blood tests. 

 

The Chairman requested that a short written update on changes to phlebotomy services be provided for circulation to the Health and Wellbeing Board and all Members of the Council following the meeting, and that a further update be reported to the next meeting of the Health and Wellbeing Board on 28th November 2018.

 

RESOLVED that the update be noted.

45.

Communications Update (including partnership working with Mytime Active)

Minutes:

A communications update was provided to the Board by Susie Clark, Communications Executive.

 

The Bromley Communications and Engagement Forum continued to bring communication and engagement representatives together from across the Bromley statutory and voluntary sector to share work ideas and best practice.  Joint campaigns, information and engagement activities were delivered on areas such as community health and wellbeing, including recent work to support community engagement in the Joint Strategy for Ageing Well in Bromley consultation and the promotion of the ‘Stoptober’ initiative.  Work was being undertaken with Mytime Active to better signpost Bromley residents to the wide range of healthy lifestyle programmes available including Prime Time, which offered a number of benefits to older people including increasing activity levels and reducing social isolation.

 

RESOLVED that the update be noted.

46.

Work Programme and Matters Arising pdf icon PDF 94 KB

Minutes:

Report CSD18124

 

The Board considered its work programme for 2018/19 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:

 

·  Update on Phlebotomy Services (28th November 2018)

·  Trailblazer Programme Bid Update (28th November 2018 and 31st January 2019)

·  Bromley System Winter Plan (31st January and 21st March 2019).

 

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

47.

Any Other Business

Minutes:

Isobel Cattermole, Independent Chairman: Children's Service Improvement Governance Board gave an update to the Board on work underway to improve Children’s Services.  Following a period of monitoring visits by Ofsted, a full Children’s Services Inspection was expected shortly and would provide a judgment on the progress made by the Local Authority and its partners over the past two years.  All partners had been requested to complete a self-evaluation in preparation for the Inspection, and it was hoped that the outcome of the Inspection would reflect the hard work undertaken by the Local Authority and its partners to embed improvement across Children’s Services.

 

RESOLVED that the issues raised be noted.

48.

Date of Next Meeting

1.30pm, Wednesday 28th November 2018

1.30pm, Thursday 31st January 2019

1.30pm, Thursday 21st March 2019

Minutes:

The next meeting of the Health and Wellbeing Board would be held at 1.30pm on Wednesday 28th November 2018.

 

Original Text: