Agenda and draft minutes

Venue: Bromley Civic Centre

Contact: Kerry Nicholls  020 8313 4602

Items
No. Item

49.

Apologies for Absence

Minutes:

Apologies for absence were received from Councillor Marina Ahmad and Colin Maclean, and Councillor Simon Jeal and Janet Tibbalds attended as their respective substitutes.  Apologies were also received from Councillor Judi Ellis, Janet Bailey and Dr Andrew Parson.

50.

Declarations of Interest

Minutes:

There were no declarations of interest.

51.

Minutes of the Meeting of Health and Wellbeing Board held on 27th September 2018 pdf icon PDF 135 KB

Minutes:

RESOLVED that the minutes of the meeting held on 27th September 2018 be agreed.

52.

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 Thursday 22nd November 2018.

Minutes:

No questions had been received.

53.

Discussion on Childhood Obesity (Verbal Update)

Minutes:

Members discussed work being undertaken to explore the key issue of childhood obesity. 

 

The Chairman proposed that a Task and Finish Group on Childhood Obesity be convened during early 2019.  The aim of the Task and Finish Group was to identify existing measures in place across Bromley to prevent and reduce childhood obesity as well further action to be taken as part of a coordinated multi-agency response.  The Managing Director: Bromley Clinical Commissioning supported the proposal and requested that the Task and Finish Group include representation from the Children’s Commissioning Team, Bromley Clinical Commissioning Group.  It would also be useful to include key partners such as Mytime Active. 

 

The Terms of Reference for the Task and Finish Group would be provided to Board Members following the meeting and Board Members were requested to contact the Clerk to the Board if they were interested in participating in the Task and Finish Group.

 

RESOLVED that the update be noted.

54.

Health and Wellbeing Strategy pdf icon PDF 64 KB

Additional documents:

Minutes:

Report CS18197

 

The Board considered the updated Joint Bromley Health and Wellbeing Strategy 2018-22. 

 

The Joint Bromley Health and Wellbeing Strategy 2018-22 was a shared agreement between a range of key partners to support improved health and wellbeing for all people living and working in Bromley.  Following consideration of the draft Joint Strategic Needs Assessment 2017 at the meeting of the Health and Wellbeing Board on 8th February 2018, it had been agreed to undertake a review of the Joint Health and Wellbeing Strategy to inform the development of a new strategy.  This work had now been completed and the draft Joint Bromley Health and Wellbeing Strategy 2018-22 was recommended to the Health and Wellbeing Board for approval.  Additional work on Priority 7 – Adults with a Learning Disability had identified Bromley was performing significantly higher in this area than previously thought, and it was therefore recommended that Priority 7 be removed from the Joint Bromley Health and Wellbeing Strategy 2018-22.

 

In considering the Joint Health and Wellbeing Strategy 2018-22, Board Members discussed the proposed priority areas.  A Board Member supported the approach taken in the strategy, but underlined the need for further work where health and wellbeing trends in Bromley were out of step with regional or national trends.  Another Member stressed that the number of priority areas should be manageable to enable resources to be focused effectively.  The Member was concerned that Priority 6: Homelessness and Priority 9: Youth Violence duplicated work by other Portfolios.  In response to this, another Member noted that the strategy had been developed to identify gaps in existing provision relating to health and wellbeing and that there were no plans to duplicate work.  A Member highlighted that many key issues, such as violence against women and girls, were cross-cutting and it was important to take an holistic approach. 

 

A Member noted that the London Borough of Bromley had the third highest level of low-level depression in London and asked that the issue of depression be included in the strategy, perhaps within an existing priority area.  The Director: Public Health explained that mental health could be divided into two main levels of severity, and that whilst the level of severe mental health problems in Bromley had remained stable and therefore had not been flagged for inclusion in the strategy, there was potential to include more minor mental health problems within the strategy, with a specific focus on depression and anxiety.  The Member also underlined that issues affecting children and young people, such as substance misuse would become an issue for older age groups as children and young people transitioned to adult services and measures should be taken to plan for future service demands.  Following discussion, the Board generally agreed that Priority 5: Suicide Prevention be renamed ‘Adult Mental Health’ and include actions around suicide prevention as well as a specific commitment to undertake further scoping on adult mental health to identify any gaps in provision.  It was also agreed that Priority 4 –  ...  view the full minutes text for item 54.

55.

Update on Joint Strategy for Ageing Well in Bromley 2019-2024 pdf icon PDF 93 KB

Minutes:

Report CS18198

 

An update on the development of the Joint Strategy for Ageing Well in Bromley 2019-24 was provided to the Board by Mark Davison, Interim Head of Programme Design (ECHS).

 

The Joint Strategy for Ageing Well in Bromley 2019-24 was being developed by the Local Authority in partnership with the Bromley Clinical Commissioning Group to provide an integrated strategic approach for ageing well in Bromley.  The development of the strategy had been informed by a comprehensive engagement process undertaken during Summer and Autumn 2018, following which a portfolio of Ageing Well projects had been co-designed with key partners and members of the community.  Consultation on the final draft of the strategy would be taken forward during late 2018, with the expectation that the final Joint Strategy for Ageing Well in Bromley 2019-24 and accompanying delivery plans would be agreed and published in Spring 2019.

 

The Board discussed ways in which socially isolated Bromley residents could be identified and supported.  A range of projects were delivered by the community and voluntary sector including ‘Community Connectors’.  Diverse leisure opportunities were also available through Mytime Active’s Primetime scheme, and Royal Mail had recently launched a scheme through which postmen checked on vulnerable residents.  A Board Member recognised that social prescribing was increasingly used to improve the health and wellbeing of the elderly frail, and emphasised the need for the Joint Strategy for Ageing Well in Bromley 2019-24 to reach the most socially isolated Bromley residents.

 

The Interim Head of Programme Design (ECHS) noted that Frome in Somerset had seen a dramatic fall in emergency hospital admissions since it launched a collective project to combat social isolation and that a similar approach might prove beneficial for Bromley, particularly in the Borough’s more rural communities.

 

The Chairman queried how the Health and Wellbeing Board could best support the Joint Strategy for Ageing Well in Bromley 2019-24.  The Interim Head of Programme Design (ECHS) advised that the strategy would be launched in April 2019 and that the Board’s involvement would be welcomed.  Board Members would have a key role in promoting the Joint Strategy for Ageing Well in Bromley 2019-24, and a Board Member suggested that Members were well-placed to identify vulnerable residents within the community, which could include those with mobility issues or caring responsibilities.  Another Board Member underlined the need to draw on the enthusiasm created during the consultation and co-design stages of developing the Joint Strategy for Ageing Well in Bromley 2019-24.

 

RESOLVED that the update be noted.

56.

Bromley Safeguarding Adults Board Annual Report pdf icon PDF 65 KB

Additional documents:

Minutes:

Report CS18187

 

The Board received a presentation on the Bromley Safeguarding Adults Board Annual Report 2017/18 by Lynn Sellwood, Independent Chairman and Raynor Griffiths, Manager: Bromley Safeguarding Adults Board.

 

The Local Authority had a statutory duty under the Care Act 2015 to establish a Safeguarding Adults Board to help and protect vulnerable adults in Bromley.  The Bromley Safeguarding Adults Board had three main functions comprising developing a strategic plan, publishing an annual report and undertaking Safeguarding Adults Reviews (SARs) to investigate serious incidents.  No SARs had been commissioned in 2017/18; however the Safeguarding Adults Review Committee had made the decision to commission a SAR in respect of one case on 29th June 2018 that was currently in progress, and a further case had met the threshold for a SAR for which the Board was seeking legal advice.  During 2017/18, the Bromley Safeguarding Adults Board had undertaken a range of work outlined in the Safeguarding Adults Strategy 2016-19, including the establishment of the Safeguarding Adults Review Committee, creating a safeguarding awareness commercial and delivering a number of events to raise awareness of adult safeguarding.  The key priorities for the year had been self-neglect, hoarding, domestic violence and fire safety in homes, and the same key priorities would be carried forward into 2019/20.  The forward work programme included the development of the Board’s strategy for 2020-2023 and a strategy and Borough-wide approach to tackling modern day slavery.  It was also planned to complete an audit of safeguarding practice in the private, voluntary and independent sectors and develop a community engagement programme to increase awareness of adult safeguarding in Bromley.

 

In considering the report, the Chairman led Board Members in commending Lynn Sellwood and Raynor Griffiths for the excellent work of the Bromley Safeguarding Adults Board during 2017/18.  A Member noted that the Adult Care and Health PDS Committee had expressed support for the Bromley Safeguarding Adults Board Annual Report at its meeting on 21st November 2018, and was looking for ways to promote the key messages of adult safeguarding in communities across the Borough.

 

In response to a question from a Board Member, the Independent Chairman: Bromley Safeguarding Adults Board confirmed that the Bromley Safeguarding Adults Board would link in with the work of the Joint Strategy for Ageing Well in Bromley 2019-24.  Another Member underlined the need for the Bromley Safeguarding Adults and Children Boards to work closely together, highlighting cross-cutting issues such as the impact of violence against women and girls.  The Independent Chairman: Bromley Safeguarding Adults Board and Independent Chairman: Bromley Safeguarding Children Board emphasised their absolute commitment to work together.  The Chairman noted that the Joint Health and Wellbeing Strategy 2018-22 had been designed to bring together health and wellbeing priorities for both children and adults.  A link to the Board’s safeguarding awareness commercial would be provided to Board Members following the meeting.

 

RESOLVED that the Bromley Safeguarding Adults Board Annual Report 2017/18 be noted.

57.

Bromley Safeguarding Children Board Annual Report pdf icon PDF 12 MB

Minutes:

The Board considered the Bromley Safeguarding Children Board Annual Report 2017/18.

 

The Bromley Safeguarding Children Board was the key statutory body overseeing multi-agency child safeguarding arrangements across the Borough.  The Bromley Safeguarding Children Board Annual Report 2017/18 provided an in-depth assessment of the effectiveness of the Bromley Safeguarding Children Board in safeguarding children and promoting child welfare in Bromley during the year.  There had been a key focus on developing, strengthening and improving partnership working and real progress had been made in a number of critical areas including commissioning more local learning, as well as supporting the Local Authority on its improvement journey.  The Bromley Safeguarding Children Board continued to deliver its own improvement plan and had led on the Borough’s response to child sexual exploitation as well as undertaking work involving missing children, gangs and other pathways to harm that could undermine a young person’s chances in life.  A wide-ranging consultation had been completed on the use of technology by children and families and the responses to this had been used to inform the Bromley Digital Footprint report.  A comprehensive work programme to build on the progress made by the Bromley Safeguarding Children Board had been identified for 2018/19, and the Board would continue to work closely with its partners, including working with the Bromley Safeguarding Adults Board on cross-cutting issues such as transition, to ensure that children and young people in Bromley had every opportunity to thrive.

 

The Chairman led Board Members in commending Jim Gamble for the excellent work of the Bromley Safeguarding Children Board during 2017/18.  An Ofsted Inspection of Bromley's Children's Services was currently underway and initial feedback was expected shortly. 

 

RESOLVED that the draft Bromley Safeguarding Children's Board Annual Report 2017/18 be approved.

58.

Better Care Fund and Improved Better Care Fund Performance 2018/19 Q2 Performance Report pdf icon PDF 175 KB

Minutes:

Report CSD18202

 

The Board considered an update on the performance of the Better Care Fund and Improved Better Care Fund during Quarter 2 2018/19, including expenditure and activity levels from Jackie Goad, Executive Assistant, Chief Executive’s Department.

 

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 had driven 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 response to a question from a Board Member, the Director: Adult Social Care confirmed that the three additional step-down flats funded via the Improved Better Care Fund were being used at maximum capacity alongside the 12 existing step-down flats.  A detailed report on Extra Care Housing provision would be considered at a meeting of Adult Care and Health PDS Committee later in the 2018/19 municipal year.  Work to progress the Care Homes Investment Options Appraisal was ongoing and further updates would be reported to the Health and Wellbeing Board when available.  A Member noted that 217 young carers had been referred to the Carer’s Pathway within the Bromley Well Service during its first year of operation, and queried whether this related to new referrals or the total cohort and this information would be provided to the Member following the meeting.

 

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 2 2018/19 be noted.

59.

Delayed Transfer of Care (DTOC) Performance Update pdf icon PDF 380 KB

Minutes:

Report CSD18203

 

The Board considered a report providing an update on Delayed Transfers of Care from Stephen John, Director: Adult Social 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 2 2018/19, and Delayed Transfers of Care had reduced to a total of 186 total bed days in September 2018 across all areas compared to 435 bed days for the previous year.  This represented a total of 249 total bed days saved compared to the previous year.  Nationally, for 2018 (year to date), Bromley had been responsible for 1506 bed days at an average of 8.3 beds per day. This compared to 2930 bed days (or 16 beds per day) for the same period in 2017/18, which was a reduction of 51%.  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 10.3 bed days for 2017/18. 

 

The Director: Adult Social Care reported that work was underway to further reduce Delayed Transfers of Care, including engaging with the South East London Sustainability and Transformation Plan and through the work of the Discharge to Assess Service.  In response to a question from a Member, the Managing Director: Bromley Clinical Commissioning Group confirmed that plans by King’s College Hospital NHS Foundation Trust to repurpose the Elizabeth Ward in Orpington Hospital as an outpatient facility had been delayed due to the pressures on the Emergency Department during Summer 2018.  Whilst it was still planned to use the Elizabeth Ward as an outpatient facility, a flexible approach would be taken to the use of the space in the short term to ensure that the needs of patients were being met, which could include the provision of ‘step-down’ care.  The longer term plan for Bromley’s integrated care model was to provide more home-based care which was expected to reduce ‘decompensation’ caused by inpatient care. 

 

RESOLVED that the update be noted.

60.

Trailblazer Programme Bid Update (Verbal Update)

Minutes:

The Board considered an update from Dr Angela Bhan, Managing Director: Bromley Clinical Commissioning Group on a recent bid made for funding via a Trailblazer programme.

 

Bromley had been one of 40 areas invited to apply to make a bid to a Trailblazer programme due to be launched in 2021.  The Borough’s bid proposed the development of a platform within schools to identify pupils with mental health needs and assist them in accessing appropriate support.  Should Bromley be successful, funding would be provided over a five year period to drive service transformation with the intention of establishing an effective and sustainable model.

 

The Managing Director: Bromley Clinical Commissioning Group advised the Board that the outcome of the bid had not yet been announced, but that the Bromley Clinical Commissioning Group was optimistic that the bid would receive funding.

 

RESOLVED that the update be noted.

61.

Bromley Health and Wellbeing Centre Project: Update and Progress Report pdf icon PDF 117 KB

Minutes:

The Board considered a report providing an update on developments in the planning and approval of the Bromley Health and Wellbeing Centre project from Dr Angela Bhan, Managing Director: Bromley Clinical Commissioning Group.  The report also sought confirmation of the Board’s continuing support for the scheme as a key strategic priority to deliver the ‘Bromley Out of Hospital Transformation Strategy’.

 

The establishment of a third Health Centre within the Borough to complement the Beckenham Beacon and the Orpington Health and Wellbeing Centre was one of the key proposals of the ‘Bromley Out of Hospital Transformation Strategy’, which had been developed jointly by the Bromley Clinical Commissioning Group and the Local Authority.  It was planned that the Bromley Health and Wellbeing Centre would be one of the three ‘hubs’ underpinning the new Integrated Care Networks and would play a key role in providing coordinated care to approximately 100,000 people via integrated services.  It would also offer significant primary care services for Bromley residents, including a Primary Care Access Hub and the relocation of the Dysart Medical Practice which would be able to expand to offer primary healthcare to additional patients. 

 

Funding had been secured from the NHS Executive’s Estates and Technology Transformation Fund in October 2016 to develop the project, following which the Strategic Outline Case and Project Initiation Document had been approved.  The Post-PID Full Options Appraisal which identified potential sites for the scheme had been approved by the NHS Executive in October 2017, and following a detailed evaluation of a number of site options by the Multi-Disciplinary Evaluation Panel which included Local Authority representation, 32 Masons Hill, Bromley had been identified as the preferred site.  The Outline Business Case was being prepared and would be submitted to the NHS Executive for approval during December 2018, and work was ongoing to develop a comprehensive community engagement plan.  The project was being steered by a Multi-Disciplinary Project Board which had established a Sub-Committee to support effective coordination of the overall site redevelopment and included representation by all key stakeholders. 

 

The Managing Director: Bromley Clinical Commissioning Group confirmed that the ‘fitting out’ of Orpington Health and Wellbeing Centre was underway and that the centre was expected to be operational in mid-2019.

 

RESOLVED that:

 

1)  Developments in the planning and approval of the Bromley Health and Wellbeing Centre be noted; and,

 

2)  The Board’s continuing support for the scheme as a key strategic priority to deliver the ‘Bromley Out of Hospital Transformation Strategy’ be confirmed.

62.

Update on Phlebotomy Services (Verbal Update)

Minutes:

The Sub-Committee considered an update on changes to phlebotomy services in Bromley from Dr Angela Bhan, Managing Director: Bromley Clinical Commissioning Group.

 

After receiving notification from King’s College Hospital NHS Foundation Trust that the space used for the walk-in phlebotomy service at the Princess Royal University Hospital would be reallocated to other services from 1st October 2018, the Bromley Clinical Commissioning Group had put a number of new arrangements in place.  The walk-in phlebotomy services at the Beckenham Beacon and Orpington Hospital sites continued to operate, and additional phlebotomy capacity had been added to the 28 General Practices across the Borough delivering phlebotomy services as an ‘enhanced service’.  The Princess Royal University Hospital continued to provide phlebotomy services for inpatient and outpatient services as well as children’s blood tests. 

 

The Managing Director: Bromley Clinical Commissioning Group reported that there had been 76% uptake of the additional phlebotomy capacity added to General Practices across the Borough with 5,400 of the 7,000 available appointments filled.  Feedback to a survey undertaken in early November 2018 had been very positive with 96% of the 233 respondents stating that they would recommend the service to friends and family.  There had been a slight increase in demand for the walk-in phlebotomy services at the Beckenham Beacon and Orpington Hospital sites, but this was expected to reduce as more patients accessed the General Practitioner service.

 

RESOLVED that the update be noted.

63.

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 Dr Nada Lemic, Director: Public Health.

 

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, and had requested that final report of the Falls Task and Finish Group be presented to the Integrated Commissioning Board.

 

The final report of the Falls Task and Finish Group had been presented to the meeting of the Integrated Commissioning Board on 1st October 2018, and had been supported by the Board.  Work was now underway to develop a multi-agency action plan to be taken forward by a Bromley Joint Working Group.  Further updates on progress in agreeing and delivering the final action plan would be provided to future meetings of the Integrated Commissioning Board and the Health and Wellbeing Board.

 

RESOLVED that the update be noted.

64.

Work Programme and Matters Arising pdf icon PDF 92 KB

Minutes:

Report CSD18149

 

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 on 31st January 2019:

 

·  Dementia Friends Initiative: Presentation

·  Mytime Active Update

 

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

65.

Any Other Business

Minutes:

The Chairman advised that he had been approached by Bromley Youth Council seeking the Board’s support for the Youth Council’s key priorities for 2018/19, which included period poverty.  The Chairman, Vice-Chairman and Director: Public Health would be meeting with representatives of the Bromley Youth Council during December 2018, and would report the outcome of these discussions to the Board

 

RESOLVED that the issues raised be noted.

66.

Date of Next Meeting

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 on Thursday 31st January 2019. 

 

Original Text: