Agenda and minutes

Apologies for absence were received from Councillor Marina Ahmad, Councillor Keith Onslow and Colin Maclean – Community Links Bromley. Councillor Simon Jeal, Councillor Colin Smith and Janet Tibbalds attended as their respective substitutes. Apologies were also received from Barbara Wall – Healthwatch Bromley.

There were no declarations of interest.

In respect of Minute 80, Councillor Cooke noted that an update on the outcome of Ravensbourne School’s pilot scheme was due to be provided to the cancelled meeting of the Health and Wellbeing Board on 21^st March 2019. The Director: Public Health advised the Board that the item had been deferred to the meeting on the 21^st November 2019, as more time was needed to see the results of the initiative.

Councillor Simon Jeal informed the Board that, along with Councillor Marina Ahmad, he had attended a Period Poverty Summit at which a number of schools had met. It was linked to the pilot scheme, but went much wider. The event had been extremely positive, with two main actions arising. The first was the installation of dispensers, which was progressing and finances were being looked at. The second was menstrual education, for which a prototype programme was in development. It was anticipated that by November 2019, the projects would be well underway. The Chairman suggested that if there was anything to report, an interim update should be provided to the meeting of the Health and Wellbeing Board on 18^th July 2019.

The Chairman noted that all Board Members had been provided with a copy of the One Bromley – Stakeholder Briefing, which he had recently received as a Governor of King’s College Hospital NHS Foundation Trust, but also carried the London Borough of Bromley logo. The LBB Communications Executive informed the Board that the Communications Team would be looking to include more Bromley contents in future newsletters, and would be speaking with their counterparts at the CCG.

The Independent Chair of the Bromley Safeguarding Adults Board highlighted that in the third paragraph of the newsletter, it made reference to Bromley Third Sector Enterprise as a partner. However, they did not represent the voluntary sector, and it was suggested that the Voluntary Sector Strategic Network (VSSN) should also be included. It was agreed that the LBB Communications Executive would feed this back to the report authors.

RESOLVED that the minutes of the meeting held on 31^st January 2019 be agreed.

In accordance with the Council’s Constitution, questions that are not specific to reports on the agenda must have been received in writing 10 working days before the date of the meeting. 

Questions specifically relating to reports on the agenda should be received within two working days of the normal publication date of the agenda. Please ensure that questions specifically on reports on the agenda are received by the Democratic Services Team by 5pm on Friday 10^th May 2019.

No questions had been received.

Report ECHS19035

The Board considered an update on the Joint Health and Wellbeing Strategy 2019-2023.

The Joint Health and Wellbeing Strategy 2019-2023 had been agreed and published, and work was now progressing towards its action plans. Following the last meeting of the Health and Wellbeing Board, arrangements had been made for the delivery of priority areas of the Health and Wellbeing Strategy. Over several months, the Director: Public Health had met with the relevant groups focussing on the priority areas, to discuss who would be best to lead on each area. An action plan had been provided to Board Members, setting out the finalised leadership arrangements for the Strategy, and included the proposed arrangements for delivery.

An example of the proposed template that each group would use to provide an action plan update was also presented. All groups leading on an area of delivery would draft an action plan for each of the priority areas. The Cancer Working Group had met twice and had discussed their priorities. Members had agreed that it was a good, simple model that helped focus their minds, and would not burden the groups. The action plan allowed them to list objectives for two or three key priorities, and how the objectives would be achieved and measured.

It was suggested that for reporting purposes, a refocussed Joint Strategic Needs Assessment (JSNA) Steering Group would coordinate the updates to the action plans. Once a year, they could provide a high level annual report, or individual groups could report to the Health and Wellbeing Board directly. It was highlighted that the JSNA Steering Group would meet every two months, and a comprehensive Terms of Reference document had been included as an Appendix to the report. The Independent Chair: Bromley Safeguarding Adults Board suggested that the membership of the JSNA Steering Group could include the Voluntary Sector Strategic Network (VSSN), which went much wider than the Bromley Third Sector Enterprise.

The Chairman considered that the action plans answered the questions of whom, what and why, but clear timelines were needed. The Chairman felt that the JSNA Steering Group coordinating the updates was a good idea, and suggested that a report be provided to the Health and Wellbeing Board every six months, starting from November 2019. In addition, a report from an individual group could be brought earlier by exception if required. A Board Member further suggested that a timescale column be added to the action plans, and that a RAG rating system be used when the reports were brought back to the Board.

A Board Member noted that there were a couple of priority areas where details on the process for delivery had not been provided, including the Learning Disability priority area. The Director: Adult Social Care advised that a first draft of the new Learning Disability Strategy was currently in development. It was suggested that this information could be included in the document. The Interim Director of Programmes advised Board Members that they were currently looking at how  ...  view the full minutes text for item 5.

Report ECHS19036

The Board considered an update on the Joint Strategic Needs Assessment (JSNA).

It had been agreed that there would be a three yearly update cycle for the main sections of the JSNA, with further needs assessments or shorter JSNA chapter updates on specific areas of needs in between. Work was currently underway to update smaller chapters of the JSNA and undertake more in depth needs assessments. The Older People JSNA chapter was last developed in 2016. This had now been updated, and was published in January 2019 in order to support the Ageing Well Strategy that had recently been developed.

A Learning Disabilities JSNA chapter was last developed in 2015. This would now be updated and published in order to support the Joint Learning Disabilities Strategy that was currently in development. A sexual health needs assessment was also currently in development. Further pieces of work planned for this year included an Older People’s needs assessment, GP practice profiles, Ward profiles and School profiles. Work planned for the following year included learning disabilities needs assessment, cancer and diabetes. In response to a question, the Consultant in Public Health confirmed that the sexual health needs assessment would be linked to the updated SRE guidance, and would be an in depth needs assessment looking at past, present and future needs.

In response to a question from a Board Member, the Managing Director: Bromley CCG clarified that ‘excess winter deaths’ were deaths over and above the number expected in a period. It was noted that there was usually a double peak in excess deaths – during the winter and summer.

A Board Member enquired if a study had been undertaken to look at where falls took place outside of the home to identify if there were specific areas of roads and pavements that were particularly unsteady. The Director: Public Health advised that an assessment had been undertaken, and a Falls Task and Finish Group had been established the previous year, which reported back through the Integrated Commissioning Board. The assessment had provided figures of where falls happened and had highlighted that outside of the home, falls tended to be rare. This information was not collected routinely, which was why this specific piece of work had been undertaken. The London Ambulance Service and hospitals were able to provide data, but there was not continuous surveillance of it. The Chairman requested that the update report on the Integrated Commissioning Board scheduled to be provided to the Health and Wellbeing Board in September be brought forward to the next meeting on 18^th July 2019.

In response to a question, the Consultant in Public Health clarified that ‘upper-tier’ Local Authorities were county councils, and city, borough and district councils were known as 'lower-tier' authorities.

A Board Member noted that it was a very interesting report that provided a good insight, but questioned if costs had been factored into the transformational programme. The Leader of the Council responded that he could not say with certainty as  ...  view the full minutes text for item 6.

Report ECHS19037

The Board considered a report which provided an overview of the performance of both the Better Care Fund (BCF) and the Improved Better Care Fund (iBCF) 2018/19. The report provided both expenditure and activity for the third and fourth quarter period, between October 2018 and up to the end of March 2019.

For the BCF, Bromley was responding to four national metrics: the reduction in non-elective admissions; delayed transfers of care (DToC); the rate of permanent admissions to residential care per 100,000 population; and the proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services. The Interim Director of Programmes advised Board Members that there had been an overall reduction in the number of non-elective admissions, and the targets set had been met. In relation to DToC’s, Bromley were now rated number one compared to the other 32 London Boroughs, and admissions to residential care and reablement had both exceeded the targets set. The Bromley Well service, one of the BCF schemes, had provided a Single Point of Access for local people to prevent them from falling into a crisis and improve their health, wellbeing and independence, and in every area all the targets were being met.

The iBCF schemes reflected three grant conditions, that the fund be used only for the purposes of: meeting Adult Social Care needs; reducing pressures on the NHS, including supporting more people to be discharged from hospital when the were ready; and ensuring that the local social care providers market was supported. One scheme was the Assessed and Supported Year in Employment (AYSE) Lead and Placements Coordinator, in which the AYSE Lead supported newly qualified Social Workers and aimed to keep them with the Local Authority.

A Board Member noted that section 4.49 (Support to the Sector) in the commentary of the report appeared to finish mid-sentence. The Interim Director of Programmes apologised, and advised that the rest of the sentence would be included in the minutes of the meeting.

Following the meeting, the Head of Early Intervention, Prevention and Community Services Commissioning confirmed that the sentence should read:

4.49 In quarter 3 and quarter 4 the service has focused on Service Improvement Plan showing results across Associate Members and Volunteering. There has been an increasing volume of Training and Learning workshops from 3 in quarter 3 to 9 in quarter 4.

In response to a question, the Head of Early Intervention, Prevention and Community Services Commissioning advised that the Learning Disability Pathway outreach targets were below the requirement in Quarter 3. As a result, partners had worked together to make improvements, and those that were excelling provided support in the communities. Quarterly information was also provided and monitored.

In respect of Continuing Care and individual packages, a Board Member queried which partners paid for which elements of the packages, and if agreement on this was easily reached. The Managing Director: Bromley CCG reported that lots more work was  ...  view the full minutes text for item 7.

Report ECHS19038

The report provided an update from the National Department on future DToC targets. Since communication was received on the 15^th May 2018 updating local areas that a nationally revised methodology had been agreed to centrally set DToC targets, there had been no further amendment to them. The measure had changed this year, and as such so had the target, which was yet to be confirmed by the NHS.

With regards to local and national performance, there was a continuation of positive results with each month being ahead of the set target. There continued to be a reduction in DToCs compared with previous years, with the final quart again being ahead of the overall target. Out of the 32 boroughs, Bromley was now ranked the best performing borough in London.

The Chairman noted that due to the Borough’s high population of elderly and elderly frail resident, it started at a disadvantage so to be ranked the best performing in London was a really good news story. The Chairman extended his thanks to all for their collective effort to achieve this.

RESOLVED that the update be noted.

Report ECHS19040

The Board considered a report which provided an update on the SEND Reforms work and continued focus on preparation for the local area inspection. The report had been provided to Board Members for comment and scrutiny, and a number of questions were raised which the Director: Children’s Social Care would take back to the Head of Service: Special Educational Needs and Director of Education. A copy of the questions and responses is provided at Appendix A.

The Chairman requested that an information paper providing an update on the delivery of the Free Special School be brought to the next meeting of the Health and Wellbeing Board on 18^th July 2019.

RESOLVES that the update be noted.

Report ECHS19039

The Board considered a report which provided an overview of the schemes delivered throughout winter 2018/19 from Bromley CCG and the London Borough of Bromley winter pressures monies fund through the Better Care Fund (BCF). These schemes were identified by the Bromley A&E Delivery Board and were presented for the Board's information. Funding for this year's Winter Resilience Schemes was £646k for Bromley CCG and £1,027k from the London Borough of Bromley and were delivered under budget.

The winter resilience funding was allocated across the health system to ensure there was additional capacity in the system to ensure patients were seen in the appropriate care setting. This included schemes to support patients and clients in secondary, community and primary care. The report looked at the utilisation and impact of the CCG schemes and the London Borough of Bromley schemes, which would inform future planning for Winter 2019/20.

Despite the PRUH A&E four hour performance target worsening this winter, all Type A&E attendances had decreased slightly when compared to the previous years. Both surgical and medical admissions were comparable to the previous year’s winter period. Although it was difficult to ascertain a sole attributable reason for this, as well as the mild weather, the significant added capacity to the system to support people in the community would have contributed to the lower attendances. Positively, there was a notable improvement in the reduction of reported Delayed Transfers of Care (DToC) for winter 2018/19, with an average decrease of 79% versus the previous year. Compared with 2016/17, winter 2018/19 saw an 82% reduction of reported DToC's. This had led to a reduction of 416 (75%) lost hospital bed days compared to the previous year.

The focus on Discharge to Assess Pathway and Community Continuing Healthcare Assessments had increased the number of patients leaving the hospital earlier with temporary packages of care whilst the full assessment was carried out in the community. Over the past two financial quarters, Bromley CCG CHC had consistently met and surpassed the NHS England target of 85% of full Decision Support Tool (DST) assessments in the community.

Although all winter schemes offered were in the majority well utilised and showed positive impact, significant numbers of people still required hospital based care, especially those with complex health and social care situations. Due to the complexity and demographic of patients, further work was required to provide a more integrated response to admission and attendance avoidance. A full review of the Bromley CCG Winter Resilience Schemes had been provided to Board Members. For 2018/19 Bromley CCG had commissioned several Resilience Schemes aiming to provide additional capacity across a range of community services. This had included increased primary care capacity through additional GP appointments, an advanced nurse practitioner home visiting service and a multidisciplinary Bromley @Home Team was piloted to prevent avoidable admissions from the community and facilitate earlier discharges from the hospital. An additional nurse post was implemented for Extra Care Housing units to support proactive and  ...  view the full minutes text for item 10.

The Board considered the Chairman’s annual report of the Health and Wellbeing Board. Board Members were asked to provide any feedback on the report prior to it being reported to the meeting of Full Council on 15^th July 2019. The Chairman extended his thanks to Board Members for the significant contribution they had made to the Health and Wellbeing Board during the 2018/19 municipal year.

RESOLVED that the report be noted.

The Chairman informed Board Members that a recommendation had been made by the Education, Children and Families Select Committee, for a Co-opted Member to represent Early Intervention Services to be appointed to the Health and Wellbeing Board. Following a brief discussion, Board Members agreed that Rachel Dunley, Head of Service for Early Intervention and Family Support be appointed to the Health and Wellbeing Board as a Co-opted Member without voting rights.

RESOLVED that Rachel Dunley, Head of Service for Early Intervention and Family Support be appointed to the Health and Wellbeing Board as a Co-opted Member without voting rights.

Board Members were asked to consider any emerging issues that they would like discussed or presented at future meetings of the Health and Wellbeing Board.

Councillor Simon Jeal suggested that an agenda item on street harassment could be considered for discussion. It was noted that this was not a strategic priority, but may link with the work being undertaken in relation to violence against women and girls. The Independent Chair: Bromley Safeguarding Adults Board advised Board Members that she had been speaking to the LBB Head of Service for Early Intervention and Family Support in relation to this. Interviews for the role of VOG would take place the following day, and it was hoped that the successful candidate would be in post over the next couple of months. The Chairman requested that an oral update be provided in relation to this topic at the next meeting of the Health and Wellbeing Board, providing a plan of how it could be taken forward.

The Chairman highlighted that he had received a number of letters from residents raising concerns about air pollution, particularly outside of schools, and requested that an oral update or short briefing paper on this topic be provided to the meeting of the Health and Wellbeing Board on 18^th July 2019. The Director: Public Health responded that work in relation to air pollution was being undertaken by colleagues in Environmental Services, and she would ask them to take this request forward.

The Managing Director: Bromley CCG advised Board Members that their Annual Engagement Report would also be provided to the next meeting of the Health and Wellbeing Board.

RESOLVED that these items be included on the Health and Wellbeing Board work programme for 2019/20.

There was one Health and Wellbeing Board Information item comprising:

·  Ramadan 2019 – A Guide for Schools

The Chairman advised Board Members that this document had been referred to the Health and Wellbeing Board from the Standing Advisory Council on Religious Education, and was provided for information.

On behalf of Councillor Marina Ahmad, Councillor Simon Jeal noted that the document was an excellent piece of work, highlighting positive and effective collaboration. It was requested that information be provided as to how the document was distributed to schools, and if it was known how many schools had used the document.

RESOLVED that the Information Item be noted.

Report CSD19028

The Board considered its work programme for 2019/20 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:

Meeting on 18^th July 2019:

·  Ravensbourne Pilot Scheme: Interim Update

·  Integrated Commissioning Group: Update

·  Free Special School: Update

·  Street Harassment / Violence Against Women and Girls: Update

·  Air Pollution: Update

·  Bromley CCG – Annual Engagement Report

Meeting on 21^st November 2019:

·  JSNA Priority Areas Report

·  Bromley Winter Assurance Plan: Update

The Chairman noted that September’s Health and Wellbeing Board may no longer be required, and a decision would be made at the meeting on the 18^th July 2019 as to whether it should be cancelled.

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

There was no other business.

1.30pm, Thursday 18^th July 2019

1.30pm, Thursday 19^th September 2019

1.30pm, Wednesday 21^st November 2019

1.30pm, Thursday 30^th January 2020

1.30pm, Thursday 19^th March 2020

The next meeting of the Health and Wellbeing Board would be held at 1.30pm on Thursday 18^th July 2019.