Agenda and minutes

Venue: Bromley Civic Centre

Contact: Jo Partridge  020 8461 7694

Items
No. Item

33.

APOLOGIES FOR ABSENCE

Minutes:

Apologies were received from Janet Bailey, Jim Gamble and Dr Andrew Parson.

 

Apologies for absence were also received from Kim Carey and Frances Westerman, and Kelly Sylvester and Mina Kakaiya attended as their respective substitutes. 

34.

DECLARATIONS OF INTEREST

Minutes:

Councillor Marina Ahmad declared that her husband was a General Practitioner who provided Bromley Healthcare services.

35.

MINUTES OF THE MEETING OF THE HEALTH AND WELLBEING BOARD HELD ON 18TH JULY 2019 pdf icon PDF 129 KB

Minutes:

RESOLVED that the minutes of the meeting held on 18th July 2019 be agreed.

36.

QUESTIONS BY COUNCILLORS AND MEMBERS OF THE PUBLIC ATTENDING THE MEETING

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 15th November 2019.

Minutes:

No questions had been received.

37.

BROMLEY WINTER ASSURANCE PLAN UPDATE pdf icon PDF 160 KB

Additional documents:

Minutes:

Report CSD19175

 

The Board considered a report providing an overview on the development of the Bromley System Winter Plan 2019/20, which was presented as part of the local scrutiny and assurance process. The Winter Plan built on the ongoing One Bromley Urgent and Emergency Care programme, which was designed to deliver the One Bromley vision of developing an integrated urgent and emergency care system.

 

Over previous winters, the London Borough of Bromley (LBB), NHS Bromley Clinical Commissioning Group (Bromley CCG) and King’s College Hospital – Princess Royal University Hospital (KCH PRUH) had made financial investment to provide additional capacity to the system during winter months, to ensure patients are seen in the appropriate care setting. This included schemes to support patients, clients and healthcare professionals in secondary, community and primary health and social care.

 

The plan was developed through the Bromley A&E Delivery Board, which delivered a whole systems approach to planning, improved performance and the development of a coherent local service framework for urgent and emergency care.

 

For the first time, Bromley’s voluntary sector had been asked to contribute to the Winter Plan, including their hospital aftercare and community services. The Bromley CCG and LBB were currently engaged with trialling a project looking to provide healthcare services to Bromley’s Homeless Shelter over the winter period.

 

The Bromley CCG and LBB would be providing flu vaccinations to their frontline staff, and Bromley Well staff that had contact with clients. Targeted leaflets would be delivered to 100,000 homes this year, providing details on the flu vaccination programme and GP hubs. It was noted that additional slots for the flu vaccinations had been allocated for Fire Brigade and Police officers.

 

The Winter Plan was a sizeable document which contained system escalation protocols for managing surges; winter scheme spend; and further winter planning including infection control / flu plans, minor breach reduction plans, improving ambulance handover plans, borough-based and South East London contact lists and provider assurances of managing demand and capacity.

 

The winter schemes spend had been based on learning from the previous year, and stakeholders had agreed that increasing capacity in existing services, whilst strengthening the community reactive / urgent response offer would be an effective use of resources for this winter. The Managing Director – Bromley CCG advised the Board that a strategic approach had been taken, with all schemes fitting into three themes:

 

-  Avoiding unnecessary hospital attendances

-  Maintaining hospital flow

-  Reduction in delayed discharges through integrated working.

 

Examples of schemes included a clinical triage system within the Bromley Healthcare Care Coordination Centre and additional GP hub appointments. A new hub was also planned in, or near to, the PRUH and additional Healthcare Assistant capacity to maintain patient flow. In response to a question, the Urgent Care Lead said that during previous winters, once a patient had presented themselves at the Urgent Care Centre (UCC), they were reluctant to be redirected to the GP hubs. To address this, the new hub would be moved closer to  ...  view the full minutes text for item 37.

38.

SPECIAL EDUCATIONAL NEEDS AND DISABILITY (SEND) REFORMS UPDATE pdf icon PDF 188 KB

Minutes:

Report CSD19176

 

The Board considered a report providing an update on Special Educational Needs and Disability (SEND) reforms.

 

The London Borough of Bromley (LBB), NHS Bromley Clinical Commissioning Group (Bromley CCG) and partners shared a strong and clearly stated commitment to improving the education, health and wellbeing outcomes for children and young people with special educational needs and / or disabilities (SEND). This commitment came from the highest levels and was implemented through effective joint governance (SEND Governance Board) which was driving rapid improvement.

 

As reported at the meeting of the Health and Wellbeing Board in May 2019, it had been anticipated that the Ofsted / CQC SEND Local Area inspection would take place within the calendar year. The inspection was announced on Monday 9th September, and took place between 16th and 20th September 2019. The inspection provided a real opportunity to evidence the local area’s hard work and the shared commitment to improving services and support for children and young people with special educational needs and / or disabilities and their families.

 

The inspection focused on three key areas:

 

·  How effectively the local area identified children and young people with special educational needs and / or disabilities

·  How effectively the local area assessed and met the needs of children and young people with special educational needs and / or disabilities

·  How effectively the local area improved outcomes for children and young people with special educational needs and / or disabilities

 

During the inspection week, inspectors from Ofsted and the CQC held a series of meetings and focus groups, which included staff from LBB and Bromley CCG. In addition, there was broad representation from partners, providers and families across the local area at the focus groups. The focus groups covered sixteen areas, such as identification of SEND and early intervention and support for children with disabilities and transition to adulthood, and provided positive feedback on partnership working. Inspectors also visited a number of schools and settings, and a closed session was held with a group of parent carers.

 

Through the self-evaluation of the local area, inspectors were provided with areas of strengths, together with the focus for improvements. The strategy and action plan reflected the commitment for improvement. The Head of Service for Special Educational Needs informed the Board that the inspection report had been finalised, however due to the general election, Ofsted would not release the document during Purdah. The report would now be published after the general election and until that time, it was not possible to provide any details of the findings. The Chairman invited the Head of Service for Special Educational Needs to present the findings of the SEND inspection to a future meeting of the Health and Wellbeing Board.

 

In relation to areas for improvement, the Head of Service for Special Educational Needs highlighted that they wanted to strengthen their engagement with children and young people, and were considering innovative ways in which to do this. The Board were advised that quarterly  ...  view the full minutes text for item 38.

39.

HEALTH AND WELLBEING STRATEGY: JSNA PRIORITY AREAS pdf icon PDF 212 KB

Minutes:

Report CSD19177

 

The Board considered a report providing an update on the progression made against the action plans of the Joint Health and Wellbeing Strategy 2019-2023.

 

Following the last meeting of the Health and Wellbeing Board, arrangements had been made for the delivery of the Health and Wellbeing Strategy priority areas. Discussions had taken place with the proposed leads, and the report provided a high level action plan, setting out progress made so far for each priority area, and a summary of the next steps and timescales. The Chairman informed the Board that going forward, it was intended that two priority areas would be invited to present per meeting. Board Members agreed, and it was suggested that this should be started from the spring.

 

A Member noted that the document was very useful to keep track of developments, and asked for an update in relation to a whole systems approach to tackling obesity in children. The Director for Public Health advised that a working group, involving Children and Young People and Environmental Services, had been established. The first meeting of the working group had taken place, and the second meeting would take place the following day.

 

In response to a question, the Director for Public Health advised the Board that the ‘Ottawa’ model implemented at King’s was a programme that had been developed and evaluated in Canada. It involved clinicians picking up on patients that smoked whilst they were in hospital, and allowed intervention at an early stage.

 

A Member noted that the incidents of cancers were still rising in Bromley, and asked if these all related to the key factors of smoking, obesity and alcohol consumption. The Director for Public Health said that some were related, however for a proportion of cancers the cause was not known. The Director for Public Health informed the Board that, in relation to obesity, it was intended that the Tier 3 service would be fully implemented across the population of South East London. The workplace obesity reduction programme would be a pilot scheme, involving a small number of CCG and LBB staff. The Community Links Bromley representative noted that consideration could be given as to how the voluntary sector could assist with the development of the workplace obesity reduction programme. It was agreed that this would be discussed further with the Director for Public Health.

 

The Healthwatch Bromley representative informed the Board that they would be conducting a survey of the Autism and Dementia service provisions in Bromley. It was agreed that these reports could be provided to a future meeting of the Health and Wellbeing Board.

 

RESOLVED that the update be noted.

40.

AGEING WELL IN BROMLEY (VERBAL UPDATE)

The Ageing Well in Bromley Strategy can be accessed via the following link:

 

Ageing Well in Bromley

 

Minutes:

Board Members had been provided with a link to the Ageing Well in Bromley Strategy which, following approval from the Council’s Executive, had now been published.

41.

BETTER CARE FUND AND IMPROVED BETTER CARE FUND PERFORMANCE UPDATE - Q1 AND Q2 pdf icon PDF 591 KB

Minutes:

Report ACH19011

 

The Board considered a report providing an overview of the first two quarters performance for the Better Care Fund (BCF) and Improved Better Care Fund (iBCF) for 2019/20, including expenditure and activity.

 

Bromley was responding to the following national metrics for the BCF:

 

a.  Reduction on non-elective admissions

b.  Delayed transfers of care (DToCs) (delayed days)

c.  Rate of permanent admissions to residential care per 100,000 population

d.  Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services.

 

Quarter one had seen non-elective admissions into hospital reported within plan, with the first five months of the year showing no clear upwards or downwards trend. Work was progressing on a number of schemes as part of the One Bromley programme aimed at reducing the pressure on the non-elective admissions, particularly in the run up to winter months.

 

Admissions to residential care homes were currently on course to exceed the target of 425.0 per 100,000 of the population. Due to the continuing drive to promote independence by supporting people in their own homes, more people were being admitted to residential placements with enduring, ever increasing and more complex needs. This in turn was resulting in the reduction of the average stay, therefore resulting in a higher turnover of admissions.

 

The progress made in delivering more robust Transfer of Care pathways was complemented through the delivery of temporary bridging reablement, where existing markets could not pick up the demand. The Head of Early Intervention, Prevention and Community Services Commissioning advised that they were working with the voluntary sector to strengthen their service offer and pathways between the statutory and voluntary / charitable sector, to maximise early intervention and prevention opportunities. An example of this was the partnership with Bromley Well.

 

The Independent Chair of the Bromley Safeguarding Adults Board highlighted that the safeguarding work undertaken with the South London and Maudsley (SLAM), Oxleas NHS Trust and The Priory had been an exemplary piece of work, which had made a huge difference.

 

A Member noted that there was a considerable BCF underspend during 2018/19, which had been carried forward into the 2019/20 financial year, and questioned what was projected for 2020/21. The Head of Early Intervention, Prevention and Community Services Commissioning agreed to provide this information following the meeting.

 

RESOLVED that the update be noted.

42.

ONE BROMLEY UPDATE pdf icon PDF 136 KB

Minutes:

Report CSD19178

 

The Board considered a report providing an update on One Bromley. The report focussed on the context and development of One Bromley – opportunities of an integrated approach across health and social care; the current status of the Bromley place based Local Care Partnership (LCP) system; and outlined the key programmes, initiatives and enabler work streams including progress and next steps.

 

One Bromley would enable partners and services in Bromley to work as a single system to deliver integrated care. The strategic aims of One Bromley were to improve the health and wellbeing of the Bromley population. Providers and commissioners (CCG and LBB) from sovereign boards committed to working together to develop a single LCP, delivering on joint priorities. One Bromley would bring together partners as a single system coordinating care for the most at-risk and vulnerable individuals.

 

Achievements to date included a 26% reduction in urgent hospital admissions and a 22% reduction in elected inpatient admissions, which made a difference to services and cost savings for other departments. Similar work had been undertaken for patients with diabetes and respiratory disease, and the end of life service had been extended to patients with chronic diseases. Eight Primary Care Networks (PCNs), including all practices in Bromley, had been established to encourage them to work together to increase resilience in relation to GP and nurse shortages. Currently 24 practices in Bromley were providing online consultations, with another 10 practices pending.

 

A review of the Transfer of Care Bureau had also been completed, and there was a programme of work currently in place to improve the efficiency of the service it delivered to those patients requiring a supported discharge. There had been a joint approach to improving the health and wellbeing of patients in care and nursing homes, through the establishment of a special general practice exclusively for this population. To date, 31 care homes had mobilised to the Bromleag Care Homes practice contract.

 

The new Orpington Health and Wellbeing Centre had opened in September 2019. It was located in Orpington town centre, in a new building on the site of the old Police Station. The Managing Director – Bromley CCG advised that a single practice, Knoll Medical Practice, was located in the Centre. However following the closure of the Chaterhouse Surgery, the number of patients registered with Knoll Medical Practice had increased significantly. Other services would be gradually mobilised, including phlebotomy and a MRI suite, and it may provide a hub for an out of hours service. The Head of Service for Early Intervention and Family Support noted that she would be happy for her staff to help publicise and direct people to the facilities offered, and asked if there may be a way for the service to have a presence at the Centre. It was agreed that this would be discussed further with the Managing Director – Bromley CCG, following the meeting.

 

A Member highlighted that following the closure of the Charterhouse Surgery, there was a risk there some  ...  view the full minutes text for item 42.

43.

BROMLEY SAFEGUARDING ADULTS BOARD ANNUAL REPORT pdf icon PDF 57 KB

Additional documents:

Minutes:

The Independent Chair of Bromley Safeguarding Adults Board (BSAB) presented their Annual Report for 2018/19.

 

The Local Authority had a statutory duty under the Care Act 2014 to establish a Safeguarding Adults Board to help and protect vulnerable adults in Bromley. The primary objective of the BSAB was to help and protect adults in Bromley by co-ordinating and ensuring the effectiveness of Board partners. The BSAB had an unrestricted remit in what it was able to do to achieve its objectives.

 

The BSAB was required, under Schedule 2 (4) of the Care Act 2014 to produce an annual report outlining its achievements and those of its members in relation to the Board’s strategic objectives. The BSAB was obligated to send a copy of the annual report to the Chair of the Health and Wellbeing Board.

 

Under section 44 of the Act, the BSAB was also required to publish the findings and recommendations from any Safeguarding Adults Reviews (SAR) undertaken. The SAR Committee made the decision to commission a SAR in respect of one case in June 2018, the executive summary of which was published in March 2019.

 

In considering the report, a Member commented that they were very pleased with the style of the document, and the number of pictures and comments included. The Independent Chair of Bromley Safeguarding Adults Board highlighted that the main aim had been for the document to be accessible and understandable by all.

 

It was noted that the performance of Bromley Safeguarding Adults Board was in line with the rest of London, and nationally. However the focus remained on further extending the reach of their strategy. The strategy was currently in draft form, and would be published in the new year. The Independent Chair of Bromley Safeguarding Adults Board advised Members that any questions or requests for further details could be emailed following the meeting.

 

The Chairman led Members in congratulating the Independent Chair of Bromley Safeguarding Adults Board and all colleagues involved in producing an excellent Annual Report.

 

RESOLVED that the Bromley Safeguarding Adults Board Annual Report 2018/19 be noted.

44.

TRANSITIONAL SAFEGUARDING WORKSHOP (VERBAL UPDATE)

Minutes:

The Independent Chair of Bromley Safeguarding Adults Board informed Members that a Transitional Safeguarding Workshop had been held at the end of October 2019, and had been extremely well attended.

 

The event was hosted jointly by the Bromley Safeguarding Children Partnership and the Bromley Adult Safeguarding Board, and focused on how to ensure the gap was closed and service provision maintained for those transitioning from one Board’s area of responsibility to the other. It had highlighted the need to build resilience for adolescents moving into adulthood, which could result in the reliance on services being reduced.

 

Following a brief discussion, it was agreed that for the January meeting of the Health and Wellbeing Board, the Independent Chair of Bromley Safeguarding Adults Board would undertake an initial mapping exercise of the current transition support available, and the Head of Early Intervention, Prevention and Community Services Commissioning would take these findings forward.

 

The Board were advised that the LBB Consultant in Public Health was currently working on the 18-25 Joint Strategic Needs Assessment (JSNA), which any further information and data could help to inform.

 

RESOLVED that the update be noted.

45.

RAVENSBOURNE SCHOOL'S PERIOD POVERTY PILOT SCHEME (VERBAL UPDATE)

Minutes:

The Director of Public Health reminded the Board that Benjamin McGowan, Bromley Youth Council had attended a previous meeting to deliver a presentation on the work being undertaken in relation to the issue of period poverty. A pilot scheme had been taken forward by Ravensbourne School, which further schools had since joined.

 

Contact had been lost with the Bromley Youth Council representative, who had since left the school. It was suggested that Public Health colleagues attend the next meeting of the Bromley Youth Council to ask for an update on the pilot, and would also write to the pastoral leads at the schools.

 

It was agreed that a further update would be provided to the next meeting of the Health and Wellbeing Board.

 

RESOLVED that the update be noted.

46.

HEALTH AND WELLBEING BOARD INFORMATION ITEMS pdf icon PDF 271 KB

The Information Item comprises:

Minutes:

There was one Health and Wellbeing Board Information Item:

 

·  Delayed Transfer of Care (DToC) Performance Update (Report CSD19179)

 

RESOLVED that the Information Item be noted.

47.

MATTERS OUTSTANDING AND WORK PROGRAMME pdf icon PDF 191 KB

Minutes:

Report CSD19168

 

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:

 

·  Update on the Telehealth Monitoring Pilot (30th April 2020)

·  SEND Reforms Update (30th January / 30th April 2020)

·  Joint Health and Wellbeing Strategy: JSNA Priority Area Updates (2 areas per meeting from 30th April 2020)

·  Mapping exercise of the current transition support available (30th January 2020)

·  Ravensbourne Period Poverty Pilot Scheme Update (30th January 2020)

 

In relation to the matters arising, the Director of Public Health advised that whilst the Gypsy Traveller site at Old Maidstone Road was located in the borough, the Public Health Bus did not attend the site.

 

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

48.

ANY OTHER BUSINESS

Minutes:

The Chairman informed the Board that the meeting on the 30th January 2020 currently had a full agenda. He observed that it was unlikely that the meeting planned for 19th March 2020 would be required. It was intended that the provisional May 2020 meeting would be brought forward to the end of April, and once confirmed, Members would be advised of the new date.

 

Due to the proposed structural changes, the Chairman advised the Board that he would suggest to the General Purposes and Licensing Committee that five meetings of the Health and Wellbeing Board be scheduled for 2020-21.

 

RESOLVED that the issues raised be noted and endorsed.

49.

DATE OF NEXT MEETING

1.30pm, Thursday 30th January 2020

1.30pm, Thursday 19th March 2020

Minutes:

The next meeting of the Health and Wellbeing Board would be held at 1.30pm on Thursday 30th January 2020.

 

Original Text: