Agenda and minutes

Apologies for absence were received from Councillor Gareth Allatt, Councillor Robert Evans, Councillor Keith Onslow, Mina Kakaiya, Dr Andrew Parsons and Lynn Sellwood.

Apologies were also received from Janet Bailey and Carol Whiting attended as substitute.

The Chairman welcomed Marg Mayne, Chief Executive – Mytime Active and Matthew Eady, Regional Manager – Mytime Active. Board Members were advised that Matthew would shortly be leaving Mytime Active, and thanks were extended for all the work he had undertaken.

There were no declarations of interest.

RESOLVED that the minutes of the meeting held on 21^st November 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 24^th January 2020.

No questions had been received.

The Board received a presentation from Gillian Fiumicelli, LBB Head of Vascular Disease Prevention Programme, Debra Weekes, Mytime Partnerships Manager and Diane Friday, Active Lifestyles Programme Manager, Mytime Active. The presentation provided the health and wellbeing benefits of physical activity; a brief overview of what was happening in Bromley; and an update from Mytime Active.

Inactivity was having a serious impact on both mental and physical health. Since the 1960’s, adults were over 20% less active, and this would increase to 35% by 2030. Physical inactivity was responsible for one in six deaths; up to 40% of many long-term conditions; and around 30% of later life functional limitation and falls. The annual cost of physical inactivity was estimated to be £7.4 billion.

The results of the Sport England Active Lives Survey 2019 indicated that adults in Bromley were slightly more active than the national average, but over 30% were not taking the recommended thirty minutes of activity per day. To help address this, the Pro-Active Bromley Strategic Framework 2017-2022 had been developed. There were a number of aims, including to support the increased participation in sport and physical activity across the Borough; to reduce the number of inactive people; and to encourage regular and sustainable activity habits for those new to physical activity. There would be a focus on under-representative groups, and on encouraging more disabled people into activity. One of the key members helping to achieve this was Mytime Active.

The Mytime Partnerships Manager informed Members that Mytime Active was a social enterprise – an independent charity that reinvested all profits back into facilities, services and programmes. Work was also undertaken within local communities, providing support and funding for a range of projects and partnerships aimed at improving wellbeing. They were an integrated wellbeing provider and trusted experts in the areas of healthy lifestyles, fitness, nutrition and childcare, and offered a wide range activities. Mytime Active also delivered specialist social, health and wellbeing programmes, providing targeted support.

One of the programmes that Mytime Active delivered for older people was their ‘Primetime Programme’. Since July 2018, the programme had expanded, with an increase of:

-  weekly activity sessions (from 85 to 100);

-  members (from 2,736 to 3,251); and,

-  volunteer ‘Primetime Buddies’ (from 24 to 30).

It was noted that the ‘Primetime Buddies’ were instrumental in helping assist older people getting into facilities, and acting as health mentors. The 30 volunteers carried out over 3,800 sessions of activities. In addition, there were now dedicated Primetime staff and an annual programme of social events. Programmes had been developed, such as strength and stability; senior circuits; and ‘Remember to Move’ classes. Community classes had also been held in areas such as Biggin Hill, Farnborough Village and Petts Wood.

In response to a question, the Mytime Partnerships Manager said that feedback received from older service users indicated that they preferred sessions to take place in the morning or afternoon, and not during evenings and weekends. This had been a challenge in terms  ...  view the full minutes text for item 54.

The Board considered a presentation from the Associate Director of Integrated Commissioning, Bromley CCG providing an update on Bromley Children and Young People’s Mental Health and Wellbeing Services, towards a refreshed transformation plan 2020/21.

Bromley Council (LBB) and NHS Bromley CCG (BCCG) commissioned a range of services to support the mental health and wellbeing of children and young people in the Borough. Whilst there were a range of different services in the area, the core mental health and wellbeing offer centred on the provision of the Wellbeing Service for Children and Young People (Bromley Y) and Children and Adolescent Mental Health Services – CAMHS (Oxleas NHS Foundation Trust). The dual service model was originally established in 2014/15, since which a strong joint working partnership had been developed between the two services.

The NHS Long Term Plan had a target to increase access to children and young people’s mental health and wellbeing services. The South-East London Sustainability and Transformation Partnership (STP) had been monitoring this target across the six boroughs of south-east London. Bromley had consistently out-performed its neighbours, with the NHS / Voluntary and Community sectors (VCS) model at the heart of the area’s success in meeting this target. However there were some significant challenges, including the year on year increase (since 2013/4) in the number of mental health emergency presentations at Accident and Emergency (A+E). A Member noted that over a third of the emergency presentations at A+E had ‘parental health issues’ listed as a factor, and asked if details of the types of issues this referred to were known. The Associate Director of Integrated Commissioning advised that work on “deep dives” was currently being undertaken to analyse this, and an update could be provided to the Board once completed.

In response to a question, the Associate Director of Integrated Commissioning advised that early indications showed that the children and young people presenting at A+E were not known previously by CAMHS, Wellbeing services or GPs. In terms of outreach, it was noted that schools could play a major role and support was needed to help them identify issues earlier.

In seeking to put in place the right future model for children and young people’s mental health and wellbeing services, supported was provided by a “deep dive” Joint Strategic Needs Assessment (JSNA) project into this area in 2018. The results of this analysis showed an increase in the number of young people being seen by CAMHS services in Bromley, and the highest numbers of issues were identified as relating to ‘home’ and ‘school’. It was noted that this would also be an area that would be looked at in more depth via a “deep dive”.

Since 2015, all NHS CCGs in England had been required by NHS England to have an agreed annual local CAMHS transformation plan. Since these plans were first put in place, Bromley CCG had worked closely with LBB to develop joint plans, which had been informed by the work of the Health and Wellbeing Board. Bromley’s  ...  view the full minutes text for item 55.

Report CEF19025

The Board considered a report on the outcome of the Bromley Local Area SEND Inspection.

As reported at the previous Board meeting, the Ofsted and Care Quality Commission (CQC) SEND Local Area inspection had been announced on Monday 9^th September, and took place between 16^th and 20^th September 2019. The inspection had considered the effectiveness of the Bromley local area in implementing the SEND reforms and determined whether the Council or CCG would be required to submit a Written Statement of Action.

The inspection had 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.

The inspection outcome letter had been finalised in November 2019, however due to the pre-election ‘Purdah’ period, Ofsted were not able to publish the letter until after the General Election. The inspection report (dated 8^th November 2019) was published on Monday 23^rd December 2019. The letter outlined the findings from the inspection, including areas of strengths and some areas identified for further improvement.

Through the self-evaluation of the local area, the Council, CCG and other partners had been able to provide inspectors with areas of strength, including evidenced examples of good practice and sustained improvement. Examples of good practice had included:

-  Leaders know the local area’s demography and geography. They were aware of the diverse needs of their communities. They deployed resources to those areas with the greatest need.

-  Elected members of Bromley Council supported leaders in prioritising improvements for children and young people with SEND. For example, the council had invested in high needs funding and created new jobs for officers and healthcare professionals to strengthen operational delivery.

-  Jointly funded services enabled children and young people with very complex needs to access good quality provision without delay.

The self-evaluation also set out eighteen key areas for improvement, under which the local area would maintain the shared focus to achieve ambitions for children and young people who had SEND. It was noted that the recommendations identified aligned closely to the areas for improvement identified by the local area, with no unexpected surprises. In response to a question, the Director of Education said that work in relation to the eighteen areas identified was already underway as part of an Action Plan. In relation to the profile and content of the Local Offer, a Local Offer Designated Officer (LODO) had been recruited to work with groups and drive forward improvements.

The self-evaluation had been judged secure by Inspectors, indicating that the Council, CCG and other partners knew the local area well, and had an accurate view of the performance and quality of services. The local area had been  ...  view the full minutes text for item 56.

Report ACH20-008

The Chief Executive of Your Voice in Health and Social Care presented the Bromley Communications and Engagement Network – Activity Report 2019.

The Bromley Communications and Engagement Network aimed to contribute to the improvement of healthcare and wellbeing outcomes for Bromley residents. It was an operational group, the membership of which was representative of the whole community and worked in a joined-up way to engage local communities, share intelligence about the views of Bromley residents and join forces to communicate important information to local people. Having such a strong and co-ordinated partnership approach to Communications and Engagement in Bromley had attracted attention from across London and beyond. The Communications and Engagement Network had been used as an example of best practice for partnership working by NHS England, featuring in national webinars and at a presentation to Sustainability and Transformation leaders across London.

Bromley CCG had to undertake an annual assurance process with NHS England and Improvement to assess how it was meeting statutory duties in relation to community and public engagement. For the third year running, Bromley had received an ‘outstanding’ (green star) rating, and was the only CCG in London to meet every single criteria that was measured as part of the assessment.

Campaign activity during 2019 had included the Bromley public flu campaign, which was targeted at communities that had higher incidences of emergency hospital admissions due to respiratory conditions. It was noted that Bromley had been amongst the highest achieving boroughs for flu vaccinations in London over the 2018/19 flu season.

The Chairman and Director of Public Health extended their thanks to the Bromley Communications and Engagement Network for all the work they had undertaken.

RESOLVED that the report be noted.

Report CEF19023

The Board considered the Bromley Safeguarding Children Board Annual Report 2018/19, presented by Jim Gamble, Independent Chair of the Bromley Safeguarding Children Board.

The annual report of the Bromley Safeguarding Children’s Board (BSCB) covered the period from April 2018 to March 2019. It was a statutory requirement for safeguarding partnerships to publish this report under section 14A of the Children Act 2014. In line with statutory guidance, the report would be submitted to the Chief Executive, Leader of the Council, the local police and crime commissioner and the Chair of the Health and Wellbeing Board.

In 2018/19, the BSCB oversaw multi-agency child safeguarding arrangements across Bromley and was comprised of senior leaders from a range of different organisations. Its two basic objectives were to co-ordinate the safeguarding work of agencies and to ensure that this work was effective.

The Children and Social Work Act 2017 legislated that Local Safeguarding Children Boards were to be replaced and transitioned into new safeguarding children partnerships by September 2019. Under the new legislation, the three safeguarding partners (local authorities, police, and clinical commissioning groups) were required to make arrangements to work together with relevant agencies (as they consider appropriate) to safeguard and protect the welfare of children in the area. Since then, the new structures had bedded in, and the BSCB has been replaced by the Bromley Safeguarding Children’s Partnership (BSCP).

The report focused on the BSCB’s work undertaken up to April 2019, and was a transparent assessment of the effectiveness of safeguarding and the promotion of child welfare in Bromley. It set out the governance and accountability arrangements for the BSCB, providing information about the structures in place that supported the BSCB to do its work effectively, as well as the roles of partners, including Designated Professionals and lay members. It was noted that it had been a year of instability for many partners, with major organisational changes within the police and National Probation Service. However, data demonstrated that the Early Intervention services continued to perform strongly, and other services such as the MASH were continuing to mature and strengthen.

The report also provided context for safeguarding children and young people in Bromley, including the Ofsted improvement journey and re-inspection during the reporting year. It highlighted progress made by the partnership across a range of areas (e.g. Early Help, Private Fostering, CSE, Missing and Gangs and the work of the Local Authority Designated Officer), as well as the challenges going forward. The top priority for the partnership this year was the health and wellbeing of the workforce, with caseloads at a much better rate than pre-2016. There was also the continued commitment to look at a strategic approach to vulnerability and considering issues such as County Lines, Child Sexual Exploitation, radicalisation, and harmful practices within vulnerability, rather than as separate issues.

Through its Learning & Improvement Framework, the BSCB had identified a number of lessons, including: Learning Reviews; the BSCB’s Practitioners Survey; and multi-agency audits on early years, drug and alcohol misuse  ...  view the full minutes text for item 58.

NB:  Information Item 14b – Sexual Health Needs Assessment will help inform the Annual Public Health Report.

Report ACH20-009

The Board considered a report providing an update on the development of the Annual Public Health Report 2020.

All Directors of Public Health produced an Annual Public Health Report (APHR) to raise the profile of emerging health issues or to highlight an area of particular interest to a wide variety of audiences. The 2020 APHR for Bromley would focus on Sexual Transmitted Infections, which was a significant public health challenge, and a national and local priority.

The Public Health team had recently completed a Needs Assessment focussed on Sexual and Reproductive Health Needs in Bromley and the findings from this needs assessment would set the focus of the APHR. The key findings from the Sexual Health Needs Assessment showed:

-  A total of 2,082 new Sexually Transmitted Infections were diagnosed in residents of Bromley in 2018 (1,140 in males and 937 in females, 5 were not recorded), a rate of 632.1 per 100,000 residents.

-  The ‘at risk’ populations continued to be young people aged 15-24 who were at highest risk of Chlamydia infection; and MSM and Black African / Caribbean ethnic groups who had the highest rates of new Sexually Transmitted Infections in Bromley.

-  Based on the diagnostic rates (diagnostic rates were used as a proxy for incidence) this indicated there was also a steep rise in the incidence of Gonorrhoea and Syphilis in recent years, and due to their resistance of current treatment, a more targeted approach was required.

The APHR would describe the major Sexual Transmitted Infections as a communicable disease and the report would be used as a tool for raising awareness.

It was noted that the Information Item relating to the Sexual Health Needs Assessment would help to inform the APHR, and further feedback would be provided to the Board as work progressed.

RESOLVED that the update on progress towards the Annual Public Health Report 2020 be noted.

Report ACH20-013

The Board considered a report providing an update on changes, challenges and progress in primary care during 2019.

The report provided by Bromley CCG covered the major areas of progress and development over the last twelve months, and key challenges and opportunities for coming years. This included the introduction and embedding of Primary Care Networks as a significant new way of working together in general practice; the changes to Bromley’s practices and population during 2019; primary care workforce and premises as two of the biggest challenges faced in Bromley; and some of the successes of locally prioritised commissioned services to increase vaccination and screening rates.

The Managing Director, Bromley CCG advised Members that the merger of six CCG’s would be completed to create a single South East London CCG from 1^st April 2020. Staff consultation had taken place, and they were working towards Delegated Authority. The proposed Bromley Based Board would be a joint LBB and CCG committee that would be established by mid-May 2020, as an oversight group looking at the services to be commissioned and the strategies to be adopted. The membership of the Board would include two local GP’s, Dr Andrew Parson and Harvey Guntrip as a Lay Member. It was hoped that the full membership would be confirmed shortly.

In January 2019, following the publication of the NHS Long Term Plan, a number of reforms to the core GP contract were announced including a mandate to develop Primary Care Networks (PCNs) across all local areas. All 44 of the GP practices in Bromley were included within eight PCNs and had networks covering populations of between 30,000 and 50,000 patients. All PCNs were required to provide 30 minutes per week of extended hours access to doctor or nurse appointments per 1,000 patients on PCN member practices’ registered lists. Extended hours had been in place in all eight PCNs since October 2019 or earlier, and offered appointments during evenings or weekends.

One of the biggest challenges was staffing of GP practices. To help address this, clinical pharmacists and social prescribers were being placed in every PCN. Future roles were also being developed that would see more advanced practitioners and paramedics placed within the PCNs, for a more wide-ranging approach.

A Member noted that as part of the Urgent Response Network, South East London had been selected as an accelerator site for an additional Urgent Response team, which was welcome news.

The Chairman noted that the last meeting of the Bromley CCG Governing Body would be taking place in March 2020, and extended his thanks to the CCG Members for their contribution to the Health and Wellbeing Board.

RESOLVED that the report be noted.

The Director of Public Health informed Board Members that she had received a response from Benjamin McGowan, Bromley Youth Council in relation to the Ravensbourne School's Period Poverty Pilot Scheme. Following conversations with the Red Box Project, they had been made aware that the Government’s own plans to tackle period poverty would be rolled out. They had been waiting for this to happen in order to participate in the national scheme.

From 20^th January 2020, the Government had announced that there would be access to free period products in schools and colleges in England, with immediate effect, as part of their bid to tackle ‘period poverty’.

Members suggested that information relating to the national scheme should be circulated to all schools.

RESOLVED that the update be noted.

Report ACH20-010

The Board considered a report providing information on a funding application for ‘Shaping Places for Healthier Lives’.

The Health Foundation had made a grant available that the Council had applied for. The potential grant was £300k over three years. The funding was for an innovative programme of work that considered and positively impacted upon the strongest determinant of health. The Health Foundation was working on this new programme with Local Authorities, and they had been invited to submit an Expression of Interest (EOI) by 17^th January 2020. Bromley had submitted an EOI for ‘Housing and Place’ to help support the wider determinants of health for people that were homeless.

In 2017, Public Health, with the support of colleagues in Housing and Bromley CCG undertook a health audit of those living in Temporary Accommodation. There were some clear evidenced links between living in Temporary Accommodation and the affect on peoples mental and physical health. The audit also identified a complex system of other wider health determinants, including the impact of people to secure training and or employment whilst living in nightly paid accommodation.

Bromley was delivering a number of Council owned housing developments for the first time in circa 30 years. As they were Council owned they would provide more secure tenancy options for people who were previously living in expensive nightly paid accommodation. Together with the reduction in costs for the Council, importantly the new homes would provide a safe place for people to live and improve their lives and health. 

With the grant, the Council would utilise the community connections made through the Council’s own learning shops and the new housing developments being developed by the regeneration team, to invest in:

-  Training opportunities for those families moving into the housing development;

-  Local Community engagement opportunities;

-  Improved green spaces nearby for families in the accommodation, that promoted wellbeing;

-  Help people moving into the accommodation to secure employment; and,

-  Help people move to permanent housing, reducing costs for the Local Authority and improving wider health for individuals.

In doing this Public Health would support the monitoring and impact of these opportunities on wider health determinants using the 2017 audit data as a benchmark and the Public Health Outcomes Framework indicators (PHE PHOF).

RESOLVED that the report be noted.

The Information Item comprises:

There were two Health and Wellbeing Board Information Items:

·  Delayed Transfer of Care (DToC) Performance Update (Report ACH20-014)

·  Sexual Health Needs Assessment (Report ACH20-011)

RESOLVED that the Information Briefing be noted.

Report CSD20018

The Board considered its work programme for 2019/20 and matters arising from previous meetings.

The Director of Adult Social Care reported that in relation to Minute 24, a meeting had been scheduled the following week with Councillor Cooke and Councillor Ellis, to discuss what DToC information was required to ensure that the Health and Wellbeing Board was meeting its statutory duties.

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

·  Update from Mytime Active (11^th February 2021)

·  Bromley Safeguarding Children’s Partnership update on emerging trends, themes and patterns (every 6 months)

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

Coronavirus Update

Board Members were provided with a handout on information relating to the Coronavirus. It was noted that Public Health England was an excellent website for sourcing the most reliable and up to date information, as it was being continually updated. The Director of Public Health advised Members that a link to the Public Health England website would be added to the London Borough of Bromley website.

The Managing Director, Bromley CCG informed Members that communications relating to potential cases had been distributed by Public Health England to all hospitals and GP practices. Patients would be advised to stay at home, and algorithms had been provided in relation to the symptoms they were presenting.

Meeting dates – 2020/21

The Chairman highlighted that a draft Programme of Meetings for 2020/21 had been circulated to Councillors. It was suggested that a request be made to the General Purposes and Licensing Committee for the meeting of the Health and Wellbeing Board scheduled for 25^th June 2020 to be moved back to 2^nd July 2020. Board Members agreed, noting that it would allow more separation between meetings.

RESOLVED that the issues raised be noted.

1.30pm, Thursday 30^th April 2020

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