Agenda and minutes

Virtual Meeting, Health and Wellbeing Board - Thursday 2 July 2020 1.30 pm

Contact: Jo Partridge  020 8461 7694

No. Item




The Chairman welcomed Board Members to the virtual meeting of the Health and Wellbeing Board, held via Webex.


A minutes silence was held to reflect and acknowledge all of the Borough’s residents who had died from COVID-19, as well as those who had, or still were, suffering as a result of the pandemic.


Apologies for absence were received from Councillor Marina Ahmad, Janet Bailey, Rachel Dunley and Frances Westerman – Healthwatch Bromley, and Councillor Ian Dunn, Stuart Hills and Mina KakaiyaHealthwatch Bromley attended as their respective substitutes.




Christopher Evans declared an interest in relation to item 10, in his role as Director of Bromley Well.



Additional documents:




i)  the minutes of the meeting held on 30th January 2020 be agreed; and


ii)  the minutes of the informal meeting held on 30th April 2020 be noted.




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 26th June 2020.


Please note that all questions will answered by written reply.



No questions had been received.





The Board received a presentation from Paul Lindley OBE, Chair – London Child Obesity Taskforce and Professor Corinna Hawkes, Vice Chair – London Child Obesity Taskforce, providing the context behind the existence of the Taskforce, its work and call to action, and a summary of its next steps.


The Chair of the London Child Obesity Taskforce noted that they were aware that child obesity had been a priority for the Bromley Health and Wellbeing Board in recent years, and the changes made to residents’ lives through its actions had been life changing. They hoped to learn from this, and receive any thoughts of what could add to the work they were currently undertaking.


The London Child Obesity Taskforce had been established nearly two years ago, as part of the Mayor of London’s Health Inequalities manifesto commitment. Other stakeholders included Guy’s and St Thomas’ Charity, Public Health England, the Association of Public Health Directors – London and the Association of London Directors of Children’s Services, plus additional independent volunteers. The Taskforce had been asked to recommend actions that would change the trajectory of the lives of this generation children of living in London, which was a very broad remit.


London was in the unenviable position of being at the bottom of the world cities league for healthy weight children. On average, 12 children in each Year 6 class (nearly 40%), and 22% of children in Reception classes, were not at a healthy weight. Unfortunately, for the majority of these children, they were likely to live at an unhealthy weight throughout the rest of their lives. It was highlighted how we are shaped by our buildings; by our city; and by our environment. London was beautiful, but it could be a very hard place to live, especially if you lived in an area of deprivation. In areas of deprivation, the environment was subject to a tide of unhealthy food advertising, and was flooded with fast food restaurant. The places that London’s children lived their lives, shaped their lives. Therefore the Taskforce aimed to unleash a transformation in London so that every child had a chance of growing up: eating a healthy diet; drinking plenty of water; and being physically active.


Over the last two years, the Taskforce had worked around five core values, or truths. The first was the environmental challenge to secure a healthy weight, as London was an obesogenic environment for its children. Pictures were displayed showing what London was like today for children that grew up there – flooded with traffic; waves of people using escalators, with very few choosing to walk. There was a deluge of opportunities to buy more and more unhealthy foods, and the encouragement to get more than was wanted.


The flood gates had opened on the growth of fast food restaurants, especially in areas of deprivation, with over 9,000 now in London. This was an increase of more than 40% in less than a generation. The Mayor of London had been working to ensure  ...  view the full minutes text for item 5.




The Chairman informed Board Members that he wished to take forward a proposal to establish a new Obesity Task and Finish Group.


It was noted that an obesity group had previously been formed, but had been partially stood down. However it was highlighted that the need was still there, with the issues of obesity in adults linking to premature deaths, cancers, dementia and diabetes. Obesity was also a major risk factor for COVID-19, and aiming to tackle it could help to reduce its severity.


It was proposed that a Task and Finish Group be set up to meet virtually every ten days, to discuss what sort of things could be implemented rapidly – such as using social media and communications to get people to improve their diet. The group would aim to gather together ideas for tackling obesity, which could then be launched in the autumn. Board Members were asked to inform the Chairman and clerk if they would like to be involved in the group.


The Borough Based Director – SEL CCG agreed that this was an excellent idea, and she would identify a GP to be involved in the group, and take some of this work forward.


In response to a question, the LBB Director of Public Health noted that the Adult Obesity Group was still partially functioning, however it had focused on a joint piece of work with South East London colleagues. It was noted that there was also a smaller Childhood Obesity Group.


In response to a question, the LBB Director of Public Health said that there was good evidence that if someone was obese during their early life, they tended to become obese adults. However it was noted by a Board Member that this was not irreversible. The LBB Director of Public Health emphasised that this highlighted the importance of tackling childhood obesity. There were also discussions to be had around breastfeeding, maternal obesity and healthy pregnancy.


The Vice Chairman stated that he was supportive of the establishment of a Task and Finish Group, and shared the view that the focus should be on engaging with children and their parents. During childhood was when habits were formed, and it was much more difficult to changes these later on in life.


A Board Member noted that a number of schools in the Borough grew vegetable on site as part of their healthy eating policies and forest schools. During lockdown, some of these schools had been sharing menus with parents and children, and posting pictures of their cooking. It was suggested that the group could look at some of the school websites to see what was already being achieved. It was highlighted that the wider involvement of schools and Residents Associations would be extremely important.


The Chairman suggested that the proposal be worked on further, with the focus being on Adult Obesity in the short term, and brought back to Board Members. At the next meeting of the Health and Wellbeing Board, it could be considered how  ...  view the full minutes text for item 6.



- an update on the Track and Trace Procedures for Bromley


Report ACH20-032


The Board considered a report providing an update on the progress towards the development of the ‘Test and Trace’ procedures in Bromley.


Public Health in Bromley had new responsibilities in relation to the COVID-19 outbreak. These included:

  -  Local outbreak management of COVID-19 in key or complex settings;

  -  Local area outreach and engagement with vulnerable, hard-to-reach or disconnected residents, groups and communities;

  -  Establishing regional or area networks to provide sharing of intelligence and mutual support if pressure on the national system; and

  -  Specialist Public Health support to Bromley Council and key local partners.


A new Test and Trace service had been launched which formed a central part of the Government’s COVID-19 recovery strategy. This would operate through online phone contact whilst an app was being developed.


Local Authorities (LA) had been charged with supporting the new Test and Trace service in their area, with each LA developing tailored outbreak control plans, working with the local NHS and other stakeholders. The plans would focus on identifying and containing potential outbreaks in places such as workplaces, housing complexes, care homes and schools. Work on plans had started immediately, and it was expected that plans would emerge during the month of June 2020.


The primary objectives of the Test and Trace service would be to control the COVID-19 rate of reproduction (R), reduce the spread of infection and save lives – and in doing so help to return life to as normal as possible, for as many people as possible, in a way that was safe, protected the health and care systems and released the economy.


A co-ordinated effort from local and national government; the NHS; GPs; businesses and employers; voluntary organisations and other community partners; and the general public was anticipated. Local planning and response had been identified by the government as an essential part of the Test and Trace service, with local government having a central role to play in the identification and management of infection.


The LBB Director of Public Health noted that the table provided on page 34 and 35 of the agenda pack, described the individual key roles of the LA and Public Health England (PHE). PHE would lead on the majority of outbreaks, whereas the LA would lead on those within community clusters.


In terms of governance, a Health Protection COVID Board had been set up, involving PHE; the SEL CCG; Bromley Healthcare; community and voluntary providers; and most recently the Metropolitan Police. The Health Protection COVID Board had overseen the production of the Outbreak Control Plan, monitored the delivery of the Action Plan, and was accountable to the Local Authority’s Gold Chief Officers Group. It was noted that since the report had been written, the Outbreak Control Plan had been completed and published on the Council’s website. Board Members had been provided with the final draft version, and a link to the published document would be circulated shortly. This had been an important piece of work, as it outlined the key  ...  view the full minutes text for item 7.




The Borough Based Director – SEL CCG informed Board Members that currently, very few cases of COVID-19 were being seen in the Borough, with just a handful of positive cases through the testing arrangements in place. In total there had been in excess of 1,300 confirmed cases in Bromley, and 337 deaths. 73 deaths had taken place in care homes, 239 in hospitals and the remainder in the community. There had been no deaths within recent weeks. Work was being undertaken to ensure the LBB Public Health team were provided with all the data available to populate the information.


The system of testing currently in place was antigen testing, to see if a person had the disease. This was ideally done during the first few days of having symptoms, after which there was a high probability that the test would come back negative. Antibody testing had also been launched, mainly for those working in health and social care settings. 1,500 tests had been carried out in Bromley, and as the test involved a sample of blood, additional phlebotomy services had therefore been arranged.


In response to a question, the Borough Based Director – SEL CCG said that in relation to the antibody testing for health and social care staff, between 17 and 18% had returned positive tests. However it was noted that the antibody disappeared very quickly, so it could not be stated that only 17-18% of these staff had been infected with COVID-19. The Chairman highlighted that some evidence suggested that the antibodies only remained present for around five weeks.


In relation to care homes, testing for residents and staff, both symptomatic and non-symptomatic, had been established early on in the pandemic. Over 5,000 tests had been carried out, with a proportion of both residents and staff testing positive and support had been provided to care homes to help segregate patients and ensure that the correct infection control measures were in place. It was noted that having a single General Practice for all Bromley care homes had made it easier to provide this support. Testing was also continuing to be offered to other residential settings, such as mental health and learning disability homes, and other environments where there were groups of residents and staff.


In response to a question, the Borough Based Director – SEL CCG said that the figures relating to the antibody testing could be circulated to Board Members following the meeting.


Antibody testing was not generally available to patients. There had been a number of people who had tested antigen positive, but were then testing as antibody negative. Therefore it could not be assumed that if you had the antibody, you would be immune to getting re-infected. It was highlighted that PPE should be worn as recommended, and that infection control measures must be followed. It was emphasised that it was not known how long the antibody lasted in those that returned a positive test.


With regards to recovery planning, work was being undertaken to look  ...  view the full minutes text for item 8.



Additional documents:


Report ACH20-036


The Board considered a report providing an analysis of performance across the Bromley Urgent and Emergency Care system as compared to last year. This took into account the COVID-19 pandemic, which had impacted on the system dramatically at the end of 2019/20 winter period.


The report also provided an overview of the schemes delivered throughout winter 2019/20 from the Better Care Fund (BCF) winter pressures monies. 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 for the London Borough of Bromley, and were delivered under budget.


The Urgent Care Lead – SEL CCG noted that due to the COVID-19 pandemic, there had not been a formal review of the Bromley winter plan this year, as resources had been focussed on mobilising the pandemic response in Bromley. However, the report provided insight into how the Bromley System Winter Plan’s successful partnership working across the system had enabled successful mobilisation of the pandemic response locally.


In relation to the PRUH A&E, All Type performance between October 2019 and March 2020 had decreased slightly when compared to the previous year from an average of 75% to 72%. Type 1 performance had been particularly low in December 2019 until mid-January 2020. The Trust had carried out deeper analysis, which had shown that during this period there had been a 9% increase in Type 1 attendances and a 6.7% increase in Type 3, which had contributed significantly to the performance challenges.


Although overall emergency admissions for all ages were relatively stagnant as compared to the previous year, there had been a significant increase in attendances of over 85’s (7.7%), and also an increase in over 85’s being admitted to hospital (6%). These patients had a significantly longer length of stay (circa 8.3 days, versus 7 days for 65-84 years and just 3 days for 0-65 years) impacting on bed management and a consequentially negative impact on 4 hour performance. However it was noted that there had been an improvement in Type 1 and All Type performance in February and March 2020. A Board Member suggested that even more emphasis would need to be put on reducing delays to ensure that performance did not slip.


The Trust had made improvements to the flow of the department, and a new Transfer of Care Bureau Lead and Nursing Head of Quality were working on patient discharge. They had initiated ‘point prevalence’ reviews of every patient on the wards who had a length of stay of over 21 days. This had been a good example of the partnership working undertaken, with these reviews being carried out by trust and community health and social care staff, and had led to a significant drop of 278 patients in the period of December to January as compared to 321 for the previous year. It was noted that the voluntary sector should be praised for the key  ...  view the full minutes text for item 9.




Report ACH20-031


The Board considered a report providing an overview of Quarters 3 and 4 (October 2019 to March 2020) 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 in non-elective admissions;

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

  c. Rate of permanent admissions to residential care per 100,000 populations; and

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


In Quarter 3, non-elective admissions continued to be reported within the activity plan set out in the CCG’s operating plan, carrying on the trend from the beginning of the year. Quarter 4 had seen a significant fall in non-elective admissions into the acute hospitals which reflected the impact of the COVID-19 pandemic towards the end of the quarter, and saw a commensurate reduction in the attendance at the Emergency Department.


The local Health and Social Care Partners of One Bromley had jointly responded to deliver services as required, to meet the local needs of Bromley patients during the pandemic. Contractually, for 2019/20, the position for King’s had been agreed for the financial year at the fixed contract level. The One Bromley Programme continued to develop programmes in the community to identify and manage patients locally, with changes to the pro-active care pathway and services for frail patients. Planning for winter had commenced, which also reflected any changes in capacity required for seasonal pressures and COVID-19.


In respect of DToC, Bromley’s target for 2019/20 had increased from 10.31 bed days per day to 12.5. This was the overall figure for Bromley which included DToC's due to both NHS and / or Social Care. It was noted that for Quarters 3 and 4, Bromley was exceeding its performance targets.


The LBB Integrated Strategic Commissioner for Early Intervention noted that the target for admissions to residential care for Quarters 3 and 4 had not been met. This was despite the continuing drive to promote independence by supporting people in their own homes, and partly due to more people being admitted to residential placements with enduring and more complex needs.


In relation to reablement, it was noted that there was a 91 day lag for data, and therefore Quarter 4 data was not yet available. This data, available at the end of July 2020, would be provided to the September meeting of the Health and Wellbeing Board. It was noted that the most recent data showed that Bromley was exceeding the target of 90% by delivering 93%. Robust plans were in place to ensure early planning, so that reablement opportunities for local residents could be maximised. The alignment between reablement and Bromley Well Prevention and Early Intervention services had been strengthened, in order to maximise reablement opportunities for residents following a period of crisis in the community or discharge from an acute ward. The Take  ...  view the full minutes text for item 10.




The Independent Chair of the Bromley Safeguarding Adults Board advised that the new Bromley Safeguarding Adults Board website had been launched, any feedback on which would be welcomed –


The Independent Chair of the Bromley Safeguarding Adults Board noted that safeguarding referrals for adults had remained steady year on year, which they found perplexing. It was anticipated that there would be growth in areas, such as safeguarding referrals for domestic abuse, which was not being seen. They would therefore be undertaking their own ‘deep dive’ looking at A&E referrals.


Another area of concern was mental health – the level of social isolation and loneliness; anxiety; fear of catching COVID-19, could see an increase in the number of case of self-neglect, with people losing the impetus to keep themselves well.


An area also being followed with interest was that of rough sleepers. All rough sleepers in the Borough had been accommodated during lockdown, however this support may come to end as hotels reopened for business. Initially around 80 households, of mainly single people had been housed, and this figure had since reduced to 63 households, and this was something that they would continue to monitor.


The Independent Chair of the Bromley Safeguarding Adults Board said that they also had a focus on care homes, and it was noted that the amount of work and information being provided by them was fantastic. It gave an understanding of how hard they were working to keep vulnerable adults safe, and they wished to thank them for doing so.


RESOLVED that the Safeguarding update be noted.




Report ACH20-034


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


All Directors of Public Health produced an Annual Public Health Report to raise the profile of emerging health issues or to highlight an area of particular interest to a wide variety of audiences. The APHR for Bromley for 2020 focused on Sexually Transmitted Infections.


The APHR described the major Sexually Transmitted Infections and would be used as a tool for raising awareness. A brief outline for the report highlighted that the audience included GPs; the general population; hospital; and schools (pupils and teachers). Its content would include:

-  Introducing the key Sexually Transmitted Infections;

-  Interventions and the evidence of their effectiveness;

-  Key facts in Bromley;

-  What were we doing now for Bromley residents?; and

-  What were we developing for Bromley residents?


The report was in final draft form, and was awaiting final comments and edits, and the impact of COVID-19 would also be added. It was intended that the final APHR would be presented to the meeting of the Health and Wellbeing Board on 24th September 2020.


RESOLVED that the Annual Public Health Report update be noted.




Report ACH20-033


The Board considered a report providing an update on the Pharmaceutical Needs Assessment (PNA).


The Director of Public Health informed Board Members that the Health and Wellbeing Board had a statutory duty to publish a PNA according to the NHS Pharmaceutical and Local Pharmaceutical Services Regulations 2013. This would normally be due at the end of January 2021.


A national communication on 21st May 2020 had been made on behalf of the Department of Health and Social Care (DHSC) announcing the following:

-  Due to current pressures across all sectors in response to the COVID-19 pandemic, the requirement to publish renewed PNAs would be suspended until April 2022. Local Authority Health and Wellbeing Boards would retain the ability to issue supplementary statements to respond to local changes and pharmaceutical needs during this time.

-  The NHS Pharmaceutical and Local Pharmaceutical Services Regulations 2013 would be updated in due course.


After discussions with the other South East London areas to ensure alignment, the delivery of the PNA had been suspended. Healthy Dialogues had continued up to this point with the literature review and the public survey had been prepared. They had now been informed of the suspension of their contract, which was expected to recommence on the 1st April 2021 for delivery at the end of March 2022.


It was noted that the Health and Wellbeing Board still had the ability to issue a supplementary statement should the need arise, and the Board would be updated if this was required in the coming year. The Board would be provided with regular updates once the PNA process was reinstated, which was expected to be in April 2021.


The Chairman noted that having an extra year to complete the PNA was helpful, but an extra section was likely to be needed regarding pharmaceutical support during the COVID-19 pandemic. Work to revise the questionnaire would be ongoing.


RESOLVED that the Pharmaceutical Needs Assessment update report be noted.




The Board considered the Chairman’s annual report of the Health and Wellbeing Board.


Board Members were asked to provide any comments or suggestions on the document to the Chairman and clerk, prior to it being reported to the next meeting of Full Council. The Chairman extended his thanks to Board Members for the significant contribution they had made to the Health and Wellbeing Board during the 2019/20 municipal year.


RESOLVED that the report be noted.




Report CSD20072


The Board considered its work programme for 2020/21 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:


·  Mental Health discussion (24th September 2020)

·  Further update regarding COVID-19 (24th September 2020)

·  Further update from the London Child Obesity Taskforce (summer 2021)


The LBB Director of Public Health advised that it had previously been agreed for JSNA Priority Area updates to be brought regularly to the Health and Wellbeing Board. As most of the work of these groups was currently paused due to the COVID-19 pandemic, it was noted that it may not be possible to bring the reports from the cancer and diabetes group to the September meeting as planned.


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




There was no other business.



1.30pm, Thursday 24th September 2020

1.30pm, Thursday 3rd December 2020

1.30pm, Thursday 11th February 2021

1.30pm, Thursday 29th April 2021


The next meeting of the Health and Wellbeing Board would be held at 1.30pm on Thursday 24th September 2020.