Agenda and minutes

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

Apologies for absence were received from Councillor Gareth Allatt, Janet Bailey and Jim Gamble – Independent Chair of the Bromley Safeguarding Children Partnership. Apologies for absence were also received from Frances Westerman – Healthwatch Bromley, and Mina Kakaiya – Healthwatch Bromley attended as substitute.

Apologies for lateness were received from Councillor Marina Ahmad and Councillor Judi Ellis. Councillor Mike Botting and Christopher Evans gave apologies for needing to leave the meeting early.

Christopher Evans declared an interest in relation to his role as Director of Bromley Third Sector Enterprises / Bromley Well.

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 27^th November 2020.

Please note that all public questions will be answered by written reply.

No questions had been received.

RESOLVED that the minutes of the meeting held on 24^th September 2020 be agreed.

The LBB Communications Executive informed Board Members that they were taking the opportunity to talk about losing weight, due to the link between obesity and COVID-19. The first stages of the ‘Don’t Wait to Lose Weight’ campaign had been launched through the ‘Better Health’ campaign, with a press release on the Council’s website and information to signpost residents to the resources available to help them lose weight. The ‘Better Health’ campaign had since moved onto its ‘Get Active’ theme, and would then move on to ‘Mental Health’.

Graphics had been designed for the ‘Don’t Wait to Lose Weight’ campaign, around which the communications plan had been created. The graphics had been included on the carousel of images on the homepage of the website, and signposted residents to the health pages and NHS resources. The story had also been covered in the LBB e-newsletter, which was distributed electronically to around 70,000 residents, and the volunteer newsletter which was sent to the 4,500 volunteers that had been engaged in response to the pandemic. There had also been continuous social media messaging using these graphics. The obesity campaign would continue to be developed separately in the run up to Christmas, and into the New Year.

RESOLVED that the update on the weight reduction campaign be noted.

To follow

Report ACH20-081

The Board considered a report providing an overview and update on the overarching One Bromley Winter Plan and the delivery of the NHS SEL CCG (Bromley), London Borough of Bromley Winter Schemes 2020/21 (funded from the Better Care Fund (BCF)). All schemes / funding lines would be evaluated at the end of the period and reported as part of the Winter Evaluation.

The plan had been considered and reviewed at the Bromley A&E Delivery Board. The Board was facilitated by NHS SEL CCG (Bromley), working in partnership with King’s College Hospital, the London Borough of Bromley, Greenbrook Healthcare, Oxleas NHS Foundation Trust, Bromley Healthcare, Bromley GP Alliance, St Christopher’s, the London Ambulance Service and Bromley Third Sector Enterprise. It had also been discussed and inputted into previously by the Bromley Health and Wellbeing Board, Bromley Health Scrutiny Sub Committee, Bromley Borough Based Board and had formed part of the assurance on Winter Plans to NHS England / Improvement.

The Plan update report was presented to the Health and Wellbeing Board as part of the local assurance scrutiny and assurance process. The report provided an update on mobilisation of the CCG and Local Authority’s 2020/21 winter schemes which the Board were asked to note and comment on. The Plan included reference to the Bromley Adult Social Services Winter Plan (the Local Authority template sent out for completion by the Department of Health and Social Care) that set out the approach to be taken around care and support sufficiency and quality of care services for residents supported in the community.

The overall aim of the plan was to provide an overview of how the Bromley system would respond to seasonal demand and a potential second wave of COVID-19 at both a tactical and strategic level. Furthermore, the plan would support the local health and social care system to effectively manage winter pressures, for example with hospital discharge pressures or supporting patients in the community through robust care and support offers to help them remain independent in their own home.

The Senior Commissioning Manager advised that the funding for CCG and LBB winter schemes is budgeted from the Better Care Fund, whilst King’s schemes were funded internally via their core contract. NHS SEL CCG (Bromley), London Borough of Bromley (LBB) and King’s College Hospital (PRUH site) had proposed winter resilience schemes that supported delivery of the strategic priorities of the winter plan. Those strategic priorities were as follows:

·  Meet additional winter demands on front line services with a focus on supporting and preventing acute pressure;

·  Focus on supporting vulnerable groups to prevent the need for hospital-based care;

·  Ensuring sufficient resource to manage a potential COVID-19 wave 2, learning from wave 1;

·  Flu vaccinations for staff at provider organisations (including Local Authority and Bromley Third Sector Enterprise staff) and patients via primary care, community and pharmacies; and

·  Alignment of winter communications with SEL CCG and robust patient engagement in planning winter services.

The Senior Commissioning Manager noted that in line with  ...  view the full minutes text for item 39.

The Chairman welcomed James Postgate, Associate Director of Integrated Commissioning – SEL CCG (Bromley), Matthew Trainer, CEO – Oxleas, Lorraine Regan, Service Director (Bromley Directorate) – Oxleas, Sheena Gohal, Associate Director – CAMHS - Oxleas and Gill Allen, Director – Bromley Wellbeing Service for Children and Young People, to the meeting to provide an update on the current position of mental health resilience in the Borough.

The Associate Director of Integrated Commissioning advised Board Members that from a commissioning point of view, they had seen significant changes to services across the Borough. It was noted that mental health resilience was also an area of focus for the Mental Health and Wellbeing Strategy.

The CEO – Oxleas advised Board Members that, as a result of the COVID-19 pandemic, they were expecting to see a sustained increase in the demand for mental health services over the next six months. During the first wave, there had temporarily been a “drop-off”, however there had been a surge in demand during June and July 2020 – the demand for emergency support for those in mental health crisis was high, and remained so. It was noted that some patients would see Oxleas, as a specialist mental health provider, whilst others would access support through their GP, Bromley Healthcare or non-NHS interventions. It was important that in recognising the increased demand that not everything became medicalised – as with the issues of social isolation and loneliness discussed earlier, the Bromley community as a whole would be able to respond and help ensure people had the support required. There had also been an increase in the demand for secondary specialist services, from those already known to Oxleas who had become acutely unwell due to the pandemic, as well as new presentations. It was anticipated that this would increase further with the expected rise in unemployment and the economic impact of the pandemic, with some national benchmarking data predicting a 20-30% increase in demand for services over the next six to twelve months. As well as managing specialist services, thought needed to be given to those who were dependent on non-NHS services to help their recovery, and working in partnership with other departments such as social care and housing. It was emphasised that it would be a difficult winter period – some funding would be received, however this would not be sufficient to address the anticipated additional pressures on the service. Partnership working across the system would be particularly important this year.

The Service Director informed Board Members that services had continued to be provided throughout the pandemic. During the first wave of the pandemic, a number of services had moved on to digital platforms. On exiting the first wave they had worked to ensure that no patients had been excluded from receiving the support required due to their digital access. Face to face appointments had been offered throughout, however recently there had been a significant increase which had been affected by relapses in a number of  ...  view the full minutes text for item 40.

Report ACH20-082

The Board considered a report providing an overview of Quarter 2 (July to September 2020) performance of both the Better Care Fund (BCF) and the Improved Better Care Fund (iBCF) 2020/21 on 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.

The LBB Integrated Strategic Commissioner for Early Intervention advised that Bromley’s performance against three of the four metrics detailed had been in line with, or exceeded, anticipated targets. It was noted that Delayed Transfer of Care (DToC) for March 2020 – September 2020 were not available as NHS England had paused this collection as a result of reduced reporting capacity during the COVID-19 pandemic. In respect of admissions to residential care, the planned target for admissions to residential care for Quarter 2 2020-21 had been met. This continued the trend from Quarter 1 2020-21, and was also lower than the same period in 2019-20 which saw 124 admissions. In relation to reablement, there was a 91-day lag for data and therefore Quarter 2 data was only up to the end of July 2020, however the most recent data showed that the target of 90% was being exceeded, with delivery of 90.9%. This was a slight reduction compared to Quarter 1 (95.9%), and the same period in 2019-20.

The feedback received had highlighted several common themes across these projects, including:

-  An increase in the number of COVID-19 related queries at the SPA;

-  Increase in online provision;

-  Increase in online client engagement;

-  Growth in client retention rates;

-  Strengthening of partnership working;

-  Increase in befriending request; and

-  Enhanced support provided to staff.

In response to a question regarding the data for admissions to residential care for Quarter 2, the LBB Integrated Strategic Commissioner for Early Intervention advised that 425 people had been last years’ target – this target had remained the same for the current year due to a delay in updated metrics being provided by NHS England. The cumulative figure for Quarter 1 and Quarter 2 was 202.8 admissions, which indicated that if this trend continued, admissions at the end of the year would be less than 425. It was noted that a population correcting calculation had been provided in the report, which allowed them to compare the data across other authorities.

The Chairman noted that performance on the projects currently looked good. A difficult period was about to be entered and it was anticipated that figures would rise, however there was some flexibility.

A Member queried if the table of BCF schemes for 2020/21 (page 30 of the agenda pack) was accurate, as the variation figure was ‘£0’ for all schemes. The Director of Adult Social Care  ...  view the full minutes text for item 41.

Report ACH20-065

The Safeguarding Adults Board Manager presented the Bromley Safeguarding Adults Board (BSAB) Annual Report for 2019/20.

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 BSAB took the decision in February 2019 to commission a SAR relating to a care home in the borough, the completion of which was still ongoing.

The Safeguarding Adults Board Manager highlighted that the report was reflective of the period April 2019 to March 2020, which was on the cusp of the country entering into the pandemic. Key priority had included:

-  Self-neglect – 22% of safeguarding enquiries in Bromley related to self-neglect, which was an increase of 10% on the previous year.

-  Hoarding – 26 cases had been reviewed by the Self-Neglect and Hoarding Panel.

-  Domestic Abuse – over 4,700 cases of domestic abuse were reported to the Metropolitan Police in Bromley during 2019 and work had been undertaken to raise awareness in under-presented groups.

-  Fire Safety – 3,278 home fire safety visits had been conducted, and ongoing safeguarding training had been provided to all station-based staff across the borough.

Key achievements of the BSAB had included:

-  Engagement – a series of presentations were delivered to communities, and a consultation questionnaire had been developed.

-  Communication – the BSAB logo had been rebranded, Safeguarding Awareness posters and Self-Neglect leaflets had been developed.

-  Annual Conference – had been well attended and received positive feedback.

-  Safeguarding Awareness Week – 1-hour bitesize learning sessions, focusing on priority areas, had been delivered.

-  As well as SAR’s; joint partnership working with the BSCP; audit achievements and local and national consultations.

The Chairman thanked the Safeguarding Adults Board Manager for presenting the BSAB Annual Report to the Board, and for all the work undertaken. It was noted that the report was very detailed, and Board Members were asked to contact the Safeguarding Adults Board Manager directly with any comments or questions.

The Director of Adult Social Care informed Board Members that the appointment of the new Independent Chair of the Bromley Safeguarding Adults Board had been confirmed. Teresa Bell was currently the Independent Chair of two other Safeguarding Boards and had a wealth of experience  ...  view the full minutes text for item 42.

Report CEF20031

The Board considered the Bromley Safeguarding Children Partnership (BSCP) Annual Report 2019/20.

The annual report of the BSCB covered the period from April 2019 to March 2020. 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.

The Independent Chair of the Bromley Safeguarding Children Partnership highlighted that 2019/20 had been a year of transition and change, beginning with the implementation of new partnership safeguarding arrangements and ending with the arrival of the COVID-19 pandemic. The report detailed much of the routine work that had continued throughout the year, as well as the beginnings of contingency oversight by the Partnership in response to the pandemic, which had continued since March 2020.

The Chair’s Foreword highlighted the achievements and challenges of the year, including:

·  the governance and accountability arrangements for the BSCP. Information was provided with regards to the structures in place that supported the BSCP to do its work effectively, as well as the roles of partners, including Designated Professionals and lay members.

·  the context for safeguarding children and young people in Bromley. Progress made by the Partnership was highlighted, 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.

·  lessons identified by BSCP through its Learning and Improvement Framework, including Learning Reviews and multi-agency audits. This section also detailed the actions taken to improve child safeguarding and welfare as a result of this activity.

·  the range and impact of the multi-agency safeguarding training delivered by the BSCP, including e-learning, face-to-face, briefings (such as lessons from local learning reviews) and the BSCP annual conference, which this year had focused on FGM.

·  the priorities going forward: The Local Safeguarding Context; Early Help and Early Intervention; Strong Leadership and Strong Partnership; and a Healthy Workforce. There were also important messages from the Independent Chair of the BSCP to key people involved in the safeguarding of children and young people.

The Chairman noted that as apologies had been received from the Independent Chair of the Bromley Safeguarding Children Partnership, Board Members had been asked to email any questions regarding the BSCP Annual Report to the clerk by 3.00pm on Friday 4^th December 2020.

A Member said that both the Bromley Safeguarding Adults Board and Bromley Safeguarding Children's Board Annual Report’s were very impressive, and highlighted the volume of work being undertaken.

RESOLVED that the Bromley Safeguarding Children's Board Annual Report 2019/20 be noted.

To include:

-  An update on the flu immunisation programme in Bromley

-  Long COVID-19 syndrome

-  COVID-19 immunisation plans for Bromley

-  Bromley Health and Wellbeing Centre

Flu Immunisation

The Borough Based Director – South East London Clinical Commissioning Group (“Borough Based Director”) informed Board Members that the flu immunisation programme across the borough was going well, despite the phasing of deliveries creating a challenging period during October and November. The national target for the over 65’s cohort was 75%, and current data indicated that this figure had been reached in Bromley. With regards to the ‘at risk’ under 65’s, the target was also 75% - only 50% of this cohort had received their vaccination, however it was noted that this was already an increase on the previous year.

The Borough Based Director advised that due to reporting delays, the data regarding the uptake of the flu immunisation by pregnant women was not yet complete, and as the school’s programme was still ongoing, the final figure for this was currently unknown. It was noted that the programme delivered by GP’s to 2 and 3 year-olds was also progressing well, with uptake of over 50%.

From the beginning of the month, immunisations had been offered to the 50-64 year-old cohort. They were aware that some pharmacies had been experiencing challenges with regard to how much stock they had been given, as they were only able to order 10 doses at a time, which it was noted was a national approach. GP practices were expecting to deliver the flu immunisation to this cohort, and were preparing to do so.

Work was being undertaken with providers to ensure they had a good uptake of staff receiving the immunisation. Over 60% of staff at King’s had received their flu immunisation, however its target was 90%. The uptake at Bromley Healthcare and Oxleas was better than the previous year, but there was still a way to go to reach the 90% target. One of the “success stories” was care homes, with over 90% of residents’ having received their flu immunisations, and now that further doses had arrived, were starting to vaccinate members of staff.

The Borough Based Director noted that they were extremely grateful for the help received from the LBB Public Health and Communications teams in promoting messages around the take up of the flu immunisation. In response to a question from the Chairman, the Borough Based Director said that she was assured that there were enough flu immunisations available for the 50-64 year-old cohort, and noted that a different system was being used for their distribution.

COVID-19 Vaccine

The Borough Based Director informed Board Members that the announcement had been made the previous day that the Pfizer COVID-19 vaccine had been licenced. 50 acute sites across England had been selected as hubs for the vaccine. The PRUH, Denmark Hill and Guy’s and St Thomas’ had been chosen to act as hubs, and they were currently looking at the local arrangements. In response to a question, the Borough Based Director siad that further sites for mass vaccination had been identified across the borough, and it was anticipated that these would be  ...  view the full minutes text for item 44.

The Director of Public Health provided an update in relation to the Health and Wellbeing Strategy: Joint Strategic Needs Assessment Priority Areas.

Board Members were advised that the Cancer group had met twice during the autumn, and their plan and actions had been agreed. This included looking at preventative actions, early detection and improved screening services. The planned role out of a cervical screening service had been put on hold until spring 2021, due to the pandemic. It had instead been agreed to focus on breast screening as this service had been paused during the pandemic, although it had since resumed during the summer. Uptake had fallen to 20% in September 2020, however the Director of Public Health was pleased to advise that as of last week, this had increased to 55%. A breast screening campaign would be used to raise awareness through GP’s and the Communications and Engagement Network. The prevention element of breast cancer would also be tied in with the obesity campaign to highlight the link between to two issues.

In response to a question, the Director of Public Health said that there had been issues regarding cancer waiting time, however all were improving. Two-week wait times were nearly at 97%, which was close to the pre-pandemic target. For other types of tumours, work was being undertaken in relation the 60-day target from when a patient was seen at the hospital, to receiving final treatment. However, these waiting times were also continuing to improve.

RESOLVED that the update on the Health and Wellbeing Strategy: JSNA Priority Areas be noted.

Report CSD20123

The Board considered its work programme for 2020/21 and matters outstanding from previous meetings.

The Chairman noted that the work programme was fluid, and it was likely that some items may slip due to the COVID-19 pandemic. It was highlighted that the following items had been added to the work programme as agenda items for the meeting of the Health and Wellbeing Board on 11^th February 2021:

·  Homelessness Update

·  Mental Health Resilience – Oxleas

With regards to a matter outstanding, a Member asked for clarification regarding which primary care services were to be de-prioritised due to the impact of the pandemic. In response, the Borough Based Director – SEL CCG advised that this had been a consideration at the time the report was written, however no services had been decommissioned at primary care level. Services had continued to be delivered, albeit some in a different way, such as via digital appointments. It was also noted that no other services in their hospitals or mental health Trusts had been cut back, and therefore a full range of services should be available. The NHS were also looking to reduce their waiting lists and complete elective procedures as some services had incurred backlogs during the first wave of the pandemic.

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

There was no other business.

1.30pm, Thursday 11^th February 2021

1.30pm, Thursday 29^th April 2021

The next meeting of the Health and Wellbeing Board would be held at 1.30pm on Thursday 11^th February 2021.

RESOLVED that the Press and public be excluded during consideration of the items of business listed below as it was likely in view of the nature of the business to be transacted or the nature of the proceedings that if members of the Press and public were present there would be disclosure to them of exempt information.

The Chairman advised Board Members that he had been approached by Oxleas NHS Foundation Trust, asking if consideration could be given to them joining the membership of the Health and Wellbeing Board, or association with it. The Chairman noted that the Constitution did not allow a representative from a health provider to become a Member with voting rights – however there was the option to appoint a representative as a non-voting Member, or an observer.

The Chairman noted that if either of these options were to be agreed, equal rules would need to be applied if approached by the other main local health providers. A Member suggested that if Oxleas NHS Foundation Trust were to be invited to attend as observers, an invitation should also be extended to the other two main local health providers, asking if they also wished to put forward representatives.

Following a discussion, the Chairman proposed that Members vote on the suggested option of inviting representatives from the three main local health providers to attend the Health and Wellbeing Board as observers:

Agreed: 8

Abstained: 1

RESOLVED that representatives from the three main local health providers be invited to attend the Health and Wellbeing Board as observers.