Agenda and minutes

Apologies for absence were received from Councillor Keith Onslow, Janet Bailey and Frances Westerman (Healthwatch Bromley), and Councillor Colin Smith, Jared Nehra and Marzena Zoladz (Healthwatch Bromley) attended as their respective substitutes. Apologies were also received from Councillor Gareth Allatt, Teresa Bell and Jim Gamble.

Apologies for lateness were received from Marzena Zoladz.

The Chairman welcomed Councillor Angela Wilkins to the meeting and informed Board Members that she would being filling the vacant role following the resignation of Councillor Marina Ahmad. The Chairman noted that he had received a letter from Marina Ahmad, saying that she had very much enjoyed her time on the Board, and a response had been sent on behalf of the Board to thank her for her contributions.

There were no declarations of interest.

RESOLVED that the minutes of the meeting held on 11^th February 2021 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 23^rd April 2021.

No questions had been received.

To follow

The Place Based Director – SEL CCG (“Place Based Director”) provided an update on behalf on the South East London Clinical Commissioning Group (SEL CCG).

The Place Based Director advised Board Members that in terms of vaccine uptake, the over 80’s age group had been Bromley’s biggest success with nearly 95% of this vulnerable cohort having been vaccinated. It was stated that a high percentage of uptake had been recorded across nearly all other cohorts and they were keen to vaccinate any further residents within them as soon as they were ready to come forward. However, there were still a few cohorts for which they wanted to improve the uptake of the vaccination – health and social care workers (84.4%) and one group of carers (72.3%), and a drive focussed on these groups was underway. It was noted that the vaccination of the 40-49 year old cohort had only started very recently and was still in its early stages – 40.9% of this age group had already been vaccinated and they were aware that a large number of those remaining were keen to receive their vaccinations.

The Place Based Director informed Board Members that there was a wide COVID-19 vaccination programme in Bromley. In addition to the Primary Care Networks (PCNs) there were several other designated vaccination sites across the borough, including a Mass Vaccination Site at the Civic Centre and pop-up clinics. It was emphasised that further pop-up clinics could be held, particularly if they were in areas identified as having a population for which they would like to see an increased uptake of the vaccination. As covered in the media, there were issues with some ethnic minority groups and those belonging to certain faiths and, in collaboration with the Local Authority, they were looking at a programme to develop relationships with local community and faith leaders to help address this. A large number of GP practices were acting as satellite sites, as well as providing domiciliary vaccinations for those residents that were housebound.

In order to address inequalities in uptake of the COVID-19 vaccination a joint LBB and CCG Vaccine Uptake Inequalities Group had been implemented. A large piece of work was being undertaken across South East London to increase the uptake of the vaccination – a particular target was the Black Caribbean (64.1%) and Black African (67.6%) cohorts as they were the populations with the lowest uptake in the Bromley. It was also known that uptake was lower in the more deprived areas of the Borough (Penge and Anerley, the Crays and Mottingham) and uptake from people with serious mental illness currently stood at 72.2%. Vaccine uptake from care home residents was approaching 95%, however uptake from care home staff was only at 71.3% and the SEL CCG were working closely with the Local Authority to continue to further increase this number. It was noted that vaccinations were still being offered to this cohort, and the figures were slowly improving. In the coming weeks a website would  ...  view the full minutes text for item 71.

To follow

Jess Seal, Primary and Community Care Transformation Manager (Bromley) – SEL CCG (“Primary and Community Care Transformation Manager”), Dr Rob Grounds and Dr Gurprit Singh Mudhar attended the meeting to provide an update on the Borough’s non COVID immunisation programme.

The Primary and Community Care Transformation Manager highlighted that it had been an unusual year, with the need to take the pandemic into consideration alongside the delivery programme of the flu immunisation. A collaborative approach had been taken across practices, pharmacies, and community providers, such as Bromley Healthcare who provided flu vaccinations to those that were housebound.

Dr Rob Grounds highlighted that influenza was a highly contagious viral illness. In people who were otherwise healthy it was usually unpleasant, but self-limiting, however the risk of serious illness was higher in infants, older people, and those with underlying health conditions, including those who were pregnant. Influenza viruses changed their external characteristics (spike proteins) gradually from season to season which produced different strains. Influenza vaccines were prepared using strains in line with WHO recommendations and were tri or quadrivalent (acting against 3 or 4 strains). Influenza immunisation had been recommended since the 1960’s and were targeted predominantly at higher risk groups. Since 2005-06, the uptake of the Influenza vaccine in England had gradually reduced in adults and those at risk from 75.3% to 70.5% in 2016-17. In 2012 the Joint Committee on Vaccine and Immunisation (JCVI) recommended that the programme be extended to include children aged 2 to 17 years, and in December 2020 it was advised that the cohort for vaccination be further expanded to include 50-64 year olds.

The South East London vaccination data for 2020/21, as at the end of January 2021, indicated that Bromley was doing very well with its Influenza immunisation programme, with figures well above the London average and similar to the national average. Data was provided by practice regarding the uptake of the immunisation by both adults and children. An average of 82.9% of at-risk patients in the 65 and over cohort, and on average 50% of at-risk patients under 65, had been vaccinated. A comparison of data from 2019/20 and 2020/21 highlighted that most practices in Bromley had recorded an increase in uptake from this cohort of patients, with just one not having seen an improvement. The data for children demonstrated that there had been a good uptake across Bromley’s practices with an average of 59% of at risk 2 year olds and 62% of at risk 3 year olds having received their vaccination. A comparison of data from 2019/20 and 2020/21 showed an improvement at all practices in vaccination uptake across all ages recorded (2-11 year olds).

Dr Gurprit Singh Mudhar advised Board Members that when comparing the flu vaccine uptake across London Boroughs, Bromley was ranked top for the over 65’s, and top across South East London for the under 65’s at risk. The comparison between 2019 to 2021 indicated that there had been a significant improvement in the overall uptake of  ...  view the full minutes text for item 72.

The Chairman welcomed Matthew Trainer, Chief Executive – Oxleas NHS Foundation Trust (“Chief Executive”) and Lorraine Regan, Service Director (Bromley Directorate) – Oxleas NHS Foundation Trust (“Service Director”) to the meeting to provide an update on adult mental health.

The Service Director informed Board Members that all adult mental health services in the Borough had been fully operational throughout the pandemic, although some were required to be delivered in different ways. There had been flexibility around appointments with staff providing a mixture of both virtual and face-to-face appointments, and the demand for the latter was beginning to increase. A survey of patients had taken place during the summer to gage how they were feeling in relation to the new ways of working and gather feedback. The responses had provided a good sense of how the virtual appointments were viewed, which was mainly positive – some patients considered that virtual appointments were as good as those held face-to-face however there were still a number that had found them difficult. As a result, a review of all patients in Bromley had been undertaken to ensure that they were receiving a mixed approach, which was person-centred and aligned to their needs.

The Trust’s community staff were largely working between their offices and homes; however, it had been recognised that inpatient staff had not benefitted from this flexibility in terms of work / life balance. The Service Director advised that staff uptake of the COVID-19 vaccine currently stood at just over 75% – there was still some work to do, but this was broadly in line with the overall figures being seen. The Trust was working with local partners to ensure that all patients had access to the vaccination. There was a 72% uptake from patients with serious mental illness, which was reasonable, however it was highlighted that some of the hard to reach patients still needed encouragement to come forward. Community nursing teams had also been working to review the care plans of a number of patients who had been shielding – these patients were struggling post-shielding, due to the shift in dynamics and increased social interaction, and they needed to be mindful that this transition would be hard for some individuals.

The Service Director advised that Primary Care Plus (PCP) was the Trust’s “front door” into their adult mental health services. It had been established five years ago to meet the needs of around 250 patient referrals per month. In October 2019 (pre-pandemic) referrals sat at around 300 per month – this figure dropped significantly in April 2020, at the start of the pandemic. However, since then a significant increase had been seen, and for the last couple of months referral had reached approximately 430. It was emphasised that the impact of the pandemic on mental health would still be felt in the coming months and beyond.

Data was provided in relation to Early Intervention in Psychosis (EIP) caseloads which were designed to sit at around 100. In October 2019 they already  ...  view the full minutes text for item 73.

The Director of Public Health advised Board Members that the obesity campaign ‘Don’t Wait to Lose Weight’ had run over the last year. The campaign had been developed to encourage people to lose weight due to the link between obesity and COVID-19.

It was noted that the Local Authority had a calendar of campaigns – this was mainly connected to monthly national campaigns and the messages were augmented locally. The ‘Better Health – Mental Health’ campaign took place throughout May and this year would have a focus on suicide prevention and bereavement. It was considered that Board Members may wish to suggest specific areas for focus which could then be discussed with the LBB Communications Executive.

The Portfolio Holder for Adult Care and Health highlighted that signposting information would shortly be added to the Council’s website for a range of activities and suggested that this be circulated to Board Members for reference.

A Member enquired as to how the success of the obesity campaign could be measured. The Director of Public Health said that it was very difficult to be certain if any preventative measures had a direct effect. However, as part of the next Joint Strategic Needs Assessment (JSNA) they would be considering the impact of COVID-19 on various diseases, including obesity, and looking at figures over time.

RESOLVED that the update on the health campaign be noted.

Report ACH21-027

The Board considered a report providing a summary of the current work of the Integrated Commissioning Board (ICB).

The LBB Assistant Director for Integrated Commissioning informed Board Members that the ICB provided leadership, strategic oversight and direction for all health and social care integrated commissioning programmes and processes undertaken jointly by Bromley health and care partner agencies. Key responsibilities included:

-  Leading and directing arrangements for integrated commissioning of health and social care within the borough.

-  Supporting the work of the Health and Wellbeing Board in delivery of the key priorities identified in the Health and Wellbeing Strategy.

-  Overseeing the management of joint resources that enable effective integrated commissioning programmes.

-  Producing a Local Plan, which allowed the Council and SEL CCG (Bromley) to draw down the Better Care Fund (BCF).

-  Develop a co-ordinated approach to managing and developing the local provider market across health and care services.

-  Ensuring the SEL CCG (Bromley) and the Council were well positioned to meet the emerging requirements from legislation, national/regional policy or best practice guidance.

A key outcome of the Board’s work in 2019/20 was the creation of an Integrated Commissioning Service that brought together the health and care commissioning teams for out of hospital and community services from across the Council and the Bromley borough service from SEL CCG. Led by an Assistant Director for Integrated Commissioning, who worked across the Council and CCG, this new service now played a key role in supporting the work of the Board. The new service was established in April 2020.

The COVID-19 pandemic had impacted on the work of the ICB in a number of ways. In some cases, projects and programmes led by the Board were temporarily put on hold whilst agencies gave priority to work on responding to the pandemic. In many instances the work of the Board made a significant contribution through the facilitation and delivery of an integrated health and care response to the pandemic. The Board had continued to meet throughout the pandemic. Now that the second wave of the COVID-19 pandemic was subsiding, work was resuming on all those projects and programmes that had been paused.

The LBB Assistant Director for Integrated Commissioning advised Board Members that there were three new priorities for the ICB:

-  Bromley Community Mental Health Services (CMHS) Transformation Programme, looking at initial priorities and plans for investment in 2021/22;

-  Recommissioning of the Primary and Secondary Interventions Service (Bromley Well) from September 2022; and

-  Looking at the emerging implications of the Government White Paper – ‘Working Together to Improve Health and Social Care for All’.

It was highlighted that updates on these priorities would be provided at the September meeting of the Health and Wellbeing Board.

RESOLVED that the Integrated Commissioning Board update be noted.

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 majority of the Health and Wellbeing Strategy: JSNA Priority Areas had been paused as a result of the pandemic, however the groups were now starting to meet and develop plans.

The focus of the Cancer group would remain on increasing the uptake of cancer screenings. The Diabetes group had met recently and considered the areas for improvement. It was noted that some funding may be received from the SEL CCG for work on pre-treatment areas, such as hypertension and cholesterol. Consideration would be given to having a particular focus on newly diagnosed diabetics who were likely to be keener to control and reduce their level of diabetes. It was noted that some elements of the National Diabetes Prevention Programme had been paused during the pandemic, although some had continued virtually, and it was considered that this could have an impact on the number of people developing diabetes and therefore some emphasis would be put on this in the coming months.

The GP Clinical Lead – SEL CCG highlighted that the impact of COVID-19, on both diabetic patients and those that were unaware they had diabetes, had been significant. There were some concerns that they may have fallen behind with the routine care for patients – patients with significant risk factors had been targeted over the most recent period of the pandemic and there was a need to return to “business as usual”.

The Chairman noted that the right priority areas had been identified – the impact of the pandemic had emphasised them further and that they would need to be kept under regular review. The Place Based Director – SEL CCG suggested that an update on the position of all screening programmes within these areas could be provided at a future meeting of the Health and Wellbeing Board.

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

Board Members had been provided with a draft copy of the Chairman’s annual report of the Health and Wellbeing Board 2020/21 prior to the meeting. The document captured that it had been an extremely busy year for the Board with all meetings having been held virtually, and with very full agendas, but also acknowledged that a number of the issues addressed throughout the year would remain going forward.

Board Members were asked to provide any comments or suggestions on the document to the Chairman and clerk, prior to it being provided for information to the July 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 2020/21 municipal year.

RESOLVED that the report be noted.

The briefing comprises:

·  Domestic Violence and Abuse Strategy for 2021-2024

Members of the Health and Wellbeing Board have been provided with advance copies of the briefing via email.  The briefing is also available on the Council’s website at the following link:

http://cds.bromley.gov.uk/ieListMeetings.aspx?CId=559&Year=0

The Health and Wellbeing Board Information Briefing comprised one report:

·  Domestic Violence and Abuse Strategy for 2021-2024

RESOLVED that the Information Briefing be noted.

Report CSD21055

The Board considered its work programme for 2021/22 and matters outstanding 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 Long COVID Service (Standing item)

·  Update on plans for the coming vaccination season – CCG (1^st July 2021 / 23^rd September 2021)

• Winter Planning – CCG (1^st July 2021 / 23^rd September 2021)
• Presentation on Children and Young People’s Mental Health Services – Oxleas (TBC)
• Update on the Adult Mental Health Hub – Oxleas (TBC)

·  JSNA Priority Areas – Screening Update (1^st July 2021 / 23^rd September 2021)

·  Integrated Commissioning Board Update (23^rd September 2021)

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

There was no other business.

1.30pm, Thursday 10^th June 2021

1.30pm, Thursday 23^rd September 2021

1.30pm, Thursday 25^th November 2021

1.30pm, Thursday 3^rd February 2022

1.30pm, Thursday 31^st March 2022

The next meeting of the Health and Wellbeing Board would be held at 1.30pm on Thursday 1^st July 2021.