Agenda and minutes

Apologies for absence were received from Kim Carey and Sean Rafferty attended as substitute. Apologies were also received from Teresa Bell, Rachel Dunley, Jim Gamble and Dr Andrew Parson.

Apologies for absence were also received from Jacqui Scott (Chief Executive – Bromley Healthcare) and Jonathan Lofthouse (Site Chief Executive – PRUH and South Sites: King’s College Hospital NHS Foundation Trust) gave prior notification that he would need to leave the meeting early.

Councillor Robert Evans declared that he was a Trustee of Mytime Active.

RESOLVED that the minutes of the meeting held on 29^th April 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 17^th September 2021.

No questions had been received.

The Chairman welcomed Marg Mayne, Chief Executive – Mytime Active (“Chief Executive”), Debra Weekes, Partnerships Manager – Mytime Active (“Partnerships Manager”) and Kelly Stead, Head of Sales and Customer Experience – Mytime Active (“Head of Sales and Customer Experience”) to the meeting to provide an update on the work being undertaken to improve wellbeing in the local community.

The Chief Executive informed Board Members that Mytime Active was a Social Enterprise, and a registered charity, with a mission to improve the wellbeing of the local community. Mytime Active were committed to doing so by being financially self-sustainable and operating without recourse to public funds. The services provided and upkeep of the facilities were funded by customers paying (monthly membership or “pay and play” session by session), and the re-investment of profits into the community programmes and facilities.

The programmes delivered were run mostly from the Borough’s leisure facilities, which Mytime Active operated. This provided a good geographical spread, easily accessible to Bromley’s community:

-  Walnuts Leisure Centre, Darrick Wood Swimming Pool and Crofton Halls;

-  Biggin Hill Memorial Library and Pool;

-  High Elms Golf Centre in Downe;

-  West Wickham Leisure Centre;

-  Spa in Beckenham and Beckenham Public Halls: and

-  Pavilion Leisure Centre in central Bromley as well as Bromley Common Golf Centre, and the Great Hall in the Civic Centre.

In addition, Mytime Active also operated Orpington Golf Centre (Cray and Ruxley) under lease from a private landlord.

The Chief Executive highlighted that physical inactivity was having a serious impact on both mental and physical health – it was responsible for 1 in 6 UK deaths; up to 40% of many long-term conditions; and around 30% of later life functional limitations and falls.

The Head of Sales and Customer Experience noted that the ethos of Mytime Active was based on research and best practice of health and wellbeing, from which the following four pathways had been derived, and could help improve wellbeing at any age:

#Be Active –  including improved awareness of own fitness levels and knowledge to make healthy activity choices.

#Eat Well –  including improved nutritional knowledge and increased confidence on choosing healthy eating.

#Be Positive –  including improved self-confidence, self-esteem, metal health resilience and knowledge of healthy choices.

#Be Together –  including more opportunities for social interaction and adding to a sense of belonging.

Mytime Active ran several referrals programme:

-  Fresh Start Exercise Referral Programmes (a supervised physical activity programme for those recovering from illness or living with a long-term medical condition);

-  ESCAPE-pain (a NICE-approved rehabilitation programme for the management of osteoarthritis of the hip and / or knee);

-  Heart Smart Exercise Referral Programmes (specialist sessions for secondary prevention for cardiovascular disease);

-  Fresh Start Friendly (FSF) (on-going classes for those completing a health programme: circuits, Managing Arthritic Pain (MAP) classes)

-  Primetime (for older adults and deconditioned adults. Includes: gym, dance, group exercise, aquafit and table tennis); and

-  Personal Coaching (qualified staff work with the customer on  ...  view the full minutes text for item 5.

The Director of Public Health noted that Board Members had been provided with a table of the Public Health campaigns that had recently taken place, and those planned for the coming months, for information. These had linked in with the general plans and priorities that the Board supported, and national campaigns were further developed with a local focus. For example, during October the annual ‘Stoptober’ campaign would take place – this linked with the national campaign and supported local residents to take the 28-day challenge to stop smoking. Board Members were asked to consider if there were any other areas for which they would like to see campaigns established.

A Member noted that the ‘Stop Smoking’ initiative which had been located in the Resources Centre at Cotmandene had ceased due to the funding ending a few years ago – whilst open, it had been one of the most successful centres running the programme. The Director of Public Health advised that the Public Health campaigns signposted people to services, including to GP’s who could provide support. It was agreed that the Director of Public Health would speak to colleagues to obtain additional information relating to this initiative following the meeting. The Member further highlighted the importance of considering areas that other Committees may lead on. For example, Public Health could work collaboratively with the Housing department to ensure that landlords improved the quality of the housing they provided.

A Member suggested there could be a focus on improving mental health as this had come to the fore during the pandemic. The Director of Public Health advised that this was a priority area, and a substantive item would be brought to the November meeting of the Health and Wellbeing Board to discuss mental health in further detail. The Chairman noted that a number of the areas were interlinked. Another Member agreed and highlighted that alcohol consumption had greatly increased, and that people needed to be made aware of the connection with mental health, blood pressure, Alzheimer’s and Dementia. The Director of Public Health informed Board Members that some of the alcohol services delivered focussed on the preventative side, but this was not as much as they would like. This service would be reprocured the following year, and they would look to undertake more preventative work as the data, particularly relating to young people, was concerning.

In response to a question, the Director of Public Health advised that a large amount of work had been undertaken a couple of years ago in relation to loneliness, and a conference had been held prior to the pandemic. As part of the Joint Strategic Needs Assessment (JSNA) the team had been looking at the impact of the COVID-19 pandemic on mental health, social isolation and loneliness. The Portfolio Holder for Adult Care and Health advised that in the coming weeks, ‘mitigating loneliness’ workshops would be held from which feedback would be gathered. Councillor Aisha Cuthbert, Executive Assistant to the Leader of the Council, was the lead  ...  view the full minutes text for item 6.

The Chairman welcomed Lorraine Regan, Service Director for Bromley and Trustwide ALD – Oxleas NHS Foundation Trust (“Service Director”) to the meeting to provide an update on support for adults with learning disabilities in Bromley.

People with learning disabilities had poorer general health, and the latest Learning Disability Mortality Review (LeDeR) report stated that the average age of death was 27 years younger for women and 23 years younger for men. In response to a question, the Service Director said that this compromised lifespan was linked with levels of capability. A large proportion of this population had comorbid physical health – it could also be difficult to diagnose physical health condition for this cohort, particularly those who were non-verbal. It was agreed that a link to the report would be circulated to Board Members following the meeting.

In addition to the NHS Long Term Plan, the NHS Improvement (NHSI) standards sought to reduce inequalities for people with learning disabilities (rights, inclusion, workforce and specialist services). Around 2% of the population were estimated to have a learning disability. This would equate to approximately 7,061 of the Bromley population – the GP registered population with learning disabilities was 1,338, and 342 were receiving Oxleas Adult Learning Disability services. There was a focus on providing specialist support for people with a learning disability to ensure they could access the same services as everyone else, and this was a key part of the work for clinicians and reasonable adjustments were needed to be made. The challenge of managing some health needs could be complex and compounded by a learning disability. When that challenge went beyond the capacity of mainstream NHS services, specialist support was needed and provided by the Oxleas Community Learning Disability Teams (CLDT).

The Service Director highlighted that there was some good work was taking place to reduce inequalities. This included:

-  GPs and pharmacists in all Primary Care Networks (PCNs) had tailored support with Annual Health Checks and prescribing.

-  Black Books were offered to everyone receiving CLDT support (these were taken to appointments and contained all the information required to provide a “complete story”).

-  Hospital Passports (provided hospital staff with essential information to make adjustments for people in their care).

-  ‘Can you understand it?’ group (who ensured that easy read materials were understandable).

-  Working in partnership with Bromley Public Health – analysis of data from Annual Health Checks (supporting ongoing learning and service development).

A key focus for Oxleas was reducing hospital admissions. In line with ‘Building the right support’, Bromley CLDT were currently supporting 125 people in the community with learning disabilities, mental illness and/or challenging behaviour, preventing hospital admissions. The Intensive Community Support Team (ICST) were also working with those who had complex challenging behaviour and risk likely to result in an admission or placement breakdown. Nursing and therapeutic interventions were combined to support people’s physical and mental health in the Bromley community and the Bromley Learning Disability Epilepsy Service currently had  ...  view the full minutes text for item 7.

The Borough Based Director – South East London Clinical Commissioning Group (“Borough Based Director”) provided an update in relation to the Long Covid service.

The Long Covid assessment clinic had been established at the Princess Royal University Hospital (PRUH) in April 2021. The clinic was continuing to receive referrals from GPs in the Borough and was extremely busy – a respiratory referral pathway had been developed, for which there was great demand. Post-Covid, a community model had also been developed and a multi-disciplinary team established, including therapists, consultants, GPs and third sector care co-ordination. A soft launch had taken place a month ago, with services asked to identify people for referral and its success would be considered before it was open up more widely. It was noted that there were concerns regarding the capacity of the services – this would be monitored closely as it may require further resources. GPs were assisting those patients who were suitable for self-management and across South East London an app was being developed which would help them access other resources.

The Borough Based Director noted that the Long Covid services would be further developed as required, and that the challenge would be the number of patients requiring them – the Long Covid clinic was held on a weekly basis, but as consultation and assessment took between 50-60 minutes per appointment, this only equated to between 6 and 8 patients. It was considered that overall this was a good programme, but there was still a way to go in terms of developing capacity.

The Chairman agreed that the growth in the number of people affected by Long Covid was extremely worrying, particularly as it was independent from the severity of COVID-19 symptoms experienced. It was noted that, going forward, updates on the Long Covid service would be presented at each meeting of the Health and Wellbeing Board. The Director of Public Health informed Board Members that a webinar on the impact of Long Covid had taken place the previous day. It was suggested that a copy of the presentation, and accompanying literature report, be circulated to Board Members following the meeting.

The Borough Based Director provided an update on the COVID-19 and seasonal influenza vaccination programmes in Bromley.

Board Members had been provided with a map showing the COVID-19 vaccination sites across the Borough, and it was noted that additional pharmacies were now deploying COVID-19 vaccinations.

With regards to cohorts eligible to receive the COVID-19 vaccination, the Borough Based Director advised that from 11^th November 2021 it would be mandatory for care home staff, including visiting professionals, to have received two doses. There would also continue to be an evergreen offer for all adults to receive two doses of the vaccine.

In the summer, the 16–17-year-olds had been added to the list of eligible cohorts, and one dose of the COVID-19 vaccine had been offered via walk-ins or invitations from GP’s. in Bromley, uptake by this cohort currently stood at around 55% – it was emphasised that the programme was ongoing, and that this figure was much higher than some other boroughs (around 35%). Another programme underway was for 12–15-year-olds with underlying health conditions. This cohort would receive two doses of the vaccine, by invite only, at GP-led or hospital vaccination services. It was noted that this cohort had recently been expanded, and national indemnity was awaited.

Vaccination programmes due to commence included a third primary dose for individuals who were severely immunosuppressed at the time of vaccination; a universal offer of one dose to 12–15-year-olds; and booster doses for the over 50’s, frontline staff, and those who were vulnerable or at risk. In response to questions regarding the vaccination of 12–15-year-olds, the Borough Based Director said that the Joint Committee on Vaccination and Immunisation (JCVI) had looked at the science and evidence and considered that the vaccinations would provide three main benefits – children were less likely to miss school; they were less likely to contract Long Covid (which was thought to affected 1 in 10 of the general population); and it supported the reduction of the spread of COVID-19 in the community. It was stressed that children would not be coerced into having the vaccination. If a child was deemed competent to make a decision, and they decided to have the vaccine, they would be given it – and if parental consent was given, but a child said they did not want to receive the vaccine, they would not be given it. It was highlighted that if a child was not deemed able to make a decision, they would not be asked to do so.

The Borough Based Director said that Bromley continued to benefit from a high overall rate of vaccine uptake. Throughout June and July, the OneBromley system participated in a vaccine ‘sprint’ to achieve maximum uptake amongst all eligible cohorts in advance of lockdown easing. GP practices continued to reach out to patients at greatest risk of severe illness, including pregnant people, and door-knocking, leafleting and pop-up clinics had taken place. Guy's and St Thomas' NHS Foundation Trust (GSTT) were operating an SEL call centre  ...  view the full minutes text for item 8b

Report ACH21-042

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 of Bromley.

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

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

•  Producing a Local Plan, which allows the Council and SELCCG (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 are 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 South East London 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 LBB Assistant Director for Integrated Commissioning noted that some projects that had been paused during the pandemic were now live. Board Members noted that there were two new priorities for the ICB, updates on which would be provided in future reports:

-  Children & Young People’s Integrated Commissioning Programme

(A programme of work covering the review of children’s therapy services; a review of community paediatrics, and; the recommissioning of children and young people’s services from Bromley Healthcare. A senior integrated commissioner post has been appointed to lead this work across the CCG and Local Authority).

-  Assistive Technology

(A business case had been agreed to test out the introduction of some new innovations to support services and residents. A programme of pilots was being developed).

The Portfolio Holder for Adult Care and Health noted that the table provided in the report was very helpful as it demonstrated the stage each programme was at. The ‘Assistive Technology’ project would be extremely important going forward, and the work undertaken would ensure that older people were supported.

In response to a question regarding the ‘Falls Project’ referenced in the report, the Director of Public Health advised that around three years ago, work had been undertaken as part of the JSNA to look at the effectiveness of treatments following a fall. A new service had since been adapted to implement effective preventative measures and therapies in response to falls. The Chairman  ...  view the full minutes text for item 9.

The briefing comprises:

• Better Care Fund and Improved Better Care Fund Performance Update - Q4 2020/21 and Q1 2021/22

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:

·  Better Care Fund and Improved Better Care Fund Performance Update - Q4 2020/21 and Q1 2021/22

RESOLVED that the Information Briefing be noted.

Report CSD21100

The Board considered its work programme for 2021/22 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:

• JNSA Priority Area – Impact of COVID-19 (25^th November 2021)
• Changes to Public Health England (Information Item) (25^th November 2021)
• Report on the Falls Project (3^rd February 2022)
• Presentation from the Falls Service (3^rd February 2022)

In response to a question, the Director of Public Health said that the matter outstanding regarding the Bromley Local CAMHS Transformation Plan and an analysis of “deep dives” would be addressed at the next meeting of the Health and Wellbeing Board, when a report would be presented on both children and adult mental health. The Borough Based Director advised that an audit had been undertaken in relation to children presenting at A+E with mental health emergencies, and feedback on this would also be included.

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

There was no other business.

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 25^th November 2021.

WITHDRAWN

This item had been withdrawn.