Apologies for absence were received from Councillor Judi Ellis, Councillor Robert Evans, Teresa Bell, Rachel Dunley, Jim Gamble, Harvey Guntrip and Dr Andrew Parson.

Apologies were received from Councillor Kevin Kennedy-Brooks, Dr Angela Bhan and Marzena Zoladz, and Councillor Vanessa Allen, Sean Rafferty and Lin Gillians attended as their respective substitute.

Apologies were also received from Councillor Mike Botting, Executive Assistant for Adult Care and Health and Jacqui Scott (Chief Executive – Bromley Healthcare).

There were no declarations of interest.

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 19^th November 2021.

No questions had been received.

RESOLVED that the minutes of the meeting held on 23^rd September 2021 be agreed.

Report ACH21-056

The Board considered a report providing an update on the Bromley Mental Health and Wellbeing Strategy 2020-25. The Chairman noted that the agenda item on ‘Children and Young People’s Mental Health’ had been incorporated into this update.

The Associate Director – Integrated Commissioning, NHS South East London CCG (Bromley) (“Associate Director – Integrated Commissioning”) informed Members that the Bromley Mental Health and Wellbeing Strategy (BMHWS) 2020-25 set out a five-year delivery plan to make improvements across mental health and wellbeing services in the borough. At the heart of the BMHWS were the voices of patients and service users who relied on good mental health services in Bromley. In the coming years, as the strategy was delivered with partners, no matter what area of mental health was involved, the Council and NHS were committed to ensuring that patients and service users were at the forefront of designing their own service offer in Bromley.

The BMHWS set out a joint vision to support communities and individuals to have improved mental health and wellbeing. The strategy set out an approach in which the Council and CCG would work together with partners to prevent children and adults reaching a crisis point through the provision of a strong prevention and early intervention offer. It also put in place a joint plan for the provision of a number of important services for people with mental health challenges, including good advice and information, talking therapies and counselling, employment and training schemes, mental health support in schools and supported housing. The BMHWS was led by the Bromley Mental Health and Wellbeing Partnership Board, which was made up of senior representation across Bromley mental health services. The specific actions for children and young people’s services were being taken forward by the CAMHS Partnership Board. The Council and CCG provided oversight to this work through the Integrated Commissioning Board (ICB) and there was also broader partnership ownership of the work through the One Bromley Executive.

With regards to children and young people’s mental health emergency and crisis cases, the BMHWS highlighted the need to develop stronger preventative and early intervention mental health and wellbeing services for children and young people in the borough. This priority was in part borne out of a recognition that the number of children and young people’s mental health emergency and crisis cases had been increasing, year on year, since 2013/14. This issue was an area of focus of the Health and Wellbeing Board and Bromley Safeguarding Children’s Partnership prior to the COVID-19 pandemic. A deep dive exercise looking at the children and young people attending A+E with mental health issues had been considered in detail by the Bromley Safeguarding Children’s Partnership and SEND Governance Board in September 2021. There had been a number of interesting correlations with regards to areas of the borough and certain schools, and work would be undertaken to provide additional support and monitoring.

Within the framework of the BMHWS, the following immediate actions in relation to children and young  ...  view the full minutes text for item 19.

Report ACH21-055

The Board considered a report providing an update on the planning and actions being taken by the ONE Bromley partnership to respond to winter demands.

The Associate Director – Urgent Care Hospital Discharge and Transfer of Care Bureau (“Associate Director”) informed Board Members that the ONE Bromley Winter plan brought together all actions being taken by ONE Bromley organisations in order to respond to additional pressures on the health and care system during winter. The plan was based around 5 pillars:

1. Increasing System Capacity

2. Data Sharing and Escalation

3. Single Point of Access and Discharge Arrangements

4. Admissions Avoidance

5. Communication and Engagement

Increasing system capacity would involve additional workforce to respond to the demand on services. This included Rapid Response Advance Nurse Practitioners (ANPs), Rapid Access to Therapy therapists, Care Managers (adult social care), brokerage and Moving and Handling Risk Assessors. There would also be additional service capacity, with over 500 extra Primary Care Access Hub appointments over the Christmas and New Year period to compensate for the opening hours of other services. Assistive Technology (AT) was also being used in creative ways across the borough to allow residents to remain at home whilst they received care.

With regards to pillar 2, data sharing and escalation, the Associate Director advised that a data dashboard would be mobilised to identify pressure on the system in terms of workforce challenges and extra demand. A Clinical and Professional Advisory Group had already been launched to break down operational and organisational boundaries and ensure that consistent messages were being heard by residents and patients. A Clinical Monitoring meeting was used to share current clinical pressures and information that would help the system to be responsive.

The Bromley Single Point of Access (SPA) and Discharge Partnership were now fully established. Capacity had been further increased by providing access to Bromley Rapid Access to Therapies (RATT); Hospital@Home for children and young people; and the Bromley Community Covid Management Service and Long Covid clinics. The Assistant Director for Integrated Commissioning chaired a Demand and Capacity meeting, which would continue to maintain system oversight of pathways and capacity, ensuring sufficient access to resources throughout the winter period. This year, in addition, a community in-reach offer would be delivered to reduce inpatients length of stay in hospital and an Enhanced Community IV/AB short course would be offered to enable early supported discharge and admission avoidance. Integrated models of care would be used in relation to admissions avoidance, including the Community Respiratory Pathway, and the provision of dedicated St Christopher’s Capacity into care homes (in line with the successful model delivered during the COVID-19 pandemic) to support rapidly deteriorating patients post discharge.

The Associate Director highlighted that communication and engagement would be undertaken to ensure that the same messages were being relayed to both the health care workforce and general public. The winter PR campaign ‘Together Through Winter’ had been launched and would support a system-wide communication and engagement plan, maintaining and providing 2-way communication  ...  view the full minutes text for item 20.

Report ACH21-054

The Board considered a report setting out the Bromley Better Care Fund (BCF) 2021-22 Plan and sought approval for its submission to NHS England.

The BCF programme supported local health and social care systems to successfully deliver the integration of health and social care in a way that supported person-centred care, sustainability and better outcomes for people and carers. The BCF encouraged integration by requiring clinical commissioning groups (CCGs) and local authorities to enter into pooled budget arrangements and agree an integrated spending plan.

In support of BCF receipts from government, all local areas were required to have a BCF Plan. The last Bromley BCF Plan had been for the period 2019/2021 with the requirement to update plans in 2020 suspended due to the COVID-19 pandemic. Despite being past the mid-year point for the year it was a requirement to submit a BCF Plan for 2021/22 as part of the assurance arrangements for receiving the BCF grant. The BCF 2021-22 planning requirements, published on 30^th September 2021, set out conditions for implementing the government’s Policy Framework for the Better Care Fund programme for this financial year. This framework set out national conditions, metrics, and funding arrangements for the BCF programmes in 2021 to 2022. As the BCF was one of the government’s national vehicles for driving health and social care integration, a key theme of local plans was the designing and delivery of integrated care across health and social care systems.

The Assistant Director for Integrated Commissioning advised that with the approval of the Chairman of the Health and Wellbeing Board, Portfolio Holder for Adult Care and Health, and agreed jointly with the Chief Executive of South East London CCG, the draft BCF Plan had been submitted to NHS England in time to meet the deadline of 16^th November 2021. The BCF guidance allowed for an arrangement whereby the Plan may be submitted to NHS England in advance of the formal approval of the local Health and Wellbeing Board.

A Member noted that it would be helpful to have a summary chart listing the outcomes of the BCF work. The Assistant Director for Integrated Commissioning advised that the BCF Plan itself only allowed the inclusion of a limited number of indicators, however further information relating to the outcomes of the BCF was provided in the Information Briefing to the Health and Wellbeing Board – item 1 – ‘Better Care Fund and Improved Better Care Fund Performance Update – Q2 2021/22’. It was noted that a summary chart could be considered for inclusion in the next BCF Plan submission.

In response to a question, the Assistant Director for Integrated Commissioning highlighted that admissions avoidance was a key priority of the Plan, with support given to people in their homes and care homes. The London Ambulance Service were involved in terms of wider practice or capacity discussions but not recipients of BCF funds. The London Ambulance Service did have greater involvement in the discharge planning arrangements outlined in  ...  view the full minutes text for item 21.

Report CEF21-042

The Board considered the Bromley Safeguarding Children Partnership (BSCP) Annual Report 2020/21.

The annual report of the BSCP covered the period from April 2020 to March 2021 and was a transparent assessment of the effectiveness of safeguarding and the promotion of child welfare in Bromley.

The BSCP Partnership Manager advised that it was a statutory requirement for safeguarding partnerships to publish this report under Working Together 2018. In line with statutory guidance and best practice, the report would be submitted to the Chief Executive, Leader of the Council, the local police and crime commissioner, Chairman of the Health and Wellbeing Board, Child Safeguarding Practice Review Panel and the What Works Centre for Children’s Social Care.

This had been the first full year of the BSCP under new multi-agency partnership arrangements. These had been put in place in response to the Children and Social Work Act 2017 and Working Together 2018 and replaced Local Safeguarding Children Boards (LSCB). Safeguarding partnership arrangements had been improved to form the BSCP and its subgroups. The work of the partnership this year had inevitably been dominated by the COVID-19 pandemic – since March 2020, Partnership Board and Executive meetings had concentrated on the direct and indirect safeguarding impact of the pandemic. In order to do so they had focused on the health and wellbeing of children and young people, their families and the partnership workforce, as well as emerging safeguarding themes, individual and collective practice, and how to develop and support innovative responses.

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

·  the governance and accountability arrangements for the BSCP. This provided information about 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. This highlighted progress made by the partnership across a range of areas (e.g. Early Help, Private Fostering, child exploitation and the work of the Local Authority Designated Officer), as well as the challenges going forward.

·  the lessons that the BSCP had identified 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 (this year all training had been held virtual due to the pandemic).

·  progress against the BSCP pledge four key areas: health and wellbeing of the workforce; understanding vulnerability; a focus on getting the basics right; continuous improvement.

The BSCP Partnership Manager informed Board Members of a number of activities undertaken by the BSCP:

·  the Contingency Oversight Group (COG) meeting had been introduced to ensure that partners could collectively address issues linked to the health and well-being of the workforce, identify emerging safeguarding trends, and early critical interoperability issues;

·  a COVID-19 survey to help provide oversight and scrutiny of partners’ response to the pandemic;

·  in response  ...  view the full minutes text for item 22.

Report ACH21-057

The Director of Public Health informed Members that a brief summary had been provided in relation to updates on the Joint Strategic Needs Assessment (JSNA) and Health and Wellbeing Strategy.

The Demography Chapter of the JSNS had been refreshed and was published on the Council’s website. It was noted that this chapter would be refreshed again when the Census data was released next year.

The Director of Public Health advised that a chapter had been drafted on COVID-19. This JSNA chapter assessed and summarised the impact of the COVID-19 pandemic on the population of Bromley and inequalities across the population. The chapter examined the issues across the life-course and highlighted the inequalities that had been exposed and exacerbated by the pandemic. It was noted that final comments and data needed to be fed into the document, which would be brought to the Board in February 2022. The Public Health Intelligence Team had also planned to produce the Mental Health JSNA chapter in 2021, to support the commissioning of Mental Health Service.

The Director of Public Health noted that the Health and Wellbeing Strategy was due to expire in 2023. In light of the COVID-19 pandemic, and changes that had occurred as a result of it, it was suggested that the Health and Wellbeing Strategy be reviewed in 2022, with a particular focus on inequalities.

RESOLVED that:

i.)  The update on progress towards the JSNA chapter updates be noted; and

ii.)  The plans proposed for updating the Health and Wellbeing Strategy be noted.

The briefing comprises:

• Better Care Fund and Improved Better Care Fund Performance update – Q2 2021/22
• Pharmaceutical Needs Assessment Updated Timeline
• Changes to Public Health England
• Healthwatch Bromley – Patient Experience Report Q2 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

Printed copies of the briefing are available on request by contacting the Democratic Services Officer.

The Health and Wellbeing Board Information Briefing comprised 4 reports:

·  Better Care Fund and Improved Better Care Fund Performance update – Q2 2021/22

·  Pharmaceutical Needs Assessment Updated Timeline

·  Changes to Public Health England

·  Healthwatch Bromley – Patient Experience Report Q2 2021/22

RESOLVED that the Information Briefing be noted.

Report CSD21125

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:

·  Update on the Bromley Mental Health and Wellbeing Strategy / Children and Young People’s Mental Health (31^st March 2022)

·  JSNA – Impact of COVID-19 (3^rd February 2022)

The Chairman informed Board Members that the Long Covid item scheduled for the meeting had been deferred and would be presented on 3^rd February 2022. The Director of Public Health advised that updates on the JSNA priority area of obesity would be presented to Board Members in the New Year.

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

There was no other business.

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 3^rd February 2022.