Agenda and minutes

A minute’s silence was held in memory of Councillor Mary Cooke.

Apologies for absence were received from Councillor Kevin Kennedy-Brooks and Councillor Gary Stevens, and Councillor Simon Jeal and Councillor Keith Onslow attended as their respective substitutes.

Apologies were also received from Rachel Dunley, Christopher Evans, Jim Gamble, Dr Andrew Parson and Jacqui Scott (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 28^th January 2022.

No questions had been received.

RESOLVED that the minutes of the meeting held on 25^th November 2021 be agreed.

The Chairman welcomed Lindsay Pyne, Head of Adult Therapies – Bromley Healthcare (“Head of Adult Therapies”) to the meeting to provide an update on the Falls and Fracture Prevention Service.

The Head of Adult Therapies informed Board Members that all referrals to Adult Therapy teams were filtered via the Single Point of Access (SPA). If a referral was considered to be urgent, or required a quick response to ensure safety and reduce risk of attendance at an Emergency Department (ED), it was passed to the Rapid Access to Therapy Team (RATT). The RATT assessed patients in their own home within two hours, or two days, and then provided equipment/intervention and referred them on for ongoing falls specific intervention.

Since an update was last provided to the Health and Wellbeing Board, the Falls Therapy Clinic had opened with locations in Orpington and Beckenham although it was noted that there was reduced capacity due to infection control. A Falls Consultant Clinic had also opened, with reduced capacity, one morning per week; a Vestibular Clinic was open one afternoon per month; home visits for initial assessments and exercise/intervention were also available; and Balanced Lifestyle Groups (12-week programme) were held face to face in West Wickham and Orpington. In response to a question, the Head of Adult Therapies said that the locations were not based on areas that had a particularly high number of falls – there were limitations due to the spaces available, and they would continue to look for further options to deliver these programmes.

The Head of Adult Therapies advised that the Falls and Fracture Prevention Service received on average 80 referrals per month. At present, the caseload stood at 342 patients, which it was noted did not include the caseload of the Fracture Liaison Nurse. The waiting time was approximately 12 weeks, which was impacted by both staffing capacity and the capacity available within the clinics. Outcomes for patients were measured by TOMs and Tinetti and positive feedback was received from patients. (TOMs stands for Therapy Outcome Measures and was in use across many therapy services in Bromley Healthcare. It was completed during the initial assessment and then end of intervention to determine if improvements had been made in four areas in line with International Classification of Functioning, Disability and Health: Impairment, Activity, Participation and Wellbeing. Tinetti was also an outcome measure used predominantly by Physiotherapists to assess a patient's gait and balance and provided a score on completion which could be compared pre and post intervention to determine progress/improvement. In response to questions from the Vice-Chairman, the Head of Adult Therapies advised that it was acknowledged that the 12-week waiting time was too long and an increase in capacity and efficiency would be needed to return to the standard waiting time of 4-6 weeks. It was highlighted that the Rapid Access to Therapy Team (RATT) assessed patients at immediate risk and referred them on if necessary.

With regards to future plans for the service, the Head of Adult  ...  view the full minutes text for item 32a

The Chairman welcomed Gillian Fiumicelli, LBB Head of Vascular Disease Prevention Programme and Jess Seal, Primary and Community Care Transformation Manager, South East London CCG (“Primary and Community Care Transformation Manager”) to the meeting to provide an update on adult weight management services in Bromley.

Members were advised that data from the Active Lives survey 2019/20, which was prior to the pandemic, indicated that around 57% of adults in the borough were classified as being overweight or obese. The complicated picture of obesity and the benefits of a whole systems approach were highlighted.

The LBB Head of Vascular Disease Prevention Programme informed Members that in regard to the Bromley adult weight management workstreams, there were a number of groups which had a focus on obesity:

-  One Bromley Obesity Working Group (Local Bromley commissioners, providers, Public Health);

-  SEL CCG Obesity Group (a new group of Public Health Obesity Leads);

-  SEL Diabetes and Obesity Commissioning Group (Commissioners from across SEL); and,

-  the Health and Wellbeing Board had itself identified obesity as a priority.

Tier 1 (universal prevention services) of the Bromley adult weight management programmes were open to everyone – the Better Health NHS Weight Loss Plan app was continually being developed and provided a wide range of useful information. During 2021/22, there had been new 12-week programmes implemented within Tier 2 (behavioural services) – NHS Digital Weight Management Programme and Slimming World. The Local Authority would fund 1,364 places on the programmes – GP practices currently referred patients, however they would be working with the social prescribing team to increase the number of referrals, and self-referrals would be accepted to fill the places before the end of March 2022. It was noted that in Tier 3 (specialist services), they were looking to recommission the healthy weight programme for patients who were more severely obese. Board Members were provided with an overview of both the general adult weight management pathway, and the pathway that focused on diabetes.

With regards to identifying individuals who would benefit from the Weight Management Programmes, there were opportunities for Community Champions and Community Pharmacies to assist, in addition to self-referrals for the universal programmes (Better Health campaigns). Primary care remained the main mechanism for individuals to be identified via NHS Health Checks; Weight Management Referral Optimisation Protocol; computer searches; National Incentive Scheme; social prescribing team; dietitians and Health Coaches. The Primary and Community Care Transformation Manager advised that developments in primary care included the national enhanced service which encouraged practices to develop a supportive environment for clinicians to engage with patients living with obesity about their weight. This enhanced service worked alongside a broader expansion of weight management services, including the launch of the NHS Digital Weight Management Service for those with hypertension and diabetes, and further investment into Local Authority Tier 2 services. The workforce that could refer into these pathways had been expanded and now included all healthcare professionals, including social prescribers and PCN dietitians.

In response to a question, the  ...  view the full minutes text for item 32b

To follow

The Chairman noted that this JSNA chapter assessed and summarised the impact of the COVID-19 pandemic on the population of Bromley. In order to ensure that the level of detail required was included in the document, this item would be deferred to later in the year when the data for 2021-22 would be available.

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

To follow

The Chairman welcomed Helen Jones – Associate Director, Community Mental Health (Bromley), Oxleas (“Associate Director”) and Ben Taylor – Chief Executive, Bromley, Lewisham and Greenwich Mind (“Chief Executive – BLG Mind”) to the meeting to provide an update on the Community Mental Health Transformation Programme.

The core offer was for adults in South East London, aged 18+, experiencing mental health problems. This would include people with severe mental illness (SMI) as well as individuals with mild mental health illness who required care and intervention. The aims were to:

-  have a diverse and personalised range of interventions for people experiencing mental health problems within the community setting;

-  enable earlier access to support; to support people to recover and stay well; to prevent mental ill health and crisis intervention; and,

-  reduce inequality in access and experience of mental health and physical health care for people with severe, moderate and mild mental illness across South East London.

The underpinning principles were for community services with clear access points that provided flexible care that considered both mind and body (i.e. mental and physical health), with targeted and measurable outcomes to assess and evaluate the benefits for residents in South East London and across the wider health and care economy. These drew on local system knowledge and feedback from service users. Four ‘Bromley principles’ had also been developed:

-  Bridging the gap across primary and secondary care;

-  No wrong door into services and frictionless movement between them;

-  Holistic approach to assessing and meeting needs; and,

-  Integrated, multi-disciplinary team providing clinical and non-clinical support.

The Associate Director advised that the Community Hub provided an opportunity to bring services together, with a holistic triage assessment of needs aiming to support reablement and integration into the local community. It was noted that social prescribing support would facilitate access to mainstream resources and activities and MDT meetings would include representatives from IAPT/secondary care to facilitate frictionless movement between services. If required, the Community Hub would also allow reengagement post-discharge to be a straightforward process.

Board Members were advised that NHS England Transformation funding for Bromley totalled £872k in 2021/22 – this was a significant investment which would mainly be used for additional staffing roles. The first year of the Community Hub would involve an integrated team of approximately 26 people, including existing Oxleas staff as well as some new roles, and BLG Mind staff. In response to a question from the Chairman, the Associate Director advised that around half of the 26 posts were newly established – for Year 1 the majority were now in post or would be appointed shortly. Work was underway to shape the new service model ready for a soft launch at the end of February 2022. Oxleas and BLG Mind teams would be co-located to carry out joint assessments, shared care planning and interventions, and service user/carer engagement groups had been established to ensure active co-production in the new service. From April 2022 the Community Hub would be  ...  view the full minutes text for item 33.

Cheryl Rehal, Acting Head of Primary Care, Bromley – SEL CCG (“Acting Head of Primary Care”) provided an update on vaccination uptake in Bromley.

The Acting Head of Primary Care informed Members that the COVID-19 vaccination services had commenced in December 2020, and since then over 500,000 vaccinations had been delivered in the borough. Currently, both bookable and walk-in services were operating from 12 sites across Bromley, offering first, second and third doses, and multiple satellites and pop-up clinics had been held over the last 15 months. Engagement events, information sharing sessions and clinical conversations had been offered to support questions and assist with individual needs. Visits were undertaken to vaccinate over 6,000 housebound patients and care home residents, and co-administration with the flu vaccine had been offered wherever possible during the 2021/22 season. The Schools Vaccination Programme had delivered almost 5,000 vaccinations for 12–15-year-olds in 37 schools across the borough, including special schools. The Acting Head of Primary Care advised that since the last update was provided to the Health and Wellbeing Board, four new pharmacies had become vaccination sites – the benefits and trusted nature of community pharmacies was recognised, and they also provided a sustainable and accessible walk-in offer for residents. A Member highlighted the need for a list of the facilities available at the community pharmacies to be publicised. The Acting Head of Primary Care said that the facilities available varied from site to site and this feedback would be provided to the team. It was noted that in regard to the sites used to deliver the vaccine to people with Learning Disabilities, a lot of thought had been given to the location and range of needs.

Board Members were advised that, in terms of the universal offer, anyone aged over 16 was eligible for a primary course of two doses, and a booster dose. Individuals who were severely immunosuppressed were eligible for a primary course of three doses, and a booster dose. For children and young people, 12–15-year-olds were eligible for two doses, 12 weeks apart, and 5–11-year-olds with underlying health conditions would be offered a first dose, with a second dose offered at 12 weeks. Vaccination was mandatory for care home staff and visiting professionals – this was due to become mandatory for health and care staff with direct patient or service user contact from 1^st April 2022, however it was noted that the Secretary of State for Health and Social Care had recently announced that this was to be reviewed, and the outcome was awaited. In response to a question, the Acting Head of Primary Care advised that a booster dose of the COVID-19 vaccination was not a requirement of employment for care home staff, however it was expected that uptake would be encouraged. The Director of Public Health said that webinars had also been held for those staff that were hesitant about getting the vaccine, and this would continue to be an open-ended offer.

The Acting Head of Primary Care advised  ...  view the full minutes text for item 34.

Teresa Bell – Independent Chair of the Bromley Safeguarding Adult Board (“Independent Chair – BSAB”) presented the Bromley Safeguarding Adults Board (BSAB) Annual Report for 2020/21.

The Independent Chair – BSAB advised Members that she had taken on this role from January 2021. The BSAB fulfilled its statutory obligations in ensuring that representatives from SEL NHS Clinical Commissioning Group (Bromley) and the Metropolitan Police Service attended the Board. The BSAB was facilitated by a broad range of representatives from across the borough, including from the private, voluntary and independent (PVI) sectors, as well as a Lay Member.

The BSAB Annual Report for 2020/21 provided information regarding the work that had been undertaken during the year. Specific reference was made to the impact of the COVID-19 pandemic in relation to the following key priority areas: domestic abuse, financial abuse, self-neglect, modern day slavery, transitional care of children into adulthood, and vulnerable adults in specialist care and residential homes. The BSAB’s partners had provided information on their work in respect of adult safeguarding and the impact of the COVID-19 pandemic. Further information was also provided outlining the safeguarding picture in Bromley, adult safeguarding statistics, board structure and the work of its subgroups. It was noted that there had been concerns at the beginning of the pandemic regarding the low number of referrals. This had been in line with other national Safeguarding Board, and a concerted effort had been made to highlight the various ways that services could be accessed. Local and national information had been shared on the BSAB website, and a care homes operational group had been established to ensure that any risks were identified swiftly, and any required action taken.

The Independent Chair – BSAB informed Board Members that, as part of their wider community engagement agenda, the BSAB has also produced an easy read version of the annual report for the first time, which had been done in consultation with members of its Communications and Service User Engagement Group (CSUEG).

In response to a question, the Independent Chair – BSAB said that she had been very impressed with the level of engagement – partners had met frequently to monitor risks and it was evident how well they worked in partnership across the borough. An area of focus for the future would be to further engage with service users and carers.

The Chairman thanked the Independent Chair – Bromley Safeguarding Adults Board for presenting the BSAB Annual Report to the Board, and for all the work undertaken.

RESOLVED that the Bromley Safeguarding Adults Board’s 2020/21 Annual Report be noted.

The Chairman noted that the JSNA chapter on the impact of the COVID-19 pandemic would be brought to a future meeting of the Health and Wellbeing Board.

The Chairman noted that several priorities for 2022/23 had been raised during the meeting, including obesity, alcohol consumption and mental health. Board Members were asked to consider if there were any further priorities for which they would like to receive updates during the next municipal year and notify the clerk by the 18^th March 2022.

The Chairman informed Board Members that he had recently attended a webinar workshop on rough sleepers. The session had been extremely informative, and thanks were extended to the Assistant Director of Public Health. It was requested that a summary of the workshop be brought to the March meeting of the Health and Wellbeing Board.

Report CSD22013

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:

• Discussion – Public Health and Wellbeing Priorities for 2022/23 (31^st March 2022)
• Summary of the rough sleeper workshop (31^st March 2022)
• SEL CCG – Latest phase of the pandemic/review of winter (31^st March 2022)
• Public Health Management of COVID-19 Pandemic Report (including Public Health Lessons Learnt from the Pandemic) (9^th June 2022)
• JSNA – Impact of COVID-19
• Presentation from the Falls Service (8^th December 2022)
• Update on the Adult Mental Health Hub - Oxleas

The Director of Public Health informed Board Members that the 5-year Health and Wellbeing Strategy would need to be reviewed by the end of 2023.

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

The Chairman informed Board Members that a request had been received to move the start time of the next Health and Wellbeing Board meeting back to 2.00pm. Board Members agreed that they were happy with this proposal.

A Member highlighted issues in relation to the sound system in the Council Chamber and noted that these needed to be resolved to ensure that anyone with a hearing impairment could listen to the discussions taking place.

RESOLVED that the issues raised be noted.

1.30pm, Thursday 31^st March 2022

The next meeting of the Health and Wellbeing Board would be held at 2.00pm on Thursday 31^st March 2022