Venue: Bromley Civic Centre
Contact: Jo Partridge 020 8461 7694
APOLOGIES FOR ABSENCE
Apologies were received from Councillor Gary Stevens, Rachel Dunley, Jonathan Lofthouse (Site Chief Executive – PRUH and South Sites: King’s College Hospital NHS Foundation Trust) and Jacqui Scott (Bromley Healthcare).
Apologies for absence were also received from Marzena Zoladz and Charlotte Bradford attended as substitute.
DECLARATIONS OF INTEREST
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 25th March 2022.
No questions had been received.
MINUTES OF THE MEETING OF THE HEALTH AND WELLBEING BOARD HELD ON 3RD FEBRUARY 2022 PDF 389 KB
RESOLVED that the minutes of the meeting held on 3rd February 2022 be agreed.
LATEST PHASE OF THE PANDEMIC/REVIEW OF WINTER - SEL CCG PDF 201 KB
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 Bromley Borough Director advised Members that the system had worked well – a difference this year had been the degree of partnership working which would see them well placed for next year. A workshop would be held to look at what could be done better, and data would be analysed to ensure the system was in the best position possible to deal with future pressures.
The Associate Director – Urgent Care Hospital Discharge and Transfer of Care
Bureau (“Associate Director”) informed Board Members that the update highlighted all actions taken / being taken by One Bromley organisations in order to respond to the additional pressures felt on the health and care system during winter. The report was based around 5 pillars which were:
1. Increasing system capacity
2. Data sharing and escalation
3. Single Point of Access and discharge arrangements
4. Admissions avoidance
5. Communication and engagement
Information had also been provided in relation to vaccinations, outbreak management, recommendations and next steps.
Data regarding increasing system capacity, up until February 2022, demonstrated the additionality that had been incorporated, including:
- More than 19,000 primary care appointments had been provided, with standard and additional appointments offered through the extended hours GP access hubs;
- Over 43,000 patients were treated at Urgent Treatment Centres (UTC), which was a significant number;
- 3,324 patients were visited by the community Rapid Response team;
- 2,688 visits had been made by the urgent therapy team to support admissions avoidance and facilitate early supported discharge; and,
- 5 additional organisations had been added to the framework of domiciliary care providers.
The Associate Director advised that month on month, utilisation rates for GP hub appointments had remained above 93% and had increased throughout the winter period. It was noted that staffing hub appointments became a challenge, and due to work pressures, some moved to virtual appointments. There had also been a request from NHS England for the mobilisation of a local Clinical Assessment Service (CAS) which had responsibility for Bromley patients who phoned 111 with primary care dispositions. Initial findings indicated that the service had a positive impact on patient access, and reduced pressure on UTCs with a 10% reduction on the number of patients being booked in. Throughout the period, the system had been intelligence-led – demand and capacity dashboards had demonstrated the need for escalation. These had been presented at regular Winter Demand and Capacity meetings to quantify demand on local services and respective teams and highlight any potential surges in activity across pathways to allow for forward planning.
A Member congratulated the Associate Director and Bromley Borough Director on the format and content of the report provided. It was highlighted that it was good to see better access to GP appointments being provided, and it was hoped that this would continue to be seen going forward. ... view the full minutes text for item 45.
INTEGRATED COMMISSIONING BOARD UPDATE PDF 168 KB
The Board considered a report providing a summary of the current work of the Integrated Commissioning Board (ICB).
The Integrated Commissioning Board 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:
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 the 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 Bromley Borough Director noted that a huge amount of joint working was being undertaken, including the SPA, All Ages Autism Board Action Plan and Child and Adolescent Mental Health (CAMHS) Programme. New projects included:
It was noted that as the new Integrated Care Service arrangements for south east London come into effect on 1st July 2022, the work of the ICB would become increasingly important. The Director of Adult Social Care agreed that Bromley was well placed to move to the new integrated ways of working across south east London.
In response to a question from the Vice-Chairman, the Bromley Borough Director noted that the waiting times for the Child and Adolescent Mental Health (CAMHS) Programme had lengthened due to the impact of the pandemic. It was noted that there were also issues with workforce capacity, however they were looking at new models to address this issue. The waiting times for Bromley Y (tier 2) were not affected, but CAMHS (tier 3) were being carefully monitored and additional services added. The Chairman requested that the Bromley Borough Director and Director of Children’s Social Care provide an update to Board Members following the meeting.
In response to further questions from the Vice-Chairman, the Bromley ... view the full minutes text for item 46.
SUMMARY OF THE ROUGH SLEEPER WORKSHOP
The Chairman welcomed Lydia Lewinson, LBB Head of Housing Options and Support to the meeting to provide an overview of the rough sleeper stakeholder event held in January 2022. A copy of the presentation is attached at Appendix B.
The LBB Head of Housing Options and Support advised that the numbers in Bromley were generally low, with two or three occasional rough sleepers. It was highlighted that this was something that could happen to anyone, and it was important that the right partnership approach was taken.
During the stakeholder event, several questions had been discussed regarding the care pathways for rough sleepers in Bromley, including:
- whose responsibility was it to safeguard/keep rough sleepers safe, when it was their personal choice to sleep rough?
- at what point should a safeguarding referral be made, and what could be expected from the service?
- whose responsibility were rough sleepers when they refused multiple offers of accommodation?
- how quickly could they get a dual diagnosis or psychiatrist to assess them on the streets?
- what if they present as having capacity and navigate themselves around the system again?
Agreed actions following the stakeholder event had included:
- Creating a directory of services – resources, threshold, transparency of provision;
- Appointment of a dedicated Single Point of Contact in each agency;
- More training in relation to cuckooing;
- Early intervention to prevent homelessness;
- Thinking outside the box;
- GP registration/list of health services; and,
- List of frequent visitors to A&E to see if intervention/support could be provided.
A Board Member said that the time intensive work being undertaken was extremely impressive and was having a really positive impact. The service operating in Bromley was “leading the way” and she would be keen to share this example with other Safeguarding Adult Board colleagues.
A Member said she was aware of families who were coping with adult children returning to the family home with mental health issues due to the impact of the pandemic and highlighted the need for interventions prior to relationships breaking down. The LBB Head of Housing Options and Support advised that the support and resettlement team received referrals and provided early intervention. They looked at things such as pathways, alternative accommodation, and access to benefits for this group of “hidden homeless”. Another Member agreed that prevention was better than cure and emphasised the need for work to be undertaken prior to behaviours becoming entrenched. A Member enquired if engagement took place with landlords to ensure that there was a timeline for people living with their parents, and not on the tenancy, to find alternative accommodation when it was required. The LBB Head of Housing Options and Support advised that a landlord would be acting illegally if they just changed the locks – prior to eviction, the landlord would need to issue a notice to the tenant and obtain a court possession order.
A Board Member enquired as to how easy, or difficult, it was for the ... view the full minutes text for item 47.
FUTURE COVID-19 SURVEILLANCE
The Director of Public Health informed Board Members that the team had stopped producing the weekly COVID-19 briefing as testing had reduced over the last couple of months and the data on the prevalence of COVID-19 was becoming inaccurate.
Nationally, there had been lots of discussion regarding the surveillance of COVID-19. Currently the Office for National Statistics (ONS) survey involved a random sample of the population undertaking a blood test – this would continue, and the sample size would be increased to provide more accurate results. It was hoped that local data could be provided, and Members would be kept informed if this could be built into future surveillance.
In response to questions, the Director of Public Health advised that current ONS data indicated that in London 1 in every 16 people had a COVID-19 infection. In the last fortnight around 400 cases were recorded in the borough per week, and this had now plateaued – however it was highlighted that as local data on COVID-19 had reduced significantly since January 2022, this figure was likely to be an underestimate. From the following day, free lateral flow tests would no longer be available to the general public and therefore the number of cases recorded were expected to decrease even further.
In response to a question from the Chairman, the Director of Public Health advised that there was an internal Bromley system for the surveillance and management of COVID-19 in care homes, which would continue. There was a good amount of data relating to care homes – they were informed about cases of COVID-19 through the local system which allowed support to be provided.
A Member considered that there had not been much coverage in the national press about the COVID-19 spring booster jab for those aged 75 and over. The Director of Public Health advised that residents aged 75 and over, and those who were immunosuppressed, would be invited to book a booster jab – a fair amount of information had been shared on TV and radio, but more could always be done. The Bromley Borough Director – SEL CCG said that letters were currently being sent to this cohort, inviting them to book a vaccination appointment. Previously the GP system had also called patients to book appointment – this had not yet taken place, but it was hoped that these additional calls would soon be utilised. The Chairman emphasised that data should be monitored closely as national figures indicated that uptake had been slow.
RESOLVED that the update be noted.
DISCUSSION - PUBLIC HEALTH AND WELLBEING PRIORITIES FOR 2022/23 PDF 90 KB
The Director of Public Health advised Board Members that the Health and Wellbeing Strategy 2019-2023 was due to be refreshed by 2023 (https://www.bromley.gov.uk/downloads/file/4759/bromley_health_and_wellbeing_strategy_2019-2023). It was noted that work was planned to provide an update on progress against the ten priorities of the current Strategy and developing priorities for the refresh.
The ten priorities of the Health and Wellbeing Strategy 2019-2023 were:
5. Adults Mental Health
7. Learning Disability
8. Drugs and alcohol in young people
9. Youth Violence
10. Adolescent Mental Health
An analysis of the key public health outcomes using the OHID Public Health Outcomes Framework, JSNA and other key public health datasets and indicators would be used to assess potential areas for improvement. Potential priority areas for the Health and Wellbeing Strategy refresh would be developed using the methodology adopted previously. This was based around the production of a matrix that classified health and wellbeing issues according to their potential impact on the Bromley population (defined by the prevalence or incidence of disease or mortality) and the recent direction of trends (improving or worsening). It was noted that a report of the findings would be presented at the June meeting of the Health and Wellbeing Board.
The Chairman considered that the ten priorities listed were likely to remain as significant issues. However there was also the need to consider issues such as Long Covid Syndrome and the COVID-19 and catch-up vaccination programmes. A Member suggested that a future priority should be ‘drugs and alcohol’ across the population, rather that specifically related to young people. Another Member highlighted that some priorities may feed into others as subcategories.
The Chairman noted that the number of priorities was not restricted to ten, and Board Members were asked to provide any further suggestions by the end of April 2022.
RESOLVED that the update be noted.
CHAIRMAN'S ANNUAL REPORT PDF 207 KB
Board Members had been provided with a copy of the Chairman’s annual report of the Health and Wellbeing Board 2021/22 prior to the meeting. The document captured the issues that had been addressed throughout the year and were likely to remain going forward. The Chairman advised that the report would be provided for information to the July meeting of Full Council.
RESOLVED that the report be noted.
QUESTIONS ON THE HEALTH AND WELLBEING BOARD INFORMATION
The briefing comprises:
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:
The Health and Wellbeing Board Information Briefing comprised of 2 reports:
RESOLVED that the Information Briefing be noted.
WORK PROGRAMME AND MATTERS OUTSTANDING PDF 225 KB
The Board considered the proposed work programme for 2022/23 and matters arising from previous meetings.
The Director of Public Health said that at the June meeting it was proposed for additional time to be spent discussing the Health and Wellbeing Strategy and a report would also be presented on the Public Health management of the COVID-19 pandemic.
A Board Member asked for an update in relation to the COVID-19 impact assessment. The Director of Public Health said that the JSNA chapter had been delayed as a full year of data was needed to evaluate the impact of COVID-19. It was anticipated that data for 2021/22 would be available in the coming months and a report presented before the end of the year. The Director of Public Health advised that the Consultant in Public Health had undertaken an extensive literature review, however there was little data available by borough.
RESOLVED that the work programme and matters arising from previous meetings be noted.
ANY OTHER BUSINESS
Board Members agreed that they were happy with the proposal for the meeting on Thursday 9th June 2022 to start at 2.00pm.
The Chairman noted that this was the final Health and Wellbeing Board meeting of the municipal year – it had been a challenging year, but had ended on an optimistic note. Members and officers were thanked for their contributions throughout the year.
RESOLVED that the issues raised be noted.
DATE OF NEXT MEETING
1.30pm, Thursday 9th June 2022
1.30pm, Thursday 22nd September 2022
1.30pm, Thursday 8th December 2022
1.30pm, Thursday 2nd February 2023
1.30pm, Thursday 30th March 2023
The next meeting of the Health and Wellbeing Board would be held at 2.00pm on Thursday 9th June 2022.