Agenda and minutes

Apologies for absence were received from Councillor Diane Smith and Councillor Kim Botting attended as substitute.

Apologies for absence were also received from Dr Ify Okocha (Oxleas).

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 Wednesday 1^st June 2022.

One question had been received from a member of the public for oral reply. The question, with the answer given, is set out in Appendix A to these minutes.

Two questions had been received from members of the public for written reply and are attached at Appendix B.

RESOLVED that the minutes of the meeting held on 31^st March 2022 be agreed.

Report CSD22071

The Board considered a report providing an update on Children and Young People’s Mental Health. The Charman welcomed James Postgate, Associate Director – Integrated Commissioning, NHS South East London CCG (Bromley) (“Associate Director”), Yvonne Onyeka, Team Leader – Bromley Y (“Team Leader”), Rebecca Wheatcroft, Consultant Clinical Psychologist – Oxleas NHS Foundation Trust (Bromley CAMHS) (“Consultant Clinical Psychologist”) and Laura Craggs, Operations Manager – Oxleas NHS Foundation Trust (Bromley CAMHS) (“Operations Manager”) to the meeting.

The Associate Director informed Board Members that Bromley Council and NHS South East London Clinical Commissioning Group (CCG) – Bromley commissioned a range of services to support the mental health and wellbeing of children and young people in the borough. Whilst there were a range of different services in the area, the core mental health and wellbeing offer centred on the provision of:

(a)  the Wellbeing Service for Children and Young People (Bromley Y); and,

(b)   Children and Adolescent Mental Health Services – CAMHS (NHS Oxleas Foundation Trust).

The dual service model was originally established in 2014/15. Since then there had been strong partnership working between the two services which were strengthened in April 2021 when the Council and CCG jointly awarded Bromley Y a new integrated contract to provide mental health and wellbeing services for children and young people in the borough.

The impact of the COVID-19 pandemic had been seismic across all groups. That said, for children and young people, who had experienced lockdowns and school closures, this had been a particularly challenging period. The impact had seen, since September 2020, a significant rise in referrals to both Bromley Y and NHS Oxleas CAMHS, notably:

-  a 47% increase in referrals to the joint NHS Oxleas CAMHS/Bromley Y single point of access (SPA) since September 2020;

-  a 16.8% increase in routine referrals to NHS Bromley CAMHS;

-  an increase in the clinical complexity of referrals resulting in an increase in contacts per case; and,

-  a 15.7% increase in emergency presentations to NHS Bromley CAMHS.

NHS Oxleas CAMHS and Bromley Y reported that, of the higher numbers of children and young people accessing the services, more were likely to have complex and multi-faceted challenges than was typical prior to the pandemic. That meant that more children and young people were staying with services for longer, increasing caseloads overall. The Associate Director said that it was important to note, however, that the current situation with children and young people’s mental health and wellbeing services was a national picture and that Bromley’s services had coped well in difficult circumstances.

In light of the current situation in services, the Council/CCG with Bromley Y and NHS Oxleas CAMHS had come together to develop proposals to meet the current challenges across service lines. The different organisations had agreed a number of priority areas to focus on in the first instance, as set out below:

·  joint leadership/communication across children and young people’s mental health and wellbeing services in Bromley.

·  the development of an integrated solution for children  ...  view the full minutes text for item 5.

Report ACH22-013

The Board considered a report providing an overview of the Public Health Department’s management of the COVID-19 Pandemic, which it was noted would also be presented to the Adult Care and Health Policy Development and Scrutiny Committee on 28^th June 2022.

The Director of Public Health advised Board Members that management of communicable diseases was a part of the Health Protection function which was one of the Public Health statutory functions. Public Health functions in the Local Authority had been defined in the Health and Care Bill 2012. The basis for the Public Health management of the COVID-19 pandemic had been the Bromley Outbreak Management Plan. Public Heath completed and published the first plan in June 2020, pulling together all key partners in the borough. The plan had been updated several times and was overseen by the Health Protection Board. There were a number of workstreams overseeing different aspects of the pandemic response and each of these workstreams had developed and changed as the pandemic had progressed. The Public Health team led in setting up new services to manage the pandemic such as contact tracing, community testing, testing in schools, surge testing and setting up systems to prevent and manage outbreaks. They had also worked closely with SEL CCG on the vaccination programme.

During the pandemic several members of staff in the Public Health team moved from ‘business as usual’ to working on the response to the pandemic almost entirely, leaving those not working on the pandemic to keep all the other work going. Key areas of work were:

1.  Surveillance – which included producing a weekly report on the COVID-19 situation in the borough, which was circulated to Councillors and Members of the Health and Wellbeing Board.

2.  Outbreak management – the Public Health team had managed or supported a very large number of outbreaks in different settings. This included incident management meetings and subsequent review meetings with a large number of care homes and schools, which had been a significant amount of work.

3.  COVID-19 clinical response service – delivered by Public Health Nurses, provided infection prevention and control (IPC) advice, support and responses to enquiries received from a wide range of health and care professionals in different settings, including businesses as well as from the general public.

4.  Local contact tracing service – a new service, which was established in October 2020, and ended on 23^rd February 2022.

5.  Community testing service – programme based on Government guidance.

6.  COVID-19 Vaccination – support had included communication and engagement events with residents, schools, care homes, social media campaigns, webinars; vaccine sprint campaign; vaccination of vulnerable and hard-to reach communities; and a vaccine hesitancy and inequalities workstream.

7.  Prevention/Communication and engagement – Public Health had worked closely with the Communication Team and other LBB and external colleagues to ensure that the latest messages on prevention were available to Bromley residents in public places and on the LBB website.

The Director of Public Health said that  ...  view the full minutes text for item 6.

Report ACH22-015

The LBB Public Health Registrar delivered a presentation providing a summary of the Substance Misuse Needs Assessment, which is attached at Appendix C.

Substance Misuse treatment and recovery services for Bromley residents were commissioned by the London Borough of Bromley, and the service was due to be recommissioned in 2023. As part of the recommissioning, a needs assessment/analysis of needs was carried out to ensure the new service adequately met the needs of the local population.

The LBB Public Health Registrar noted that 27 recommendations had been made on the basis of Needs Assessment, and were categorised into:

1. Improving data collection
2. Improved partnerships
3. Targeting risk and vulnerable groups
4. Drug use in Young People
5. Harm Reduction
6. Bromley Drug and Alcohol Service (BDAS)

The Health and Wellbeing Board were asked to consider:

-  How can better partnerships be fostered with the organisations mentioned? – these organisations knew the individuals well and were trusted. A way to capitalise on this to reduce drug related harm and death to the individual, their family and beyond needed to be sought. This was highlighted in the Dame Carol Black review, and echoed in national policy.

-  How can inequalities in access to services, as well as drug-related harm and deaths, be tackled? – inequalities in access and harm/deaths were clearly evidenced. With the levelling up agenda, as well as national drugs policy and the aims of health groups, this would be an important consideration.

-  How can substance misuse and addiction be shifted  to become a health issue rather than a criminal justice issue, thereby reducing stigma? – the evidence from both the Dame Carol Black review and literature was clear that substance misuse treatment and recovery works for both the individual and society, reducing harms and costs.

The LBB Public Health Registrar advised that a copy of the full Substance Misuse Needs Assessment could be circulated to Board Members following the meeting.

The Chairman enquired as to where overall ownership of the Substance Misuse Needs Assessment lay. The Director of Public Health said that Public Health had a role in commissioning services and developing programmes around early intervention and prevention. Lots of work was undertaken with GPs and hospital services and programmes were also commissioned jointly with the CCG – it was a multiagency approach with the involvement of community groups, charities, Police and criminal justice system.

In response to questions from Members, the LBB Public Health Registrar advised that a separate Alcohol Misuse Needs Assessment was underway and could be presented to a future meeting of the Health and Wellbeing Board. It was highlighted that lots of good prevention work was being undertaken for both young people and adults, and there was a need to ensure that this was integrated. The Director of Public Health noted that the initial focus had been on substance misuse as the contract with the service provider was coming to an end the following year. An in-depth piece of work had been undertaken to look at  ...  view the full minutes text for item 7.

Report ACH22-014

The Director of Public Health advised Board Members that the Health and Wellbeing Strategy 2019-2023 was due to be refreshed by 2023. The ten priorities of the Health and Wellbeing Strategy 2019-2023 were:

1. Cancer

2. Obesity

3. Diabetes

4. Dementia

5. Adults Mental Health

6. Homelessness

7. Learning Disability

8. Drugs and alcohol in young people

9. Youth Violence

10. Adolescent Mental Health

It was noted that an update on progress against the ten priorities of the current Strategy had been undertaken and is attached at Appendix D. The priority areas had been selected following 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). The Director of Public Health said that rates had continued to increase across all areas, except for dementia which had seen a decrease in rates both locally and nationally. The reasons for this were not clear, but may be linked to improved cardiovascular health. It was noted that obesity rates were still very high and were an increased risk factor for a number of the other areas listed.

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 said a further item for consideration could be around the impact of the economy on people’s health. Another Member enquired as to the statutory period that the Health and Wellbeing Strategy needed to cover. The Director of Public Health said that it was between three and five years. The Chairman asked Board Members to consider over the summer how they could take this forward and proposed that a longer meeting be scheduled in September to discuss the priorities and period that the Strategy covered. A Member highlighted that granular information would need to be provided in advance of the meeting in order to allow Board Members to consider this in detail.

RESOLVED that the update be noted.

Proposal from the Chairman to set up a Task and Finish group

The Chairman advised that several countries were introducing the concept of promoting brain health. It was suggested that a Task and Finish group could be established, which could be held virtually, to consider this in more detail.

The Borough Based Director – SEL CCG said that promoting brain health was a good idea, and highlighted that this was something that people often worried about too late in life. It would be an interesting concept to look at brain health from childhood/adolescents as this was when the brain was forming – there would be lots of learning to take from this which could link in with other ideas.

The Chairman requested that Board Members contact the clerk if they were interested in being involved in a Brain Health Task and Finish group.

RESOLVED that the issues discussed be noted.

The briefing comprises:

• Better Care Fund and Improved Better Care Fund Performance Update
• Healthwatch Bromley - Patient Experience Report Q4 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 of two reports:

• Better Care Fund and Improved Better Care Fund Performance Update
• Healthwatch Bromley - Patient Experience Report Q4 2021/22

RESOLVED that the Information Briefing be noted.

Report CSD22057

The Board considered the proposed work programme for 2022/23 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 Children and Young People’s Mental Health (8^th December 2022/2^nd February 2023)
• Report on learning from the COVID-19 vaccination programme (TBC)
• Alcohol Misuse Needs Assessment (TBC)

The Chairman noted that the suggestion to hold an extended Health and Wellbeing Board meeting in September had been proposed, which would allow additional time to discuss the priorities for the Health and Wellbeing Strategy. Members were advised that further items would be added to the work programme throughout the municipal year.

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

Monkeypox

The Chairman advised that Members had requested a short statement in relation to monkeypox.

The Director of Public Health advised that monkeypox was a rare infectious disease. There were a number of cases in the UK, mostly in London (around 98%), and that number was rising but the risk to the general public remains very low. These were mainly in central areas, and it was noted that data was not available by individual borough – however Public Health departments would be notified if there were issues within a specific area.

Monkeypox was usually associated with travel to West Africa, however there had been a significant number of cases that were not linked to travel and were from local transmission. Monkeypox was usually a mild self-limiting illness, spread by very close contact with someone with monkeypox and most people recover within a few weeks. The virus could spread if there was close person-to-person contact or contact with items used by a person who had monkeypox, such as clothes, bedding or utensils. The risk to the UK population was low, however recent cases had been predominantly in gay, bisexual and other men who have sex with men, so these groups were being advised to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service if they had concerns.

There waspublished information on the Council’s website Health and wellbeing | London Borough of Bromley which acknowledged this was still an emerging situation and also outlined that UK Health Security Agency (UKHSA) was investigating a number of cases as well as signposting towards the official NHS health advice. It was noted that Monkeypox had recently become a notifiable disease.

The Borough Based Director – SEL CCG said that the NHS was taking an active approach. The 111 system could refer people to a clinic at Guy’s and St Thomas’ Hospital, which was also the location of a monkeypox vaccination centre.

RESOLVED that the issues raised be noted.

1.30pm, Thursday 22^nd September 2022

1.30pm, Thursday 8^th December 2022

1.30pm, Thursday 2^nd February 2023

1.30pm, Thursday 30^th March 2023

The next meeting of the Health and Wellbeing Board would be held at 1.30pm on Thursday 22^nd September 2022.