Agenda and minutes

Apologies for absence were received from Nada Lemic – Director of Public Health and Charlotte Bradford – Healthwatch Bromley, and Chloe Todd – Consultant in Public Health and Jane Walters – Healthwatch Bromley attended as their respective substitutes.

Apologies were also received from Teresa Bell, Rachel Dunley and Dr Andrew Parson.

Apologies for lateness were received from Councillor Chris Price and Jacqui Scott (Bromley Healthcare).

Apologies were received from Dr Ify Okocha – Oxleas NHS Foundation Trust. Apologies were also received from Jonathan Lofthouse (King’s College Hospital NHS Foundation Trust) and David Sharif (Head of Performance and Planning – PRUH) attended as substitute.

The Chairman informed Board Members that he had written to Jonathan Lofthouse to thank him for all the work undertaken and extend congratulations on his appointment as Group Chief Executive for Hull University Teaching Hospitals NHS Trust and Northern Lincolnshire and Goole NHS Foundation Trust.

There were no declarations of interest.

In accordance with the Council’s Constitution, members of the public may submit one question each on matters relating to the work of the Committee. Questions must have been received in writing 10 working days before the date of the meeting – by 5pm on Thursday 15^th June 2023. 

Questions seeking clarification of the details of a report on the agenda may be accepted within two working days of the normal publication date of the agenda – by 5pm on Friday 23^rd June 2023.

No questions had been received.

With regards to a matter outstanding from the February meeting of the Health and Wellbeing Board, relating to the waiting times for Child and Adolescent Mental Health Services (CAMHS) and ASD, the Director of Children's Social Care clarified that the delays sat wholly with the Oxleas NHS Foundation Trust, rather than jointly with the Local Authority.

In respect of Minute 48, a Member requested an update regarding the reference made in the Bromley Metal Health and Wellbeing Strategy that Bromley had the third highest level in London of adults diagnosed with depression and enquired if the reasons for this were known. The Bromley Place Executive Director – NHS South East London (“Bromley Place Executive Director”) said that there may be a number of reasons for this, including increased levels of diagnosis and a general increase in mental ill health. The Consultant in Public Health advised that this would be a project area covered in the mental health needs assessment and suggested that the work on the depression element could be brought forward. A Member considered that this was a positive statistic, with the borough being better than others in identifying depression. Some excellent work was being undertaken in relation to the loneliness agenda and as these areas were linked they could be taken forward together.

The Chairman advised that, in relation to Minute 59, discussions were ongoing in terms of how the Local Authority could assist with the distribution of the GLA grant, set aside to respond to the challenge of food insecurity that was resulting from the cost-of-living crisis. With regards to the wider issue, Board Members were advised that conversations had been held with health colleagues in relation to this and the validity of the report.

RESOLVED that the minutes of the meeting held on 30^th March 2023 be agreed.

The Bromley Place Executive Director advised that Integrated Care Boards (ICBs) had been asked to produce a 5-year Joint Forward Plan (JFP) in order to ensure a strategic approach was in taken in terms of delivery. The SEL ICB had taken the approach that this would be brought together by incorporating input from all six boroughs into the SEL Plan. Another element was the Integrated Care Strategy – this was a longer-term piece of work which set out the ambitions for South East London – improving health; providing better quality services; and reducing the need for acute services. This would incorporate a number of elements, including improving mental health services; ensuring the best start for children and families; and improving the management of long-term conditions.

Within the borough they had worked with partners to develop a strategy for Bromley over the next five years. Support had been secured from the King’s Fund and through the One Bromley Executive and Local Care Partnership Board a set of local priorities had been agreed. The local strategy linked with the Bromley Health and Wellbeing Strategy and was structured around improving population health and wellbeing through prevention and personalised care. It also aimed to ensure that high quality services were closer to home, delivered through communities, and there was good access to urgent and unscheduled care services. Other strategies had also been taken into account. The Fuller Review had prompted further work in relation to better working within localities and neighbourhoods and supporting general practice.

The Bromley Place Executive Director advised that the Health and Wellbeing Board were being asked to confirm that they were content with the proposals and noted that the strategy would continue to evolve over time.

The Chairman stated that the process had been very inclusive, and consideration was being given as to how services could be best delivered within the overall framework. Congratulations were extended to all who had been involved in this work. The Director of Children's Social Care said it was positive to see that children were reflected throughout both documents, which was not necessarily the case within other ICBs. The Chairman considered that the development of this work was seen as an exemplar in London, and beyond, and had been noted at the highest level.

In response to a question, the Bromley Place Executive Director said that prevention was at the forefront of many pieces of work, such as proactive care, Health Checks and vaccinations. They would ensure that when implementation plans were being discussed this would be made much clearer. The Chairman highlighted that the Board’s response, which stated that they strongly supported the aim of preventing illness and promoting health through local place-based initiatives.

A Board Member said they welcomed the latest version, which took into account the comments provided, which acknowledged the voluntary sector’s role in terms of being a trusted mechanism to engage with the community and provide an important source of data. It was noted that there was a paper being  ...  view the full minutes text for item 5.

The Chairman welcomed Lucy Hindell – Associate Director of Business Development, NHS South East London (Bromley). to the meeting to provide an update on the Bromley Health and Wellbeing Centre.

Board Members were advised that a decision had been made back in May to change the location of the new Bromley Health and Wellbeing Centre, which was previously planned to be housed on the Adventure Kingdom site, and would now be included in part of the development of Churchill House in Bromley town centre. 

A project team was in place which included colleagues from the both the ICB and LBB. Surveys were currently being undertaken and internal designs were being drawn up. A new communications engagement plan was being established – internal meetings would be held in the coming weeks, followed by meetings with stakeholders and the wider public.

The new Health and Wellbeing Centre would house the Dysart GP practice and community, outpatient and other flexible space for wellbeing services.

RESOLVED that the update be noted.

To follow

Report ACH23-032

The Board considered a report providing an overview of the Better Care Fund (BCF) 2023-2025 Plan submission to NHS England.

The Assistant Director for Integrated Commissioning advised that the government had published the BCF Policy Framework for 2023-25 on 4^th April 2023, followed by a set of BCF Planning Requirements for 2023-25. The guidance set out the requirements for implementing the government’s Policy Framework for the BCF programme for 2023-24 with some further guidance for 2024-25 yet to be published. Unlike previous years, where the submission process covered a 1-year period, the current BCF policy framework set out national conditions, metrics, and funding arrangements for the BCF programmes for 2 years (2023-24 and 2024-25)

The BCF 2023-25 submission plan required the partnership to report on two new metrics – one on ‘Falls’ and another on ‘Discharges from Hospital’. The submission to NHS England was to include the completion of a planning template that set out and details the range of planning, finance and performance data. The Plan was to be agreed by the local Health and Wellbeing Board and submitted to NHS England by 30^th June 2023.

The Assistant Director for Integrated Commissioning informed Board Members that Bromley was continuing to spend money on a number of preventative services and services provided by the voluntary sector. In recent years the borough had been very successful in terms of its BCF Plans, with all of the metrics set by the government rated as ‘green’.

In response to a question regarding the census data referenced in the report, the Assistant Director for Integrated Commissioning advised that data relating to ‘supporting unpaid carers’ was a new addition to the census in 2021. It was noted that the consistent use of 2021 census data would be checked prior to the Plan’s submission.

The Chairman and Portfolio Holder for Adult Care and Health extended their thanks to the Assistant Director for Integrated Commissioning for providing a very detailed paper within such a tight deadline.

RESOLVED that the submission of the Better Care Fund 2023-2325 Partnership Plan to NHS England be approved.

Report ACH23-031

The Board considered a report providing an update on the suicide prevention workstream and outline of future plans.

The Consultant in Public Health advised that the Suicide Prevention Steering Group meets regularly and were responsible for developing a Suicide Prevention Plan with an accompanying action plan. The current plan could be found at the following link (Suicide prevention plan – London Borough of Bromley) and progress had been made on the action plan in relation to pathways, training, raising awareness and sharing of good practice.

The Bromley Suicide Prevention Plan 2019-2024 and the action plan were due for renewal and update in 2024. In preparation for this the Public Health Intelligence Team were conducting a review and audit of the Suicide and Self-Harm data for the borough. The last Suicide Audit that took place was in 2017 and therefore a review of the data would take place once more to identify any issues / trends. The suicide and self-harm review / audit planned to look at the following:

-  trends in suicide and self-harm rates;

-  the burden of suicide and self-harm in the borough;

-  local mortality data related to suicides;

-  demographic differences of suicide and intentional self-harm; and,

-  methods used in suicide and intentional self-harm.

The suicide and self-harm review / audit report was due to be complete by November 2023 after which the findings would be presented at a future meeting of the Health and Wellbeing Board.

A Member enquired if the impact of social media would be considered as part of the review. The Consultant in Public Health said they were aware of this being well documented in the press. It was noted that the reasons behind taking their own life and methods of suicide had changed since the last plan was produced. As part of the work to be undertaken, they would be provided with access to information from the first responders, and a review of the individual circumstances would be undertaken. Key stakeholders would be involved in developing a plan that was more fitting in meeting the needs within the borough.

In response to a question regarding the extent to which suicides were known to services, the Consultant in Public Health advised that when the previous plan had been produced it had not been possible to access that level of data. However systems recording suicide deaths had been implemented, and this was something that they planned to look at in greater detail, including looking at whether other services had been accessed.

RESOLVED that the update be noted.

The Chairman advised that the notes from the initial discussions of the Brain Health Task and Finish Group had been provided in the agenda pack. The actions identified had included:

-  Mapping exercise

-  Consider ‘Brain Health’ JSNA chapter

-  Focus on physical brain health

- Link with Loneliness Day on 16^th June 2023 (and importance of social  isolation)

-  Link with next years’ ‘Brain Awareness Week’

It was noted that these elements would be taken forward by both Public Health and NHS colleagues. Jacqui Scott, CEO – Bromley Healthcare, said that Bromley Healthcare would be happy to participate in this work.

In response to question, the Chairman highlighted that discussion point 4 had recognised the need to educate both children and adults of all ages to recognise that taking steps to protect the health of their brains ought to be a top priority. The Director of Children’s Social Care considered that healthy brains in childhood would have an impact on mental health in later life.

A Board Member asked for further information regarding the approach to engagement. The Bromley Place Executive Director noted that this work was still in the very early stages, however co-production and wider engagement on specific pieces of work would be helpful. The Chairman advised that aspirations could be set out in the JSNA chapter, but this would be a long-term project. In response to a question from another Member, the Consultant in Public Health said that within the Public Health department they had a Public Health communications group, which could take on work to connect with organisations in relation to joint campaigns. The work currently being undertaken was the mapping exercise to determine what was available and what the evidence base was. It was noted that the JSNA Steering Group was about to be restarted which would capture lots of input for the chapter on brain health.

RESOLVED that the update be noted.

The briefing comprises:

• Better Care Fund and Improved Better Care Fund Performance update
• Combating Drugs and Alcohol Partnership (CDAP) Update
• Healthwatch Bromley Patient Experience Report

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 3 reports:

• Better Care Fund and Improved Better Care Fund Performance Update
• Combating Drugs and Alcohol Partnership (CDAP) Update
• Healthwatch Bromley Patient Experience Report

RESOLVED that the Information Briefing be noted.

Report CSD23091

The Board considered its work programme for 2023/24 and matters arising from previous meetings.

The following item was added to the forward rolling work programme for the Health and Wellbeing Board:

• Suicide & Self-harm: a review and analysis of the data and trends over time (1^st February 2024)

The Consultant in Public Health advised that a significant amount of work would be undertaken this year in relation to the JSNAs. The Alcohol and Substance Misuse Needs Assessments were in production and close to being finalised before publication, and the Homeless Health Needs Assessment was also in production. A JSNA chapter on Morbidity and Mortality in Bromley would be produced as well as an update to the demography chapter on a rolling basis as census data was released. In addition, there would be chapters on suicide, brain health and mental health and learning disability. As mentioned, the JSNA steering group was being reinstated and would have a monitoring role of the content and strategic direction of the JSNA.

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

There was no other business.

1.30pm, Thursday 21^st September 2023

1.30pm, Thursday 16^th November 2023

1.30pm, Thursday 1^st February 2024

1.30pm, Thursday 18^th April 2024

The next meetings of the Health and Wellbeing Board would be held on:

1.30pm, Thursday 21^st September 2023

1.30pm, Thursday 16^th November 2023

1.30pm, Thursday 1^st February 2024

1.30pm, Thursday 18^th April 2024