The Chairman led a period of silent reflection in memory of John Harrison, Richard Lane OBE and Professor Mark Monaghan.

Apologies for absence were received from Councillor Robert Evans, Kim Carey and Dr Andrew Parson.

Apologies were also received from Jacqui Scott (Bromley Healthcare).

Councillor Colin Smith gave prior notification that he would need to leave for a short period at 2.00pm to attend another meeting.

The Chairman welcomed Angela Helleur, Interim Site Chief Executive, PRUH and South Sites – King’s College Hospital NHS Foundation Trust (“Interim Site Chief Executive”) to the meeting.

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 7^th September 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 15^th September 2023.

No questions had been received.

RESOLVED that the minutes of the meeting held on 29^th June 2023 be agreed.

Report AC23-043

The Board considered a report outlining the proposed detail of the draft Health and Wellbeing Strategy 2024 to 2028.

At the Health and Wellbeing Strategy workshop held on 8^th December 2022, Members of the Board discussed in small groups the potential priority areas for the next publication of the Health and Wellbeing Strategy to focus on. At the Health and Wellbeing Board meeting on 30^th March 2023 the Board agreed on the three overarching priority areas for the new Health and Wellbeing Strategy 2024 to 2028, these areas were as follows:

1.  Improving Health and Wellbeing of young people (to include obesity, youth violence, adolescent mental health);

2.  Improving Health and Wellbeing of Adults (to include obesity, diabetes, dementia, mental health, substance misuse); and,

3.  Disease prevention and helping people to stay well (linking with the ICB prevention priority and achieving this through the vital 5 work).

Members had been provided with a copy of the new Joint Health and Wellbeing Strategy and were asked to agree on its content and structure. The Director of Public Health advised that the document would be put through a design phase to ensure the document was ready for publication later in the year. Details would be sought from partners in terms of how they would respond to the priorities in the new strategy and how they would address them. Potential partners included LBB, One Bromley and the voluntary sector – the Public Health Team would then work with these partners to co-ordinate updates on progress against the strategy, reporting twice a year to the Health and Wellbeing Board.

The Chairman suggested that within the vision/ambition section the concept of working on early prevention should be made explicit, and the outcomes around dementia should reference the work around brain health.

The Bromley Place Executive Director said that the document reflected the various discussion held and linked well with the Local Care Partnership strategic approach. It was considered that the outcomes could be broken down further – all agencies would have a different role to play, and could be given a couple of targets/ambitions. These comments were echoed by the Interim Site Chief Executive. The Chairman agreed and advised that this would grow out of the next stage of consultation. The Director of Public Health said that the Health and Wellbeing Board had a statutory responsibility to develop a Health and Wellbeing Strategy, but the areas of work would overlap with the work of other partners/groups – to develop a delivery plan for the individual priorities they would need to undertake further engagement and discussion. Once the strategy was approved and published, it could be presented to other groups such as the One Bromley Executive and Children’s Executive Board. In response to a question, the Director of Public Health said that in terms of nutrition, this would be included in the delivery plan for tackling obesity.

Members suggested that having an appendix of the current position of the priorities would  ...  view the full minutes text for item 18.

Report ACH23-041

The Board consider a report outlining the ONE Bromley Winter Plan 2023-24.

The ONE Bromley system developed a Winter Plan each year which described how seasonal pressures would be mitigated and managed locally. The Winter Plan built on learning from previous years, and responded to any new national policy change and local system changes since the previous plan. The co-ordination and delivery of a joint Winter Plan placed Bromley in a strong position to respond effectively to the changeable position through winter. The joint plan set out how local services would be arranged, expanded, flexed and work together to meet the pressures experienced throughout the period and manage risk as a system. Through this residents would be supported to make the most cost-effective and sustainable use of joint resources, while enabling better outcomes and ensuring they were able to provide services for the most vulnerable.

The Associate Director – Urgent Care, Hospital Discharge and Transfer of Care Bureau, SEL ICB (“Associate Director”) advised that the 2023-24 Joint Winter Plan described how health and care services across Bromley would organise themselves and work together to ensure local residents were able to access the services they needed and stay well throughout winter. The Plan was set out in two sections:

Section 1 – described the work that would take place before winter to reduce risk to vulnerable residents; and,

Section 2 – described, under the 3 pillars of winter planning, the activity that would take place during winter to increase capacity across key health and care services, manage the impact of seasonal pressures and viruses and maintain oversight to manage the system throughout.

Engagement with a wide range of stakeholders had taken place to inform the Plan with specific, special interest working groups set up around key themes to develop the plans in these areas. Workforce engagement had also taken place throughout the development of the Plan including engagement of primary care, community health providers, social care workforce and providers and the voluntary sector.

The Bromley Place Executive Lead highlighted that this was a partnership piece of work to manage winter and some schemes would be expanded to ensure that residents and patients had a good flow through the urgent care pathways. Board Members were advised that, in terms of discharge arrangement, Bromley was performing the best in London. Over the last few months there had been a significant reduction in ambulance delays at the PRUH, which reduced waits for patients, and it was hoped that this would be maintained throughout autumn and winter.

The Associate Director noted some of the key additionality for this winter:

-  bigger net increase in primary care and GP appointments;

-  increased availability of all hospital discharge services and improving their connectivity;

-  increased focus on respiratory conditions (a more robust pathway from diagnostics, proactive management and responsive support);

-  paediatrics – additional GP capacity (particular focus on proactive communications, building the confidence of parents to manage children’s illness over the winter);

-  children’s  ...  view the full minutes text for item 19.

Report ACH23-047

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 care and health partner agencies. Its key responsibilities included:

-  Leading and directing arrangements for integrated commissioning of health and social care within the borough of Bromley;

-  Supporting the work of the Health and Wellbeing Board in delivery of the key priorities identified in the Health and Wellbeing Strategy;

-  Overseeing the management of joint resources that enabled effective integrated commissioning programmes;

-  Producing a Local Plan, which allowed the Council and the South East London Integrated Care Board (SELICB) (Bromley) to draw down the Better Care Fund (BCF);

-  Develop a co-ordinated approach to managing and developing the local provider market across health and care services; and,

-  Ensuring the SELICB (Bromley) and the Council were well positioned to meet the emerging requirements from legislation, national/regional policy or best practice guidance.

The Assistant Director for Integrated Commissioning advised Board Members of some key highlights:

-  Mental Health Services – they were 3.5 years into the current strategy – a review would be undertaken to put in place new arrangements from 2025;

-  Falls – a workshop would be held on 2^nd October 2023 and would allow a review of the interventions/programmes in place;

-  Hospital discharge – the final part of the single point of access (SPA) arrangements were now in place, with hospital social workers now being co-located with Bromley Healthcare; and,

-  Assurance arrangement for Bromley Healthcare – the subgroup had been stood down as they were satisfied that Bromley Healthcare had made all the improvements required. The CQC were also happy with the progress made, however the judgment would not change until another inspection was undertaken.

In response to a question from the Chairman regarding the end of life programme, the Assistant Director said that the during the pandemic huge strides had been made in relation to the work around end of life care. Patients at the end of their life at discharge were returning home, and were not being discharged into residential care. St Christopher’s were providing more support and care to people at home and there had been a big shift in how these services were managed. The Bromley Place Executive Lead advised that a significant part of this was the use of the universal care plan, which all agencies could access to ensure there was adequate co-ordination of care. It was agreed that an update on the progress of the end of life programme could be brought to a future meeting of the Health and Wellbeing Board.

The Chairman thanked the Assistant Director for the update to the Board.

RESOLVED that the update be noted.

Report ACH23-045

The Board considered a report outlining the proposals for the Health Protection Board (HPB) to be accountable to the Health and Wellbeing Board.

During the COVID-19 pandemic the multi-agency oversight of the local response to the pandemic was co-ordinated by the Health Protection COVID Board, chaired by the Director of Public Health. This board reported to Council’s Chief Officers Group. Towards the end of the pandemic, the Health Protection Covid Board was renamed the Health Protection Board in order to oversee the local response to a wider range of communicable diseases. The Board had led on the production of Bromley Outbreak Management Plan.

With the ending of the pandemic, it was no longer appropriate for the HPB to report directly to Chief Officers. In other areas the HPB reported to the Health and Wellbeing Board, and it was proposed that this system of reporting and accountability be put in place in Bromley. An annual report from the HPB was suggested as an appropriate format.

In response to questions, the Director of Public Health advised that the health protection function dealt with communicable and infectious diseases. With regards to the growing issue of damp and mould in housing, the Consultant in Public Health Medicine said that this had not been covered by the HPB to date, and would be an interaction between housing and environmental services. The Director of Public Health advised that the HPB had some statutory responsibilities, and a key function was the management of outbreaks. The HPB was starting to look much wider and environmental health colleagues made up part of its membership. It was suggested that this issue could be put to them for consideration.

RESOLVED that the Health Protection Board report to the Health and Wellbeing Board.

The Chairman advised that discussions had taken place at the Health Scrutiny Sub-Committee on 5^th September regarding the Right Care, Right Person (RCRP) approach – Health Scrutiny Sub-Committee minutes - RCRP – and a further update would be provided to the November meeting. RCRP was a transfer of functions in terms of mental health from police being called to intervene to it being seen as purely an NHS health delivery aspect.

The Chairs of the London Health and Wellbeing Boards had received the proposals from the Assistant Commissioner of the Metropolitan Police. Discussions had then taken place with the four London ICBs, led by North West ICB – as a result the timetable for implementation had been move back to November 2023 and it was recognised that the first year would be a pilot. In response to a question, the Chairman said that this approach had backing from central government. The police emphasised that they were not trained for this and had other priorities, but would be involved if there was threat of violence. The issue was then how this could be picked up by the health service as they did not have the resources either.

RESOLVED that the update be noted.

Councillor Colin Smith returned to the meeting at 2.35pm.

The briefing comprises:

• Alcohol Needs Assessment
• Healthwatch Bromley Patient Experience Report – Q1 2023-24

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 2 reports:

·  Alcohol Needs Assessment

·  Healthwatch Bromley Patient Experience Report – Q1 2023-24

In response to a question regarding the Alcohol Needs Assessment, the Director of Public Health advised that individuals who had an alcohol dependency were considered to have a health condition, but not necessarily a mental health condition. However, individuals with an alcohol or drug dependency often had another mental health condition – this used to be dual diagnosis, having two conditions at same time, but was now referred to as ‘co-occurring’.

The Operations Co-ordinator, Healthwatch Bromley (“Operations Co-ordinator”) advised that the template for the Patient Experience Report had changed significantly this year following feedback gathered. The next report (October-December) would be adjusted in terms of the 1-5 ratings to mirror Healthwatch England. In response to questions, the Operations Co-ordinator advised that as the report was for Q1, and the start of the year, comparisons to the previous quarter had not been included – however comparison data would be referenced in the reports going forward for Q2, 3 and 4. A Member noted that it would be helpful if the comparison to Q4 had been included. The Operations Co-ordinator agreed that this was a valid point, which had been raised with Your Voice in Health and Social Care (YVHSC). The Chairman suggested that as there would be a change in different quarters if may be more beneficial to provide comparative data for the same quarter in the previous year. The YVHSC agreed that this feedback would be passed on to YVHSC.

The Chairman enquired if more complaints tended to be received during the winter period. The Bromley Place Executive Lead confirmed this was accurate and noted there was usually a seasonal approach to complaints. This could often be related to the volume of activity and patients feeling more unwell during the winter period. The issue they had was that sometime the numbers the reports were based on were quite small, and how applicable they were was something being discussed with the Operations Co-ordinator. In response the Operation Co-ordinator said that it would be helpful to have discussions regarding the sample size wanted for stronger representation. The Bromley Place Executive Lead said it was not necessarily the overall numbers, but the inferences drawn if one respondent had a particularly bad experience.

RESOLVED that the Information Briefing be noted.

Report CSD23106

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

The following items would be added to the forward rolling work programme for the Health and Wellbeing Board:

·  Update on the End of Life Programme (date of meeting - TBC)

·  Health and Wellbeing Strategy (18^th April 2024)

With regards to matters outstanding, the Director of Public Health advised that partners had been trying to source the data relating to falls. There was data available, however it was collected in different ways and efforts would need to be undertaken to extract and analyse it. As mentioned during the Integrated Commissioning Board update, work would be undertaken in relation to falls and they hoped to get some more data on the current position. The Chairman said it was hoped they could get data in relation to the number of falls the London Ambulance Service was called out to; the breakdown of age; how many were managed at home; how many were taken to A&E; how many were then sent home; and how many were admitted to hospital.

It was agreed that an update in relation to the proposed free school would be requested from the Education Directorate.

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

The Chairman said he had been notified by several Members that the Health and Wellbeing Board meeting on 1^st February 2024 clashed with key health policy meetings. It was therefore proposed that the meeting be moved back a week, taking place on Thursday 8^th February 2024.

RESOLVED that the issues raised be noted.

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 16^th November 2023

1.30pm, Thursday 8^th February 2024

1.30pm, Thursday 18^th April 2024