Agenda and draft minutes

Apologies for absence were received from Charlotte Bradford and Jane Walters attended as substitute. Apologies for absence were also received from Rachel Dunley and Dr Andrew Parson.

Apologies were received from Angela Helleur (King’s College Hospital NHS Foundation Trust) and Debbie Hutchinson attended as substitute. Apologies were also received from Jacqui Scott (Bromley Healthcare).

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 4^th April 2024. 

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 12^th April 2024.

One questions had been received from a member of the public for written reply and is attached at Appendix A.

RESOLVED that the minutes of the meeting held on 8^th February 2024 be agreed.

To follow

The Chairman noted that this item had been withdrawn and would be presented to a future meeting.

The Chairman welcomed Mark Cheung – One Bromley Programme Director (SEL ICB), Rachel Perry – Head of Integrated Services (SEL ICB) and Lindsay Pyne – Head of Adult Therapies (BHC) to the meeting to provide an update on the Post-COVID syndrome services.

The One Bromley Programme Director informed Board Members that the Bromley Post-COVID services were an integrated system, with acute service delivered by the PRUH and community services provided through Bromley Healthcare with input from primary care and voluntary sector colleagues.

The Head of Adult Therapies advised that the Post-COVID community pathway provided a high quality and effective services for those diagnosed, and those still living with Post-COVID syndrome. The service would continue for the current financial year and the staffing within the community services had been expanded with additional roles added. The service continued to receive referrals, with an increase having been seen over recent months – patients were assessed within a week of referral. The service received approximately 5 referrals per week and the current total caseload stood at around 150 active patients. The 11-week programme, living with Post-COVID syndrome, continued to be delivered – feedback was gathered from participants and the contents of the programme was regularly amended to reflect this. A project had also recently been undertaken looking at patients who had received the basic service and 50% were still living with Post-COVID syndrome having been discharged – these patients had been brough back into the case load and were receiving 1-2-1 interventions. There were two peer support groups located in different area of the borough, which were very successful, and now being supported by ‘patient champions’. Representatives had attended the second Long COVID Conference where a peer support poster had been presented, and they would be participating in a number of upcoming events.

The Head of Integrated Services provided feedback on behalf of Dr Lynette Linkson – Consultant at King’s College Hospital NHS Foundation Trust:

-  there were some vacancies within secondary care service, but a new therapist had been appointed from June 2024.

-  assessments were being completed in the community, with fortnightly multi-disciplinary team meetings taking place.

-  patients can either be seen in the community or secondary care service for follow up treatment, as appropriate.

-  in February 2024, the COVID Recovery Puzzle films had been launched across SEL covering themes to deal with particular conditions: https://www.youtube.com/playlist?list=PLcaVWbSw-0R1-Cactd7LZy-hM6HjR1RYI

-  a workshop event had recently been held across SEL to consider the future of Post-COVID services, attended by a range of representatives including healthcare professionals and service users. The aim was to look at ways to make services more accessible and a number of themes identified – a follow up session would be taking place on 9^th May 2024.

It was noted that a full report on the Post-COVID pathway would be provided to the Health and Wellbeing Board meeting on 27^th June 2024 and would include information on patient feedback and future service development plans. The One Bromley Programme  ...  view the full minutes text for item 58.

Report ACH24-023

The Public Health Intelligence Analyst presented the Bromley Suicide Audit, A Trend Analysis 2024 to the Board.

The Bromley Suicide Prevention Steering Group met regularly and were responsible for developing a Suicide Prevention Plan with an accompanying action plan. A link to the current plan had been provided 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, ready for publication in 2025 – in preparation, the Public Health Intelligence Team had conducted a review and audit of the Suicide and Self-Harm data for the borough. Conclusions drawn included:

-  suicide rates in Bromley fluctuated annually, averaging around 21 suicides per year, requiring continuous prevention efforts;

-  men were disproportionately affected by suicide, while intentional self-harm rates were higher among women and young people;

-  common suicide methods in Bromley included hanging, strangulation, or suffocation, emphasising the need for targeted interventions;

-  hospital admissions for intentional self-harm were highest among girls aged 0 to 18 years, necessitating early intervention;

-  there was an increase in intentional self-harm admissions among individuals from "Black" or "Other" ethnic backgrounds;

-  older residents (aged 65 and over) with fewer self-harm admissions were at higher risk of subsequent suicide, requiring tailored support; and,

-  deprivation was associated with hospital admissions for intentional self-harm, particularly in specific wards like Penge and Cator and Cray Valley East, highlighting the need for targeted interventions.

In response to questions, the Public Health Intelligence Analyst advised that other demographics could be considered, however there was currently only very limited data available on sexual identity and disability. With regards to statistics on the number of people who died by suicide being known to services, some had access to mental health services however the level of support received would need to be investigated further. The Member noted that this would be useful to monitor – a key area was prevention and if already known to services consideration should be given as to whether the support provided was adequate. A Board Member noted that acute mental health services would record each suicide within their service and therefore may be able to provide some data in relation to this. The Director of Public Health advised that the data received for the audit was anonymised – in the past there had been an agreement with the Coroner’s Office to look at each record in depth, however this had been stopped nationally. It was noted that the department had links to other partner organisations and social care colleagues – mental health was one of the risk factors of suicide and they would actively seek to widen the work undertaken to inform the Suicide Prevention Plan.

In response to questions regarding the connection between self-harm and suicide, the Public Health Intelligence Analyst advised that self-harm data was included to give an indication of the risk of suicide –  ...  view the full minutes text for item 59.

The Director of Nursing – PRUH and South Sites (King's College Hospital NHS Foundation Trust) advised that a review of the stoma advise issued to patients by Stoma Care Nurses had been undertaken. Board Members were informed that:

-  every patient with a new stoma within their care was provided a RADAR key which allowed them access to a disabled toilet where they could access the sanitary bin;

-  for patients with an ileostomy bags, they were advised to empty their bags in the toilet and just flush;

-  for patients with a colostomy bag, they were advised to use a disposal bag and throw in a bin;

-  it should be noted that the contents in a bag did not have to be disposed of in a clinical waste bin, as long as it was in a bag, then it could be disposed in a general waste bin.

In response to a question from the Chairman, the Bromley Place Executive Director advised that this group of patients were overseen by the hospital and therefore the advice for those in the community remained the same.

A Member noted that Prostate Cancer UK were running a campaign for more sanitary bins to be installed in male toilets. The Chairman considered that good advice was being provided to stoma patients and was widely available – the provision of sanitary bins within male toilets may need to be referred to Environmental Services.

The Chairman thanked the Director of Nursing and Bromley Place Executive Director for their update to the Board.

RESOLVED that the update be noted.

Report ACH24-022

The Board considered a report providing a summary of the current work of the Integrated Commissioning Board (ICB).

The ICB 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 drew to the attention of  Board Members some of the recent successes of the Integrated Commissioning Board in relation to mental health services. In March 2024 a joint contract had been awarded to provide housing support and rehabilitation services for adults with mental health issues. In the coming weeks they would also be going out to market to recommission the community-based mental health services for adults, including providing employment support projects and housing support services for adults with mental ill-health. With regards to children and young people’s services, they were continuing to work to respond to demand post pandemic and had introduced a single point of access across the Bromley Y preventive services and Oxleas NHS Trust. It was noted that work on new strategic needs assessments for adults and children’s mental health and children with learning disabilities were underway and would be presented later in the year. This would provide a baseline of the work being undertaken in the community and impact the next stage of development for integrated services.

In response to questions, the Assistant Director for Integrated Commissioning advised that the care homes market position statement would be completed later in the year. Local authorities had a specific responsibilities, such as ensuring there was a sufficient care homes market available for local people. A significant amount of work had been undertaken to support care homes, including the dedicated GP service for care homes and support in relation to digitalisation. A block contract had also been introduced to provide 20 beds and support was provided in relation to Discharge to Assess.

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

RESOLVED that the update be noted.

Report ACH24-025

The Public Health Registrar delivered a presentation on the Annual Public Health Report 2023, a copy of which is attached at Appendix B.

Each year, the Director of Public Health had a statutory duty to produce an Annual Public Health Report looking at the health and wellbeing of the community. This year, the Annual Public Health Report was titled ‘The Prevention Journey through NHS Health Checks and Beyond’. The report took an in-depth look at the 23 years of work carried out in Bromley in the prevention, early detection and management of risk factors for cardiovascular disease (CVD) and other non-communicable diseases, culminating in the NHS Health Checks programme.

This year’s report highlighted the impressive work of GP surgeries and partners across the Borough, who had delivered more than 56,000 NHS Health Checks over the last 10 years. Of note was the impressive post-pandemic recovery of the NHS Health Checks programme. Last year Bromley more than tripled the proportion of eligible people invited for Checks, reaching pre-pandemic levels of invitation. At the same time the absolute number of health checks more than doubled, from 1,933 checks in 2021/22 to 4,966 checks in 2022/23.

The data in the report aimed to support partners across Bromley to continue delivering a high-quality health programme to residents, learn from best practices, and find new ways to innovate and improve, such as digital health checks and improved ‘call and recall’.

In response to questions, the Director of Public Health advised that each year a quarterly report was produced by GP practices on all patients seen – a follow up audit was also undertaken, including treatment received and identifying and key risk factors such as hypertension and high blood pressure. It was noted that patients completing a health check were recalled every 5 years. Each risk factor had a programme attached – for example advice/signposting to weight management programmes was provided in relation to obesity, and management/treatment for hypertension.

In response to questions regarding digital apps, the Director of Public Health said that the piloting of controlled programmes and apps for digital health checks was something that may been seen in the borough in future. Part of the programme would also include evaluating other health apps.

The Chairman thanked the Public Health Registrar for the presentation to the Board. It was suggested that the Annual Public Health Report be presented to Full Council, and it was agreed that the Director of Public Health would investigate this possibility.

RESOLVED that the publication of the Annual Public Health Report be acknowledged and promoted with relevant stakeholders.

Board Members had been provided with a copy of the Chairman’s annual report of the Health and Wellbeing Board 2023/24 prior to the meeting. The document captured the issues that had been addressed throughout the year and would be presented to the meeting of Full Council in July 2024.

RESOLVED that the report be noted.

The briefing comprises:

• Healthwatch Bromley Patient Experience Report – Q3 2023-24
• Update on the Joint Strategic Needs Assessment

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:

·  Healthwatch Bromley Patient Experience Report – Q3 2023-24

·  Update on the Joint Strategic Needs Assessment

In response to a question, the Director of Public Health advised that proposals for the inclusion of additional JSNA chapter content would be presented to the Health and Wellbeing Board meeting in June 2024.

RESOLVED that the Information Briefing be noted.

Report CSD24048

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

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

• Bromley Suicide Prevention Plan and Action Plan (6^th February 2025)
• Strategic needs assessments for adults and children’s mental health and children with learning disabilities (19^th September 2024)
• Proposals for additional JSNA chapter content (27^th June 2024)

In response to a question, the Director of Public Health advised that the Outbreak Management Plan would be provided as part of the Annual Update from the Health Protection Board. This would be presented to the Board meeting in November 2024.

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

Board Members were advised that the Chairman would be stepping down to take on another role within the Council. The Chairman extended his thanks to Board Members and officers for their support and participation over a number of years.

RESOLVED that the issues raised be noted.

1.30pm, Thursday 27^th June 2024

1.30pm, Thursday 19^th September 2024

1.30pm, Thursday 14^th November 2024

1.30pm, Thursday 6^th February 2025

1.30pm, Thursday 24^th April 2025

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

1.30pm, Thursday 27^th June 2024

1.30pm, Thursday 19^th September 2024

1.30pm, Thursday 14^th November 2024

1.30pm, Thursday 6^th February 2025

1.30pm, Thursday 24^th April 2025