Agenda and minutes

Apologies for absence were received from Councillor Robert Evans, Paul Feven and Stephen John.

Apologies for absence were also received from Janet Bailey and Dr Angela Bhan, and Carol Whiting and Mark Cheung attended as their respective substitutes.

Councillor David Jefferys declared that he had recently attended the London Youth Games as a guest of Mytime Active, although this is already listed in the Members' Declaration of Interests.  The Chairman drew Members’ attention to the success of the Bromley Youth Team in winning the Youth Games 2018, and securing a third successive top team position.  He had written on behalf of the Board to congratulate the team, coaches and managers.

RESOLVED that the minutes of the meeting held on 7^th June 2018 be agreed.

In accordance with the Council’s Constitution, questions to this Committee must be received in writing 4 working days before the date of the meeting.  Therefore please ensure questions are received by the Democratic Services Team by 5.00pm on Friday 13^th July 2018.

No questions had been received.

The Board received a presentation from Matthew Eady, Regional Manager (Bromley and South), Helena Taylor, London Regional Manager: Child Weight Management and Prevention Services, Debra Weekes, Mytime Partnerships Manager and Ann Wilbourn, Primetime Manager, Mytime Active on health and wellbeing initiatives being delivered by Mytime Active.

Mytime Active was a social enterprise that aimed to improve people’s wellbeing, regardless of their stage of life.  Mytime Active offered a wide range of provision across the Borough including fitness and leisure activities as well as breakfast and after school clubs, and had established a Wellbeing Hub at the Spa Leisure Centre that aimed to support people of all ages and fitness levels to improve their wellbeing through becoming more active, eating healthily, developing a more positive approach to life and socialising with others.  Key initiatives included Primetime which was a scheme supporting older people to become more active and participate in social events.  A number of programmes were available to children and young people including swimming, soft play and the London Youth Games, and programmes to promote healthy lifestyles were also available to children and young people and their parents.  Targeted initiatives available to specific groups of young people included sports and music programmes delivered via MyFuture, Arts Train and Bromley Y, and a free leisure offer and training and apprenticeship programme for children looked after.

The Portfolio Holder for Children, Education and Families was pleased to note the variety of universal and targeted Mytime Active programmes available to children and young people, and emphasised the close working links between the Local Authority and Mytime Active, which included representation on the Local Authority’s Corporate Parenting Board.

In response to a question from the Chairman regarding Mytime Active’s work in reducing social isolation, the Primetime Manager advised the Board that the Primetime scheme was promoted as widely as possible to encourage more older people to become involved including via the volunteers programme, advertising at community events and presentations to residents’ associations and other community groups.  A Board Member reported that the Bromley Safeguarding Adults Board had identified older men as being more vulnerable to social isolation and was developing a project to address this vulnerability.  The Regional Manager (Bromley and South) confirmed that Mytime Active undertook a range of work with older men including a nationally recognised programme encouraging older men to participate in golf, and would be pleased to link in with this project.  A Board Member announced that as part of Jo Cox’s legacy, a £20M fund had been made available to charities and community groups to support groups to understand the impact of their work and share best practice about how to prevent loneliness.  Charities would be able to apply for a grant from the Building Connections Fund until the end of December 2020, and this represented an opportunity for Bromley-based charities and community groups to undertake further work to address social isolation in the Borough.

In response to a question from a Member, the Regional Manager (Bromley and  ...  view the full minutes text for item 21.

Report CS18159

The Board considered the final report of the Falls Task and Finish Group.

The Falls Task and Finish Group was convened by the Health and Wellbeing Board to investigate the number and types of falls affecting Bromley’s older population and consider falls prevention work in Bromley, including assessing the level of collaboration across primary, secondary, community and social care providers.  The review was chaired by Professor Cameron Swift and a range of work had been undertaken including data analysis to establish falls epidemiology in the Borough and meetings with primary, secondary, community and social care partners.  The final report of the Falls Task and Finish Group presented a number of recommendations including improving data management and systems, data sharing to identify a strategy to reduce falls in the Borough, increased case identification and referrals to prevention services, workforce development and collaboration across services.  It was proposed that the final report of the Falls Task and Finish Group be presented to the Integrated Commissioning Board and that a Bromley Joint Working Group be established to take forward the recommendations of the review within a specified timescale.

In considering the report, a Member stressed the high number of locums and agency staff within primary care and underlined the importance of ensuring that General Practitioners and healthcare organisations were made aware of the support services available to encourage falls referrals.  Another Member noted the value of information sharing between health agencies.  Mark Cheung, Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group suggested that the proposals reflected the move towards increasingly integrated service models between key health partners, and that there was a need to remove artificial divides between health and social care services.  Another Board Member highlighted that the cohort most vulnerable to falls was often reluctant to engage with services until the point of crisis, and that key messages around falls prevention should be conveyed in different ways, such as via residents’ associations or community publications.  A number of private companies provided health and social care support to Bromley residents and these companies should also be made aware of falls prevention work in Bromley.  Another Member suggested that the built environment of care homes be assessed to minimise the risk of falls by care home residents.

A Board Member recognised the link between falls and loss of confidence and noted that this could lead to increased risk of social isolation.  From a safeguarding perspective, domestic abuse could also be a causative factor of falls in some cases and partners should be made aware of this.

Members requested that regular updates be provided to the Health and Wellbeing Board to ensure that the recommendations of the Falls Task and Finish Group were delivered in a timely way.  To support this, the Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group agreed to act as Lead Officer for this workstream and an update on the Falls Task and Finish Group would be included as part of the regular update to the  ...  view the full minutes text for item 22.

The Children’s Joint Strategic Needs Assessment 2018 is available on the Council’s website at the following link:

http://cds.bromley.gov.uk/ieListDocuments.aspx?CId=559&MId=6529&Ver=4

Report CSD18160

The Board received a presentation from Dr Jenny Selway, Consultant in Public Health on the draft Children’s Joint Strategic Needs Assessment 2018.

The Local Authority and NHS Primary Care Trusts had a statutory requirement to produce a Joint Strategic Needs Assessment which aimed to develop an understanding of the current and future health and wellbeing needs of the population to support the setting of strategic priorities in the short and longer term and to inform local commissioning across health and social care.  The Children’s Joint Strategic Needs Assessment 2018 explored factors affecting health and wellbeing of children and young people in Bromley and had identified a number of key issues including health, mental health, social and lifestyle issues of parents and carers, a reduction in some protective factors including breastfeeding and immunisation rates, and health, mental health, social and lifestyle issues of children and young people including childhood obesity, substance misuse and mental health and wellbeing issues such as self-harm. It was proposed that the findings of the Children’s Joint Strategic Needs Assessment 2018 contribute towards the new Joint Health and Wellbeing Strategy in 2018.

In considering the report, the Chairman was concerned to note the findings in relation to substance misuse.  The Consultant in Public Health Medicine confirmed that schools had a number concerns around substance misuse by young people and that work would be undertaken with schools to further explore this issue. The Chairman suggested that the Bromley Youth Council be approached to contribute towards this exploration.  Another Member noted that previous work by the Bromley Youth Council had identified a ‘disconnect’ between young people and the police, and that it was important to support young people to build good relationships with the police.  A Board Member commented that in his personal experience as a General Practitioner, young people were often referred to support services before the involvement of primary care services but General Practitioners should be made aware of emerging health issues for children and young people in the Borough, as well as the full range of support available.

The Chairman noted that the findings of the Children’s Joint Strategic Needs Assessment would contribute towards the Draft Health and Wellbeing Strategy that would be considered at the next meeting of Health and Wellbeing Board on 27^th September 2018 along with a number of other items relating to the health and wellbeing of children and young people.

The Chairman led Members in thanking Dr Jenny Selway for her presentation which is attached at Appendix B.

RESOLVED that:

1)  The draft Children’s Joint Strategic Needs Assessment 2018 be approved; and,

2)  The findings of the Children’s Joint Strategic Needs Assessment 2018 feed into a new Joint Health and Wellbeing Strategy in 2018; in particular the Board highlighted the need for the strategy to address the issues of childhood obesity, adolescent mental health, misuse of drugs and the anxieties over violence. 

The Chairman gave an update on work underway to explore the key issue of childhood obesity.  This included a meeting that had been arranged with Mr Ashish Desai, Consultant Paediatric Surgeon, King’s College Hospital NHS Foundation Trust in August 2018.  Mr Desai would be attending the next meeting of the Health and Wellbeing Board on 27^th September 2018 to lead a discussion on childhood obesity.

RESOLVED that the update be noted.

Report CS18161

The Board considered the findings of an evaluation of the Community Alcohol Pathway Pilot Programme and proposals to mainstream the Community Alcohol Pathway.

The Community Alcohol Pathway had been designed to address the increasing prevalence of harmful alcohol consumption in Bromley, improving the low treatment rates for alcohol users and supporting closer working between primary care and the specialist substance misuse treatment service.  Delivered by Change Grow Live, the current provider of substance misuse services for adults and young people, the five month Pilot Programme commenced in January 2018 and was delivered at three General Practitioners Surgeries comprising Broomwood Surgery, Elm House Surgery and Cator Medical Centre.  During the course of the pilot, 36 clients had been referred to the Community Alcohol Pathway, with 27 clients completing the assessment process.  Of those clients completing the assessment process, 13 had been identified as drinking at harmful and hazardous levels, 11 of which had engaged with treatment with 9 successfully completing treatment and reducing their alcohol consumption to safe drinking levels.  14 clients who had completed the assessment process had been identified as drinking at dependent levels and were referred for structured treatment at the substance misuse service with 11 clients still engaged in treatment via Harm Reduction Groups or Pre-Detox Groups.  The Community Alcohol Pathway had been included in the specification for the new contract for the Adult Substance Misuse Service and it was planned to use the findings of the Pilot Programme to inform the mobilisation of the new contract.

The Assistant Director: Public Health underlined the importance of raising public awareness of the harmful effects of substance misuse.

A Board Member noted that delivering the Pathway via General Practitioners Surgeries had reduced the stigma of accessing substance misuse services and that community-based services were often easier to access for service users.  The Board Member emphasised the need to ensure better coverage of the scheme across the Borough, and the Assistant Director: Public Health confirmed that work was underway to identify and establish a number of Community Alcohol Pathway hubs across the Borough.

RESOLVED that:

1)  The findings from the evaluation of the Community Alcohol Pathway Pilot Programme be noted; and,

2)  The Community Alcohol Pathway be supported and promoted amongst partners.

Report CS18163

Mark Cheung, Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group presented an evaluation of £628k of services commissioned to provide additional capacity and help manage increased seasonal demand during Winter 2017/18.

The Bromley Clinical Commissioning Group had commissioned a range of schemes that enhanced and provided additional capacity for key health services during Winter 2017/18.  The commissioned schemes were targeted towards admission avoidance, patient flow and primary care, and included a Community Matron resource, packages of care and emergency placement support and an additional Discharge Coordinator to reduce Delayed Transfers of Care.  Investment had also been made in Urgent Care Centres to maximise the efficiency of primary care services which had been supplemented by an increased number of General Practitioner home visits, with 274 patients visited in their own home as at the end of January 2018.  There had been a significant increase in attendance of health services during Winter 2017/18, and although performance had not met national standards it had been higher than in previous years and showed a considerable improvement in responsiveness and recovery rates.  Work was underway to identify learning from Winter 2017/18 that could benefit future planning, and this was likely to include earlier planning and mobilisation of schemes and the use of existing service provision to develop an integrated urgent and emergency care system in the community to reduce the need for hospital-based care and support.

In considering the update, the Portfolio Holder for Adult Care and Health Services noted that increased demand for health services did not just impact the Christmas period, which was why many winter services had been designed to run until the end of April each year.

 In response to a question from the Chairman, the Programme Director: Integrated Care Services, Bromley Clinical Commissioning Group confirmed that the Bromley Clinical Commissioning Group’s response to managing the health impact of the recent heatwave was set out in its Adverse Weather Response Plan.  The Bromley Clinical Commissioning Group worked closely with key partners to ensure the right measures were in place to address health issues caused by a sustained period of hot weather.  The Director: Public Health reported that the Local Authority had established a system by which messages and advice from Public Health England was provided to all care homes and domiciliary care providers across the Borough.

RESOLVED that the update be noted.

Report CSD18038

The Board considered an update on the performance of the Better Care Fund 2017/18 up to the end of March 2018, including expenditure and activity levels.

The Better Care Fund was a programme spanning the NHS and the Local Authority which aimed to join up health and care services to support people to manage their own health and wellbeing and live independently in their communities for as long as possible.  Developed by the Local Authority and Bromley Clinical Commissioning Group, Bromley’s Better Care Fund 2017-19 Local Plan had been endorsed by the Health and Wellbeing Board at its meeting on 7^th September 2017 and formally approved by NHS England on 27^th October 2017.  The Better Care Fund allocation for Bromley for 2017/18 was £22.1M which was being used to fund a number of locally agreed schemes including additional capacity for Reablement Services, the Dementia Universal Support Service, Health Support for Care Homes and Extra Care Housing and Early Intervention and Self-Management schemes to support people to maintain their independence in the community for longer.  Schemes providing carer support services and community equipment were also funded and the Local Authority and Bromley Clinical Commissioning Group would continue to work towards the increasing integration of health and social care.

In considering the report, the Chairman underlined the need to raise public awareness of the positive impact of schemes funded by the Better Care Fund.  Revised performance data for Bromley Well for the period of October 2017 to March 2018 that had been included in the report at Paragraph 4.29 would be provided to Board Members following the meeting.

Board Members were advised that future performance updates on the Better Care Fund and Improved Better Care Fund would be presented in a joint report. 

RESOLVED that the report be noted.

Report CSD18094

The Board considered its work programme for 2018/19 and matters arising from previous meetings.

A number of items were added to the forward rolling work programme for the meeting of Health and Wellbeing Board on 27^th September 2018 as outlined below:

·  Bromley Local CAMHS Transformation Plan

·  Draft Health and Wellbeing Strategy

A number of existing items on the forward rolling work programme for the Health and Wellbeing Board were also rescheduled. 

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

The Chairman led Board Members in considering new themes to be added to the Health and Wellbeing Board Work Programme 2018/19. 

RESOLVED that the Health and Wellbeing Board Work Programme 2018/19 be updated to reflect Members’ comments.

There was no other business.

1.30pm, Thursday 27^th September 2018

1.30pm, Wednesday 28^th November 2018

1.30pm, Thursday 31^st January 2019

1.30pm, Thursday 21^st March 2019

The next meeting of the Health and Wellbeing Board would be held at 1.30pm on Thursday 27^th September 2018.