Agenda and draft minutes

Venue: Bromley Civic Centre

Contact: Kerry Nicholls  020 8313 4602

Items
No. Item

67.

Apologies for Absence

Minutes:

Apologies for absence were received from Councillor Colin Smith, Harvey Guntrip and Lynn Sellwood.  Apologies for absence were also received from Colin Maclean and Janet Tibbalds attended as his substitute. 

 

The Chairman led the Committee in offering their thanks to the Executive Assistant to the Chief Executive and the Clerk to the Committee who would shortly be leaving the Local Authority.  The Chairman thanked Kerry Nicholls for her exemplary support to the Board and to himself and the Vice-Chairman. She had displayed all the best features of a dedicated public servant and the Board wished to place on record its sincere thanks to her and wish Kerry great success in her new role with the City of London Corporation.

68.

Declarations of Interest

Minutes:

Councillor Marina Ahmad declared that her husband was a General Practitioner who provided Bromley Healthcare services.

69.

Minutes of the Meeting of Health and Wellbeing Board held on 28th November 2018 pdf icon PDF 130 KB

Minutes:

RESOLVED that the minutes of the meeting held on 28th November 2019 be agreed.

70.

Questions by Councillors and Members of the Public Attending the Meeting

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 25th January 2019.

Minutes:

No questions had been received.

71.

Mytime Active Child Weight Strategy Programmes Presentation

Minutes:

The Board received a presentation from Helena Taylor, London Regional Manager: Child Weight Management and Prevention Services and Jalpa Patel, MEND Programme Manager, Mytime Active.

 

Mytime Active was a social enterprise that aimed to improve people’s wellbeing, regardless of their stage of life.  Mytime Active had been delivering health programmes to children and families for over ten years and had engaged with 19,000 families across a number of Boroughs.  Key initiatives included the MEND healthy lifestyle service which took a whole family approach to engaging children and families in activities to improve their health and wellbeing, and included postnatal, universal and targeted services.  MEND in Schools was a bespoke multi-component healthy lifestyle programme delivered in 52 primary schools across six London Boroughs that incorporated healthy eating, physical activity, oral health and sustainable behaviour change.  Mytime Active continued to work to develop its range of MEND programmes and was working with London South East Colleges to design a series of Twilight Clubs to provide physical and creative activities for students and the wider college community. 

 

In response to a question from a Member, the London Regional Manager: Child Weight Management and Prevention Services confirmed that a MEND in Schools six week pilot programme had been successfully delivered in Bromley during 2018, but that no Bromley schools were currently participating in the programme which cost approximately £5-8k.  Work was being undertaken to approach schools individually to create bespoke healthy lifestyle programmes.

 

The Chairman led Board Members in thanking Helena Taylor and Jalpa Patel for their excellent presentation which is attached at Appendix A.

 

RESOLVED that the presentation be noted.

72.

Childhood Obesity Task and Finish Group: Verbal Update

Minutes:

The Chairman provided an update to the Board on the Childhood Obesity Task and Finish Group which had met on 25th January 2019.  It was planned to undertake a gap analysis of childhood obesity provision in Bromley, and the findings of this work would be reported to the next meeting of Health and Wellbeing Board on 21st March 2019.

 

RESOLVED that the update be noted.

73.

Health Support to School Age Children: Update pdf icon PDF 133 KB

Minutes:

Report ECHS19009

 

The Board considered a report by Dr Jenny Selway, Consultant in Public Health Medicine outlining work being undertaken to commission the 0-19 years Public Health Nursing Service from 1st October 2020.

 

The Health Support to Schools service had two elements comprising safeguarding nursing support and strategic health to schools which aimed to minimise the risks of children with health conditions in schools.  In November 2018, the Council’s Executive agreed to extend the existing Health Support to Schools contract for 18 months to align it with the Health Visiting contract.  Schools had been working hard to put individual health care plans in place for all children and young people with identified health needs, and there were now more than 2000 individual health care plans in place for children and young people in Bromley schools.  Work was also being undertaken with the Head of School Nursing to review the questionnaire used by schools to identify children and young people’s health needs.  It was planned to commission a joint 0-19 years Public Health Nursing Service from 1st October 2020, and this was being supported by a multi-agency steering group working to develop the service specification.

 

In considering the report, the Chairman was pleased to note that the needs of children and young people being electively home educated were being included in the work to develop the specification for the new joint service, and the Consultant in Public Health Medicine confirmed that elective home education continued to be a priority area, with 280 electively home educated children and young people resident in the Borough.  When the Health Support to Schools contract was extended, provision had been made to reintroduce a dedicated school nurse for electively home educated children and young people which would initially be focused on new pupils and unannounced home visits would also be undertaken by the school nurse where families chose not to engage with the service. 

 

In response to a question from a Member, the Consultant in Public Health Medicine explained that at approximately 10%, the smoking rates in young people in Bromley were higher than the London and national rates and that this was disproportionately affecting areas of highest deprivation.  This was part of a wider trend of risky behaviour by young people in the Borough which had been identified by the Children’s Joint Strategic Needs Assessment 2019, and a survey was being developed to provide a baseline for the health of secondary-aged pupils which would support effective targeting of future services.  A Member noted the mismatch between the perception of crime and violence and the reality for young people in Bromley, and the Consultant in Public Health Medicine confirmed that young people had a high awareness of issues such as knife crime and violence and that this would be further explored within the survey. 

 

The School Nursing Team was providing support to General Practitioners on safeguarding and was prioritising those GP practices with the highest number of patients with Child Protection Plans.  The reference  ...  view the full minutes text for item 73.

74.

Update on Infant Mortality in Bromley pdf icon PDF 167 KB

Minutes:

Report ECHS19010

 

The Board considered an update by Dr Jenny Selway, Consultant in Public Health Medicine on the infant mortality rate within the Borough.

 

The Health and Wellbeing Board had considered a report on infant mortality at its meeting on 29th March 2019, following the identification of an upturn in infant mortality rates within the Borough in recent years.  The reasons for this had been investigated and had indicated that the variations were due to the small number of infant deaths in Bromley which were very low in comparison with statistical neighbours and were lower the England average. Infant mortality was kept under close scrutiny by the Public Health team as part of health surveillance, as well as by the multi-agency Child Death Overview Panel which scrutinised every child death in Bromley with the aim of identifying any factors of concern. 

 

The Consultant in Public Health Medicine confirmed that the Local Authority was participating in both regional and national databases to collate information relating to infant mortality, and that infant mortality would continue to be monitored closely to identify any concerns at the earliest stages.

 

RESOLVED that the update be noted.

75.

Delayed Transfer of Care (DTOC) Performance Update pdf icon PDF 417 KB

Minutes:

Report ECHS19011

 

The Board considered a report from Stephen John, Director: Adult Social Care providing an update on Delayed Transfers of Care.

 

The performance of Delayed Transfers of Care at the Princess Royal University Hospital had continued to improve.  Positive results had been attained each month during Quarter 3 2018/19, and Delayed Transfers of Care had reduced to 137 total bed days in November 2018 across all areas compared to 553 bed days for the previous year.  This represented 416 total bed days saved compared to the previous year.  Nationally, for 2018 (year to date), Bromley had been responsible for 1746 bed days at an average of 7.1 beds per day. This compared to 3914 bed days or 16 beds per day for the same period in 2017/18, which was a reduction of over 55%.  Bromley was now ranked as the 7th best performing London Borough. 

 

In considering the update, a Board Member was pleased to note the significant improvement in Delayed Transfers of Care performance and noted that this had been supported by a range of work undertaken by key partners including the introduction of the Discharge to Assess pathway.

 

RESOLVED that the update be noted.

76.

Bromley Winter Assurance Plan Update pdf icon PDF 379 KB

Minutes:

Report ECHS19012

 

The Board considered a report from Clive Moss, Urgent Care Lead: Integrated Commissioning, Bromley Clinical Commissioning Group providing an update on the delivery of the Bromley System Winter Plan.

 

The Bromley System Winter Plan had been presented to the Health and Wellbeing Board on 27th September 2018 and aimed to provide a framework for health and social care partners in the Bromley system to manage surge and capacity issues during Winter 2018/19.  For the period of October to December 2018, the Princess Royal University Hospital had not consistently met the 95% 4 hour Accident and Emergency performance target set by NHS England with performance averaging at 76.62%.  For the same period all Type Accident and Emergency attendances had decreased slightly on the previous year and this would continue to be monitored as a potential consequence of community admission avoidance pathways introduced to reduce pressure on the Accident and Emergency system.  There had been a consistent fall of ‘Long Length of Stay’ (more than 7 days) patients between October and December 2018, as well as a reduction in Delayed Transfers of Care which could in part be attributed to the expansion of the Discharge to Assess pathway pilot scheme which enabled patients to leave hospital earlier with temporary packages of care whilst a full assessment was undertaken in the community.  A range of Winter Resilience schemes were in place with the aim of preventing avoidable hospital attendances and admissions, reducing unnecessary readmissions and shortening hospital length of stay for Bromley residents.

 

In considering the report, a Member queried why the Princess Royal University Hospital had not consistently met the 95% 4 hour Accident and Emergency performance target set by NHS England when all Type Accident and Emergency attendances had decreased slightly on the previous year.  The Urgent Care Lead: Integrated Commissioning explained that there was an increasing acuity of need of those presenting to the Accident and Emergency Department, evidenced by the increasing number of ambulance conveyances and greater use of intensive care services.  The South East London region had also continued to experience a number of workforce issues and measures were in place to address this, including work by NHS Improvement to review the organisation of the Accident and Emergency Department at the Princess Royal University Hospital.  The Chairman highlighted that further workforce pressures might be created by the United Kingdom’s withdrawal from the European Union, and a Board Member outlined work being undertaken by key partners including the Association of Directors of Adult Social Services to manage the impact of Brexit on the health and social care workforce.

 

RESOLVED that the update be noted.

77.

Primary Care Commissioning Update pdf icon PDF 109 KB

Additional documents:

Minutes:

 

The Board considered an update from Jessica Arnold, Associate Director: Primary Care, Bromley Clinical Commissioning Group on primary care performance and strategy which included the relative performance and achievement of Bromley’s 45 General Practitioner practices against key locally and nationally commissioned services and measures.  The report also provided an update on progress towards developing a Bromley General Practice Strategy and Action Plan for 2019/20-2020/21.

 

The Bromley Care Performance Dashboard had been developed to enable robust performance monitoring of the key services and targets commissioned by Bromley Clinical Commissioning Group and NHS England, as well as help General Practitioner (GP) practices, commissioners and other stakeholders to have a better understanding of GP practice performance across the Borough.  Key highlights from the dashboard included the identification of a drop of 3-4% in childhood immunisation rates for most immunisations as well as the low rates of flu immunisation of under 65 years ‘at risk’ groups, although Bromley continued to be the highest performer for flu vaccinations within the South East London region.  The dashboard also identified variable levels of GP practice referrals into the proactive care pathway for integrated case management of the most vulnerable patients for which a review would be undertaken in early 2019.  The Bromley General Practice Strategy and Action Plan for 2019/20-2020/21 had been developed to clarify the strategic direction and local priorities for Bromley GP practices and would also outline commissioning intentions for GP practices, as well as funding allocations and bid writing with the aim of supporting the transformation of GP practices within a challenging primary care context.  Alongside the strategy, an action plan would be implemented for delivery of primary care improvement, resilience and transformation into Primary Care Networks within an Integrated Care System.  The Bromley Care Performance Dashboard and General Practice Strategy were in the final stages of development and were expected to be adopted and implemented by Bromley Clinical Commissioning Group in April 2019. 

 

The Chairman welcomed the update and placed it into context alongside recent announcements in the media about the new five-year contract for General Practice across England that would see significant investment made in improving access and offering expanded services, as well as increasing the role of other community services including those offered by pharmacists.  The Associate Director: Primary Care, Bromley Clinical Commissioning Group noted that work was underway to develop clinical and non-clinical roles within General Practice and that this would include the use of physicians’ associates who would support doctors in patient diagnosis and management.  There would be an increased emphasis on signposting patients to the right care to meet their needs, and a Member underlined the need to better promote self-referral services such as the physiotherapy service.  Early intervention services including social prescribing would also help to reduce pressure on GP services.  The Associate Director: Primary Care, Bromley Clinical Commissioning reported that the GP online consultations pilot had been introduced at nine GP practices and that patient feedback had been positive.  There was an increasing uptake of the  ...  view the full minutes text for item 77.

78.

"Bromley CAMHS Trailblazer" - Children and Young People's Mental Health Support Teams and Four-Week Waiting Time Pilots pdf icon PDF 90 KB

Minutes:

Report ECHS19022

 

The Board considered an update from Nazmin Mansuria, Senior Commissioning Manager: Integrated Commissioning and Transformation, Bromley Clinical Commissioning Group on the recent bid to a Trailblazer programme which had been successful in securing funding to establish new Mental Health Support Teams to provide an early intervention and prevention service for children and young people with mild to moderate mental health issues.  Funding had also been secured to trial a four week waiting time to access specialist NHS Mental Health Services for children and young people.

 

In December 2017, the Government published a green paper on ‘Transforming Children and Young People’s Mental Health Provision’ which set out a commitment to expand support for children and young people’s mental health services through three key proposals which comprised incentivising and supporting all schools to identify and train a Designated Senior Lead for mental health, to fund new Mental Health Support Teams and to trial a four week waiting time for access to specialist NHS Mental Health Services for children and young people.  Bromley Clinical Commissioning Group and its partners had submitted a successful bid for £2.1M of Trailblazer pilot funding for 2019-21.  This funding would be used to establish two Mental Health Support Teams that would provide an early intervention and prevention service for children and young people with mild to moderate mental health issues for half the school population in Bromley.  There would be a strong emphasis on bringing all schools together to enable learning to be shared across the Borough and learning events would be held throughout the course of the pilot scheme.  There would be a redesign of existing care pathways into Specialist Community Child and Adolescent Mental Health Services in Bromley to meet a four week waiting time target from referral to initial assessment.  This would build on wider system-based transformation work that was already underway including improvements to care pathway interfaces and joint working practices with key partners such as the Bromley Wellbeing Service.

 

The Senior Commissioning Manager: Integrated Commissioning and Transformation, Bromley Clinical Commissioning Group advised that preparation was underway to launch the pilot schemes as soon as the Trailblazer pilot funding was released, and that governance structures and delivery teams were already in place. 

 

The Chairman commended the work of Bromley Clinical Commissioning Group and its partners in successfully securing Trailblazer pilot funding that would enable the development of innovative and sustainable mental health services across the Borough, and contribute towards the national approach to providing child and adolescent mental health support. 

 

In response to a question from a Board Member, the Senior Commissioning Manager: Integrated Commissioning and Transformation confirmed that the early intervention and prevention service for children and young people with mild to moderate mental health issues would be developed in partnership with schools and service users to provide mental health support in an holistic way.  Around 40-50 Bromley schools would participate in the pilot scheme via two clusters of approximately 20 schools.  The establishment of peer support and parenting groups would  ...  view the full minutes text for item 78.

79.

Update on Implementation of the Recommendations of the Falls Task and Finish Group

Minutes:

The Sub-Committee considered an update from Dr Nada Lemic, Director: Public Health on the implementation of the recommendations of the Bromley Task and Finish Group.

 

The Falls Task and Finish Group had been 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.  Chaired by Professor Cameron Swift, the final report of the review had made a number of recommendations including improving data management and systems, increased case identification and referrals to prevention services, and workforce development and collaboration across services which had been supported by the Health and Wellbeing Board and Integrated Commissioning Board. 

 

The Director: Public Health confirmed that work was underway to develop a multi-agency action plan to be taken forward by a Bromley Joint Working Group.  Further updates on progress in agreeing and delivering the final action plan would be provided to future meetings of the Integrated Commissioning Board and the Health and Wellbeing Board.

 

RESOLVED that the update be noted.

80.

Young People's Survey Presentation

Minutes:

The Board received a presentation from Benjamin McGowan, Bromley Youth Council on the young people’s ‘Make Your Mark’ survey.

 

Every year the UK Youth Parliament ran the ‘Make Your Mark’ campaign to enable young people to choose the issues most important to them from a shortlist of ten issues.  The Bromley Youth Council had distributed the survey to young people across the Borough with 9,110 votes being cast, representing a 30.5% turnout of all 11-18 year olds.  The top three issues in Bromley were ‘End Knife Crime’, ‘Mental Health’ and ‘Period Poverty’ which reflected the top three priorities within the London region and nationally.

 

The Chairman congratulated the Bromley Youth Council for the exceptionally high response to the ‘Mark your Mark’ survey. 

 

In considering the presentation, the Chairman confirmed that knife crime and mental health were key priorities of the Local Authority and its partners, and that the survey provided a timely reminder of the public health aspects of youth violence.  The Director: Public Health was reassured that the key priority issues of youth violence and mental health had also been identified as priority areas within the Children’s Joint Strategic Needs Assessment 2018, which suggested that the data being used to inform strategies was accurate.

 

Board Members generally discussed the issue of period poverty which had not previously been identified as a key concern with the Borough.  A Board Member advised that a voluntary sector scheme, the Red Box Project, was in operation in the majority of secondary schools and some primary schools in the Borough which aimed to ensure no young person missed school due to their period by providing free menstrual products, and suggested that all Bromley schools be encouraged to participate in the scheme.  A Member noted that having to request menstrual products at school could be embarrassing for young people, and praised a pilot scheme at the Ravensbourne School where free menstrual products would be made available in a specific location without young people having to request them; the Member suggested that this pilot scheme be rolled out to other schools across the Borough.  The Bromley Youth Council Representative reported that at its Full Council meeting on 30th January 2019, the Royal Borough of Greenwich had agreed a motion to fight period poverty in a range of ways including by supporting the Red Box Project and that this was reflected in action taken by a number of local authorities across the United Kingdom.  A Board Member stressed the impact of period poverty on young people’s physical and mental health and suggested that links be made with General Practitioners around this issue. 

 

The Bromley Youth Council Representative gave anecdotal evidence around the lack of information provided to some young people around menstruation and underlined the need for schools to ensure that young people were well-informed, suggesting that this learning could be given at a fixed point within the primary school curriculum.  The Interim Director: Children's Social Care proposed that this issue be raised with the  ...  view the full minutes text for item 80.

81.

Bromley Communications and Engagement Network – Activity Report pdf icon PDF 55 KB

Additional documents:

Minutes:

The Board considered an update from Tim Spilsbury, Chairman, Bromley Communications and Engagement Network and Susie Clark, Communications Executive (LBB) on the activity of the Bromley Communications and Engagement Network during 2018.

 

The Bromley Communications and Engagement Network had been established in 2014 as an operational group bringing together communication and engagement representatives from across the Bromley statutory and voluntary sector to share work ideas and best practice, as well as delivering joint campaigns, information and engagement activities.  The Network also worked to help local people to improve community health and wellbeing, and support agreed Borough priorities and other community initiatives.  During 2018, there had been a significant increase in the membership of the Bromley Communications and Engagement Network which now included the Fire Service, Metropolitan Police Service and local schools and colleges.  The Network had met on a regular basis to share information and advertise high profile campaigns, encourage wider participation of public surveys, and promote public events and high profile meetings which was supported by the use of an engagement tracker.  Work planned for 2019 included promoting primary and domiciliary care services, as well as engaging service users with the opportunities available through Direct Payments. 

 

In response to a question from a Board Member, the Chairman, Bromley Communications and Engagement Network confirmed that the Bromley Communications and Engagement Network had no direct funding, but that the Bromley Clinical Commissioning Group provided administrative support to the Network.  A Board Member emphasised the vital importance of engaging patients with any plans to develop new care pathways and commended the work of the Network in informing and engaging Bromley residents.  Another Board Member was pleased to note the work undertaken by the Network to bring partners together in promoting key health and wellbeing messages.

 

RESOLVED that the update be noted.

82.

Health and Wellbeing Board Information Item

The Information Item comprises:

82a

NHS Ten Year Plan pdf icon PDF 381 KB

The full Plan is available for Board Members to view at:

 

https://www.longtermplan.nhs.uk/

Additional documents:

Minutes:

There was one Health and Wellbeing Board Information item comprising:

 

  • NHS Ten Year Plan

 

RESOLVED that the Information Briefing be noted.

83.

Matters Arising and Work Programme pdf icon PDF 92 KB

Minutes:

Report CSD19005

 

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 Health and Wellbeing Board on 21st March 2019:

 

·  Childhood Obesity Task and Finish Group: Update

·  Ravensbourne School’s Period Poverty Pilot Scheme: Update

 

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

84.

Any Other Business

Minutes:

There was no other business.

85.

Date of Next Meeting

1.30pm, Thursday 21st March 2019

Minutes:

The next meeting of the Health and Wellbeing Board would be held on Thursday 21st March 2019

Appendix A: Mytime Active Child Weight Strategy Programmes Presentation pdf icon PDF 1 MB

Appendix B: Young People's Survey Presentation pdf icon PDF 1 MB

 

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