Agenda and draft minutes

Venue: Bromley Civic Centre

Contact: Jo Partridge  020 8461 7694

Items
No. Item

8.

APOLOGIES FOR ABSENCE AND NOTIFICATION OF SUBSTITUTE MEMBERS

Minutes:

Apologies for absence were received from Councillor Keith Onslow and Councillor Christine Harris attended as his substitute. Apologies were also received from Councillor Robert Mcilveen, Justine Jones and Lynn Sellwood.

9.

DECLARATIONS OF INTEREST

Minutes:

There were no declarations of interest.

10.

QUESTIONS FROM COUNCILLORS AND MEMBERS OF THE PUBLIC ATTENDING THE MEETING

In accordance with the Council’s Constitution, questions that are not specific to reports on the agenda must have been received in writing 10 working days before the date of the meeting. 

 

Questions specifically relating to reports on the agenda should be received within two working days of the normal publication date of the agenda. Please ensure that questions specifically on reports on the agenda are received by the Democratic Services Team by 5pm on Wednesday 2nd October 2019.

 

Minutes:

No questions had been received.

11.

MINUTES OF THE MEETING OF HEALTH SCRUTINY SUB-COMMITTEE HELD ON 2ND JULY 2019 pdf icon PDF 111 KB

Minutes:

RESOLVED that the minutes of the meeting held on 2nd July 2019 be agreed.

12.

PRESENTATION BY THE CHARTWELL CANCER TRUST

Minutes:

Michelle Simpson – The Chartwell Cancer Trust presented an overview of the fundraising work currently being undertaken by the charity.

 

The Chartwell Cancer Trust was founded in 2005 by Michael Douglas, after he had undergone treatment in the Chartwell Unit at the Princess Royal University Hospital (PRUH) and had been struck by how understaffed the unit was. Ever since, The Chartwell Cancer Trust had funded additional medical staff specifically for the unit. As a small charity they were able to say “yes” to requests quickly, and had become the “go to place” when fundraising campaigns were needed. A lot of work took place behind the scenes, including the funding of four specialist haematology clinics a week, and fundraising £80k to help make the layout of the treatment suite at the Chartwell Unit more accessible.

 

The Chartwell Unit consisted of an inpatients’ ward, outpatients and a treatment suite. There was no longer a treatment offer for children, as this had been moved to the Queen Elizabeth Hospital (QEH) – Woolwich, Kings College Hospital and Croydon University Hospital. Through their fundraising, The Chartwell Cancer Trust provided support to these out of borough children’s wards including: additional staff, medical equipment, training for the nursing staff, coffee machines, toys, games, DVD’s, books, and arts and crafts. Childhood Cancer Support Groups had been set up in Bromley, which included regular monthly meet-ups and parties at Christmas, Easter and Halloween. These events provided families with the opportunity to make special memories together, and allowed them to have some “normal” time with other families in similar situations. The Bromley events had been so successful that they had also established them for the three children’s wards.

 

The Chartwell Cancer Trust had a number of capital projects currently running for the PRUH. In February 2019, they had been approached by the PRUH to raise £80k to purchase a state of the art breast scanner. As the machine had been so vital, funding already raised had been moved across to make the purchase and fundraising was taking place retrospectively. Other projects had included fundraising £350k for the upgrade of the Endoscopy Unit at the PRUH and £250k for a Virtual Conferencing Facility which linked Guy’s, St Thomas’, King’s and the PRUH. A Member noted the fantastic work that The Chartwell Cancer Trust undertook, and questioned what support had been received from the NHS in relation to the Endoscopy Unit. Ms Simpson said that the £350k being raised was just a “stop-gap” to keep the unit going until funding was signed off, as millions of pounds were needed due to it being in a state of disrepair. They had been unable to raise the money as quickly as needed, so King’s had stepped in. Another Member queried if, in relation to the Endoscopy Unit, they were replacing things that should be provided through the NHS, or if they were adding little extra to make patients more comfortable. Ms Simpson said that they added extras in all areas, however the Endoscopy Unit  ...  view the full minutes text for item 12.

13.

UPDATE FROM KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST: IMPROVEMENT PLAN

Notice is given that part of this item may be heard under Part 2.

Minutes:

Professor Nicola Ranger, Chief Nurse and Executive Director of Midwifery – King’s College Hospital NHS Foundation Trust (“Chief Nurse and Executive Director of Midwifery”) provided an update on the Trust and its Improvement Plan following the outcome of the Care Quality Commission (CQC) Inspection Report.

 

The Chief Nurse and Executive Director of Midwifery informed Members that she had been in post for around seven weeks. An overview of the King’s Executive Team was provided, which included Dr Clive Kay – Chief Executive and Bernie Bluhm – Chief Operating Officer who had attended the Health Scrutiny Sub-Committee meeting in July 2019. It was noted that the longest serving member of the King’s Executive Team had been in post for three years. A number of “fresh eyes” had come into the team, and they were aware of the impact that constantly changing the top team could have – they wanted to listen to staff and create a sense of stability. The Chief Nurse and Executive Director of Midwifery said that this was highlighted by the case of Frimley Park Hospital, which was the first to receive an ‘outstanding’ rating from the CQC and had a Chief Executive in post for twenty nine years. The King’s Executive Team were committed to being at the Trust, and to resolving issues for staff and patients. The Chairman enquired how many of the King’s Executive Team were in permanent roles. The Chief Nurse and Executive Director of Midwifery confirmed that the only post on a fixed term contract was that of the Chief Operating Officer. This contract had been for two years, however there were plans to make this post substantive.

 

The primary narrative of the Trust was for financial stability and addressing its huge reported deficit. Over the last two quarters, the Trust had reached its ‘control total’, and had been £1.6m ahead of plan at the end of August 2019. This had brought a sense of confidence and the aim was to stay on track, and reach the ‘control totals’ during the winter months which it was often harder to do. The Trust had significantly reduced the number of patients waiting over 52 weeks, from 450 to 130. It was intended that this would be reduced to zero in a maximum of six months. Fines were usually incurred for having 52 week waiters, but due to the Trust’s better financial performance these had not been issued. However, there were still challenging times ahead, at the Trust needed to “get on track”, but not at the expense of staff or patients.

 

A Member highlighted that in relation to the Trust’s financial performance, pay was £9.6m below budget, and queried what lay behind this. The Chief Nurse and Executive Director of Midwifery said that the Trust had one of the best fill rates at 80%, and they had recruited to posts rather than using agency staff. The Trust had one of the lowest vacancy rates, at just below 8%, and also one of the lowest staff  ...  view the full minutes text for item 13.

14.

PLANNING OF WINTER SERVICES (CCG) pdf icon PDF 89 KB

To follow

Additional documents:

Minutes:

The Sub-Committee considered a report providing an update on the development of the 2019/20 Bromley System Winter Plan from Clive Moss, Urgent Care Lead, Bromley Clinical Commissioning Group (“Urgent Care Lead”).

 

The Winter Plan built on the ongoing One Bromley Urgent and Emergency Care programme, which was designed to deliver the One Bromley vision of developing an integrated urgent and emergency care system. Over the past few winters, the local health and social care system had felt increased pressure during the winter months, with most services seeing a surge of activity and demand, with a more complex range of patient needs. Additional challenges had included seasonal presentations of influenza and norovirus. These additional pressures on the health and social care system affected all age groups, but were primarily from older and frail people. Bromley health and social care system leaders had developed a plan to manage safely and effectively the additional pressures during this period.

 

The plan was developed through the Bromley A&E Delivery Board, which delivered a whole system approach to planning, improved performance and the development of a coherent local service framework for urgent and emergency care. The plan contained within it System Escalation Protocols for managing surges, Winter Scheme Spend and further Winter Planning (including infection control / flu plans, minor breach reduction plans, improving ambulance handover plans, borough based and South East London contact list and provider assurances of managing demand and capacity). The A&E Delivery Board was responsible for the oversight and management of the plan, which would be a live document throughout winter to ensure that all information was kept as up to date as possible.

 

The focus for this year was to provide schemes that built on the lessons learned from previous year, and there were three joint strategic themes: avoiding unnecessary hospital attendances; maintaining hospital flow; and a reduction in the delayed discharges through integrated working.

 

A Member noted that the handyman service was a fantastic year-round offer, and asked for more information on the twelve dedicated Extra Care Housing Assessment Flats. The Urgent Care Lead said that these flats were located in different warden based housing units across the borough. Three of these flats were dedicated to Discharge to Assess (D2A) step down beds. The Managing Director, Bromley Clinical Commissioning Group advised that these step down beds were available within twenty four hours to those needing extra rehabilitation. Occupants would live in the flats on their own, but may have packages of help which came in, and took place in a controlled environment.

 

A Member highlighted that there was a need to maintain patient flow at the hospital at all times. The Urgent Care Lead said that a new pilot had been trialled at another UCC over the winter, with a floor co-ordinator role being implemented. This role covered the evenings and weekends when there was not a service manager scheduled to work, and supported patient flow. The aim was for it to have a positive impact on waiting  ...  view the full minutes text for item 14.

15.

BROMLEY HEALTHCARE QUALITY ACCOUNT 2018/19 (BROMLEY HEALTHCARE) pdf icon PDF 5 MB

Minutes:

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) and Janet Ettridge, Director of Operations – Bromley Healthcare (“Director of Operations”) presented the Bromley Healthcare Quality Account 2018/19. The document outlined the findings of a review of their quality priorities and performance during 2018/19, and looked forward to a planned improvement in the quality of services across five priority areas for 2019/20.

 

During 2018/19, there had been a number of key highlights for Bromley Healthcare. These included outcome measures being developed for every service to demonstrate improved outcomes for patients following their care. There had been a successful relocation of the rehabilitation beds to the Foxbury unit, with positive patient feedback received regarding the move and the new location. The National Audit of Intermediate Care had also found the service to demonstrate exceptional (positively deviant) performance in outcomes, despite facing the same constraints as others. A bespoke Nursing Band 5 Development Programme for newly registered nurses had also been introduced. This was an intensive programme which provided a focussed target on clinical skills, immediately followed by clinical practice with a tailored list of patients.

 

The Bromley Healthcare Care Coordination Centre, which played a significant role in ensuring continuity and consistency of patient care, had extended its operating hours to 24 hours a day, seven days a week. Phase two of the project would include a clinical monitoring unit, and the trialling of a tele-hub. A ‘daily safety huddle’ and ‘near live’ safety dashboard had been introduced to drive improvement, resulting in the reduction of missed visits. It was noted that this had all been possible due to the wonderful, committed team they had at Bromley Healthcare.

 

For 2019/20, priority areas had been identified for improvement which reflected learning from the Care Quality Commission (CQC) inspections undertaken since 2016/17 and were underpinned by the five CQC core standards for a healthcare organisation comprising Safe, Caring, Responsive, Effective and Well Led.

 

A Member noted that the organisational aim was for a minimum of 85% of staff achieving a regular annual appraisal. The Chief Executive Officer said that she was not happy with the appraisal rate being below 100%, and as a result, a compliance bundle had been introduced that was linked to pay progression.

 

In response to a question, the Chief Executive Officer said that Bromley Healthcare had previously delivered a 0 to 19 service in Bromley, but this had been lost through procurement. The Director of Operations advised that they still provided school nurses through ‘Health Support for Schools’.

 

The Chairman led Members in thanking Bromley Healthcare for an excellent report which had been very informative.

 

RESOLVED that the Bromley Healthcare Quality Account 2018/19 be noted.

16.

PERINATAL MENTAL HEALTH SERVICE UPDATE (OXLEAS)

Minutes:

Adrian Dorney, Associate Director – Oxleas NHS Foundation Trust (“Associate Director”), Dr Sushma Sundaresh, Consultant Perinatal Psychiatrist and Clinical Lead – Oxleas NHS Foundation Trust (“Consultant Perinatal Psychiatrist and Clinical Lead”) and Sarah Hooton, Perinatal Team Manager – Oxleas NHS Foundation Trust (“Perinatal Team Manager”) provided an update in relation to Perinatal Health Services.

 

Since 2014, there had been an evident need to prioritise perinatal mental health. A small service had been provided from 2016, and Oxleas NHS Foundation Trust had applied for NHS England funding to develop the service they provided today. When this service went live on the 28th February 2019, it had turned the map of London green, indicating that all women had access to a perinatal service. Almost a quarter of women who died between six weeks and one year after pregnancy died from mental health related causes, with one in seven women dying by suicide. A report on the costs of perinatal mental health problems had found that the known costs per year’s births in the UK totalled £8.1 billion. Of these costs, 28% related to the mother, and 78% related to the child. Up to 20% of women developed a mental health problem during pregnancy, or within a year of giving birth, however women in around half of the UK had no access to specialist perinatal mental health services.

 

The Oxleas Perinatal Mental Health Team was a multi-disciplinary mental health service for pregnant and postnatal women with severe and complex mental illness. The aim of the Perinatal Mental Health Team was to detect, prevent and treat perinatal mental health problems. The team saw women who were residents, or registered at GPs, in the London Boroughs of Bexley, Bromley and Greenwich. The service had adopted a ‘hub and spoke’ model, and the team was based at Queen Mary’s Hospital, Sidcup. The service had external interfaces with three local maternity sites (two within the borough and one in a neighbouring borough), one health visiting service provider, two Improving Access to Psychological Therapies (IAPT) providers, and three Local Authorities. Internally, the service had interfaces with two health visiting services, one IAPT service, two Mental Health Liaison services, three Home Treatment / Crisis Teams and nine Community Mental Health Teams. The large number of interfaces highlighted that it was vital for there to be good communication between the services.

 

The service continued to work closely with third sector organisations through various co-produced activities which included: a Mind support worker / Mindful Mums group; a co-facilitated group with Mums Aid (Greenwich); Maternal Journal; and resilience intervention for fathers which was CCG led. There was also involvement from women with live experience in the form of focus groups, recruitment, publications, implementation groups and overall service development. In response to a question, the Consultant Perinatal Psychiatrist and Clinical Lead said that through the Trust’s work with Mind there was buddy model and peer support group for patients in Bromley. The Perinatal Team Manager noted that there was also a Perinatal  ...  view the full minutes text for item 16.

17.

JOINT HEALTH SCRUTINY COMMITTEE VERBAL UPDATE (REPRESENTATIVES)

The minutes from this meeting will be circulated once available.

Minutes:

The minutes from the meeting of the Joint Health Scrutiny Committee on the 25th September 2019 would be circulated to Members once available.

18.

WORK PROGRAMME 2019/20 pdf icon PDF 61 KB

Minutes:

Members considered the forward rolling work programme for the Health Scrutiny Sub-Committee.

 

The Chairman noted that Healthwatch Bromley had been invited to present their Service User Engagement at the next meeting of the Health Scrutiny Sub-Committee. Members requested that Michelle Simpson at The Chartwell Cancer Trust be invited to return to the Sub-Committee in six months’ time to provide an update on the work being undertaken.

19.

ANY OTHER BUSINESS

Minutes:

There was no other business.

20.

FUTURE MEETING DATES

4.00pm, Tuesday 28th January 2020

4.00pm, Thursday 23rd April 2020

 

Minutes:

4.00pm, Tuesday 28th January 2020

4.00pm, Thursday 23rd April 2020

 

Original Text: