Agenda and draft minutes

Contact: Jo Partridge  020 8461 7694

Items
No. Item

26.

APOLOGIES FOR ABSENCE AND NOTIFICATION OF SUBSTITUTE MEMBERS

Minutes:

The Chairman welcomed Members to the virtual meeting of the Health Scrutiny Sub-Committee, held via Webex.

 

Apologies for absence were received from Councillor Angela Page – Executive Assistant for Adult Care and Health and Roger Chant.

 

The Chairman informed Members that Dr Angela Bhan – Borough Based Director, SEL CCG had recently been unwell, and on behalf of the Sub-Committee wished her a speedy recovery.

 

 

UPDATE FROM KING’S COLLEGE HOSPITAL NHS FOUNDATION TRUST

 

The Chairman welcomed Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites (“Site Chief Executive”) to the meeting and thanked him for attending at short notice to provide an update on the King’s College Hospital NHS Foundation Trust.

 

The Site Chief Executive informed Members that since the beginning of December, the PRUH and South Sites had seen a marked increase in the number of COVID-19 presentations, and this had continued at pace. On the 24th December 2020, the PRUH Campus had around 250 COVID-19 positive patients, which was a higher volume than at the absolute peak of the first wave of the pandemic. Numbers had remained steady between Christmas Day and New Year, but had then been followed by a further spike. The most significant day for the PRUH had been the 8th January 2021, on which they had been housing and caring for 297 COVID-19 positive patients, including 18 receiving fully ventilated Level 3 care in ITU and a further 20 receiving Level 2 high dependency care. It was stressed that these were extreme volumes of patients.

 

Since the 8th January, there had been a small reduction in the numbers, which statistically would be considered a downward trend, and as of that day there were 275 COVID-19 positive patients across the PRUH and South Sites (with some being nursed at the Orpington Campus). Currently, there was the capacity to respond to the daily ebb and flow of patients, with only a very minimal number of ITU Level 3 patients having been transferred to Denmark Hill to received more intensive and complex therapy.

 

In response to a question, the Site Chief Executive said that when comparing the previous six weeks with the peak of the first wave, the rate of presentations with COVID-19 was 51% higher. This highlighted the marked impact of the second wave, and indicated that the virus was significantly more virulent. However, over the last six weeks there had not been the same need for ventilated Level 3 beds which the PRUH had experienced during the first wave. Presently, there were 18 of these beds open, compared to 28 beds during Wave 1. As a result of the learning taken from the first wave, new and different interventions were being used early on in a patient’s admission, such as CPAP positive pressure ventilation. It was too early to say if they would see the same number of deaths that occurred during the first wave, but the number of presentations had been significantly higher, resulting in a far greater impact. With  ...  view the full minutes text for item 26.

27.

DECLARATIONS OF INTEREST

Minutes:

There were no declarations of interest.

28.

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 Friday 8th January 2021.

 

Please note that all public questions will be answered by written reply.

Minutes:

No questions had been received.

29.

MINUTES OF THE MEETING OF THE HEALTH SCRUTINY SUB-COMMITTEE HELD ON 21ST OCTOBER 2020 pdf icon PDF 371 KB

Minutes:

RESOLVED that the minutes of the meeting held on 21st October 2020 be agreed.

30.

UPDATE ON THE SINGLE POINT OF ACCESS (SPA) AND DISCHARGE ARRANGEMENTS pdf icon PDF 317 KB

To follow

Minutes:

The LBB Assistant Director for Integrated Commissioning provided an update to the Sub-Committee on the Single Point of Access (SPA) and discharge arrangements.

 

On the 19th March 2020 the government had published its ‘COVID-19 Hospital Discharge Service Requirements’ which stated that unless required to be in hospital, patients must not remain in an NHS bed. The guidance required acute trusts and community health and social care providers to work together to deliver a discharge to assess model that facilitated immediate discharge from hospital with assessment of need taking place in the community.

 

The guidance outlined four discharge pathways – pathway 0, where patients were discharged home with no further support, was managed by the Trust; and pathways 1-3, where discharge required further support in the community (such as requiring domiciliary care; a rehabilitation bed; or care in a residential / nursing home), were accessed via a Single Point of Access (SPA) for community health and social care services.

 

Each area was required to establish a SPA and had been provided with some additional funding to do so. The government had also underwritten some of the early parts of the discharge process and since March, the first six weeks of discharge were covered by NHS COVID funds. The SPA was required to:

-  Function seven days a week, 8am-8pm;

-  Provide a single route for all community health and social care services;

-  Accept assessments from hospital staff on the needs of individuals;

-  Use multi-disciplinary teams on the day of discharge to assess and arrange packages of support;

-  Provide timely access to equipment; and

-  Maintain the flow of patients through the pathway, ensuring assessment of long-term care and support needs were undertaken following a period of recovery.

 

Led by Bromley Healthcare, partners from across the system (the PRUH and King’s College Hospital NHS Foundation Trust; the Local Authority; Oxleas and St Christopher’s), had collaborated resources to form a SPA and worked as a Multi-Disciplinary Team (MDT) to simplify the hospital discharge process. The key features of the SPA were:

-  Discharge to assess (so needs can be evaluated most appropriately);

-  Single referral process (bringing together what was a complex system with multiple discharge pathways into a single, simple process);

-  Clinical triage (nurses and therapists efficiently triage to ensure clients access the most suitable service);

-  Streamlined referral pathways (revised protocols for referral pathways which enabled timely allocation);

-  Welfare calls (management of welfare calls/visits for all clients discharged from hospital, including ED, ensuring safe discharge); and

-  Virtual Multi-Disciplinary Team (partners coming together to provide a whole systems approach to managing a client’s transition).

 

Data provided on the SPA’s activity between March and December 2020 highlighted the volume of its work, processing on average 576 referrals per month. During this period, around 50% of the patients discharged from the PRUH had been supported through the SPA, with a large number requiring further nursing and domiciliary care. A Member asked for further clarification regarding the columns  ...  view the full minutes text for item 30.

31.

GENERAL UPDATE - BROMLEY HEALTHCARE pdf icon PDF 682 KB

To follow

Minutes:

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) and Janet Ettridge, Director of Operations – Bromley Healthcare provided an update on the work being undertaken by the organisation.

 

The Bromley Healthcare incident room had been running via a mixture of physical and virtual attendances since March 2020. In December 2020, this had been stepped back up to daily meetings, alongside which the following had been rapidly mobilised and implemented:

-  Cataloguing over 400 separate items of guidance;

-  Issuing more than 1 million items of PPE to staff (since the beginning of the pandemic);

-  Completing six daily situational reports (Sitreps);

-  Rolling out rapid lateral flow testing for patient facing staff from 14th December 2020, and extended to the whole organisation from 21st December 2020, with twice weekly testing being undertaken; and

-  Issuing 500 laptops and 400 phones to enable remote working.

 

The Chief Executive Officer emphasised that their staff had been outstanding, and extremely flexible. It was noted that the increase in COVID-19 related workforce absences were in line with local population increases. As of the 12th January 2021, the organisation had 100 staff sickness absences, of which 57 were COVID-19 related (5% of the workforce). Some of these absences were in key services, however these were being managed through additional bank and agency shifts. A small number of staff had been redeployed, although it was highlighted that this was at a much lower level than during the first wave of the pandemic.

 

As services had recommenced following Wave 1, patient interventions had started to increase, along with a corresponding increase in activity. The referrals during October and November 2020 were above the levels seen for the same period in 2019. Over the last four months there had been a focus on reducing the waiting lists that had built up during the first wave of the pandemic. Overall, most areas were now “back on track”, and in line with their key performance indicators (KPIs). During the second wave, they had been successful in keeping as many services as possible operating in some format, including their Hollybank site which had been open and fully functioning.

 

With regards to Hospital Discharge Services, the key to its success had been the close partnership working with the PRUH, CCG and Local Authority. There had been a reduction in the length of stay (LOS) and an increase in the number of discharges. LOS in the home pathway had continued to decrease, with patients spending 1.5 fewer days (-6%) on the pathway in Quarter 3 2020-21, compared to the same period the previous year. LOS in beds had continued to decrease further. In Quarter 3, a patient spent on average 4 days fewer (-20%) on the pathway, compared to the same period the previous year, with an increase of 10 patients (+9%) discharged in the period to date. Members were informed that Foxbury rehabilitation unit had experienced a small outbreak of COVID-19 before Christmas, which had been  ...  view the full minutes text for item 31.

32.

UPDATE ON THE 0-19 SERVICE - BROMLEY HEALTHCARE pdf icon PDF 711 KB

To follow

Minutes:

The Sub-Committee were provided with an update on 0-19 Public Health Service being delivered by Bromley Healthcare, presented by Fe Akers, Associate Director for Children's Services and Loretta McGurry, Head of Health Visiting – Bexley and Bromley 0-19 Service (“Head of Health Visiting”).

 

The Associate Director for Children's Services advised Members that the 0-4 element of the service had transferred on the 1st October 2020. Due to the pandemic, mobilisation had been slightly different to what they were used to, but the transfer had gone as well as expected.

 

The Head of Health Visiting informed Members that the Health Visiting and Family Nurse Partnership (FNP) were based in three localities across the borough (central Bromley, Penge and Orpington), in alignment with the Children and Family Centre reach areas. Health Visitors led the delivery of the 0-4 Healthy Child Programme, which was provided in partnership with other agencies, providing a universal offer for all, and more intensive support for the families that required it the most. The 0-4 element now formed part of the 0-19 Public Health Nursing Service with health support for schools, and offered families seamless support. Post-pandemic, there was the potential for child health clinics to run alongside Speech and Language and Dietetic drop-in sessions.

 

At the time of transition, there had been one Head of Service; 3 Operational Leads; an FNP Supervisor; 36 Health Visitors; 16 Nursery Nurses; 3 Family Nurses and 9 Administrators. The aim had been to maintain the safety of clients and ensure that service and quality standard were maintained during the transition. Progress to date had included the recruitment of three fulltime Health Visitors, who would be starting in post shortly – this left only a 3.5% vacancy rate in Health Visiting, which was the lowest it had been for some time. They were also in the process of recruiting an FNP Supervisor, for which the interviews would be taking place the following week. In terms of service delivery, a centralised duty system had been established which was the “front door” for any client queries. Due to some staff being required to self-isolate or having COVID-19 related sickness, a centralised rota and allocation tool was being used to plan across the service, and was working well. Communication had been vital due to the high volume of remote working, and fortnightly team and leaderships meetings had been held. The team had also been developing processes and standards, aligning them across Bexley and Bromley and sharing best practice. Access to the service had been increased via duty and appointment only clinics – this included the appointment only weight clinics, which had been increased from 27 to 51, and allowed any client whose weight needed to be monitored to receive an appointment within a matter of days. Demand and capacity were being monitored on a weekly basis, in collaboration with commissioners. They were also engaging with teams and seeking feedback and ideas from them, particularly in relation to service delivery and the EMIS template designs.  ...  view the full minutes text for item 32.

33.

OXLEAS MENTAL HEALTH SERVICE UPDATE (VERBAL UPDATE)

Minutes:

The Chairman noted that apologies had been received on behalf of Oxleas NHS Foundation Trust, and their item would be deferred to the next meeting of the Health Scrutiny Sub-Committee.

34.

HEALTHWATCH BROMLEY - Q2 PATIENT ENGAGEMENT REPORT pdf icon PDF 764 KB

Minutes:

As the Healthwatch Bromley representative was not present at the meeting, the Chairman noted that a response to questions relating to their Quarter 2 Patient Experience Report, received from the Co-opted Member representing Bromley Experts by Experience, would be followed up outside of the meeting.

35.

HEALTH SCRUTINY SUB-COMMITTEE INFORMATION BRIEFING

The briefing comprises:

 

  • Executive Report – Consideration for Agreement to Exempt from Tendering: Service for Co-Occurring Mental Health, Alcohol and Drugs Conditions

 

 

Members and Co-opted Members 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

 

Minutes:

The Health Scrutiny Sub-Committee Information Briefing comprised of one report:

 

  • Executive Report – Consideration for Agreement to Exempt from Tendering: Service for Co-Occurring Mental Health, Alcohol and Drugs Conditions.

 

The Chairman informed Members that the recommendations in the report had been agreed at the meeting of the Council’s Executive the previous evening.

36.

WORK PROGRAMME 2020/21 AND MATTERS OUTSTANDING pdf icon PDF 317 KB

Minutes:

The Chairman noted that a number of the matters outstanding related to the PRUH and its Emergency Department, and had been marked as ‘in progress’ for some time. Members were asked if responses to these issues were still required. A Member responded that a lot had changed since January 2020, as a result of the pandemic. It was agreed that the key issues should instead be discussed with the Site Chief Executive and his team, and removed from the work programme.

37.

ANY OTHER BUSINESS

Minutes:

There was no other business.

38.

FUTURE MEETING DATES

4.00pm, Tuesday 23rd March 2021

Minutes:

4.00pm, Tuesday 23rd March 2021

 

Original Text: