Agenda and minutes

Health Scrutiny Sub-Committee - Tuesday 21 November 2023 4.00 pm

Venue: Bromley Civic Centre, Stockwell Close, Bromley, BR1 3UH

Contact: Jo Partridge  020 8461 7694

No. Item




Apologies for absence were received from Councillor Robert Evans and Co-opted Member, Stacey Agius.





Councillor Stammers declared that she was Chair of the Patient Participation Group (PPG) for The Chislehurst Partnership.




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 Tuesday 7th November 2023. 


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 Wednesday 15th November 2023.


No questions had been received.




RESOLVED that the minutes of the meeting held on 5th September 2023 be agreed.



to include Postpartum Haemorrhage


To follow

Additional documents:


The Chairman welcomed Angela Helleur, Site Chief Executive – PRUH and South Sites and Frances Barnes, Senior Head of Midwifery – KCH, Denmark Hill to the meeting to provide an update on the King’s College Hospital NHS Foundation Trust.


The Chairman led Members in congratulating the Site Chief Executive on her permanent appointment to the role.


The Site Chief Executive informed Members that Epic, an electronic patient record system, had been jointly launched across King's and Guy's and St Thomas' (GSTT) on 5th October 2023. The roll out had gone as well as expected. It was noted that they were still in the implementation phase and issues were being experienced in relation to reporting access which had been anticipated. There had been some issues specifically within primary care and they were working with colleagues to rectify this.


With regards to performance, Members were advised that the figures for elective recovery looked concerning, however this had been impacted by the reporting issues and they were monitoring the accuracy of this data. It was noted that some activity had been scaled down due to the implementation of Epic – there were challenges in addressing the elective backlog, however clear plans were in place. The cancer diagnostics were below trajectory, partly due to industrial action and Epic, but processes were in place to ensure patients were tracked. The Site Chief Executive advised that emergency performance was also below trajectory and remained a challenge. However improvement plans were in place, and they were working closely with community partners on admission avoidance and hospital@home services.


Members were informed that the new MRI at the PRUH was on track and a microwave thyroid ablation procedure had been completed. The mortuary redevelopment was also underway and on target for handover in January 2024. The new EV charging facilities in the car park would be installed by March 2024 and, following a question at the last meeting, it was confirmed that the stability of the car parking deck had been fully tested and there were no concerns. The endoscopy unit had now been signed off – there had been an increase in the cost due to the length of time for tenders to be issued and returned, but was on track to be completed by March 2025. In terms of next year’s programme, further works would be undertaken including a complete roof replacement; nurse call system replacement; and ward lifecycle refurbishments.


The Site Chief Executive informed Members that the annual King's Stars Awards event had been held on 2nd November 2023 to celebrate the efforts of staff across the organisation. More than 300 nominations were submitted earlier in the year and winners were announced on the night.


In response to questions, the Site Chief Executive said that the challenges related to Epic had been anticipated as they were moving a number of electronic patient record systems onto one, but this would ultimately provide a number of advantages. There had been issues around transition, particularly for the  ...  view the full minutes text for item 20.



To follow


The Chairman welcomed Lorraine Regan, Service Director, Adult Community Mental Health/Adult Learning Disability – Oxleas NHS Foundation Trust (“Service Director”) to the meeting to provide an update on the ‘Right Care, Right Person’ (RCRP) approach and demand on services.


The Service Director informed Members that they were currently three weeks into the implementation of the RCRP approach – this was the new threshold to assist the Metropolitan Police Service in determining when to attend calls related to health care incidents. There had been some apprehension about the implementation of the programme however the first few weeks had gone smoothly – Oxleas had not made escalations in terms of decisions that they felt had not been appropriate. Data from the police suggested that there had been a reduction in calls – they were currently undertaking some scenario testing to identify if this had resulted in increased activity within services. It was noted that during the same period they had introduced the new South East London ‘136 Co-ordination Hub’ for those that were detained by the police under Section 136 of the Mental Health Act. As a result they had seen a significant reduction in the number of conveyances to the Emergency Department (ED). Members were advised that daily meetings continued to be held regarding RCRP. There was still work to be undertaken in relation to welfare checks which remained one of the biggest areas of risk for causing increased activity for health and social care partners.


In response to questions regarding planned future work, listed on page 9 of the pack, the Service Director said that a number of the items would be completed by the end of the calendar year, and the remainder by the end of the financial year. To date, all actions agreed had been implemented within the agreed timeframe and there were no reasons to believe any would be delayed.


With regards to demand for services in Bromley, the Service Director advised that community mental health services had seen the most significant increase. The Hub was seeing 600-800 referrals a month which was a 50% increase in demand compared to 2019. This had limited some of the progress and benefits of the transformation programme, however they were staring to see a shift in demand following some successful interventions being implemented. Patients were being placed into group programmes quickly and the ‘did not attend’ (DNA) rates were very low within the initial assessment service. Their partnership with BLG Mind was strong and the service would shortly be co-located in the Rachel Notley Day Centre, Beckenham which would further enhance joint working.


With the significant increase in demand for community mental health services, an increase in demand for crisis and bedding services would usually be anticipated – however this had not been the case and suggested that the work around community transformation had been successful. Bedding services remained a challenge as they often used more beds than they had within the Oxleas footprint. They had a bed recovery programme  ...  view the full minutes text for item 21.



To follow


This item was deferred to the next meeting of the Health Scrutiny Sub-Committee on 30th January 2024.




The Place Executive Lead advised that pressure was being experienced within the Trust following the roll out of the Epic system – there had been a lot of pressure for general practice in relation to the way results were received and reviewed. In response to questions, the GP Clinical Lead advised that the hospital provided pathology services for primary care. These were reported, and results were coded in a particular way which fed into referral/recall systems. Following the roll out some codes had now changed or were reported differently, and they were working closely with primary care across the South East London to resolve these issues as quickly as possible. The delays and issues with coding had impacted on workload and caused some frustration within primary care. However there would be a number of benefits going forward, including the use of My Chart which was an excellent care navigation offer. Patients could interact with the app, and it would also help hospitals interact directly with its patient cohort.


With regards to acute services the Place Executive Lead noted that they had been impacted be periods of industrial action, with more to follow. The hospital had done a good job in ensuring that minimum standards were met, however this had resulted in increased waiting lists. Across South East London they were managing to “keep their heads above water” in relation to this years’ target of patients not waiting more than 78 weeks, but this was a considerable challenge.


Members were advised that, as mentioned at the previous meeting, a national management cost reduction exercise was being undertaken – all ICBs had been asked to reduce management costs by 30% by April 2025, with 20% of these reductions in place by April 2024. The ICB had reviewed its activities and delivery to ensure they were fit for purpose, meeting core requirements and statutory functions. The proposed structure, which included the Bromley team, was out for consultation until 29th November 2023. A management response would be provided by mid-December 2023 and the structure would be implemented in the new year. They were working with partners to ensure the right structures were in place to deliver the One Bromley priorities and it was noted that not all processes would be completed for 2024. In response to questions, the Place Executive Lead noted that the management cost reduction just related to the ICB team, and did not include partner organisations, and a broad approach had been taken. There was already a lot of sharing of resources, information and intelligence – they had looked at what they could do differently as a partnership, for example using the Better Care Fund (BCF) to support some posts. They were looking to reduce the baseline cost of running an ICB team – inevitably there would be some redundancies, but savings would be made in terms of the ongoing costs.


The Place Executive Lead informed Members that the autumn/winter campaign for flu and COVID-19 immunisations had commenced in September.  ...  view the full minutes text for item 23.




 The Sub-Committee received the Quarter 1 Patient Experience Report for Healthwatch Bromley, covering the period from April – June 2023.


The Operations Co-ordinator, Healthwatch Bromley (“Operations Co-ordinator”) advised that the document provided a snapshot view of the feedback gathered from patients across the borough. During the Quarter 1 period, 658 reviews of health and care services were shared, and 65 engagement visits were undertaken. It was noted that the Quarter 2 report had been published the previous day and would be presented at the next meeting.


In response to questions, the Operations Co-ordinator advised that, following a request from internal committee members, the next report would provide a breakdown of responses by hospital Trusts. Regular visits were made to the PRUH and Orpington Hospital and therefore their number of reviews were significantly higher. When visiting organisations to get feedback on services participants were also asked to share wider feedback on other services they had accessed across the borough. There would be a similarity in the majority of the data collected by Healthwatch services that came under the remit of Your Voice in Health and Social Care and the reports had been redesigned to align across these borough. However some data/information may be included following other requests received – they would be happy to receive feedback in terms of areas for improvement.


The Operations Co-ordinator advised that Healthwatch Bromley attended a number of governance meetings across the borough and the reports were distributed to a large number of local partners, including Oxleas, King’s, and the SEL ICB. The reports provided a snapshot for a particular quarter – they then looked at the information gathered across the year to identify any emerging issues or opportunities for further research. It was noted that it was not the responsibility of Healthwatch Bromley to address the themes highlighted, they provided the data to local partners to open up further discussion.


In response to questions, the Operations Co-ordinator informed Members that Healthwatch Bromley aimed to try and conduct as many visits as possible, but this also required partners/services to respond to their request for engagements. They always looked for new opportunities to reach out and they would be happy to consider other areas, such as new services that would be offered by pharmacies, to investigate further – however the number of engagements was limited as they relied heavily on volunteers.


The Chairman thanked the Operations Co-ordinator for her update to the Sub-Committee.


RESOLVED that the update be noted.


GP ACCESS pdf icon PDF 1 MB


The Chairman welcomed Cheryl Rehal, Associate Director of Primary and Community Care, Bromley – SEL ICS (“Associate Director”), Dr Andrew Parson, Co-Chair and GP Clinical Lead – One Bromley Local Care Partnership (“GP Clinical Lead”) and Dr Claire Riley, GP and Clinical Director for Orpington PCN (“Clinical Director”) to the meeting to provide an update on GP access.


The Associate Director highlighted some key points from the presentation provided. As previously mentioned, the local priorities for improving GP access were reflected in the delivery plan published in May 2023. Work had included:


-  empowering patients – Bromley practices had expanded the functions available through the NHS app. An increase in repeat prescriptions, appointment bookings, and general use of the app was being seen – each contact was potentially an avoided phone call.

-  implementing modern GP access – this related to patients understanding how their requests would be handled, based on clinical need, and respecting their preference for a response. There was an end to end reshaping of how patient requests were received, assessed and consultations offered.

-  building capacity – additional roles were implemented within the wider general practice teams. It was noted that eight new GP trainers had been supported in the borough to expand training places. The training hub was also offering virtual training.

-  cutting bureaucracy – the interface between primary and secondary care was important in ensuring there were as few handoffs as possible, and patients were not going back and forth to get the care, advice and support required.


The Chairman highlighted that it was positive to see the increased use of the NHS app and other online platforms. It was requested that an age breakdown of patients using these functions be provided in the next report to the Sub-Committee.


In response to questions, the Associate Director said it was recognised that practices sometime made changes without involving their patients as much as they needed to, and this was being emphasised to them through various forums. As mentioned at the last meeting, support guides had been developed to help structure conversation on access with the Patient Participation Groups. In one area of the borough major changes were due to take place with the introduction of a new system and they had been providing support to practices in terms of ongoing engagement with their patients. The GP Clinical Lead considered that there variation across the borough but there was a move to try and standardise access. It was highlighted that whichever means was used to contact a GP practice it should result in the same offer, and practices should be explaining this to their patients. A Member advised that their Patient Participation Group had introduced a newsletter to supplement the communication from the practice, which helped remind and direct patients to the NHS app.


The Clinical Director provided two examples of Bromley Primary Care Networks taking a neighbourhood approach to improving access – one related to frailty and the other children as a cohort.  ...  view the full minutes text for item 25.




The Chairman informed Members that the South East London Joint Health Overview and Scrutiny Committee had met virtually on 19th September 2023. An in depth update had been provided regarding the autumn/winter vaccination programme. As mentioned earlier in the meeting, the consultation on the proposals for the reconfiguration of children’s oncology services was underway and would run until 18th December 2023 – it was agreed that a link to the consultation would be circulated to all Members following the meeting.


It was noted that a meeting of the Committee would be taking place that evening, which coincided with the Adult Care and Health Policy Development and Scrutiny Committee. Further dates into the new year were still to be confirmed.


RESOLVED that the update be noted.




Report CSD23128


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


As suggested during the meeting, the following item would be added to the work programme:


-  Update on postpartum haemorrhage – King's College Hospital NHS Foundation Trust (summer 2024)


RESOLVED that the update be noted.





There was no other business.



4.00pm, Tuesday 30th January 2024

4.00pm, Tuesday 12th March 2024



4.00pm, Tuesday 30th January 2024

4.00pm, Tuesday 12th March 2024