Agenda item

GENERAL UPDATE - BROMLEY HEALTHCARE

Minutes:

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) and Janet Ettridge, Director of Operations – Bromley Healthcare (“Director of Operations”) presented a general update on Bromley Healthcare; proving an overview on performance, new initiatives and programmes; and their focus for 2020/21.

 

Highlights of the Bromley Healthcare performance for 2019/20 included patient satisfaction of 98.1%, and a dramatically reduced response rate of 6.7%, which was the best across London. The service had monitored 471,000 patient contacts and in Year 1 of the Bromley CCG contract they had met the target for adults, and exceeded the baseline for children by 15.6%.

 

Members were advised that the staff vacancy rate across all services had reduced to 7.5%. The main area of increased recruitment was Band 5 and 6 nurses, and Bromley Healthcare had also ran an apprenticeship programme. A bespoke Nursing Band 5 Development Programme for newly registered nurses had been implemented, and 20 nurses had been recruited over an eighteen month period.

 

The Chief Executive Officer noted that £4m of their contract was payable on the achievement of Key Performance Indicators (KPI). Adult’s Services had achieved 89% of KPI’s, and Children’s Services had achieved 92% of KPI’s, both against a 70% target.

 

In relation to rehabilitation beds, the National Audit of Intermediate Care (NAIC) had identified the service as positively deviant, with patients under Bromley Healthcare being more dependent but having better outcomes, and shorter wait times and length of stay than the national and London averages. This work had been recognised within the industry, and Bromley Healthcare had received the Laing Buisson Rehabilitation Award in November 2019.

 

One of the new initiatives piloted by Bromley Healthcare had been Telemedicine. The Remote Patient Review Service provided a monitoring cuff, which was worn on the arm of a patient and enabled health care professionals to monitor vital signs (oxygen saturation; respiratory rate; pulse rate; skin temperature; motion; blood pressure), whilst the patient remained in their own home. Health care professionals were able to access and review a patient’s data remotely via the internet (through a secure server) as part of the patient’s ongoing care needs. In response to a question, the Chief Executive Officer noted that this was currently being used to support the service provided. It was suggested that an evaluation of the Remote Patient Review Service be provided to a future meeting of the Health Scrutiny Sub-Committee.

 

In June 2019, Bromley Healthcare had commissioned a Therapy services productivity analysis. Following the results of the initial analysis, a 17-week improvement programme had commenced within the following areas: Dietetics, Occupational Therapy and Physiotherapy (for both Children’s and Adult’s Therapies) and Falls, Home Based Rehab (removed mid-way through), Neuro Rehab, Respiratory and Home Oxygen Service (Adult’s Therapies). This had involved work such as reviewing activity data to look at historical trends; team engagement; six weekly leadership programme; and reviewing expectations of each banding / role and setting a percentage for patient contact with the Service Leads. It was noted that after the first twelve weeks, the impact of the review had really become noticeable.

 

The Chief Executive Officer informed Members that a pilot for Case Management, which built on the existing Integrated Care Network (ICN) pathway had also been undertaken. The pilot had commenced with the Stock Hill GP practice, to test recommendations. This had been undertaken with 30 patients so far, and a 13-week pre and post assessment cost and activity comparison showed that:

 

-  Emergency Attendances were reduced by 71% for cost and activity;

-  Non Elective Inpatient Attendances were reduced by 65% for costs, and 69% for activity;

-  The overall pathway saving per patient was £1,720.

 

The Chairman requested that a further update on the Stock Hill pilot scheme be provided at the next meeting of the Health Scrutiny Sub-Committee.

 

Members were informed that a national approach to achieve the two hour access to crisis support and two day access to intermediate care was being co-developed. South East London was one of seven accelerator sites that had been selected following an application, and Bromley Healthcare would be one of the community providers. Key objectives included determining a national operating mode, developing a workforce model and sharing good practice across England. The South East London focus would be on mapping existing Urgent Community Response (UCR) models across different boroughs to develop a ‘core offer’, and the development of an optimum workforce model for demand and capacity assessment.

 

The Chief Executive Officer noted that following Bromley Healthcare’s successful procurement of the Bromley 0-19 Public Health Services contract, mobilisation of the new service had commenced. Work streams had been identified, with a point of contact and delivery within each team.

 

The priorities of Bromley Healthcare for 2020/21 were to offer all patients and carers the best care possible, sharing their clinical knowledge and resources wisely for a sustainable financial future. To achieve this, four goals had been identified:

 

-  Best outcomes possible in the community;

-  Build a culture for growth;

-  Optimum Care Co-ordination;

-  Financially sustainable (profit for reinvestment).

 

A Member noted that the support required when patients were discharged from hospital was not always physical, and asked how Bromley Healthcare worked with other agencies in relation to adjusting a patient’s mind-set and building confidence. The Chief Executive Officer responded that they had close links with Bromley Well, who had recently moved to be located in the Care Co-ordination Centre. Talk Together Bromley were also delivering sessions related to Diabetes, which had proved to be a good model of support, and they were looking to do the same for Lymphoedema. The Director of Operations informed Members that the Proactive Care pathway allowed patients to access a number of services. Patients received co-ordinated care packages, and it was noted the Bromley Healthcare staff worked closely with other agencies.

 

The Co-opted Member representing Healthwatch Bromley raised concerns that there were some inconsistencies in the ‘red bag’ scheme when discharging patients back to care homes, and asked if this process was monitored. In response, Dr Angela Bhan, Managing Director – Bromley CCG said that this was not specifically monitored, but they were aware of the numbers as they were required to replace the bags. Further work was needed in relation to hospital admission arrangements and Transfer of Care, as the ‘red bags’ tended to be lost when a patient was moved from one ward to another.

 

The Chairman led members in thanking Bromley Healthcare for their presentation.