Agenda and minutes

Health and Wellbeing Board
Tuesday, 10 November 2020 6:00 pm

Venue: Meeting to be held virtually

Contact: John Dawe, Senior Governance Officer 

Media

Items
No. Item

78.

Apologies for Absence

Minutes:

Apologies were submitted on behalf of Cllr Evelyn Carpenter and Ian Winter.

 

79.

Declaration of Members' Interests

In accordance with the Council’s Constitution, Members of the Board are asked to declare any interest they may have in any matter which is to be considered at this meeting.

Minutes:

There were no declarations of interest.

80.

Minutes (15 September 2020) pdf icon PDF 82 KB

Minutes:

The minutes of the meeting held on 15 September were confirmed as correct.

81.

Director of Public Health update on Covid-19 cases in Barking and Dagenham pdf icon PDF 51 KB

Minutes:

The Director of Public Health (DPH) introduced the regular report on Covid-19 cases in Barking and Dagenham and asked the Intelligence and Analytics Officer to present the latest data (as of 30 October), highlighting the relevant local aspects such as the geographical spread of the virus and the different groups at higher risk of admission to hospitals and of deaths, and a range of comparisons with cases across NE London.

 

The DPH referenced the main drivers for the upward trend of positive cases in the Borough and in NE London generally with increasing rates of testing, which was in contrast to the reduction in testing and lowering positive case numbers in London as whole. It was therefore inevitable that the number of positive cases per 100,000 of the Borough’s population would exceed 200 probably by tomorrow.

 

In total there had been sadly 183 deaths in Barking and Dagenham which was up four from the previous week. The increasing death rates were mirrored in the other NE London Boroughs with the over 59’s having the largest mortality rates. This was particularly concerning given that based on the first wave it was this age group which tended to get hospitalised leading sadly to death.

 

The presentation also set out the latest COVID statistics for schools which since the October half term showed a marked increase in positive cases both in staff and pupils, and that given that these statistics did not include the more vulnerable teachers who were isolating, it meant that a number of schools were starting to struggle to cope. The DPH commented that the increase during half term did not bode well for the upcoming Christmas and New Year break and would require detailed planning between the Council and schools as to how this worsening situation could be managed.

 

The statistics indicated a considerable increase in adult household transmission and the DPH drew particular attention to the worsening case rates in the over 65’s, which had spilled over into the Borough’s care homes. Whilst the testing regime in the homes had identified asymptomatic cases, given the two-day window of testing to results, this had meant an opportunity for the virus to spread. The DPH confirmed that in most homes the virus had been contained. However unfortunately in one home there had been a significant outbreak of up to 40 cases.

 

It was evident that lapses had occurred in procedures where in particular three patients released from hospital back into care homes and who had tests carried out in hospital, did not have their results recorded on their discharge notes, resulting in a lack of infection protection support in the homes. There was also a variation in the primary care support available to the local care homes when it was most needed. Despite the positive news coming out of government about a possible vaccine and ramped up testing, it was the DHH view that for colleagues in both the local hospitals and care homes this Winter would be very challenging,  ...  view the full minutes text for item 81.

82.

Adult Social Care Winter Plan pdf icon PDF 89 KB

Additional documents:

Minutes:

Having regard in particular to the increasing second wave of COVID-19 all local authorities have been asked by government to present an Adult Winter Plan which outlines steps being taken to reduce the impact of the pandemic and normal winter pressures on the health and social care system.

 

The Head of Adult Commissioning presented an overview of the Plan which was appended to the report, the full extent of which contained over 100 elements which the local authority in liaison with health partners and local stakeholders were required to address.

 

Sharon Morrow informed the Board that the local CCG was working closely with the Council to ensure that the NHS and Adult Social Care winter plans were fully joined up.

 

The Board noted the content of the local Plan. 

 

 

83.

Integrated Care Partnership planned arrangements update pdf icon PDF 58 KB

Additional documents:

Minutes:

The health and care system in BHRUT had faced a number of significant challenges in the last few months, demonstrating the need to work together across health and social care and have the right structures in place.

 

At a joint meeting on 20 October members of the seven NEL CCGs supported a merger to form a new single North East London CCG from April 2021, paving the way for the three systems across NEL to further develop local integrated care partnership arrangements based on what is referred to as the 80:20 principle, namely 80% of delivery continuing at a local level and 20% at NEL level, where it makes sense to do things together and achieve economies of scale.

 

Alison Blair, Director of Transition and colleagues in BHRUT have continued to work over the past few months on these arrangements, bringing forward regular progress reports to this Board. This latest report and presentation focussed on governance and structural matters building on developing the current structure of the ICPB including the role of the Borough Partnership Delivery Group chaired by the DPH, and which currently reports through this Board. A more detailed report on these matters is due to be presented to the Board in January 2021, when approvals would be sought as to how the ICPB proposes to work together in practice including the proposed terms of reference for the key governance bodies of the BHR Integrated Care Partnership.  It was noted that a workshop is being held at the end of November to progress these issues.

 

The DPH commented that these structural changes will hopefully present the opportunity for the Delivery Group to get on and make a real difference such as the place based changes that are necessary to address a number of health needs from paediatric through to older people services.  

 

The Deputy Chair remarked that for him this was about the B&D Partnership and therefore structurally it was important to get this right as based on the 80:20 principles most decisions should be taken locally and be accountable.

 

The Chair commented that from her discussions with colleagues across London the pace and direction of changes varied considerably. Important for B&D the changes were being led and directed from the bottom up rather than being dictated nationally. She concluded that once the governance and structural arrangements were more finalised, she would present them to her Cabinet colleagues for a view.

 

Accordingly the Board noted the report.  

   

 

 

 

     

84.

Phlebotomy System Update pdf icon PDF 56 KB

Minutes:

Following concerns expressed about the lengthy waiting times for local residents for non-urgent blood tests, Ceri Jacob, Managing Director, BHR CCG provided the Board with an update on the current position.

 

Prior to the pandemic Barking, Havering and Redbridge a range of providers across acute, community and primary care provided phlebotomy services/clinics across approximately 53 sites. However, with the onset of the COVID-19 pandemic, the focus shifted to enable providers to respond with the priority being to keep patients and staff safe while maintaining a blood testing service for people living in the three boroughs.


As the position moved into the recovery phase of services from June, BHRUT was unable to re-open up its phlebotomy sites as staff had been ‘re-purposed’ to support inpatient care, and as such could only continue with phlebotomy for priority patient groups. In response, the CCGs and the community services and primary care providers worked closely together to restart community clinics (previously provided by BHRUT and NELFT) and to rapidly increase capacity by funding additional clinics and staff resources, enabling the introduction of a number of new community clinics.

 

However, despite this a gap between capacity and demand remains with a consequent rapid increase in waiting times, and which led to a Serious Incident (SI) being declared on 14 October 2020. In response NELFT agreed to lead an investigation into the SI under the leadership of a Non-Executive Director (NED) across both NELFT and BHRUT.  Oversight of the whole process will be via a weekly system meeting jointly chaired by a CCG Governing Body Lay Member and the CCGs’ Managing Director. It was recognised that this had been an incredibly difficult time for patients causing them considerable stress and anxiety about getting a simple blood test.     

 

The Deputy Chair recognised that this issue had been a disaster for all concerned, and that despite the subsequent good work carried out by NELFT supported by Community Solutions and the positive ‘call to action’ by local practices, his preference would have been to see all GP’s offering routine blood tests to their patients. Going forward the priority now was to reduce the backlog in the coming months, in respect to which despite recruitment challenges, two additional phlebotomy staff had been secured locally.

 

In response to a question Ceri Jacobs reassured the Board that the infrastructure was in place to ensure there was sufficient lab capacity to manage the uptake in blood tests now being performed to address the backlog.  

 

The Chair whilst welcoming the steps and efforts now being taken to address the backlog had concerns as to why locally we were so dramatically affected compared to other areas. Ceri Jacobs explained that in part the problem was due to the fact that unlike many other Boroughs, Barking and Dagenham did not have the model of primary care support in place prior COVID and therefore when the pandemic struck it was not geared up to respond. This is now being addressed for the future.  

The Chair concluded that  ...  view the full minutes text for item 84.

85.

Situational update on waiting lists including use of King Georges as a Day Centre to support NE London

Presentation from the Barking, Havering and Redbridge University Hospitals NHS Trust

Minutes:

In the light of the pandemic the Board received a presentation from Shelagh Smith, BHRUT on the current position regarding waiting lists at both Queens and King Georges Hospitals as well as the use of the latter site as a day centre to support NE London.

 

The presentation detailed the progress around reinstating services during the various national responses to the pandemic, and which whilst complicated and complex, has seen the majority, when safe to do so, and in accordance with IPC guidelines, restarted through a phased approach. Given the ever changing circumstances and challenges a number of these services are being delivered from differing locations across NE London with a series of hubs being set up. Locally work started at King Georges as it was easier to set up green pathways, those being non-COVID protected pathways to allow for elective programmes to get up and running quickly. Endoscopy is now operating at both sites and all patients are now able to have blood tests ands children under 12 able to be seen. However, given the increase in COVID infection rates, patients are again declining appointments due to anxiety or isolation requirements.

 

The presentation also covered infection prevention controls, an overview of national standards and targets including referrals for treatment, diagnostics and cancer treatment and performance, introduction of a temporary surgical hub at King George to support NE London with plans to make it permanent, details of waiting times and numbers which given the second lockdown and rises in COVID cases will inevitably vary, and challenges and constraints going forward . Staff wellbeing is seen as a high priority with shielded staff again where possible working from home although burn out, stress and mental anxiety is taking its toll with increasing levels of staff sickness.

 

In response to the presentation the Chair made the point about the importance of having more joined up communications to reassure the public about the safety of going into hospital, given the level of COVID secure precautions that are in place. On that point she suggested that the BHRUT might want to speak to the Council’s Media team about using the Leader to rely the safety message in one of his weekly video calls, given the large local audiences they reach. 

 

86.

COVID funding

Minutes:

The Chair wanted it placed on record the ongoing dispute with colleagues in NHS as to the disparity of COVID payments to outer NE London authorities in comparison to inner NE London authorities, and which she will continue to lobby for. 

 

In response Ceri Jacob, Managing Director, BHR CCG stated that as far as she was aware the rules around financial payments had been applied consistently and that this was not an issue of outer v inner NE London, but more to do with the treatment of exceptional circumstances concerning Newham CCG. She was aware that the initial response to a representation made by Barking and Dagenham had not been accepted and that further discussions were taking place to reach an agreement.