Agenda and minutes

At 8.00 p.m. the Chair moved that the meeting be extended by half an hour, this was seconded by Cllr Carpenter and agreed by all present.  At 8.30 p.m. the Chair moved that the meeting be extended by a further half an hour, this was seconded by Helen Jenner and agreed by all present.

The minutes of the meeting held on 8 March 2016 were confirmed as correct.

Sharon Morrow, Barking and Dagenham Clinical Commissioning Group (CCG) Chief Operating Officer presented the report and explained that the CCG’s Draft Primary Care Transformation Strategy, which was attached to the report, had been developed in response to a number of drivers for change, such as the NHS Five Year Forward View and the challenges of changing demographics, the increasing number of patients with long-term and multiple-long-term conditions and the number of GP practices that were saying their workload would be unsustainable. 

Sharon explained that the emerging vision was of Primary Care led locality based services, which would be supported by other medical professional services such as pharmacies.  The CCG felt the integrated services would provide personalised, responsive, timely and accessible care that was both patient centred and co-ordinated, which would improve benefits for patients.  It would ensure that patients received a standard offer across all practices.  The Strategy would also encourage partnership working between GPs and would drive a better use of IT.  The King’s Fund framework would be used to develop place based care in Barking and Dagenham.  Sharon drew the Board’s attention to the timescale and the next steps set out in the report.

Dr John, Clinical Director Barking and Dagenham CCG, commented that the current GP model would not be sustainable and this vision was trying to improve longstanding problems and to improve patient outcomes.  The strategy would encourage partnership working, including with local authorities to integrate health and social care.  There was also the added pressure of the number of GPs retiring in the area and across London and the South generally. 

The Board raised a number of issues, including: 

-  Other Factors – Health and care provision alone was not the answer and other social impacts, such as jobs and quality housing all have an impact on long-term health outcomes.  Matthew Cole, Director of Public Health agreed to provide some wording on this issue to the CCG.

-  Delivery and Funding - How would this Strategy be aligned with other issues, such as the Better Care Fund and how would delivery be achieved?  How would it be resourced, bearing in mind the £400m funding gap that exists across the BHR health and social care system? 

Ambition 2020 and any proposals emanating from that would impact on social care services will be delivered in the future.  This had not been taken into account.

Preventative Health measures and better lifestyle choices may not have an impact for many years to come.  As a result there were still pressures that needed to be met both now and in the short to medium future.

-  Document Accuracy - The details in the document also needed to be accurate, for example one GP mentioned in it had already retired a few months ago.

-  Staffing Levels - LBBD was second from bottom for GP staff numbers per 1,000 population.  Why was Barking and Dagenham so low in the rating and why were other boroughs better staffed when they had  ...  view the full minutes text for item 89.

Sharon Morrow and Andrew Hagger, LBBD Health & Social Care Integration Manager jointly presented the report and explained that in December 2015 there had been a report to the Board with details of the progress the BCF had made in 2015, which gave details of performance against agreed metrics, delivery of the agreed schemes and actions being taken to address underperformance.  This was then followed by the end of year report in March 2016 that assessed performance and provided an outline of the plans and timescale for developing the 2016/17 BCF Plans.  The report and its attachments before the Board now provided both an overview and detailed plans for submission to NHS England.

Sharon explained that issues such as the reduction of non-elective admission and permanent admissions into residential / nursing placements had been taken on board.  In regard to delayed transfers of care, the aim was to achieve a 2% reduction in 2016/17. Andrew advised that BCF schemes in the 2015/16 plan had been amalgamated to make them more cohesive and the themes and metrics for these were set out in Appendix B to the report. 

Contributions would be in the order of £7.5m from LBBD and £13.2m from the CCG.  It was also anticipated that a Section 75 Agreement would be in place by June 2016.

Cllr Carpenter, LBBD Cabinet Member for Education and Schools, drew attention to the funding allocation in section 4 of the report and the 170 admissions target in section 3 of the report and the risk to this not being achieved when we had both an ageing population growth and increasing budget pressures.  Anne Bristow advised that there was indeed a risk if the older population grows significantly and also because the borough had a high level of non self funders.  The usual rate for residential care settings had been increase by £100 a week, which would should help keep individuals in the community, which is generally a better setting for them.  It was noted that the pooled budget had already been committed in existing services and there was not any new funding allocated. Cllr Carpenter commented that the £105,000 was a very modest amount allocated to end of life care.  Sharon Morrow advised that this did not reflect total end of life spend and details of the spend would be provided direct to Cllr Carpenter.

Healthwatch advised that they would be able to monitor the patient and service user impact across a range of issues and ascertain if patients had discerned any improvement in services.

The Board:

(i)    Endorsed the Better Care Fund plan, budget for 2016-17 and activity and Delegated Authority to the Strategic Director, Service Development and Integration and the Accountable Officer for the BHR CCGs, to agree and submit to NHS England the Plan as set out in Appendix A of the report, subject to the adjustments advised at the Board; and

(ii)  Delegated authority to the Strategic Director, Service Development and Integration, to extend the Section 75  ...  view the full minutes text for item 90.

Matthew Hopkins, Chief Executive, Barking, Havering and Redbridge University Hospitals NHS Trust, introduced the report and led the presentation, supported by Clare Burns, BHRUHT Programme Director for Demand Management.  Matthew explained that the NHS Constitution gave patients the right to access services within 18 weeks following a GP Referral.  It became apparent in 2014 that in BHRUT this was not being achieved and due to the lack of confidence in the reliability of the data BHRUT had suspended formal reporting of its Referral to Treatment (RTT) performance in February 2014. 

The Patient Administration System (PAS) computer system had been updated in December 2013.  There appeared to have been both a misunderstanding and mismanagement of the data within the Trust over a number of years, for which the Trust was now apologising.

NHS England had subsequently tasked BHRUT and Barking Havering and Redbridge CCGs to develop a recovery plan and to report regularly to the NHSE / TDA to provide the necessary assurance that changes were happening.  Despite the data not being assured in March 2016, BHRUT Board Papers stated that it had 1,015 patients waiting more than 52 weeks on the elective RTT pathway, which had led to significant national publicity.  Independent auditors had now been appointed to verify the data and patient numbers but the exact numbers were still being verified.  The only positive resulting from this problem was that the data deficiencies had allowed an opportunity to investigate where there were gaps between patient demand and capacity of services.

Since March the number of people waiting 52 weeks had reduced to around 800.  NHS London had also written to BHR CCGs outlining their concern.

Matthew explained that 95% of patients should have had their procedures / diagnoses within 18 weeks of GP referral.  For an organisation the size of BHRUT it would be expected that there would be around 30,000 people on the process / waiting list at any one time.  The Trust had 58,000 people on the waiting list.  In the past year the Trust had delivered an additional 1,200 operations and 30,000 extra outpatient appointments but there were still a large number of people waiting over 18 weeks.  Matthew added that the Junior Doctors strike action had resulted in 4,000 appointments being cancelled on 26 April alone.

The aim now was to achieve compliance with the NHS Constitution standards by March 2017.  To achieve that BHRUT were now looking towards other providers across the region, however, some people have indicated that they would prefer to wait longer to stay local.  BHRUT had a programme of improvement for the data accuracy and to deal with the backlog of patients waiting for appointments or treatment.

Clare Burns explained that work now needed to be undertaken to provide services locally to resolve demand at the hospitals.  As patients do not seem to want to travel for treatment, this would include alternative routes to treatment, such as a community dermatologist service in LBBD.  Clare added that LBBD referrals were often  ...  view the full minutes text for item 91.

Terry Williamson, Stakeholder Engagement Manager, London Ambulance Service (LAS), presented the report and updated progress on the Improvement Plan.  The Improvement Plan had been out into place following the inspection by the care Quality Commission (CGC) in June 2015 which had rated the services as “inadequate”. 

Terry gave the background to the service and the Improvement Plan, which provided the details of the LAS intention to provide a better service to patients and a better place to work and the work plans to achieve those required improvements.  The details were set out in the report but particular attention was drawn to:

·  Approximately 200 operational staff cover vehicles deployed in the North East London, which included stations in Dagenham, Ilford, Hornchurch, and Romford and there were also supporting resources from Newham, Hackney and Waltham Forest.  The prioritisation of 999 calls was undertaken at the Emergency Operations Centres at Waterloo and Bow.

·  Culture change workshops had been held on bullying and harassment. 

·  Recruitment of Paramedics was being undertaken across the world and the services had been particularly successful in attracting staff from Australia; some of whom would be starting work at the end of March 2016.

·  An innovative ‘elderly fallers’ provision had been set up in partnership with NELFT.  This provided an appropriate care pathway for these patients that prevented attendance at hospital.

·  The Quality Improvement Plan wouldl involve all staff in all its work streams, which would include an investigation into pathways to treatment at Urgent Care Centres etc and identifying what issues may be stopping staff from using them.

·  For the year-to-date, the demand for the service (calls) in Baking and Dagenham had increased by 4.7%.  The North East London sector was currently the third highest performing area across the whole LAS area.  However, the target for Category A calls nationally was 75% attendance within 8 minutes and whilst this  was not achieved by many national services, the LAS was only achieving 58.3% and wished to improve on this.

In response to a question from Cllr Butt, Terry advised that the performance data in section 2.2 of the report were response times for Category A (life threatening) calls, for which the response time to arrive at the patient was 8 minutes.  Abbey Ward had the highest level of Category A calls.  Sean Wilson, Interim Borough Commander, Metropolitan Police, advised that Abbey was also their highest calls area for violence.  It was noted that the call status would not be downgraded if on arrival it transpired the patient did not be life threatening condition.  Terry advised that he would provide the necessary data to enable it to be mapped if it may result in some partnership innovation.

Cllr Turner advised that he had seen the data and added that he was pleased to see the LAS engagement with the Board.

Sean Wilson advised that there was some joint working initiatives being trialled with other 999 services, for example LAS are intending to use Havering Fire Brigade on a safe stand-by point  ...  view the full minutes text for item 92.

Helen Oliver, Managing Director Care City, presented the report on the progress made by Care City, which included its formal launch two months earlier, the confirmation of NHS Innovation Test Bed, Barking Riverside designation as a NHS Healthy New Town site and collaborations with national and international groups. 

Helen also drew the Board’s attention to the innovation work stream, which included investment achievements of £1.8m to test nine IT devices, Activity 2 Exchange innovation with stakeholders, the research and education work streams, which included improvements to cross community skills and capacity, the details of which were set out in the report and presentation.

The Board were pleased to see the innovative use and testing of IT that would enable people to look after themselves whilst they were still being safeguarded.

The Chair encouraged people to visit Care City to see the work that was going on there. 

The Board

(i)   Noted the work that had been undertaken following the launch of Care City in January 2016 and the evolving programmes of work which were being developed.

Matthew Cole, presented the report and explained that the Public Health Programme Board and its sub-committee the Health Protection Committee had oversight responsibility on the national programme for immunisation and screening and how the screening tests helped to identify those at higher risk of a health problem: which in turn would enable early intervention to reduces mortality, morbidity and the economic cost of life-long treatment and support from health education and social services.

Matthew reminded the Board that further actions to improve performance in Antenatal Newborn Screening Programme at both BHRUT and Barts Health NHS Trust in regards to foetal anomaly, Sickle Cell, Thalassaemia and newborn bloodspot screening, and infant physical examination. 

Matthew pointed out the performance of other non-cancer screening for abdominal aortic aneurysm and diabetic retinopathy were performing well.  However, the uptake of child immunisation at two and five years and the seasonal flu vaccination were still areas that needed to improved performance.  The area that was showing a ‘R.A.G’ red rating was the uptake rates for cancer screening which was below both the London and England average within the last three years.

The Board was surprised to hear that there was a worldwide shortage of BCG vaccinations and UK stocks were almost totally depleted and reminded Public Health England that the duty of candour applied to them also.

NELFT advised that they only had BCG vaccine stocks for a couple of weeks maximum and as there were no further scheduled deliveries of the vaccine they were trying to ascertain when supplies would be forthcoming.  NELFT advised it had suspended accepting new BCG vaccination patients and were only immunising those already booked into the BCG clinics and they would also shortly be suspending the universal neonatal BCG programme.  With no vaccinations at birth or at the clinics being undertaken there would be an increasing backlog of individuals that would need to be followed up. 

Helen Jenner said she was concerned about the loss of ‘herd protection’ levels for children and asked what would happen if there was an Tuberculosis incident in a local school as the protocol currently was to immunise all children in contact within the school.  NELFT advised that they had been told there was a small amount of BCG vaccine held nationally for emergency, but not for a local emergency such as Helen had described.

The Board were very concerned about the lack of BCG vaccination supplies nationally and the number of high risk adults and children who were not being vaccinated.

The Board was also concerned about the need for a proactive plan to urgently obtain BCG vaccination supplies and the apparent failure of the national and London resilience plans in regards to this and any further vaccination supply shortages. 

In response to a question about the Measles outbreak, Public Health England advised that there were 64 confirmed cases across London and these were mainly in young adults.

Cllr Turner raised the issue of early testing in pregnancy for Sickle Cell and was advised  ...  view the full minutes text for item 94.

The Board received the report from Matthew Cole, which set out the Council’s commissioning plans around Public Health and Adult Social Care for 2016/17, which included information on contracts over £500,000 in value that were due to expire during 2016/17 financial year. 

The report also provided information on how the plans would meet with the Joint Health and Wellbeing Strategy, Partners’ commissioning intentions and Legislative requirements including the Care Act 2014 and Children’s Act 2014,

The Board:

(i)  Noted the proposed procurement and commissioning plans for 2016/17, including the list of list of contracts over £500,000 that were set to expire during the financial year. 

The Board received the report on the work of the System Resilience Group (SRG), which included the issues discussed at the SRG meetings held on 29 February and 30 March 2016.

The Board noted the work that was ongoing in regards to the BHRUT Trust and its Improvement Plan, including performance over the Easter period and the front and back door service of Accident and Emergency, influenza uptake, neuro-rehabilitation, Referral to Treatment and Cancer Improvement Plan, the latest position on the Urgent and Emergency Care Vanguard and the governance and delivery arrangements for the SRG.

The Board noted the reports on the work of the:

·  Children and Maternity Sub-Group

·  Mental Health Sub-Group

·  Learning Disability Partnership Board Sub-Group 

The Board noted the Chair’s report, which included information on:

·  Sustainability and Transformation Plans (STP)
There were now 44 STP areas across England and LBBD was in the North East London STP, which also included Havering, Redbridge, Waltham Forest, Newham, Tower Hamlets, City and Hackney. 

The full Sustainability and Transformation Plans were due for submission at the end of June 2016 and a draft version of the STP would be presented at the next Board meeting.

·  Health and Wellbeing Bard Development Session
The Session would be held on 19 May 2016, Care City, Barking.

·  Women’s Empowerment Month

-  Women’s Empowerment Awards 2016 and events held in March.

-  The Adoption of the Gender Equality Charter by the Council.

·  News from NHS England:

-   Resources to support early detection and secondary prevention in primary care.  The CVD Primary Care Intelligence Packs had been launched by the National Cardiovascular Intelligence Network (NCVIN).

-  New whistle-blowing guidance for primary care. 

The Board noted the draft June edition of the Forward Plan.