Agenda and minutes

For Members of the Board to note any apologies for absence.

Apologies for absence were received from the following:

·         Councillor Mili Patel, who was substituted by Councillor Muhammed Butt

Members are invited to declare at this stage of the meeting, the nature and existence of any relevant disclosable pecuniary or personal interests in the items on this agenda and to specify the item(s) to which they relate.

None declared.

To approve the minutes of the previous meeting as a correct record.

RESOLVED: That the minutes of the meeting, held on 13 October 2022, be approved as an accurate record of the meeting.

To consider any matters arising from the minutes of the previous meeting.

The Chair confirmed that the Better Care Fund for Brent had been approved formally.

To provide an update on the joint health and local authority response to winter pressures arising in the shorter-term and outline the Integrated Care Partnership’s (ICP) priorities for children over the medium and longer term.

Councillor Gwen Grahl (Cabinet Member for Children, Young People and Schools, Brent Council) introduced the update, highlighting that she was grateful for the request to update the Board on contingency planning for children’s healthcare and addressing new challenges such as Polio and Strep A.

In further introducing the report, Jonathan Turner (Borough Lead Director – Brent, NWL NHS) advised the Board that the report reviewed the current situation and response to winter pressures with a specific focus on children, and also detailed the Integrated Care Partnership (ICP) priorities to bring together a specific focus on children. In updating the Board on current issues, he highlighted the following points:

·         In the latter part of the summer, routine monitoring of sewage in London showed the presence of the Polio virus,, therefore the Joint Committee for Vaccination and Immunisation (JCVI) had advised that across London the NHSE should offer an inactivated polio vaccine booster for children aged 1 – 9 years. The ICP had moved rapidly to set that up, and the latest figures were that around 13,000 children had received their booster in Brent. This equated to around 32% of the eligible population, which was a strong starting basis.

·         Routine immunisations were ongoing, including an outreach centre with SPIN GPs specifically working around improving childhood immunisation uptake.

·         Strep A clinics had been set up to reduce the pressure on the system and provide extra access for parents and children. As of the week of the meeting, the additional clinics had delivered around 892 additional appointments.

·         Enhanced access hubs were in operation, with joint primary and secondary care clinics set up for paediatrics in the North and South of the borough.

·         Within the ICP, the children’s priorities working group had met to look at where the areas of need were and where partners could collaborate most effectively, which was outlined on pages 12-13 of the report. Focus was on developing a holistic support offer to address the inequalities and prevention agenda, which included specific focus on healthy weight, smoke free homes and a healthy start. Immunisations were also a priority for the ICP

·         In relation to mental health and wellbeing there was a new national Thrive model, and partners were now working together to map out the requirements of that. CAMHS was another area of focus to reduce the substantial waiting list, and there had been work across the system to secure additional non-recurrent funding for the year to reduce the waiting list. Jonathan Turner and Robyn Doran (ICP Director) had been in discussion with NWL ICS to secure additional resources to reduce those waiting lists and keep them down.

·         A new neurodiversity pathway was being implemented, with jointly commissioned speech and language therapy.

·         Work was being done to improve the diagnosis and control of asthma, focusing on inhaler technique, and working with housing teams on mould in houses and the links between air quality and environment on asthma.

·         It was anticipated that these workstreams would report to the ICP exec groups and  ...  view the full minutes text for item 5.

To provide the current arrangements for childhood and school aged immunisations, including responsibilities for commissioning, delivery and quality assurance.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report, which described the current arrangements for childhood and school aged immunisations. She advised the Board that the scope of the report had been deliberately limited due to the complex nature of childhood immunisations. NHSE were responsible for the commissioning of routine immunisations and had been able to provide figures for the Board. In Brent, the school age programme was commissioned through CNWL. She concluded that there were longstanding challenges with raising childhood immunisation rates in Brent.

The Chair thanked Dr Melanie Smith for introducing the report and invited NHSE colleagues Susan Elden (Public Health Consultant, NHSE) and Anne Tunbridge (Immunisation Commissioning Manager, NHSE) to speak. The following issues were raised:

• The Board’s attention was drawn to section 6 and 7 of the report, which detailed the headline figures for Brent. Generally, London coverage of childhood immunisations was lower than the national average. In Brent, the figures were slightly lower than the regional London average, but were on par with other boroughs in NWL.
• During the pandemic, coverage figures fell to their lowest ever across Brent, which were now showing signs of recovery but still not back to the 2018 baseline. As NHSE attempted to close that gap, new children fell into the age category of requiring vaccinations ie the numbers of children now needing immunisations is increasing.
• Section 7 detailed the collective efforts happening across agencies to improve vaccination rates in Brent. A focus going forward was around reducing inequalities and catching up on missed groups, listening to communities and building trust with providers and people.

In considering the presentation, the Board raised the following points:

• The Board asked if there was any demographic data on the groups where vaccination uptake was particularly low and if there was anything the Council could do to work more closely with those groups. Dr Melanie Smith advised the Board that she was looking to improve data quality, and a big achievement of the work done during Covid-19 was the ability to track vaccination rates alongside deprivation which was not currently possible for childhood immunisations. Immunisation data was held on a national system, and, until Covid-19, NHS data collection did not prioritise ethnicity or deprivation. She felt there was a need to supplement the very well-established national database with other initiatives to improve that data quality. In terms of working closely with groups who had low vaccination rates, Dr Melanie Smith highlighted that there was targeted outreach and a variety of offers from primary care to encourage uptake of vaccinations and make access easier, acknowledging, that for some families, attending their GP surgery was not always convenient. School aged immunisations had been offered outside of school settings and in December 2022 79 children had been vaccinated in 1 day in Brent Civic Centre. She commended children and young people services, public health, and NHSE colleagues who had been flexible in their approach to immunisation since Covid-19. Going forward, she wanted  ...  view the full minutes text for item 6.

·         7i. NWL Additional Health Inequalities Funding

To receive a summary of additional health inequalities funding

·         7ii. Brent Health Matters Update

To receive an update on the Brent Health Matters Programme

7i. NWL Additional Health Inequalities Funding

Nipa Shah (Programme Director, Brent Health Matters) introduced the report, which provided a summary of additional health inequalities funding. She informed the Board that additional funding had been released nationally in October 2022 to fund health inequalities work, and NWL had been allocated £7m from that fund. Out of that, a decision was taken to give 60% of that funding to borough-based partnerships, with Brent’s allocation being £783k. Officers had prepared a business case which split that fund, with around £300k earmarked for community organisation grants and £483k going towards implementing Community Co-ordinators, dedicated GP time, and business analyst support to work more closely with the 5 Brent Connect areas. There was also a pot of money for additional schemes, and Brent had asked for £300k from that pot of money to continue supporting Brent Carers Centre who were providing a Health Educator Service. Brent Health Matters were now awaiting a final decision on the business case before implementation.

RESOLVED: To note the report.

7ii. Brent Health Matters Update

Nipa Shah (Programme Director, Brent Health Matters) introduced the report, which provided an update on the Brent Health Matters Programme. In considering the report, the following points were raised:

• The Board commended the work done so far, and were encouraged to hear about the UCL funding to use community assets to improve Health and Wellbeing. They felt that learning from the programme could be used for other mainstream services.
• Noting that some of the health events that had been held had identified some people who were acutely unwell, the Board asked whether there was any learning around types of conditions, demographics or where they were living. Nipa Shah informed the Board that the presentations had been varied, from people who had not seen their GP to people who were well versed in looking after themselves but had not felt it was important. Dr Haidar added that some of the conditions being identified were cases of high blood pressure, and those patients had now been educated and help allocated accordingly. The more events that BHM did, the more themes officers could pick up on. Data collection was in the process of being improved, with BHM working with the performance team to take cuts of data on the people they saw, including ethnicity, age range, and the last time they had seen a GP. When the new BHM dashboard was developed, officers would be able to start recording these engagements, which could then be quantified and included within reports.
• The Board asked what the dashboard intended to capture and who was intended to use it. Nipa Shah advised that the intention was for officers to be able to use the dashboard to record data and pull reports, and this could be shared with councillors. Tom Shakespeare (Managing Director, Brent ICP) informed the Board that there was ongoing work around the development of population health dashboards, and the intention was for them to be available at practice level,  ...  view the full minutes text for item 7.

To provide an update on Brent Integrated Neighbourhood Teams Development.

Josefa Baylon (Head of Integration, NHS NWL) introduced the report, which updated the Board on the progress of integrated neighbourhood team development in the borough since the last Health and Wellbeing Board meeting. She provided the Board with a summary of activity that had taken place, risks and mitigations, and the next steps for the development.

The Chair invited comments and questions from those present, with the following issues raised:

·         In considering the next steps for the development of integrated neighbourhood teams, the Board asked if there were any risks with achieving those. Josefa Baylon advised the Board that there could be risks with use of premises, such as rent rates and service costs, meaning there was a need to work in partnership to find and use premises, including considering waiving or reducing rates for partners. There was a need to acknowledge that the voluntary and community sector paid bills for their premises.

·         Dr Haidar added that the purpose of the neighbourhood work was to put residents at the heart of services. He was encouraged by the design of the programme and the hard work the team was doing to wrap around services for residents to access. He highlighted that it would not be a quick process and would have short term, medium term and long term goal setting.

RESOLVED:

i)              To note the report.

To provide an update on healthy lives, one of the five themes of the Health and Wellbeing Strategy.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report with an update on Healthy Lives, which formed one of the 5 themes of the approved Health and Wellbeing Strategy. She highlighted that the theme focused on enabling residents to make healthy, easy choices for themselves and who they cared for and had ten commitments. She drew the Board’s attention to the wide range of partners involved in delivering those commitments, such as the local authority, NHS and voluntary and community sector organisations. The overall progress on this theme had been good, and work had begun on developing a food strategy, which would drive forward some of the commitments such as healthy catering and Incredible Edible Brent.

In terms of areas of achievement, Dr Melanie Smith highlighted the work of the Brent Resident Support Fund and the oral health work where public health had seen an innovative and award-winning model implemented. In addition, two workstreams that focused childhood obesity, which had been a long-term entrenched issue in Brent, had seen some positive success. In one programme, professionals delivered intervention for pre-school children through their regular duties, such as Family Wellbeing Centres and the 0-19 service. Public Health had also commissioned an intervention programme for school aged children which had been co-produced with families. Both of those interventions had shown positive benefits in terms of behaviour change and weight loss, which was the first time Public Health had been able to report positive outcomes in interventions to reduce childhood obesity in Brent.

RESOLVED:

i)              To note the report.

To provide the Borough Plan to the Health and Wellbeing Board.

Councillor Nerva introduced the item by commenting on the importance of all statutory agencies involved in health and wellbeing knowing what was envisaged in Brent as part of the new Borough Plan. There would be responsibilities and key issues for implementation which could not be done by the Council alone but in partnership with NHS and other agencies. He had requested this item at the Board as an opportunity to reflect on discussions on the issues raised during the meeting such as asthma, childhood obesity, and health inequalities.

In introducing the item, Tom Pickup (Policy, Partnerships and Scrutiny Manager, Brent Council) presented a powerpoint with the following key points raised:

• The public consultation on the Borough Plan had ended on 10 January 2023, so the information presented to the Board was the most up to date feedback received. It was estimated that the consultation period had resulted in approximately 900 responses through various different means including an online survey and engagement such as workshops, focus groups, community hubs and forums.
• The Plan was drafted in the context of operating in a post-pandemic era with a rising cost of living. This had an impact on what the Plan could commit to, what priorities to pursue, and what should be considered over the next 4 years. The rising cost of living affected not only residents, communities, and businesses but also the Council, NHS and other organisations. As a result, the Plan was written in the context of the Council looking to make £18m in savings over the next year.
• The priorities of the Plan were outlined. The final priority most relevant to the Health and Wellbeing Board was healthier Brent. This priority was about tackling health inequalities and ensuring there were localised services for localised need.
• One of the questions during consultation had been ‘what should Brent look like in 2027’, and the three most common words emerging from that question had been ‘clean’, ‘safe’ and ‘green’, which was something to consider for the final iteration of the Plan due to be presented to Cabinet for approval on 6 February 2023. Each of the existing priorities would now be tweaked to reflect the feedback from consultation, which broadly aligned with the draft priorities. For example, prosperity and pride saw a clear theme around creating more jobs and skills. A cleaner, greener future showed themes around better maintained parks and more visible greenery. The theme of safety had emerged and the importance of feeling safe, particularly for women and children. Respect and renewal saw feedback focused on improved air quality, reducing congestion and traffic and a visibly cleaner borough. Those who engaged in consultation wanted more and better affordable housing with accessible infrastructure such as GP surgeries. There were calls for more opportunities for work experience to support young people into work under the best start in life priority. In relation to healthier Brent, people aligned health with happiness, and linked to that was awareness and access for mental health support and reducing  ...  view the full minutes text for item 10.

To provide a brief update on the winter schemes in Brent and to inform the Health and Wellbeing Board of Brent’s preparedness to manage the additional Adult Social Care (ASC) Discharge Funds to support winter pressures on the local health and social care system.

Tom Shakespeare (Managing Director, Brent ICP) introduced the report, which informed the Board of Brent’s plan and preparedness to manage the anticipated winter pressures on the local health and social care system and manage the additional Adult Social Care (ASC) Discharge Funds to support winter pressures. He highlighted that this work was being done in the context of the significant pressures the NHS was currently facing. In updating the Board, he raised the following key points:

• Members had heard at the previous Board meeting the £1m worth of schemes Brent were proposing, and some additional funding of approximately £2.2m was now coming into the Brent system in addition to that £1m to support winter pressures on the acute system. It was hoped those additional schemes would have a significant impact on reducing pressures in the hospital and improving flow.
• All schemes were now live with the exception of three. Two of the three schemes were now in the process of being mobilised. This meant there were a total of 24 schemes developed in Brent from the significant amount of funding that had entered the local system.
• Simon Crawford added that, from an acute trust perspective, they had received good support from the local authority and community services regarding discharges. There were individual cases that were more complex where escalation calls were required occasionally, but generally there was reliable attendance on all discharge calls on a daily basis, including out of hours coverage. He added that this was a significant improvement to several years prior.
• The formal ratification of the Adult Social Care Discharge Funding was required from the Health and Wellbeing Board as this would form part of the Better Care Fund and Section 75 Agreement.

In considering the report, the Board raised the following points:

• The Board highlighted the recent press coverage that elderly people were being discharged into large hotels, and asked if that was happening within Brent. Phil Porter (Corporate Director Adult Social Care and Health, Brent) confirmed this was not the case within Brent.
• The Board commended Antoinette Jones (Head of Delivery (Brent and Harrow), NHS NWL) and her team for co-ordinating the very complex set of funding that had been released from different pots at different times. The timing of funding releases had not always been helpful, and the Council had fed back to the Department of Health and Social Care that it would be helpful to receive money earlier, be clearer about the outcomes they wanted partnerships to achieve, and allow partnerships the flexibility to implement the schemes that were locally needed. The Board recognised the difficulties of the timings of funding announcements. Tom Shakespeare agreed that there was a shared view that it had not been an ideal process, but was confident that Brent had planned some positive schemes despite those difficulties.
• Carolyn Downs (Chief Executive, Brent Council) had been in discussion with all 8 NWL borough Chief Executives and the ICS leadership to raise the issue of the newly announced funding of  ...  view the full minutes text for item 11.

Notice of items to be raised under this heading must be given in writing to the Head of Executive and Member Services or her representative before the meeting in accordance with Standing Order 60.

Simon Crawford informed the Board that LNWUHT had moved from level 3 to level 2 in terms of NHS assessment of performance, which was a positive move in the right direction. The Trust had previously been at level 3, requiring monthly oversight meetings to review performance, quality and implementation of plans for a number of years. Level 2 was a lighter touch of oversight, reflecting the sustained improvement of performance quality. For example, the emergency pathway had seen improvements, and there was good progress on elective and recovery, with around 105% of activity compared to pre-covid. There had been good improvements on the CQC maternity improvement plan with less incidents, better management, improved infection control and good progress on financial efficiency. Theatre performance was judged as good and there were reduced cancellations. The Trust had delivered its financial plan for the past 2 years and was on track to deliver it again this year. He highlighted that the improvements were reflected in the feedback received from patients and staff.

The Board commended this positive achievement, and hoped that partners present could work together to disseminate that message so that residents had a perception that they had access to a good and safe service.