Agenda and minutes

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

Apologies for absence were received from the following:

·         Kim Wright (Chief Executive, Brent Council)

·         Councillor Tatler, substituted by Councillor Krupa Sheth

·         Basu Lamichane (Residential and Nursing Sector)

The Chair led introductions and welcomed Rachel Crossley as the new Corporate Director for Care, Health and Wellbeing.

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 25 July 2023, be approved as an accurate record of the meeting.

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

None.

To update the Health and Wellbeing Board on a comprehensive winter plan with input and engagement across system partners in Brent.

Tom Shakespeare (Managing Director, Brent Integrated Care Partnership) and Antoinette Jones (Head of ICP Delivery, NHS NWL) introduced the report, which set out the winter schemes that the Integrated Care Partnership (ICP) would be implementing in Brent with all key partners. In introducing the report, the following key points were highlighted:

·         The system was now into winter and the acute system was under significant pressure. As a borough partnership, the ICP took its responsibility in supporting the system very seriously and had taken a number of actions to progress the support to the system during winter pressures, including escalation meetings and focused support around discharge.

·         The focus of winter planning was on a whole system approach, including incorporating prevention, housing, and wider social determinant interventions within the system.

·         In relation to prevention in order to keep people well in the first place, an area of focus was on covid and flu vaccinations, with a robust vaccination programme across all cohorts. There were a number of community pharmacists, local Primary Care Networks (PCNs) and Brent Civic Centre engaged in the vaccination programme. At the time of the meeting, the ICP had been notified that the majority of patients residing in care homes had been vaccinated as planned. Within the area of prevention and keeping residents well, the Brent Well and Warm Service offered advice and vital support to vulnerable residents to help keep bills down.

·         Subject to final approval, primary care would increase additional appointments in core hours, in addition to the existing enhanced appointments offered at weekends and bank holidays.

·         There was now a primary care programme supporting carers with their health and wellbeing while they cared for loved ones to help reduce hospital admissions of carers and subsequently the person they cared for.

·         Across the system, the ICP was engaging with key stakeholders and partners and there were community strategies in place to ensure residents could be navigated to the right care offer and receive the right service at the right time. Self-care messaging would begin in November 2023. In addition, the wider NWL winter communications and engagement plan would support patients and residents with information about what services they could access during winter.

·         A Children and Young People Campaign had launched in September 2023,

·         BHM were reaching out to homeless people and asylum seekers to encourage vaccinations. There was Brent wide housing need preparedness operating through a number of services, geared towards supporting those experiencing homelessness and sleeping rough, including Turning Point, Brent Outreach Link Service, and the winter shelter which would be open 7 nights a week from the coldest period in the year.

·         London North West University Healthcare NHS Trust (LNWUHT) would be opening additional beds to support the system over winter, and Central London Community Healthcare (CLCH) would support Brent through rapid response times, preventing admissions to hospitals. The ICP knew that, in 2022-23, CLCH delivered a 98% response rate and managed over 400 referrals a month, and that support was expected to continue into  ...  view the full minutes text for item 5.

To seek comment and approval from the Health and Wellbeing Board for the Better Care Fund Plan for 2023-24, which has been agreed by the Brent Integrated Care Partnership (ICP) Executive and submitted in draft pending approval to the National Better Care Team.

Tom Shakespeare (Managing Director, Integrated Care Partnership) introduced the proposed Better Care Fund (BCF) 2023-25. He highlighted that there had been no substantive changes to the concept presented to the Board in July 2023, but the BCF had now received national approval and Integrated Care Board (ICB) approval pending formal ratification of the Health and Wellbeing Board.

RESOLVED: to ratify the Better Care Fund 2023-25.

To provide an update to the Health and Wellbeing Board on key community transformation work streams.

Jackie Allain (Director of Operations, CLCH) introduced the report, which provided an overview of the progress and activity of the community services workstream. In introducing the report, she highlighted the following points:

• The Community Services Executive was one of 4 priority Executives within the Integrated Care Partnership (ICP), and its aim was to look at ways to help reduce admissions into hospital and keep people out of hospital post discharge. The group was chaired by Jackie Allain and Simon Crawford (Deputy Chief Executive, LNWUHT) to ensure both community and acute representation.
• The Community Services priority had been split into 6 main priorities – respiratory, care homes, heart failure, frailty, rehab and reablement, and integrated neighbourhood teams, and more recently a 7^th priority had been added looking at children’s services, including special schools. The report showed a breakdown of each of those workstreams.
• On respiratory, work had been done to look at new oxygen assessments and review the specification to ensure the requirements were being delivered locally. Officers were also looking at a new pulmonary rehab offer at the Willesden Centre to help reduce waiting lists within the acute sector.
• Officers were working closely on the Integrated Neighbourhood Teams Project to deliver services locally, joining with Primary Care and the Council to ensure services were delivered in the heart of communities.
• Officers were looking at making a business case for a strong children’s continence service within the borough.

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

·         The Board noted the priority around continence services for children, but asked where continence services for adults featured, as this was something that could particularly affect the elderly and women. Some residents were reporting waiting over 22 weeks for a referral to the Bladder and Bowel Service, with GPs not providing continence pads during that waiting period. The Board was advised that there was an adult Bladder and Bowel Service in Brent and it was very much under pressure. Central London Community Healthcare (CLCH) were looking at how that service could be enhanced, working with commissioning colleagues. The reason children’s continence was deemed a priority was because it was felt there was no strong or robust children’s continence service at all, and a lot of support for children with incontinence was referred to the Bladder and Bowel Service, which was an adult service without the right expertise for children’s incontinence. As such, this had been recognised as a joint priority with CLCH and the Children’s Commissioning Team.

·         Nigel Chapman (Corporate Director Children and Young People, Brent Council) welcomed the priority on special school places and the need over the coming years, but highlighted that the situation was unlikely to resolve itself quickly. Brent continued to see a year on year growth of at least 5% in children with Education Health and Care Plans (EHCPs), and would need to look at extra capacity above and beyond the additional 427 places that had been committed to. There would need to  ...  view the full minutes text for item 7.

To update the Health and Wellbeing Board on the status of the Air Quality Action Plan (AQAP) and acknowledge the critical role that health partners can play in the delivery of the AQAP and improving health outcomes through reducing pollution and raising awareness of its impacts.

Councillor Krupa Sheth (Cabinet Member for Environment, Infrastructure and Climate Action) introduced the report, which presented the revised Brent Air Quality Action Plan (AQAP) for adoption. She reminded the Board that Brent Council declared a climate emergency in 2019, and air quality played a big role in that. There was a sense of urgency to tackle poor air quality, particularly in the most deprived areas in the borough. The updated plan strengthened the work to improve air quality across the whole borough rather than specific areas. Brent Council knew air quality affected everyone, but it could severely affect the health of babies, young children and the elderly, and it contributed to the development of asthma and many other health conditions, demonstrating why it was important to improve air quality, protect the health of residents and support the NHS. The AQAP would be presented to Cabinet for formal adoption in December 2023.

Lauren Salisbury (Air Quality Policy and Projects Officer, Brent Council) presented some data in relation to air quality. In presenting the information, she highlighted the following key points:

·         Globally, air pollution remained significant. In 2019, of the global estimated number of deaths attributable by different types of pollution, air pollution was at the top of the list, with 6.67 million deaths. When looking at the wider causes of death, air pollution was still a significant contributing factor and estimated to be responsible for the third highest number of deaths globally, following high blood pressure and smoking. Air pollution was estimated to cause 40,000 premature deaths per year in the UK and affected morbidity, where people living within areas of poorer air quality had an additional 20% chance of having multiple long-term illnesses. This had an impact on the health and social care system, and it was estimated that the health costs of air pollution could cost up to £20 billion by 2035.

·         In 2013, Ella Kissi-Debrah, a 9-year-old girl from Lewisham, died from an Asthma attack and was the first person in the UK to have her death linked directly to air pollution on her death certificate. Spikes in particulate matter and nitrogen dioxide near her home, which was close to the South Circular, corresponded with Ella Kissi-Debrah’s hospital admission in the lead up to her death. The outcome of this was a Prevention Of Future Deaths Report, published in 2020, which outlined three major concerns; that air quality objectives in the UK were too high, far higher than WHO guidelines, and there was no safe level for air pollution; that there was low public awareness on where to get information about air pollution in the local area and; that the effects of pollution on people’s health were not being communicated to patients by their medical care teams. Officers highlighted that these were all areas that the local authority could work together with health to alleviate through the AQAP.

·         In recent years, there had been 2 key developments in air pollution knowledge driving forward air pollution policy, which informed  ...  view the full minutes text for item 8.

To provide an update to the Health and Wellbeing Board on the progress of a new food strategy, highlighting the emerging themes and outlining next steps.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report, which provided an update on the progress towards a new Food Strategy for Brent. In introducing the report, she highlighted the following key points:

• Officers had reached out to voluntary and community sector organisations to understand what was already happening in the borough in terms of activities and enthusiasm towards food. She did not feel there was a complete picture there yet but there was enthusiasm and expertise within that sector.
• A visioning day was hosted a couple of  weeks ago, bringing together Council officers and community organisations to ask what they thought the scope of a food strategy should be and how it should be developed. The clear message arising from that visioning day was that the strategy needed to be developed in partnership, which was gratifying, as those boroughs who had done better work to date in this area had been characterised not just by doing that in partnership but by being led by the community sector.
• The visioning day prioritised food poverty, food and environment, food growing and food education. It was felt that the focus of the day reflected the participants, with the very pressing issue being around food poverty, but the next step was to broaden that work and, for example, engage businesses. The Council was looking to do a piece of work to address food and employment and food as an economic driver.
• The work would likely involve the establishment of a task group to oversee it and take the work forward, which was hoped would have a community chair.

In considering the report, the following issues were raised:

• The Board agreed with the recommendation to widen the food strategy.
• Councillor Krupa Sheth (Cabinet Member for Environment, Infrastructure and Climate Action, Brent Council) felt that many of the activities outlined in the report aligned well with the actions being taken on the climate emergency agenda and green neighbourhoods work, and therefore proposed some joined up work. Communities in green neighbourhoods were growing their own vegetables, and the Council had produced a book in collaboration with Veolia with different recipes inspiring residents to reduce food waste.
• Brent was declared a ‘right to food’ borough several years ago so members asked for some of that work to be encapsulated within the food strategy.
• Members suggested that one of the goals should be to completely eradicate food poverty in the borough.
• The Board highlighted the need to connect the food strategy with the work around free school meals.
• The Board highlighted the importance of working with local businesses around food waste and supply chains.
• Simon Crawford (Deputy Chief Executive, LNWUHT) highlighted that the London North West University Healthcare NHS Trust (LNWUHT) aimed to use local produce for their meals for patients and could look at the franchises and contracts onsite and set expectations around those. He highlighted that food sometimes was a contributing factor to poor health, and so there was likely actions providers could  ...  view the full minutes text for item 9.

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.

None.