Agenda and minutes

Apologies for absence were received from the following:

·         Kim Wright (Chief Executive, Brent Council)

·         Jackie Allain – substituted by Patrick Laffey

·         Simon Crawford – joined online

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 as a correct record, the attached minutes of the previous meeting held on 30 October 2023.

RESOLVED: That the minutes of the previous meeting, held on 30 October 2023, be approved as an accurate record of the meeting.

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

The minutes referenced discussions in relation to health, environment and air quality on page 11, with actions for this to be taken up with LNWUHT and Public Health. Dr Melanie Smith (Director of Public Health, Brent Council) confirmed that a meeting had been arranged to meet with the London North West Lead for Strategy at the Trust to discuss.

This report provides the Health and Wellbeing Board with an overview of the progress achieved in meeting the Brent Joint Health and Wellbeing Strategy objectives, which was first approved by the Board in March 2022. The report also proposes the approach for the Strategy refresh.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report, which provided a status update of progress against the commitments made in the Health and Wellbeing Strategy and suggested a way forward. In introducing the report, she highlighted the following key points:

·         Members were reminded that the current Health and Wellbeing Strategy had been shaped by extensive community engagement which specifically focused on asking residents about inequalities in health and what they thought could and should be done about inequalities. In response to that engagement, the Board had defined 5 key themes for the strategy: healthy lives, healthy places, staying healthy, healthy ways of working, and understanding, listening and improving.

·         Against the 5 key themes, Board members committed to a number of actions that residents had asked of the Board and the paper detailed where progress on each of those commitments were.

·         There was a breadth of activity taking place and positive progress had been made on most actions. Officers highlighted that much of the data was qualitative rather than quantitative, this would be addressed when looking at ways forward.

·         Officers proposed that the next steps, through each Council department and Integrated Care Partnership (ICP) Executive Group, was to undertake a review of which of the commitments had been met, which had become business as usual, and which may no longer be relevant. Each Council department and ICP Executive Group would be asked to identify 1-2 new commitments, including quantifying those commitments and identifying how the Board would know whether they had been met by providing a set of metrics to measure against. Those commitments should then be incorporated into each service areas’ planning processes for the 2024-25 year.

The Chair then invited contributions from those present. The following points were made:

·         The Board was pleased to hear about the installation of an accessible changing place facility at Vale Farm Leisure Centre. Dr Melanie Smith highlighted that the future expansion of additional changing places in other locations was dependent on securing additional funding. 

·         The Board noted that the report detailed improved access to parks and events for people with disabilities, and asked whether the working group set up to progress this work included adults who were disabled and had considered what barriers adults with disabilities using parks and event spaces faced. The Board was advised that the work was currently child focused, but there were plans to expand that to involve adults, which was an area that had not yet been worked on. It was agreed it would be helpful to discuss this work with the Disability Forum to ensure this was done through co-production.

·         The Board was pleased to hear about the installation of a wheelchair accessible swing in one of the parks in the borough but noted the comment in the report that it had elicited a mixed response. Officers explained that the facility of the swing was welcomed, however this had highlighted other accessibility issues with access to the surrounding areas that needed to be  ...  view the full minutes text for item 5.

This report provides the Health and Wellbeing Board with an update on the implementation of Integrated Neighbourhood Teams.

The Board received a report from Josefa Baylon (Head of Integration – Brent, NWL NHS) which provided an update on the progress made and the overall strategic approach taken in the continued development of Integrated Neighbour Teams (INTs) in Brent. The approach focused on 3 key enabling pieces of work; workforce and organisational development; estates; and ICT data, digitisation, and connectivity. The Board was asked to approve the next steps and comment on how best INTs could ensure the next phase of work involved meaningful input from communities and best ways to measure and track impact.

In introducing the report, Josefa Baylon reiterated that INTs were a large scale, long term development approach which followed guidance on what integration should look like. It focused on co-production, engagement, and working collaboratively with partners and residents to discover, design, develop, implement, evaluate and sustain models of integrated working. Some of the achievements of the work so far included some neighbourhood deep dives with visioning days, which had fostered an environment of continuous learning and engagement. The Board heard that, collectively, those engagement events had engaged over 200 residents between June – November 2023 on in Willesden, Wembley, and Stonebridge, Harlesden, Kensal Green & Roundwood. Those neighbourhoods were now ready to fulfil their delivery plans within their areas. There was still work to do on the remaining 2 neighbourhoods in Brent, which were Kenton & Kingsbury and Kilburn.

Next steps would include looking at understanding workforce training and development needs across all key delivery partners, and estate optimisation. A local estates strategy had been drafted which was being shared with stakeholders for review. The report provided further details on initiatives which included the opening of a new site for Wembley Medical Practice. As part of the new site, it was hoped it would be possible to integrate it with nearby services, such as Brent Civic Centre, to act as integrated care hubs, meaning residents would not need to repeat their stories more than once. This would look to integrate and connect information, with work was being done with London Care Records, Care Information Exchange, Universal Care Plans, Pharmacy First and Optica to ensure this was done appropriately. The work would look to establish a defined theory of change that would enable INTs to measure and track the impact of delivery.

The Chair then invited contributions from those present, with the following points raised:

• Within the report there was a section on population health needs analysis, which showed a life expectancy and deprivation map outlining that the highest areas of deprivation had less life expectancy. The Board asked, as a result of that information, whether the approach should be more targeted with more resource put behind those areas. Tom Shakespeare (Director of Integrated Care Partnership) felt this was an important point. He stressed that this particular programme was about enabling and did not come with significant additional resource in itself, but looked at aligning existing resources within the system to achieve outcomes. In other areas of  ...  view the full minutes text for item 6.

This report provides the Health and Wellbeing Board a further update on the process of the primary care access priorities, associated challenges, and the planned proposals for further improving access to primary care services in Brent.

Versha Varsani (Head of Primary Care - Brent) introduced the report, which provided an update on access to primary care following the previously presented paper a year ago which had responded to the ‘No One Left Behind’ Scrutiny Task Group Report into access to primary care. In introducing the report, she highlighted that ‘No One Left Behind’ had made a number of recommendations and the report presented an update on progress against those. Some of the key points were highlighted as follows:

• In terms of the patient population, there was a diverse population with the number of patients growing year on year. People were living longer and having lengthier periods of ill health.
• There was a lot of work being done around proactive healthcare and neighbourhood work.
• The demand for GP led appointments surpassed the supply, so primary care was continually seeking different avenues and providing progressively more services to meet this demand.
• There were 51 GP surgeries across Brent, and in a period of one month, GPs collectively provided 210,000 GP led appointments.
• Enhanced access hubs were available which provided delivery of services across the 5 different hubs in the borough and operated outside of GP core hours – in the evenings from 6:30pm–8pm Monday to Friday, and Saturdays 9am–5pm. Those hubs provided an additional 12,500 appointments per month.
• Between GP-led appointments and enhanced access hub appointments, there was an average of 3 appointments per month per patient, or 36 appointments per year per patient. Not every patient registered with a GP would need an appointment, so some patients would have more access than others, but this gave an understanding of the  offer.
• NWL was currently piloting a service operating between November 2023 to March 2024 with PCNs to provide more at scale services during core hours and was beginning to analyse the data from that trial.
• There had been additional pressures over winter due to the usual winter pressures, as well as Junior Doctor strikes. PCNs stepped up to provide additional access over the 3 bank holidays during Christmas.
• PCNs and GP practices had active triage models and aimed at signposting patients to the right place at the right time to see the right professional.
• There had been an increase in employees on the Additional Roles Reimbursement Scheme (ARRS), with 206 full-time equivalent additional roles, such as pharmacists, dieticians and social prescribers, compared to 88 two years previously. These additional roles provided specialist skills within GP practices and PCNs.
• A priority of primary care was to help patients chose the right setting to access and there was a range of services to chose from including community pharmacy services, NHS 111 for non-life threatening conditions, and promotion of self-care. Community pharmacists were expanding their offer with the Pharmacy First Scheme in line with the national programme. Pharmacy First would be a walk-in service for access to treatment for minor ailments, initially with 7 pathways. There would be ongoing work to further integrate all these additional services, and pharmacists were  ...  view the full minutes text for item 7.

This report provides the Health and Wellbeing Board with a summary of the SEND and Alternative Provision Local Area Inspection process and key themes from the Brent partnership self-evaluation as part of the SEND Area Inspection preparation.

Nigel Chapman (Corporate Director Children and Young People, Brent Council) introduced the report, which detailed the preparedness for the joint inspection of SEND services of both the local authority and health. In introducing the report, he highlighted the following points:

• The inspection was conducted by both CQC and Ofsted as a joint inspection of health and the Council, rather than a solely local authority inspection.
• The SEND inspection would use a new framework which was introduced just over a year ago, the details of which were in the report.
• Brent had been inspected as an area partnership in 2017 and 2019 in relation to SEND.
• Since the new framework had been introduced, approximately 18 inspection reports had been published nationally with a wide variety of outcomes. There had only been three published inspection reports in London, with Haringey’s inspection starting the day of the meeting.
• In Brent, it was felt that the local area partnership was in a reasonable place in relation to SEND. The strengths were detailed in the report, and Nigel Chapman highlighted the strong relationship with parents and carers that gave the opportunity to improve services and flow their voice through the work done around SEND.
• Shirley Parks (Director of Safeguarding, Performance and Strategy, Brent Council) added that the appendix provided a good summary of the SEND inspection process and the preparedness for that, which had been shared across the partnership. Where areas of development had been identified, work was already underway to address them, such as CAMHS waiting lists. She highlighted that Brent knew itself quite well, which was important for being inspection ready.
• Jonathan Turner (Borough Lead Director – Brent, NWL NHS) added that the borough-based partnership had been working closely with the local authority to prepare the self-evaluation and the documents that form the required annexes. As a result of the restructure which was currently underway in the Integrated Care Board (ICB), it was likely there would be a full-time Designated Clinical Officer for SEND which was positive news.
• Overall, it was expected that Brent would be inspected during the current year.

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

·         The Board felt that the strengths identified under 3.2.5 were not evidenced, for example, where it stated ‘SEND provision in Brent schools is strong’, there was no explanation of how that was measured or how that conclusion had been arrived at. Nigel Chapman explained that the purpose of the paper was to explain the readiness and process for the inspection rather than specific details from the self-evaluation. The SEND arrangements had been scrutinised by the Community and Wellbeing Scrutiny Committee during the year where the Committee had scrutinised SEND performance around working with schools, outcomes for children, health provision and working with parents and carers, and the report was available online.

·         The Board was aware that the inspectors would choose some cases to review during their visit, and asked how that process would work. Shirley Parks explained that  ...  view the full minutes text for item 9.

This report provides the Health and Wellbeing Board with information on the progress on preparing for CQC inspection, the CQC assurance framework and the continued work to integrate CQC preparation work, improvement action, and transformation work within Adult Social Care.

Rachel Crossley (Corporate Director Care, Health and Wellbeing, Brent Council) introduced the report which detailed the process for the CQC Inspection of Adult Social Care Services. The new inspection process was focused on a single assessment framework, meaning that from a local authority perspective it would be focused on Adult Social Care. The slides included in the agenda pack aimed to ensure an understanding of the framework and would be used for briefings to get the message out about what the inspection was. Claudia Brown (Director of Adult Social Care, Brent Council) added the following points:

• The inspection would look at 4 main areas;
  • How Adult Social Care (ASC) worked with people and provided support to market providers, including the monitoring of contracts and ensuring services were equitable for users. As part of evidence gathering there would be interviews with service users.
  • Leadership of ASC including directors of the Council. Principle social workers would be spending some time looking at quality and standards as part of preparing for inspection.
  • Safety, particularly safeguarding vulnerable adults.
  • Feedback from partners, including councillors and health colleagues. The inspectors would be looking to see how ASC worked with other partners, and ASC could demonstrate that social workers were very much involved in Integrated Neighbourhood Teams and worked closely with GP surgeries.
• The inspectors would collect data through interviews with people who have lived experience of ASC services. The inspectors would also be using documentation from case file audits, chosen from a list of 50 cases selected by ASC, and the inspectors would then audit those cases and provide feedback on them.
• The inspectors would look at outcomes for service users and what service users had to say about their outcomes.
• Brent’s ASC had not been inspected for over ten years, so the department was being supported by colleagues in the children and young people’s department who were more accustomed to being inspected regularly.
• Work around engagement had begun, particularly with the multi-disciplinary team, staff, health and other organisations including providers. The information gathered from engagement would help to inform the ASC self-assessment, and ASC was now at a stage where there was a working self-assessment document that continued to be developed.
• Dr Haidar (Vice Chair) added that the CQC would focus on safety, care, responsiveness, effectiveness and leadership. He felt that responsiveness was key, and the borough team had been very responsive and engaged in the process. Brent was in a good position with a regular monthly meeting involving ASC, voluntary and community sector partners and health to address challenges. The CQC would be looking at the borough-based partnership to see if there was dialogue between ASC and health, and how the partners responded to each other and supported each other.
• It was likely that ASC would be inspected every two years, so there was a need to have a process in place that ensured preparedness at all times for inspection.

The Chair thanked colleagues for their introduction and invited the Board to contribute, with  ...  view the full minutes text for item 9a

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.

9a. Follow up on Winter Pressures – Risk Management of System Pressures

Simon Crawford (Deputy CEO, LNWUHT) provided an update on the winter pressures at the local acute trust – London North West University NHS Healthcare Trust. He highlighted that the Trust had been exceptionally busy over the winter period which had been exacerbated by the challenges of the 7-day Junior Doctor Strike, which had meant cancelling elective appointments and procedures. Across the Trust, safe rotas were maintained during that time but there were a number of days ambulatory services were diverting staff into A&E departments to support the emergency pathway. On a daily basis, Northwick Park Hospital continued to receive the highest number of ambulances across London at an average of 170 a day from 23 December 2023 to 10 January 2024. During the bank holiday weekend following Christmas, there had been 70 empty beds made available in preparation, but this had been followed by a busy two weeks which put the Trust under a large amount of pressure. There had been an unprecedented number of patients waiting in corridors to be assessed and patients were being sent to wards before a bed was ready so they were waiting in ward corridors for other patients to be discharged. Northwick Park operated daily on the Full Capacity Protocol on Opal Level 4, with senior staff supporting A&E departments. Ealing was under similar pressure. Staff were redistributed across sites to support safer staffing ratios within emergency departments and in-patient wards. The Transfer Teams had been mobilised within emergency departments to support the move of patients and ensure they were monitored and kept safe. Additional Discharge Support Teams were available over the weekends who were well supported by Brent Council through an additional social worker to support packages of care and placements. The Trust had been able to open some temporary beds in emergency department units to maintain the balance of safety, and support same day emergency care as much as possible as well as alternative pathways which prioritised patients who could be assessed quickly.

Dr Haidar provided an update on the support primary care had provided during the pressurised period. He acknowledged the challenging period and highlighted that all partners had aimed to work as one system and have strategies in place for hospitals to manage demand with the support of primary care and the community team. The Primary Care Team had opened PCN hubs on three Sundays throughout the Christmas period to take some pressure away from acute settings, and with Adult Social Care supporting discharges, it had showed how working as one team together as a borough-based partnership could make a positive difference to residents. There were learnings from the period, such as for the primary care team to work better in terms of communications to inform colleagues in the acute sector of plans such as opening hours over the holiday period. The London Ambulance Service had asked GPs to not request ambulances or refer patients  ...  view the full minutes text for item 10.