Agenda and minutes

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

Apologies for absence were received from the following:

·         Janet Lewis, Central London Community Healthcare NHS Trust

·         Dr Ketana Halai, CCG

·         Judith Davey, Healthwatch, apologies for lateness

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 20 October 2020 be approved as an accurate record, subject to an amendment in the attendees of the meeting to include Councillor McLennan.

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

None.

To update the Health and Wellbeing Board on the single CCG and ICS, including the Health and Social Care White Paper, and introduce the Quartet.

Reports published on 31 March 2021

Phil Porter (Strategic Director Community Wellbeing, Brent Council) introduced the item on the single CCG and the quartet. The Health and Wellbeing Board had been receiving six-monthly update reports on the Health and Care Transformation Board, which had now formally came to an end and been subsumed within the “quartet” to take forward the agenda for adult care integration. The quartet would build on that work that had been done, for example the work done together to ensure hospitals were freed up as much as possible during the pandemic to support those who really needed them. Care homes were a key part of the work with a multi-agency approach led by care homes and Basu Lamichaane as the Chair. At the time of the meeting 87% of care home residents had been vaccinated in Brent and 75% of care home staff had been vaccinated. The care home support scheme had been introduced which provided a dedicated team working with care homes requiring improvement to improve their quality of care and CQC rating. Basu Lamichaane (Brent Nursing and Residential Care Sector) strongly agreed that vaccination uptake was going up, and there were lots of support initiatives from Brent including funding, webinars, leaflets and information cascading. In general care homes in Brent had managed the last wave well, he felt, and the weekly meetings had enabled care homes to share letters, policies, protocol, guidance and opportunities with each other. Care homes had resumed visiting with one designated visitor and the following Monday this would increase to 2 designated visitors.

In relation to rehabilitation and re-ablement, Phil Porter advised that an integrated approach was being taken and the rehabilitation beds in Birchwood Grove through wave 2 of the pandemic were very successful. This was tied together with a range of other projects as part of the Better Care Fund Bid (BCF), which was spoken about at the previous Board meeting and which the Board was asked to formally ratify at this meeting.

Robyn Doran (Chief Operating Officer, CNWL) introduced herself as the new health lead working in the quartet with other colleagues. In relation to the quartet, Robyn Doran advised that there were actually 5 members as part of the new structure and the idea behind it was to bring together all of the health and social care work and pull resources to have a very focused approach. It included herself and Phil Porter as co-Chairs, Dr MC Patel, Simon Crawford (LNWUHT) for acute services, Janet Lewis as the lead director from new community provider CLCH, and was well support by Jonathan Turner (Brent CCG) and Tom Shakespeare (Brent Council). The quartet would oversee and co-ordinate health care in particular and she felt the input from the Council had been incredible bringing services together. The quartet would build on the work around health inequalities, which was a number one priority alongside the vaccination programme. The second priority was Primary Care Network (PCN) development and reduction in practice variation. The third priority was to  ...  view the full minutes text for item 5.

To present to the Health and Wellbeing Board details of the second wave of the pandemic and its impacts, an update from the work of partners during the pandemic, a vaccination programme update and a Brent Health Matters update.

This paper is made up of several reports with Appendices as detailed:

·         i. Epidemiology of Covid-19 in Brent (including one appendix)

·         ii. Partners Update

·         iii. Brent Covid-19 Outbreak Plan (including five appendices)

·         iv. Vaccination programme (including two appendices)

·         v: Brent health matters

reports published on 31 March 2021

COVID-19 Epidemiology

Dr John Licorish (Public Health Consultant, Brent Council) introduce the report outlining the epidemiology of the COVID-19 outbreak in detail. He highlighted that at the time of writing the report 835 people had passed away in Brent due to COVID-19 and that during the second wave of the pandemic there was a wider demographic across the Borough in terms of cases and deaths, including various ethnicities. The Board were advised that during the second wave the public health department were able to get better data with regard to ethnicity so had a better handle on the data of cases. In addition during the second wave there was access to more testing. Subsequent to the timing of the report Dr John Licorish suggested that numbers were plateauing.

The Chair thanked Dr John Licorish for the introduction and invited comments and questions from those present, with the following issues raised:

·         In relation to the ethnicity data in section 3.7, it was confirmed that this referred to mixed ethnic groups using the census summary.

·         It was noted that statistically in the report Brent was at the bottom of NWL for vaccination figures, but was no longer the highest in terms of rate per 100k in comparison to Harrow, Hounslow and Hillingdon which all had higher vaccination rates. Dr John Licorish advised that the report looked at the entirety of the pandemic. There was significant disproportionality and Brent had initially been affected, but as the pandemic had gone on there was a broader set of people being affected and Brent was no longer the top for death rate. Dr Melanie Smith (Director of Public Health, Brent Council) added that currently the purpose of vaccination was to reduce hospital admission and death and vaccinations were not yet being given to cohorts that would have a big impact on transmission, therefore she would not expect the overall infection rate to be affected by vaccination levels at this stage, but would expect infection rate in older age groups to reflect vaccination rates which it did.

·         The Board highlighted that the statistics within the report showed that the Caribbean community was lowest on vaccination uptake in the majority of data, despite various webinars being undertaken and community and faith leaders encouraging vaccination uptake, and queried what further work would be done to address the vaccination hesitancy within the Caribbean community. Dr Melanie Smith advised that there had been movement and while it was still differential that differential had reduced. The vaccination programme was being looked at through a more flexible and tailored approach now addressing not just beliefs but also practical barriers to people getting vaccinated. In addition, through library staff phone calls, something emerging as a finding for vaccination refusal was the influence of family and friends, so a lot of work had been done with trusted messengers and community leaders. Dr Melanie Smith suggested a focus could be on younger family members who may influence someone’s decision to receive the vaccination.  Dr John Licorish  ...  view the full minutes text for item 6.

To provide the Health and Wellbeing Board with an update report of the Brent Children’s Trust (BCT) work programme covering the period between October 2020 and March 2021 and outlines the priority areas of focus for the BCT from April 2021 to March 2022.

Gail Tolley (Strategic Director Children and Young People, Brent Council) presented the report which provided an update on the work of the Brent Children’s Trust (BCT) over the past six months following the update provided to the Board in October 2020. The following key points were raised:

·         There had been 3 meetings since October 2020 which focused on family wellbeing centres, which had begun a soft implementation process from September 2020 and was beginning to pick up speed and resource.

·         The Trust had contributed to the Health and Wellbeing Board strategy update.

·         A number of health colleagues including Dr Ketana Halai (CCG) had presented a paper from the CCG on a number of areas relating to children’s mental health and wellbeing, and the Trust was working to make some links in clinical areas and wellbeing areas for children and young people in terms of work in schools.

·         Priorities for the coming year included children’s health and wellbeing, working on parents’ reluctance to take children to routine medical appointments during lockdown such as oral health appointments and immunisation, and childhood obesity. It was noted that reference would be made to healthy weight in childhood rather than obesity for the priority description. There would be a continued focus on special education needs and disability which was an area of joint accountability with Ofsted and CQC. Particularly the Trust were being alert to anything that may come out of any major national reviews as a result of the 2014 reforms that resulted in large increases in the number of Education Health and Care Plans (EHCPs). Children’s mental health and wellbeing would also be a priority and there was a transformation plan for CAMHS being worked on. The Integrated Disabled Children And Young People’s Service phase 2 would focus on integration with health colleagues but that had been paused from January 2021 due to the pandemic and would need revisiting. Transitions work, particularly around safeguarding, would be a priority, and young carers who it was expected would increase in population as a result of the pandemic. Gail Tolley advised that there was a large number of priorities, some of which built on work already being done, but there was also a need to be aware of any legislative changes that may come through in relation to children’s health and additional needs, and the Trust wanted to retain the flexibility to bring those in if needed.

Members of the Board highlighted that in response to Covid-19 from an acute perspective colleagues had seen far more presentations of children in crisis through A & E at Northwick Park, and queried whether there was any plan for data collection on the acuity of presentation of children in crisis and analysis of what was leading to that. Many were new presentations and it was queried whether a broader piece of work was being considered to identify the increased prevalence of these presentations. Gail Tolley advised that the section in the report in relation to children’s mental health and wellbeing  ...  view the full minutes text for item 7.

To present a progress update report from the development group of activity so far and agreement of next stages.

Reports published 31 March 2021.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the update, explaining that the Board was due to refresh the strategy the previous year but that following the pandemic the Board had agreed it needed to fundamentally rewrite and review the strategy to focus on health inequalities, which had not been caused by Covid but were exacerbated and highlighted by Covid. She advised that reworking the strategy during a pandemic had been challenging and she commended health colleagues for the time they had been able to devote to it. Progress was not as fast as they would like but she hoped the agenda of the evening’s meeting demonstrated that colleagues were fundamentally reviewing the ways of working as a system and working with communities, being much clearer about the response to health inequalities and she felt they had set the groundwork for a really good strategy. In relation to the report, Dr Melanie Smith highlighted the following:

·         The Board heard that the team had reviewed what was known about need in Brent and done consultation through Healthwatch and Brent Health Matters. As a result of that engagement the strategy would have a much bigger focus on the greater determinates of health with an ambition to be broader than the previous strategy which focused on health and social care services. This had been echoed in the consultation findings where residents recognised the complex interplay of factors that determined their health and gave rise to health inequalities. The consultation also found that there was a desire from residents to focus on the needs of children and young people, particularly regarding mental health, wellbeing and mental illness.

·         Emerging areas of focus for the strategy included ensuring everyone was able to make healthy choices, and making the healthy choice the easy choice for everyone. There would be a greater focus on healthy and sustainable communities and places and there would be a greater role for prevention of ill health, including prevention of mental illness and the promotion of mental wellbeing. This would be done in the context of recovery from Covid through the system and workforce.

·         The strategy aimed to make much better use of data to ensure services were meeting the needs of all residents, with a need for a greater focus on consistent recording and use of ethnicity data, examining differences in access and outcomes by deprivation and an explicit focus on the needs of particular groups, including those with additional needs. There was a need to work with those who were using services and also reach out to those who were not using services, to allow them to influence how the services develop.

·         The paper proposed the strategy was framed around a number of areas as outlined in the report, which the Board was asked to comment on and subsequent to those comments the work would be taken forward to the next phase.

The Chair thanked Dr Melanie Smith for the introduction and invited comments and questions from those  ...  view the full minutes text for item 8.

To update the Health and Wellbeing Board on community services commissioning.

Jonathan Turner (CCG) introduced the report, explaining that at the end of the previous year LNWUHT gave notice on some of the community services they had provided to Brent for a considerable amount of time. This had since been reviewed at ICS level and largely the vast majority of those services would now need to transfer to another organisation. The report explained how they had came to the conclusion of who would provide those services, and the following key points were highlighted in relation to the report:

·         The aim was to stabilise services during a period of significant change of demand on health services and a changing NHS environment, with legislation anticipated to go through later in the year which would mean a move away from choice and competition commissioning to a more collaborative approach. Instead of running procurement processes the new model would look within the NWL health economy to determine who was best placed to provide those services. Given the timescale and the need to mobilise services they had ran a relatively short process to determine who to award to, and determined to award to Central London Community Healthcare NHS Trust (CLCH). There were also a limited number of services in Harrow but they were not relevant to this group. The award would include district nursing, nutrition and dietrics, respiratory, long term conditions in the community and children’s services. There would only be a change in the provider of the services rather than the content of the services, with staff remaining the same. The contract award notice had been published which was a legal requirement and the period for challenging the award was about to expire. The expected transition date was 1 August 2021.

·         The Board heard that the ICS would have hoped to do more community engagement prior to award but had not been able to due to the short timescales involved and the need to make a quick transition of services. They were going through a review process in terms of how they could continually improve the service specifications and that would involve members of the public and Healthwatch.

·         There was a working group between CNWL, CLCH and LNWUHT to manage the transition and the quartet would be involved in the future, reporting into the ICS. Simon Crawford (LNWUHT) expanded, explaining that the weekly working group meeting focused on staffing issues, digital issues, estates issues, estates IT and workforce and there was a joint project plan in relation to that. He had been engaging staff on the change since December 2020 with major Teams meetings, and 2 weeks ago CLCH and CNWL joined the conversation with staff around the transfer process and were setting up their own engagement plan for staff transferring. It was expected that the effective working relationships already held with CLCH and CNWL would continue, and which had strengthened during the pandemic, and that partners would work together delivering effective services.

The Chair thanked the health colleagues for their introduction and invited comments  ...  view the full minutes text for item 9.

To update the Board on the commissioning outcome and implementation of Healthwatch Brent. For background, the approval to award a contract decision can be accessed here. 

Julia Mlambo (Partnership and Engagement Manager, Brent Council) updated the Board on the Healthwatch recommissioning process. She advised that the Council had found a new provider who was present for the meeting. A lot of good practice had been learned from the procurement process. Brent’s commissioning team had held a capacity building programme to support bidders, had service user involvement as part of the panel and had input from partners as part of the evaluation process as well as useful input from public health. The process of implementing the new service was now fully underway with most information handed over to the new provider. It was highlighted that the previous provider had been very co-operative and helpful with the handover project. The new provider was also a member of the health and wellbeing strategy development group so right from the start of their contract their work was being linked into policy.

Judith Davey, the new Chief Executive of Brent Healthwatch, introduced herself. She highlighted that the procurement process had been very good, particularly with the involvement of service users and communities, and she looked forward to working with the Board moving forward. The key priority of quarter 1 was reaching out and ensuring they had the right links with the right people and relevant Boards. They would also be setting up a governance structure, so in addition to an advisory Board they would also have a grassroots steering group going out to where communities were and a network of independent experts.

RESOLVED: to note the outcome of the commissioning process and welcome the new Healthwatch provider and Board member.

Ratification of the Better Care Fund (BCF) 2021/22.

The Board RESOLVED: to ratify the Better Care Fund for 2021/22.

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

None.