Agenda and minutes

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

Apologies for absence were received from the following:

·         Apologies for lateness from Carolyn Downs (Chief Executive, Brent Council)

·         Phil Porter (Strategic Director Community Wellbeing, Brent Council)

·         Dr Ketana Halai (NWL ICS)

·         Sheik Auladin (NWL ICS)

·         BasuLamichhane (Brent Nursing and Residential Care Sector)

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.

To ratify any decisions made at the previous meeting.

RESOLVED: That the minutes of the meeting held on 14 July 2021 be approved as an accurate record of the meeting, and to ratify the decisions made during the meeting.

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

None.

To provide an update of the Brent Children’s Trust (BCT) work programme covering the period April 2021 to September 2021.

Gail Tolley (Strategic Director Children and Young People, Brent Council) introduced the report, which provided an update of the BCT work programme covering the period April 2021 to September 2021. She advised that the Brent Children’s Trust fed in to the Health and Wellbeing Board as a statutory requirement, and ensured that the needs of children and young people had a strong profile in Brent.

The Trust had focused on transitional safeguarding with some good close working with Community Wellbeing colleagues and health partners. A report on transitional safeguarding had been presented to the Brent Safeguarding Adults Board that week. Children’s mental health and wellbeing had also been a focus, particularly during the pandemic, and Gail Tolley advised that there had been good synergy between the Trust and the Integrated Care Partnership on that work. Support for children with SEND was a priority for the Trust and Gail Tolley expressed that she was pleased with the launch of the Brent SEND Strategy 2021-2025, which had been endorsed by Councillor Stephens (Lead Member for Schools, Employment and Skills, Brent Council), and parents and children at the Learning Zone. The Strategy and the work being done on Education Health Care Plans (EHCPs) had been shared with the Department for Education (DfE) who had flagged it as an exemplar of best practice and had wanted to know more about how it was being delivered so effectively. Gail Tolley advised that parents and children & young people were at the core of the work and they would ensure it was being delivered on behalf of children. She hoped the members of the Health and Wellbeing Board were content to provide support to the ongoing work of the Trust.

The Chair thanked Gail Tolley for introducing the item, and invited comments and questions from those present, with the following raised:

·         The Board welcomed the report, expressing that it was a comprehensive update. The Board highlighted the importance of the Trust’s focus on children’s mental health, and Healthwatch colleagues advised they were seeing children’s mental health emerging strongly as a priority in the community and were happy to engage with the Trust and bring those voices into the discussion. 

·         In relation to children and young people’s mental health services and CAMHS, Gail Tolley advised that schools and family wellbeing centres at the pre-CAMHS stage were now seeing a strengthening of resources and training for staff in that area, but there remained challenges for CAMHS services regarding resourcing of staff. Robyn Doran (ICP Director for Brent, COO for CNWL) advised that there was money going into CAMHS via the national mental health investment standard, but one of the challenges was recruitment due to shortages of CAMHS specialists. She advised that waiting times had improved slightly over the past few months but there was still a lot of work to do which the ICP was monitoring closely. The working group sponsored by the ICP, which had been requested by the Brent Children’s Trust, was a multi-agency group  ...  view the full minutes text for item 5.

To present the Brent Health and Wellbeing Board with an update on the work of the Integrated Care Partnership (ICP).

Janet Lewis (Director of Operations for CLCH) introduced the report, which provided an update on the setup and progress of community health services in Brent as part of the new Integrated Care Partnership (ICP). Central London Community Healthcare (CLCH) were the current provider for Brent Community Services following the transfer from London North West Hospital Trust (LNWHT) on 1 August 2021. The Board were advised that CLCH as a provider sat within the NWL Integrated Care System (ICS), and sat within the Brent Integrated Care Partnership (ICP) as part of that system. Within the ICP executive there were 4 priorities, agreed following feedback from stakeholders and Brent residents, one priority of which included community services. A Community Services Executive Group had been set up which Janet Lewis co-chaired with Simon Crawford (Director of Strategy and Deputy CEO, London North West Healthcare NHS Trust) with wide stakeholder engagement. They were looking to include voluntary groups and third sector organisations in that group at a strategic level.

In updating the Board on community services, Janet Lewis advised that the first piece of work conducted was to safely transfer community services from LNWHT to CLCH. She expressed that throughout the period of transition it had been a pleasure to work with the acute hospital trust, the ICP, the Council and others to ensure the transfer was safe for patients within Brent and that 400 staff members were safely transferred from the acute hospital to CLCH. She advised that there had been some small challenges during the transfer, such as maintaining IT systems, but on the whole it was a successful transfer which was monitored through a mobilisation board that fed into the ICS regularly.

In terms of the priorities of the Community Services Executive Group, Janet Lewis advised that many aligned with the NWL ICP priorities. The priorities focused on planned care, such as district nursing, tissue viability, and in-reach in care homes to standardise care across NWL and ensure services were provided as close to home as possible. The aim was to work at a local level because patients wanted to access services much closer to their homes. Priorities also focused on unplanned care and the need to ensure the rapid response service within Brent was maintained to prevent hospital admissions. The Board were advised patients appreciated that they could have frontline care and management in their own homes with an assessment of whether hospital care was required. The Executive Group were also making sure children’s community services were aligned with the work of the Brent Children’s Trust so there was no duplication. Work on rehabilitation and reablement was in progress, in order to deliver those services in a more integrated way. Work in care homes was being prioritised, focusing on improving 9 care homes in the Borough rated by CQC as ‘needing improvement’. This was being done through a peer support programme, and those care homes who had been engaged were transitioning nicely to moving out of requires improvement. The Board  ...  view the full minutes text for item 6.

To provide the Brent Health and Wellbeing Board with an overview of the main service changes at London North West University Healthcare NHS Trust (LNWH) since the start of the pandemic.

Simon Crawford (Director of Strategy and Deputy CEO, London North West Healthcare NHS Trust) introduced the report which detailed the changes within the Trust that were necessary during the response to Covid-19. Changes were detailed in Appendix 1 of the report. He highlighted the key points as follows:

• In response to Covid-19, all elective activity had been reduced and then moved to Central Middlesex Hospital to provide a “green” pathway for elective activity.

• Elderly care transfers from Northwick Park to Central Middlesex Hospital for step-down recovery care was stopped to enable the Central Middlesex site to remain a Covid-19 “green” pathway for elective activity. This also meant elderly care patients did not have to move site which reduced the length of time they needed to stay in hospital, therefore reduced their risk of infection exposure and helped them return home sooner.

• The high volume, low complexity surgical hub was also provided on the Central Middlesex site alongside services provided by St Mark’s Hospital. This increased the bed capacity at Northwick Park and provided benefits to Saint Mark’s patients by allowing surgery and cancer care to continue. The CQC had been impressed with the improvements following the changes that had been made.

• Due to the benefits of the changes made as a result of Covid-19, the Trust would work on a Case for Change particularly around St Mark’s Hospital, which would be brought to the Council in the new year following stakeholder engagement with patients, staff and Healthwatch. This would involve detailed analysis of patient referrals, where they lived, and travel times.

The Chair thanked Simon Crawford for the update and invited members to comment, with the following issues raised:

• Regarding how patient voice was factored in to the decision making and how it would be included moving forward, Simon Crawford advised that decisions taken were in response to Covid-19 as an immediate and necessary action to provide access to surgical interventions to patients. Patients had been engaged on an individual basis to explain the move in site but that they would continue to access their consultant and surgical team. Not all patients had been transferred on day 1, and he acknowledged there was some confusion for some patients in the early days of the transfer but the Trust had worked hard on those communications and improved on them. He added that as time moved on it became more uncertain for patients where their care would be delivered and that was why the Trust felt the need to do a Case for Change.

• In relation to the Case for Change, Simon Crawford advised that they would be commissioning a piece of work through the St Mark’s Foundation to undertake the Case for Change. The Trust would look to engage with partners and stakeholders as part of that and get Healthwatch involved as well as members of the Council and the broader patient population. There would be a need to agree which Committee the case was most appropriate to be seen  ...  view the full minutes text for item 7.

To receive a Public Health Covid-19 update

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the update on Covid-19. She advised that, at the time of the meeting, Brent’s infection rates were lower than the London average and London rates were considerably lower than the rest of England. The rates in Brent were currently increasing slowly as were the rates across the capital, with a steady upward trend as the country entered winter. The testing rates in Brent overall fared favourably with the rest of the country and the positive rate was lower than England and London. The highest rates for positivity were amongst 11-16 year olds, who tended not to become severely ill with Covid-19. Rates for older age groups were being monitored.

The vaccination programme was now focussed on providing boosters, and there was still work being done on the ‘evergreen’ offer reaching out to those who had not had their first dose or second dose of the vaccine. The schools vaccination programme in Brent had started the previous week and Brent was seeing lower consent rates than the public health team would have liked, but that were expected given the JCVI had determined the risk / benefit of the vaccination for those age groups to be less clear cut than for older age groups.

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

·         The Board had some concern about the level of take up in schools compared to the standards in the rest of North West London. Dr Melanie Smith advised that she had opened up the conversation with NHS England Leads about what Councils could do in schools, and the positive news was that the national booking system would soon open up to allow vaccination for school age children through the national system. She advised there was a need to ensure capacity outside of schools to meet that demand. Fana Hussain (Borough Lead Director, NWL ICS) added that from the 23 October GPs and local vaccination sites would have permission to vaccinate 11-15 year olds with consent, and the LDO vaccination site would be working with those age groups. Other vaccination sites were also interested in vaccinating 11-15 year olds. In relation to the recording of vaccinations, Fana Hussain advised that all vaccination sites, including schools, were using the same system in one place. Gail Tolley (Strategic Director Children and Young People, Brent Council) advised that Brent Council placed some Brent children in schools outside of Brent, and there were some schools in Brent with children from outside of Brent. As such, those records provided for immunisations taking place on a school site would include both Brent and non-Brent resident children. She advised it was important to look at the London and subregional picture to give a view.

·         The public health team would look at a combined communication to explain that the mass vaccination centre within Wembley was now closed and that the national booking system was now  ...  view the full minutes text for item 8.

To receive an update on the Joint Health and Wellbeing Strategy (JHWS) Development.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the update on the development of the Joint Health and Wellbeing Strategy. She advised that since the last update there had been development in the consultation and engagement with communities and she thanked Healthwatch for the work they had done on that to reach a large number of people. The Council would now go back to communities to check what they had heard was correct with the 5 priorities identified. The draft Strategy, included in the papers, included “we will” statements to indicate the commitment of the Council. 

The Chair thanked Dr Melanie Smith for the introduction and invited comments and questions from the Board, with the following issues raised:

• In relation to how the Strategy would be reviewed and monitored to ensure delivery, Dr Melanie Smith advised that the work that had been done on the Covid-19 vaccination programme had shown that it was very possible to measure objectively the impact on inequalities, and they were striving to develop performance indicators for the strategy. They would look to measure the impact by ethnicity, deprivation, age, sex and disability.

• The Board noted that the Carers’ Forum and care leavers had been engaged on the strategy and Dr Melanie Smith advised that they would be going back to those groups who had inputted on the strategy previously, plus any groups that they may have missed. She hoped that a much greater emphasis on children and young people, and their mental health and wellbeing, was evident in the current draft of the strategy.

• Robyn Doran (COO, CNWL) advised that it was important there was a focused discussion within the Integrated Care Partnership (ICP) involving all key members about what they as service providers would do to deliver on the strategy.

• Simon Crawford highlighted section 4 of the report and advised that from a Trust perspective they were interested in working within that space with the Council to implement healthy ways of working. For example, the Trust aimed to get to level 3 as a Disability Confident Employer, and there were a number of things they were doing that would work on a broader scale if they could do that in partnership.

RESOLVED:

i)              To note the work so far to develop the Joint Health and Wellbeing Strategy (JHWS) and the key findings from Stage 2 of consultation.

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.