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 Donnelly-Jackson (Brent Council)

·         Dr Mohammad Haidar (Vice Chair)

·         Tom Shakespeare (Managing Director Brent Integrated Care Partnership)

·         Sarah Law (Nursing and Residential Care Sector), substituted by Ramona Muraru

·         Jackie Allain (Director of Operations, CLCH), substituted by Patrick Laffey

·         Simon Crawford (Deputy CEO, LNWT), substituted by Mark Titcombe

The Chair welcomed those present to the meeting and advised attendees that would be Dr Mohammad Haidar’s final meeting as Vice Chair of the Health and Wellbeing Board and Clinical Director for Brent. He asked the Health and Wellbeing Board to record its thanks to Dr Haidar for the work he had put in to the Board from a health perspective and wished him well in his new role undertaking work across NWL for vascular, renal and community pharmacy.

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 previous meeting, held on 23 July 2024, be approved as an accurate record of the meeting.

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

None.

To outline the approach to the development and operationalisation of the 2024-25 winter plan for immunisations for the Brent borough and an update on progress to date for seasonal immunisations.

Zaid Dowlut (Head of Place – Primary Care, NWL ICB) introduced the report, which provided an update on Brent’s flu and covid-19 vaccination programme 2024 in the context of the national immunisation programme. In introducing the report, he highlighted the following key points:

·         In line with national guidance, the NHS was offering the vaccination programme in Brent to the eligible cohort, which remained the same as the previous year as outlined in section 3.5 of the report.

·         The adult flu campaign began on 3 October 2024 and the children’s and maternal flu campaign began in early September. By the end of the first week of October over 61,000 flu vaccinations had been carried out in Brent which included those administered by GPs, Primary Care Networks (PCNs) and community pharmacies.

·         Another vaccination was also being delivered which was the RSV vaccination for older adults particularly at risk and pregnant women passed more than 28 weeks gestation to protect their babies.

·         Up to 6 October 2024, there had been 16,500 covid-19 vaccinations administered with no figures available yet for the remainder of the month. Those vaccinations had been delivered in community pharmacies and PCNs, supported by the NWL roving team and UCLH Find and Treat Teams. Whilst those mechanisms were being well utilised and good progress was being made, the progress did vary across NWL.

·         The appendix to the report provided a breakdown of vaccination rates by PCN areas in Brent, with Harness being the leading PCN.

·         Members were reassured that throughout Brent, primary care was working in partnership with the NWL roving team, GPs, PCNs and UCLH, as well as Brent Health Matters (BHM) which had a network of events planned in November 2024 to promote the vaccinations campaign. 

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

·         The Board noted the drive to encourage parents to get their 2-3 year olds vaccinated and, highlighting the fact that older children were also eligible, asked what the general advice was for parents and carers who had children older than 2-3 years old. They were advised that the guidance stated that all children within the eligibility criteria should be vaccinated, but NWL ICB had a task in convincing parents of the benefits of the vaccination programme, which was why they had scheduled promotion events with partners such as BHM to disseminate those messages.  

·         The Board were pleased there appeared to be good take up from community pharmacies in delivering vaccinations and an increase in the number of locations that people could receive their vaccinations, but raised concerns that there were still some gaps in coverage such as in Church End where there were no local pharmacists delivering vaccinations and challenges in encouraging take up. They queried how proactive the NHS was in reaching out to pharmacies to encourage them to get authorisation to administer vaccinations. In response, officers agreed to take away the issue relating to the south of the Borough to reach out to pharmacies and increase the  ...  view the full minutes text for item 5.

To provide an update on Healthwatch Brent’s progress from April to October 2024, and plans for November 2024 to March 2025.

Cleo Chalk (HealthWatch Service Manager) introduced the report, which provided an update on HealthWatch Brent’s progress against its annual plan between April to October 2024. The report also provided a forward plan for November 2024 to March 2025. In introducing the report, Cleo highlighted the following key points:

• A major area of focus for HealthWatch had been on Adult Social Care (ASC), including engagement with particular groups and demographics, a series of enter and view visits to care homes, and mystery shopping with volunteers accessing the ASC customer service line. This had not been a quantitative piece of work, instead focusing on understanding people’s individual stories and the lived experience they went through when accessing ASC. There had been a lot of positive feedback about the experience of receiving ASC and having a social worker in a person’s life, but there had been some challenges around access and access to accessible information. In undertaking this work, HealthWatch had received support from ASC and had worked closely with the Director of Adult Social Care to develop the programme, provide feedback, and consider how to take forward some of the challenges.
• Hospital discharge had also been a focus for HealthWatch during the reporting period. HealthWatch had spoken to residents and care home staff about the challenges they faced when patients were discharged from hospitals into care homes, including concerns regarding the amount of information provided after discharge, confusion from staff on how they should look after the resident once they were in the care home, and the welfare of patients following discharge whilst they were awaiting transport to their care home.
• The third area of focus during the reporting period was GP access, particularly the proposals relating to same day access and how that might affect patients. HealthWatch had spoken to residents about what they wanted to see from their GP and how they would like to contact their GP about their health. This was then being fed back to NWL Integrated Care Board (ICB) to help inform that piece of work.
• The final piece of work HealthWatch had been focused on over the period was maternity, and it was highlighted that Northwick Park Hospital had the highest rate of positive feedback, with no patient who had recently given birth telling HealthWatch they had a negative experience. There had been a small number of patients who had mixed feedback relating to communications, but the vast majority was positive. However, HealthWatch had found that a number of patients were still choosing to go out of Brent to other hospitals for their care, which had been attributed to the reputation of services. HealthWatch had delved further into the reasons for this and those patients had found that their experience tended to be worse due to issues of continuity of care for post-natal services. Following these findings, HealthWatch had met with the Director of Midwifery at Northwick Park Hospital to look at the key themes and consider how post-natal services could be promoted more effectively.  ...  view the full minutes text for item 6.

To provide an update on the progress of Family Wellbeing Centres (FWCs) and Family Hub and Start for Life programmes.

This item provided an update on the progress of the Family Wellbeing Centres (FWCs), Family Hubs and Start for Life programmes. This update also included the Family Wellbeing Centre Annual Report for 2023-24.

The Chair opened the item by welcoming three parents who used the FWCs to the meeting and invited them to tell the Board about their views and experiences on how services were working for families.

Wahid told the Board that he and his 9-month old daughter had used the FWCs and found them very helpful, particularly for information and signposting to health services and legal advice. All the help the FWCs had provided had been really appreciated and he felt that the centres were something positive in the borough. In terms of accessing the services as a father, he highlighted that he was not treated any differently as a man and he was welcomed by all the staff within the FWC.

Isra informed the Board that she was a migrant refugee who worked in co-production, researching migrant health, and she particularly appreciated the initiative the Board had taken to include service users in this discussion. Her experience of FWCs had been very helpful for her because she did not have her family in the country for support and could turn to FWCs for advice from someone she trusted. She expressed appreciation for the staff within the FWCs, and when she attended sessions feeling stressed about the challenges of parenting, the staff there helped her to think in a way that best supported her and her family. Isra highlighted that she had not known about FWCs until her daughter was one year old when her health visitor had mentioned it to her, and whilst she had been attending other playgroup sessions with her daughter, she felt that FWCs were distinguished from other organisations in the way the staff supported families, with the triage service being very well managed, taking a holistic approach.

Khadra introduced her two and a half year old daughter to the Board who had attended the meeting with her. She began her remarks by informing the Board she had not known about FWCs when her daughter had been born. In the first year of her life, her daughter had been diagnosed with multiple medical conditions and at one and a half years old had been diagnosed with a learning disability. At this time Khadra had felt isolated and overwhelmed and asked for support from her paediatrician. Her paediatrician had referred Khadra and her daughter to a FWC, which she informed the Board had changed their lives. She expressed gratitude to her key worker who would see them face to face when needed, called her every fortnight, got them in touch with SEND playgroups, referred her to a course for managing behaviours in autistic children, and arranged for a play therapy specialist to visit her home and help them adapt play to their needs. She concluded that this had helped her adjust and kept her family  ...  view the full minutes text for item 7.

To provide an update of the Brent Children’s Trust (BCT) work programme covering the period April to October 2024.

Nigel Chapman (Corporate Director Children and Young People, Brent Council) introduced the report, which provided an update on the Brent Children’s Trust (BCT) work programme covering the period April to October 2024. He explained that the document set out how the Trust operated and its governance arrangements. He added that, whilst it was unusual to still have a children’s trust in local authorities, Brent had retained its Trust as it was felt to be a good vehicle to ensure all issues affecting children and health related matters were contained within one place to avoid the risk that they become overwhelmed or subsumed within adult work. The BCT pulled together areas that needed greater attention and oversight. In presenting the update, he highlighted the following key points:

• During the reporting period the BCT had looked at the progress of the Thrive Programme in terms of improving and delivering better mental health services for children and young people and families in Brent.
• The Trust had also looked in detail at issues around SEND and how effectively services for children with SEND were commissioned, particularly in the health space. 
• Issues around school readiness and children having an appropriate level of development to be ready for school at reception age had also been considered.
• The fourth area the Trust had focused on was the actions being taken to deal with poor oral health and tooth decay in children.
• It was highlighted that the Trust was not solely a place for discussion but also set actions to be taken forward. Appendix B set out the current plans in place and actions against them.
• Nigel Chapman would now sit on the Integrated Care Partnership (ICP) Executive as the Corporate Director of Children’s Services to help strengthen future connections from a governance perspective.

Jonathan Turner (Borough Lead Director – Brent, NWL ICB) added that the partners within the Trust were working more closely together than ever before, taking joint ownership of issues across both the local authority and NHS together. Some of the issues surrounding SEND did involve a level of dialogue between the ICP and Integrated Care Board (ICB) as a lot of those services were delivered at NWL level, and there was dialogue surrounding where there were issues such as CAMHS.

Robyn Doran (Director of Transformation, CNWL, and Brent ICP Director) re-emphasised the benefit of integrating the BCT within the ICP structure to build a tighter interface between the ICP workstreams and children’s work. The Trust had providers and commissioners at the table, so all were responsible for delivering a better service for children in the borough.

The Chair then invited comments and questions from members, with the following issues raised:

• In noting the focus on reducing dental decay in children, the Board highlighted that this was a recurring theme reported to the Health and Wellbeing Board and was not improving in Brent or nationally. Members asked how the Board could support the improvements that were being aimed for. Dr Melanie Smith (Director of Public  ...  view the full minutes text for item 8.

To provide a briefing note summarising the recently published Darzi report and any next steps for Brent in response to the report.

Jonathan Turner (Borough Director, Brent Integrated Care Partnership) introduced the report, which had been commissioned by the new government to review the current ‘state of play’ of the NHS and looked at patient access, quality of care and the overall performance of the health system. The final report identified some themes on how to ‘repair’ the NHS but did not provide a plan or set of recommendations. The report aimed to set the context and tone for the coming NHS 10 Year Plan, due to be published in Spring 2025. In presenting the document, he highlighted the following key points:

• The report looked at the context of where the NHS was currently, such as the aging population, increase in demand, and deterioration of the access targets and national targets that had been in the system for some time including A & E waits, 62 day cancer waits, and increased waiting times for ADHD and ASD assessments.
• The report suggested that some aspects had improved and the NHS had taken advantage of some of the improvements in technology over the years, but there were also areas for concern, including maternal deaths and the deterioration in children and young people’s mental health.
• The report looked at the finances of the NHS and proportion of income from across the different parts of the system and noted that, whilst there had been discussions about shifting more funding into community and preventative services, the acute system was still taking up more of a proportion of the NHS budget. A theme of the report was to make that shift to more preventative work in the community, which supported the direction of travel Brent had already been attempting.
• The report looked at the per capita spend in England compared to the EU 15 countries, which England was broadly on par with, but which included countries that less economically affluent than the UK.
• One of the features of the report was the capital investment on buildings and technology and the report suggested this should be a key area for investment in future.
• Darzi had looked at the impact of the pandemic on staff mental health and wellbeing and the resilience of the system, noting that England had gone into Covid with much lower bed capacity than a lot of countries and had higher excess mortality.
• The report looked at structures of the NHS and internal reorganisations and showed a want for stability in those structures to focus on planning in coming years. The report did not suggest major changes in organisational structures but referred to the need to clarify the purpose and remit of Integrated Care Boards (ICBs).
• The report focused on shifting care closer to home, re-engaging with staff and patients about the future of the NHS, increasing productivity in hospitals and reducing waiting lists, getting people back into work and making better use of technology. 
• Officers had then outlined in the Health and Wellbeing Board report what some of these findings meant for Brent. It was thought  ...  view the full minutes text for item 9.

To agree how the responsibility for the revision of the Pharmaceutical Needs Assessment should be discharged.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report, which proposed how the revision of the Brent Pharmaceutical Needs Assessment (PNA) should be undertaken in Brent. In introducing the report, she highlighted the following points:

• The Health and Wellbeing Board had a duty to publish and keep up to date a PNA, which Brent had discharged effectively in the past. Brent had published its first PNA in 2015 and the regulations required periodic revisions which were now due.
• The Board heard that PNAs were governed by regulations which were very prescriptive and described what a pharmaceutical need was as well as the process by which the PNA should be produced.
• The NHS used PNAs to make decisions about pharmaceutical need. In practice, that meant PNAs were used to make decisions about whether a new pharmacy was needed in a particular area, with new applications to open a pharmacy assessed against the PNA, as well as applications to move pharmacies or change opening hours.
• Pharmaceutical needs related to the dispensing of medications and appliances.
• Whilst the Board had discussed two services delivered by community pharmacies that evening – the provision of vaccination services and Pharmacy First – neither of those were pharmaceutical services that were within the scope of the PNA.
• As such, she suggested the PNA should be considered as required and necessary for the NHS to function well and efficiently and avoid judicial challenge, but it should not be considered as a document that described all a pharmacy should or could do.
• The paper proposed that the process by which the PNA was revised and published was done in the same way as previous iterations; establish a PNA steering group and delegate authority to that steering group to conduct, consult on and publish the PNA.

As no further issues were raised, the Board RESOLVED:

i)              To agree the establishment of a task and finish Pharmaceutical Needs Assessment Steering Group.

ii)             To agree the terms of reference for the PNA Steering Group attached as Appendix 1 of the report.

iii)           To delegate to the PNA Steering Group the task of overseeing the conduct, consultation and publication of the revised PNA.

To discuss and agree any future agenda items for the Health and Wellbeing Board.

The Chair gave members the opportunity to highlight any items they would like to see the Health and Wellbeing Board consider in the future. The Board asked for further details on when to expect the NWL Children’s Mental Health Strategy to be presented.

Notice of items to be raised under this heading must be given in writing to the Deputy Director – Democratic Services or their representative before the meeting in accordance with Standing Order 60.

None.