Agenda item

Paper attached from Public Health to inform the ongoing review into : ‘Access to Health Services in Southwark’. 

Dr. Ruth Wallis, Public Health Director, will present.

8.1  Dr Ruth Wallis, Director of Public Health went through the paper on access to A & E.

8.2  The chair noted that there was no overall increase in attendance by local residents, but there had been a small increase in  older people visiting A & E ; she asked if this was commiserate with population growth. Dr Ruth Wallis said that this is inline with the growth in the older population and the report identifies the need for better social care interventions. The chair asked if there is an expectation of a further growth in older people and what plans are in place. The Director responded that there are plans for the CCG and social care to gear up their interventions, which will include health checks, improved Diabetic care, better uptake of the flu jab and improved care for long term conditions. There will also be improvement in the housing stock to protect older people from cold.

8.3  A member noted the increase in mental health conditions and raised concerns about people being moved out of Maudsley Hospital. The Public Health Director  commented that people with mental health problems are more likely to have other long term conditions and more work is going to be done on this. She added that sometimes people turn up at A & E who  may not identify themselves as having a  mental health condition, but it  may be a component ;  only a minority of people use specialist mental health services.

8.4  A member asked to what extent A & E is used by people coming from abroad, and if there was an influx of people not paying. The Public Health Director responded that this was not closely monitored or information that was local collected, however she did not think it was a big percentage but  these figures may be recorded by the Department of Health; the ethos at A & E is to treat based on need. The chair indicated that this line of questioning can be pursued when King’s College Hospital  visit the next meeting to discuss the performance of the Emergency Department and acquisition of the Princess Royal University Hospital .

8.5  A member commented that there is some evidence from the survey that people do go to A & E when they can not access their G.P and asked the Public Health Director to comment. She responded that that there is nothing dramatic in data and it largely looks like people using A & E appropriately.

8.6  The chair asked the director to comment on presentations at A & E that might be open to being reduced. The Public Health Director commented that people with long term conditions are usually  well diagnosed and controlled - for example diabetes and asthma , but other conditions are  harder to manage , for example  alcohol abuse and the links to violence and domestic abuse , another is epilepsy. There is work on long term conditions but some are complex and difficult to manage. The chair asked if more so investment in long term conditions would help and the  Public Health Director agreed and added preventative interventions such as improved take up of flu jabs will also help.

8.7  A member reiterated that he was still considered that there was an issue with access to G.Ps. The Director commented that there have been no new and dramatic changes to population usage of services- there will always be people who are less inclined to wait.

8.8  A member commented that flu uptake has been an issue for sometime and asked what is being done. The Director commented that there is a flu action group working with primary care. One of the issues is pre ordering supply and ensuring there is sufficient capacity. The Public Health Director was asked who this programme was targeted at and the percentage of coverage and she responded that it is over 70% uptake for older people and even higher for people long term conditions. A member commented that his recent experience ,  and that of his friends and neighbours was very good - there was better information and very good access.

8.1  A member noted the high level of delirium with concern and commented that in her experience (as a nurse) this takes a while to happen; this could be indicative of poor access. The Public Health Director undertook to get back with more detailed data.

RESOLVED

The Director of Public Health undertook to get back to the committee on the high increase in 2010/11 of emergency admission rates for delirium as a secondary co-morbidity, which climbed by 42.3% for Southwark patients.  She undertook to provide details on the numbers of patients involved.

King’s will be asked to provide figures on the number of people from outside the UK who use Denmark Hill Accident and Emergency.