Southwark CCG Governing Body

Southwark CCG Governing Body 13 th June 2013 CAMBRIDGE HOUSE MINUTES Present: Dr Amr Zeineldine (AZ) CCG Chair & Clinical Lead Dr Adam Bradford (ABR) Clinical Lead Dr Roger Durston (RD) Clinical Lead Dr Simon Fradd (SF) Clinical Lead Dr Jonty Heaversedge (JH) Clinical Lead Dr Patrick Holden (PH) Clinical Lead Dr Sian Howell (SH) Clinical Lead Dr Nancy Kuchemann (NK) Clinical Lead Dr Tushar Sharma (TS) Clinical Lead Professor Ami David (AD) Registered Nurse Member Linda Drake (LD) Practice Nurse Diane French (DF) Lay Member Dr Richard Gibbs (RG) Lay Member Robert Park (RP) Lay Member Andrew Bland (AB) Chief Officer Malcolm Hines (MH) Chief Finance Officer Tamsin Hooton (TH) Director of Service Redesign Gwen Kennedy (GK) Director of Client Group Commissioning Dr Alison Furey (AF) Consultant in Public Health, Lambeth & Southwark Alvin Kinch (AK) HealthWatch Southwark Professor John Moxham (JM) King s Health Partners Dr Jane Cliffe (JC) LMC Representative In attendance: 1 Vicky Bradding (VB) Maggie Kemmner (MK) Apologies: Sarah McClinton (SM) Dr Ruth Wallis (RW) Corporate Secretary Director of Southwark and Lambeth Integrated Care Programme Director of Adult Social Care, Southwark Council Director of Public Health Lambeth & Southwark 1 Members of the public and observers are listed at the end of the document 1

Public Open Space Ms Rylance-Watson (ERW) stated that she had submitted an e-mail to the CCG regarding a perceived inaccuracy to minute CCG144/13 for Governing Body meeting (9 th May 2013). MH confirmed her submission had been received and circulated to Governing Body members, apologised that it had not been appended to the minutes and agreed an amendment would be made (attached at Appendix 1). ERW also referred to the perceived incompleteness and lack of context for minute CCG156/13; MH replied that this will also be amended (attached at Appendix 1). ERW asked when the CCG will consider options for the Dulwich Hospital site, the authority under which current discussions have been undertaken, whether discussions have been about exclusively health provision on the site, and whether or not discussion has taken place during the consultation period. CCG158/13 MH replied that the CCG were working through responses to the consultation and will consider recommendations for future use of the site during August/September 2013. He added that to date discussions have been held only with Diabetes UK and GST Charitable Trustees and discussion will not be extended until the outcome of the consultation has been presented to the Governing Body. MH stated that there had been contact with the Local Authority and highlighted that it is the responsibility of the planning department to review use for the site. The CCG has had discussion with Councillor Colley to increase awareness and update her regarding relevant issues. MH assured ERW that discussion about use of the site for areas such as free school provision will not take place until the discussion on provision of health services has been concluded. AB added that partners including the local authority will continue to be updated as part of the consultation process. Ms Portwine (GP) requested the CCG comment on information she had received whereby the CCG are in discussion with Harris Academy and that agreement exists to open a new school on the Dulwich Hospital site in 2014. She added that a Local Authority councillor had stated that health would retain only a small proportion of the site. She highlighted the confusion this caused and reiterated her understanding that permission had been granted for a new school to be built on the Dulwich site. GP requested that the CCG obtain more information. AB clarified that there have been no discussions with the CCG to this effect however if GP were able to provide written details which confirmed her information they would be reviewed. Declarations of Interest CCG159/13 The register of declarations was circulated, updated as necessary, and signed as correct by each Governing Body member. Copies of the previous register were made available to the meeting. The register will be updated with amendments from the meeting and published on the CCG website. 2

The minutes of 9 th May meeting were agreed to be a correct record with the following amendments: CCG160/13 CCG 144/13 Public Open Space [also see CCG158/13] - a copy of ERW s submission be attached to minutes CCG149/13 Commissioning Strategy Committee report Primary & Community Care Strategy, fourth paragraph ERW requested that the following comment from RP be recorded when we plan for Dulwich we must make sure that it is future proofed. Also there should be no inequalities in how we organise ourselves and the CCG must learn from what it does well CCG 153/13 second paragraph to add SELDOC will continue to provide out of hours GP advice after the implementation of 111 CCG156/13 Public Open Space, replace statement with the following: ERW highlighted that the SCCG Annual Draft Operating Plan 2013/14 and Draft Business Plan 2013/14 report do not take account of Professor Dame Sally Davies's recent recommendations. She encouraged the Governing Body to review these and to build the recommendations into its forward planning. She requested that Professor Dame Sally Davies's recommendations on infection control, on antibiotic resistance, on the settings of care and her wider recommendations need to feature in the SCCG's strategic planning. - ACTION: VB Actions & Matters Arising CCG161/13 CCG153/13 - CCG Operating Plan AB reported that all Southwark residents will receive a summary document outlining the CCG focus for 2013/14 and suggesting ways in which they can become involved. Integrated Governance & Performance Committee Report May 2013 RP reported on discussions from the Integrated Governance & Performance Committee [IGP]. He highlighted the IGP s concern about the number of long-waiters at Kings College Hospital (KCH) for certain procedures, and the high number of Never Events at Guys and St Thomas (GST) in Q3 2012/13. AB updated the meeting regarding waiting times at KCH stating that the Trust were being pushed to ensure consideration was given to all options for clearing the backlog. AB also highlighted that discussions are being held with the Chief Operating Officer at KCH regarding using spare capacity to address the issue. CCG162/13 AB proposed the plan for backlog clearance be considered at the Lambeth and Southwark Planned Care Board and asked the Governing Body to approve that course of action. The GB agreed this approach and endorsed AB to sign off the actions required to take this forward. ACTION: AB JM agreed with the concern raised on Never Events and recommended the Governing Body seek further assurance of providers that the necessary processes are in place. SF stated that he is a member of the Serious Incident Committee at KCH and that 3

the processes there are transparent, clinically represented, with a Root Cause Analysis carried out following every adverse incident. He recommended a generic discussion was relevant to the Governing Body rather than specifics of individual cases. JH welcomed an opportunity to review incident trends but also expressed concern about the lack of improvement in the numbers of pressure ulcers and falls. JM highlighted that the increasing fragility of patients was relevant to this and had written to AZ on the issue. He suggested special mattresses be considered for use in A&E and for transport of frail patients. AZ recommended JMs letter be circulated with the minutes of this meeting. ACTIONJM/VB SH added that the Serious Incident Committee is replicated at GST. SH added that the Never Events at GSTT were predominately in the dental department and action was being taken. AB highlighted that providers will be increasingly busy and suggested the incident situation continue to be monitored through Quality reports to the IGP. DF asked that the presentation of data in the Integrated Performance report be reviewed, especially for SLaM where the RAG indicators used are not sufficiently informative. ACTION KS AZ noted that the In/Out target for SLaM had been missed. JM stated that following SLaM Medical Director s presentation to the Governing Body he had not been fully assured in some areas and requested SLaM be invited back with a clear brief on areas to cover. ACTION: GK to lead brief Governing Body leads were also asked to review the transfer of information back to primary care for clients with mental health issues ACTION RD/NK Conflict of Interest Policy MH requested the Governing Body accept the policy which had been approved at the IGP. He reported that the revised policy clarifies the approach to be used and applies to members of all GB committees and to CCG staff. PH/RG commended the document as thorough and inclusive. SH requested an executive summary of key points be to assist easy interpretation. ACTION MH/JF The GB noted the minutes of the IGP Committee May 2013 and the actions undertaken. The GB approved the CCG Conflict of Interest Policy 2013/14. 4

Lambeth & Southwark Integrated Care Programme Update MK joined the meeting. She outlined the programme update and invited comments and questions. SH expressed concerns about the IT systems for the ICP. MK stated that there are four software solutions enabling information to be shared. In answer to a question from TH, MH confirmed that they were part of a pilot assessment for data sharing. JH welcomed the involvement with primary care especially regarding co-ordination of patient care, and stated his support for the pioneer project; he queried how the patient perspective could be incorporated. MK responded that an Older People s Reference Group and the Citizens Board were in place with several layers of input and a key role in decision making. There are also a range of bespoke groups to discuss specific issues with clients. CCG163/13 JM supported the ICP programme and raised concern regarding the importance of input required from public health to change behaviour, and whether the ICP programme has sufficient public health input. MK recognised the concern however states work is still at an embryonic stage and identification of what is required is being undertaken. AD highlighted the need to break barriers across organisations in order to achieve a holistic approach, particularly for practice and community nurses to work closely. MK agreed and stated that work had commenced on reviewing workforce requirements for the future. AB noted the importance of the programme and consequently requested that the bid to be an integrated care pioneer did not detract focus from delivery. RD reported that four practices in his locality were collectively reviewing how to deliver ICP as they recognised its growing importance. The Governing Body agreed all leads would promote ICP to Southwark practices. The GB received the update on the Southwark & Lambeth Integrated Care Programme and supported the proposal to become an integrated care pioneer. Items for Discussion Commissioning Strategy Committee (CSG) report AB outlined the discussion from the recent meeting. CCG164/13 He updated that further to the Trust Special Administrator s (TSA) report, the full business case proposal for KCH to pursue acquisition of Princes Royal University Hospital (PRUH) had been presented to and accepted by the King s College Hospital Board. As the business case is currently commercial in confidence, however, the CCG is not able to view it. AB noted that all business cases relating to TSA recommendations will be considered under shared governance arrangements. 5

AB reported that the CSG had considered options for re-commissioning the urgent care centre at St. Thomas hospital. Following the CSG meeting a business case had been circulated; the CSG had agreed option 2 be progressed. JH requested that the comments from CSG discussion on the recommendations be fed back to Lambeth (lead commissioner). AZ stated that following agreement with the Lambeth CCG chair the two CCGs will host a workshop in the Autumn to review progress on joint areas of work. Engagement & Patient Experience Committee (EPEC) report JH outlined discussion from the meeting and noted an example where PPG involvement had resulted in arrangements to reinstate the mobile breast screening unit at Surrey Quays. This had been initiated from discussion at the Bermondsey & Rotherhithe locality group meetings and highlighted the importance of patient involvement. He also reported on training being undertaken for EPEC members to enable patient leaders to become more effectively involved with CCG and the community. Modules have been developed and offered out to broaden and deepen engagement of the public, to the benefit of the community. The CCG Governing body received the reports from the Commissioning Strategy and Engagement & Patient Experience Committees and received assurance that the Committees are completing their full scope of responsibilities and conform to the agreed structure of delegation. A&E Recovery Improvement Plans TH summarised the document and the approach it recommended. She noted the plan had been structured to address the needs of NHS England and consequently it didn t clearly highlight the areas most important to Southwark CCG. NHS England had requested the CCG to consider the benefits of working at greater scale and re-submit the plan in one week s time. TH requested views from the Governing Body on how to develop further. CCG165/13 JM asked if the extra capacity planned to open at KCH before close of 2013 would be beneficial. TH confirmed that capacity will be brought on stream before Christmas which would help. AB reported that discussions have been held with the Chief Operating Officer at KCH to consider what services could be provided in the community. The Governing Body noted that A&E performance was a national issue and that Southwark needed to ensure a system-wide rather than single organisation approach. AZ stated Lambeth, Southwark and Lewisham CCGs will work closer together and look at patient flows across the area. AB also noted the periphery of Southwark geography was relevant to the plan i.e. St Georges Hospital, and Croydon. A workshop for Lambeth and Southwark CCGs is to be held by September to look at 6

patient flows and a system-wide approach to addressing A&E issues. ACTION: TH RG supported a system-wide approach to A&E capacity. He highlighted the London Quality Standards and the need to increase consultant cover at weekends to improve outcomes and efficiency. TH replied that the London Quality standards will be addressed however there is a need to understand the costs involved. JM stated that it is important for CCG clinicians to pressure service providers to change as not all wish to do so. AF stated that public health is starting work to analyse whether acuity has increased as is often cited as a reason for A&E problems. The Governing Body agreed communications with healthcare professionals and the public were needed as there continues to be confusion regarding what treatment each type of unit was for. The Choose Well programme was well-regarded however the need to change patient behaviour was paramount. JH asked how this could be influenced. In answer to a query from NK, AZ reminded the Governing Body that PH is the GP representative on the Urgent Care Network Board. NK highlighted the number of alcohol and mental health presentations at A&E. TH agreed to present a report to the CSG regarding progress and learning on Alcohol. ACTION TH RP enquired about drug and alcohol work being carried out by the CCG and Health & Wellbeing Board (HWB) and whether more collaborative work could be carried out. The Governing Body agreed it needed to consider how it could improve its influence at the HWB. The CCG noted the A&E Recovery Improvement Plan including the recommendations discussed for strengthening the action plan and supported the proposal for a Lambeth & Southwark workshop. CCG Start Budgets MH highlighted that the budgetary framework had been presented to the CCG Governing Body in March 2013 and that changes since then were mainly related to the NHS restructure. CCG166/13 He highlighted that a number of budgets adjustments are still outstanding (particularly due to changes with specialised commissioning budgets) and it is likely that final agreement will not be reached until October. Details of budget envelopes were in the report. The IGP will continue to receive regular reports on the use of resources. MH noted that the percentage of risk was disproportionately larger than the percentage of budget the CCG had retained due to case mix. As the CCG had retained unpredictable areas such as A&E, RTT, these were more difficult to forecast, which made the levels of reserves the CCG retained very pertinent. AB stated the consequence of making real changes through service redesign plans were impacted by the volatility of the budget. 7

DF enquired about QIPP decisions. AZ stated that the QIPP will be discussed in depth at the IGP. GK noted that some of the QIPP titles were unclear and so will provide a briefing of the services included under mental health QIPP so that they are more descriptive of their intent. ACTION: GK The Governing Body recommended the opening budgets for 2013/4 be taken to Council of Members for final approval approved the QIPP programme subject to its detailed review by IGP noted the risk mitigation approach being taken noted that regular updates will be made to the IGP Chief Officer s report AB congratulated MH and the Finance team for the quick turnaround of the Annual Accounts for 2012/3. He raised a number of items in his report for which he sought Governing Body approval: 1. Transfer scheme Due Diligence - the Governing Body authorised the Chief Officer to complete the transfer scheme due diligence process. 2. Conflicts of Interest the Governing Body approved the decisions of the Conflicts of Interest panel that had met on 28 th May 2013. CCG167/13 3. Remuneration committee 7 th June 2013 DF (Chair of Remuneration Committee) reported that the meeting had been held in conjunction with Lambeth CCG, assisted by human resources staff. Conflict of Interest had been closely monitored. Following discussion at the Remuneration Committee DF requested the Governing Body change the terms of reference and delegate decision making to the Remuneration Committee; Governing Body would then ratify the decisions made by that committee. AB supported the proposal. He raised that as this would be a change to Southwark CCG s constitution it would need to be agreed by the Council of Members and forwarded to NHS England for approval. AB reported that transparency and openness is unchanged and the details of the remuneration of governing body members are reported within the annual report and accounts and are public information. ACTION: MH The CCG Governing Body noted the Chief Officer s report CCG168/13 Items for Information 8

The CCG noted the following minutes of CCG Committees Dulwich Project Board [April 2013] Integrated Governance & Performance [May 2013] Commissioning Strategy Group [May 2013] Engagement and Patient Experience [ May 2013] Any Other Business CCG169/13 There was no other business Public Open Space Richard Procter (RPr) highlighted that the CCG budget needed to be commended to the Council of Members for their approval. AB stated that this will be presented to their next meeting. GP enquired whether a risk assessment had been carried out on maternity capacity. TH replied that maternity capacity has been included on the CCG risk register. Increasing capacity has been raised with KCH at the Clinical Quality Review meetings and a visit has been arranged to look at the actions being undertaken to ensure quality of services. She updated on the actions being undertaken to provide more capacity. In answer to a query from GP on how risk is handled, TH stated that most deliveries are prebooked although mothers can go to A&E. KCH have not requested a postcode limitation for referrals though this could be an option. CCG170/13 GP asked how other sites, including Orpington Hospital, may be used. TH said the answer referred to the KCH Business Case for acquisition of the PRUH and as that was commercial in confidence it was not possible to respond. Following the ICP presentation, ERW noted that this raised questions and opportunities for the Dulwich Hospital site. ERW asked that the CCG consider third sector health benefactor options before a final decision be made. GP requested the CCG push back to politicians before the proposals for Dulwich are agreed. AB replied that discussions are being held on the current situation, but emphasised that this is not predicated on charitable donations. There is a need to consider services required by the local population not only older patients and then consider possible source of funds. The meeting closed. CCG171/13 Date of next meeting 11 July 2013 9

Other attenders including members of the public: Elizabeth Rylance-Watson (ERW) Katie Kelly Gill Portwine Nick Torry Stuart Jackson Richard Proctor Norma Lawrence Kieran Swann Jacquie Foster Rebecca Scott Daniel Blagdon Kate Radcliffe Southwark resident Lay Member Development KDH & Southwark resident Public GSK Chair, Southwark CCG Council of Members Southwark resident and carer SCCG SCCG SCCG SCCG SLCSU 10

CCG Governing Body 13 th June 2013 ACTION TRACKER ITEM ACTION BY Minutes of the previous meeting Notes on open space to be amended from 9 th May to be amended VB DATE FOR COMPLETION/REPORT BACK July Integrated Governance & performance Committee report Proposed plan to reduce RTT backlog to be reviewed by Lambeth and Southwark Planned Care Board Copy of letter JM sent to AZ regarding increased frailty and acuity of patients to be circulated with these minutes Providers presenting at the GB to be asked to update how they are minimising the occurrence of Never Events SLaM Medical Director to be invited back to update the GB to a clear brief to be given by GK Governing Body leads to review the transfer of information back to primary care for clients with mental health issues Presentation of data in Integrated Performance report to be reviewed, especially for SLaM where RAG indicators are not sufficiently informative. Conflict of Interest policy executive summary of key points to be added AB VB/AZ KS KS/GK NK/RD July July July onwards September September KS July JF/SM July A&E recovery plan A workshop for Lambeth and Southwark CCGs to be held by September to look at patient flows and a system-wide approach to addressing A&E issues A report to be presented to CSG regarding progress and learning on Alcohol TH TH August September CSG Start Budgets To be taken to Council of Members for final approval Wording of QIPP programmes to be reviewed and more descriptive of their intent (especially mental health) QIPP budget to be reviewed in detail by IGP MH KS/GK RP/KS Next COM meeting July July 11

Committee work Rem Com ToR to be amended to enable it to be decision making with the GB ratifying their decisions MH August 12

Appendix 1 From: Elizabeth Rylance-Watson Sent: 12 June 2013 16:40 To: Zeineldine Amr (Aylesbury Partnership); Bland Andrew (NHS SOUTHWARK CCG); Hooton Tamsin (NHS SOUTHWARK CCG); Watts Rosemary (NHS SOUTHWARK CCG) Subject: FW: Minutes of the 9th May 2013 Meeting Challenge Importance: High Dear Amr I have just returned from France and am therefore now reading the CCG Papers for tomorrow's meeting. Please refer to Item 1, the Minutes of 9th May 2013 Encl A. The text which I read out in the Public Open Space (CCG144/13) and a copy of which I passed to the minute takers to assist them with the minutes, has not been reproduced in these minutes. The text which I read is to be found immediately below, within my letter to Tamsin Hooten. That represents what I said. As a result of the minutes' shortening what I said, accuracy has now been compromised and I must therefore challenge CCG/144/13. It is essential, for the integrity of the governance of the new Clinical Commissioning Boards and for the avoidance of all doubt, that my careful context setting, quotations from reports and statistics be faithfully and accurately recorded and that it be absolutely clear what the SCC Board heard me say. I should be grateful if the correction to the minutes would please reproduce what I did say and that this correction then be incorporated in the minutes for tomorrow's meeting. May I also please bring to your attention the fact that I have not received the full response from Tamsin Hooten. I have not sent a reminder, because I appreciate just how busy Tamsin will be at this time. Please also see CCG156/13 my first point. When the minutes do not provide any context, the effect is make my intervention bland and of course, it makes suggestions for action unattributable. I was, I believe referring to the SCCG Annual Draft Operating Plan 2013/14 and Draft Business Plan 2013/14 and to the Integrated Governance and Performance Committee report.i was noting that nowhere in these key SCCG strategic planning documents was there any mention of Professor Dame Sally Davies's recommendations. I was encouraging the Board to take another look and to build Professor Dame Sally Davies's recommendations into its forward planning. The minute takers may still have my recording of what I said. I suggest that, clearly, Professor Dame Sally Davies's recommendations on infection control, on anti biotic resistance, on the settings of care and her wider recommendations need to feature in the SCCG's strategic planning. Thank you With Best Regards Elizabeth (Rylance Watson) From: Elizabeth Rylance Watson Date: Wed, 08 May 2013 21:03:15 +0100 To: "Hooton Tamsin (NHS SOUTHWARK CCG)" Andrew Bland "Watts Rosemary (NHS SOUTHWARK CCG)" Cc: Dr Amr Zeineldine Malcolm Hines "Scott Rebecca (NHS SOUTHWARK CCG)" "Foster Jacquie (NHS SOUTHWARK CCG)" "McCarthy Robert (NHS SOUTH LONDON COMMISSIONING SUPPORT UNIT)" Subject: Re: Jim Watson right of reply and conduct of the Dulwich Project Board for meeting of SCCG 11th April 2013 Tamsin Hooton's email of 10th April 2013 13

Dear Tamsin, Thank you very much for your email of the 10 th April. Pre the Francis report and the 2012 NHS Act, patients could be channeled and funneled down the PALS individual complaints route: managed away in the hope that they would give up. I am afraid that if your excellent analysis of the Francis Report is to have real meaning and real teeth, the SCCG will indeed need to Develop innovative approaches to hearing the patient voice (Draft Operating Plan 2013 14) and will therefore need to pay attention to how I have, through communication of my direct experience, sought to have addressed deep issues of the health and care of our older population. Your response does not speak to those deep issues. I have been speaking out because on three occasions, in public, (24 th July 2012 Patient Engagement, 18 th September 2012 Dulwich Community Council Meeting, 23 rd March 2013 Southwark Pensioners Forum Meeting to discuss the Dulwich Consultation) every time I raise the matter of the Betty Alexander Unit being in the wrong place (that is, on the Denmark Hill site) the audience applauds. I have struck a chord and that chord is not unique to me. Therefore this is not a matter to be channeled through the King s complaints procedure. I would have expected you to challenge their assumption not endorse it. Here is a quote from King s College Hospital s own Annual Report of 2004 5: SOS service for the elderly reduces pressure on A&E: King s has developed a SOS service for elderly patients as an alternative to visiting A&E. The Betty AlexanderSuite at Dulwich Hospital is a medical day unit focused on emergencyassessment, treatment and rehabilitation of acute and chronic conditions. It accepts referral for urgent cases that require immediate investigations or treatment... Elderly patients benefit from the suite s one stop shop approach: x rays, blood tests and ECGs can be carried out on the same day. The service is multi disciplinary and links to social services, occupational therapists, physiotherapists, chiropodists, tissue viability nurses and thepain team. Of the 213 referrals seen in 2004, 93% were successfully managed in community settings. Only 4 patients were transferred to A&E and 10 wereadmitted to hospital. This perfectly makes the case for an integrated medical day unit which keeps the frail older population away from a site which all the experts agree is not in most cases suitable for this population. Professor Dame Sally Davies has recently published Volume 2 of her first report as Chief Medical Officer. In it she has warned in the most unambiguous and powerful terms of the dangers of antibiotic/antimicrobial resistance. She talks of the dangers being greater than those of global terrorism. She says: Infection is an important cause of illness and pre mature mortality in older adults and can hasten the decline in health of an otherwise active older person. (p 118). Her recommendation (4) is that infection control policies of organisations responsible for the care of individuals should explicitly address the setting of care, including a focus on the home and the community. Therefore, inaddition to the increasing danger of exposing the frail elderly population to an already overpopulated hospital, (Professor John Moxham at the Health Scrutiny Committee meeting which you and Andrew Bland attended on the 1 st May talked of the pressures on King s of patients with multiple diagnoses) why do you (SSCG) and King s insist on the co habitation benefits of adding yet more frail older patients onto an already over crowded Denmark Hill hospital site? Why not, instead, provide the integrated medical day unit at Dulwich Hospital for the vast majority and require King s to fund a shuttle hospital bus for those patients whose further diagnostics require them to go to Denmark Hill? 14

You mention that you have not raised with King s the information relating to older adults which I asked for in February. I have copied and pasted what I did ask for below. And Yes please I do need the answers. It may be that you already hold the information in the data you analyse from King s on Southwark referred patient populations. You may not need to ask King s at all. What were the numbers of A&E attendance QIPP 2? What were the numbers aged over 65? Is the all England data published by the Nuffield Trust of the age specific admissions rate for the over 85 s having increased by over 40% reflected in the King s experience? Nuffield reports that Emergency Admissions for 85+have risen from 74,661 to 140,731 from 2001 2011. I am trying to establish for my response to the consultation credible data on the older population of Southwark and their call on our principal hospital (King s). So, if we puttogether: Professor Dame Sally Davies s recommendations The need to remove as many of the frail older populations and their carers from a hospital setting which is a cause of stress SCCG s failure to achieve reduction of its A&E attendance (QIPP) Two wards where all patients require total care (King s) ICU always full (King s) Pressure ulcers reflecting frailty (All quotes from Professor Moxham to the Southwark Council Health scrutiny committee 1 st May 2013) Then I cannot understand why the SCCG and King s would put so much effort into not addressing holistically the older population and why in your discussion with King s you would want to in your own words achieve closure on the topic of setting and transport, especially when the Integrated Pathway is work very much in development. (See Home Wards as an example) The draft 2013/14 Plan which the SCCG will be discussing tomorrow still shows planning being funneled and blocks of work placed into silos. Believe me I do recognize and appreciate the complexities which you are handling, but your plans must be written in such a way that the various work streams can be brought back together (re integrated) and then be tested by a scrutiny of their interdependencies from the perspective of patient populations and carers. In the example of your meeting with King s on the 21 st February, I see a Hospital irritated by an approach which it wants addressed as an individual complaint, and definite irritation in their admonishing me for failing to recognize the distinction between premises issues and issues affecting standards of care. I fully understand the distinction. I am interested in both because they are or should be integrated! I see the SCCG wanting to square away the issue of Betty Alexander by achieving some mild improvements in re configuring the waiting area and in Transport. Of course King s can rightly say that patients will be happy with the clinical service from Professor Jackson s Department of Clinical Gerontology. It is outstanding! The issue was never that. It was and it remains that the SCCG and King s are placing the day treatment of a lot of older people and their carers on the wrong site, on a site which is difficult to access and which the Chief Medical Officer warns will be increasingly unsuitable for the older population. I am really saddened that after all the effort I have put in, I still have not heard a word from Dr. Roger Durston himself on where he thinks such an integrated service for the post 65 population should be sited. I would like a reflective and substantive response to this email in time for the June SCCG. And when the SCCG is looking at its draft 2013 14 Annual Operating Plan tomorrow, perhaps it could point me to where 15

and to how it will be configuring its plan to take account of the most powerful call to action from the Chief Medical Officer? Have I missed it, or is there no reference at all to Professor Dame Sally Davies s report and her recommendations? Where is the planning for isolation wards? Also, I would like a response to my observations above about the Draft Operating Plan. And, I do please need the data informationwhich I asked for in February and again in March. (See below for ease of reference) With Best Regards Elizabeth Rylance Watson This is what I requested in February and again in March: Also, please, would the committee request a short report from Professor Moxham to provide a list of all the clinics and services run in the Betty Alexander Unit (KOPAU) per week and per month in the last recorded year? It would be helpful to have in the public domain a breakdown of numbers attending with the age profiles as compiled by the 2011 census (65 74, 74 79. 80 89, 90+). Please ask for the numbers referred to King's by the Southwark, Lambeth and Lewisham GPs directly to KOPAU Betty Alexander broken down by Local Authority GP Practices. It would also be most helpful to know what data is available to GP practices overall, by Local Authority on numbers who might first enter King's via another route such asa&e or GP referrals into another specialism which are transferred internally to the specialist care of Gerontology. If there are existing reports for me to look at, I would be most grateful to be pointed in the right direction. Also, what % of total GP commissioning into the Acute Sector (particularly King's) is represented by the post 65 population? The Part of ERW's PRE Consultation submission to the SCCG after a Visit by Dr Roger Durston, Rebecca Scott and Elizabeth Rylance Watson to King's College Hospital on 18th December 2012 which gives the 2011 census figures I have taken a look at the 2011 census figures for Southwark, Lambeth and Lewisham, being the principal catchment populations for King's and, I assume, in scope to the Dulwich plans: Southwark 60 90+ years old> 31,401 Southwark 45 59 > 47,275 Southwark Planning alone needs to factor in a population of 78,676 of elderly or carers, or elderly coming down the track. Lambeth 60 90+years old > 32.199 Lambeth 45 59 > 47870 Lambeth Planningalone needs to factor in a population of 80,069 of elderly or carers, or elderly coming down the track. Lewisham 60 90+ years old > 35924 Lewisham 45 59 >47754 16

Lewisham Planning alone needs to factor in a population of 83,678 of elderly or carers, or elderly coming down the track. The total 45+ generation of the three catchment boroughs stands at 242,423. I would like to know please what are the planning assumptions which will determine what % of those numbers are going to make demands on the community and acute sectors? What I can say right now, is that a waiting room at King's which can seat 8 comfortably and cannot accommodate two wheel chair patients at one and the same time, simply does not cut it. 17