Priority 2: Improved identification and support for people with Dementia
Verbal Report by Debbie Mayor, Dementia Programme Manager
Minutes:
Priority2: Improved identification and support for people with Dementia
Members of the Board received a tabled report that provided an overview on progress of delivery of the National and local Dementia Strategy.
Dementia remained a key national and local priority, as set out in the Havering Health and Wellbeing Strategy 2012-14 (Theme A: Prevention, keeping people healthy, early identification, early intervention and improving wellbeing). The National Dementia Strategy published by the Government in 2009 contained seventeen objectives, fourteen being relevant at local level which were:
Objective One: Improving public and professional awareness and understanding of dementia
Objective Two: Good quality early diagnosis and intervention for all
Objective Three: Good quality information for those diagnosed with dementia and their carers
Objective Four: Enabling early access to care, support and advice following diagnosis
Objective Five: Development of structured peer support and learning networks
Objective Six: Improved community personal support services
Objective Seven: Implementing the Carers Strategy
Objective Eight: Improving quality of care for people with dementia in general hospitals
Objective Nine: Improved intermediate care for people with dementia
Objective Ten: Considering the potential for housing support, housing-related services and telecare to support people with dementia and their carers
Objective Eleven: Living well with dementia in care homes
Objective Twelve: Improved end of life care for people with dementia
Objective Thirteen: An informed and effective workforce for people with dementia
Objective Fourteen: A joint commissioning strategy for dementia
The fourteen objectives were mapped to locally agreed pathways as agreed by the Dementia Partnership Board. It was the intention of the Board to undertake a detailed self- assessment against progress in delivering and implementing the National Dementia Strategy. In further developing the work of the Board, two sub-groups were in the process of being established:
· Training and Education Sub-group: this group would be charged with achieving Objective 13 of the National Dementia Strategy, which was to have an informed and effective workforce for people with dementia.
· User Engagement Sub-group: this group would ensure that the voices and views of people with dementia and their carers were heard and used to inform the on-going development of a range of quality services and initiatives
The key purpose of the Training and Education sub-group would be to develop and oversee the delivery of the Havering Dementia and Training Programme, and to ensure that all staff working with older people in the health, social care and voluntary sectors have access to dementia care training.
The User Engagement sub-group would ensure that service users and their carers are fully engaged in the development, implementation and progress to delivery of the local Strategy. Finally, in order to enhance capacity, and drive progress, LBH and Havering CCG have recently appointed a Dementia Programme Manager to support the work of the Board and its Sub-groups.
There had been a number of local public awareness campaigns about dementia and priority was currently being placed on establishing the true level of prevalence of dementia, and to understand the ‘gap’ in people receiving a diagnosis.
Concern has been expressed at national level about the under-diagnosis of people with dementia, and emphasis has been placed on the importance of individuals receiving a diagnosis, following assessment, in order that they and their carers can plan for their on-going care and support needs.
NHS England, had set a target for every area of achieving a diagnosis and appropriate follow up support for two thirds or 66% of the local relevant population. Local areas were being asked to set their own ambition target and the Board were therefore asked to consider setting the local ‘ambition target’ for Havering.
The number of cases for Havering in 2011/12 was 3,419. The GP Dementia register recorded 1,332 people, giving a diagnosis rate of 39%. Since then, a detailed audit has been undertaken by Public Health, and on the basis of the audit, those practises with lower than average anticipated numbers were in the process of being visited by the Dementia Programme Manager, in order to:
· Raise the overall importance of dementia and outline the national and local picture
· Develop an understanding of the GP practice issues
· Support the individual practises with any potential recording issues, in order to ensure that records are accurate
The vast majority of GP practises in Havering had also signed up to a specific and enhanced service specification for facilitating timely diagnosis and support for people with dementia. Constant and detailed liaison with GP practices and Public Health would continue over the coming months, with regular updates on diagnosis rates reported to the Dementia Partnership Board.
The Havering Memory Service, provided by NELFT, was another critical part of the local Dementia pathway, providing formal assessment and follow-up care and support once a diagnosis of dementia is made.
Other Key Services were listed as follows:
· Dementia Adviser Role: This role supports the delivery of Objectives 1,11,12and 13 of the National Dementia Strategy.
· A Dementia Forum, which is an open group, has been established and in place since March, 2013, providing information, updates and peer support for all attendees. The post holder has engaged with Havering Museum, who is now providing reminiscence and life story work, both at the museum and in a small number of care homes.
· Training about dementia, including such topic areas as dealing with behaviours which challenge, End of Life Care, and Mental Capacity Act has been provided to a range of care homes. The Dementia Advisor has also provided support to four local care homes to submit a successful bid to Department of Health for funding to create ‘dementia friendly’ environments in their establishments.
· In respect of Objectives 3 and 4 of the National Strategy, Age Concern is commissioned by Havering CCG to provide the Dementia Advisory Service. The service works across organisations to provide information, advice, on-going support and signposting for people who have concerns about their memory, those with a diagnosis of dementia, and their carers. The service had contact with 1435 cases in 2012/13, and has collated positive outcome data re: impact of support for carers over time. Havering CCG intends to review this contract over the coming months, as part of its overall review of contracts with voluntary sector organisations.
· Peer Support, as set out in Objective 5 of the National Dementia Strategy, is provided by Alzheimer’s Society, via three support sessions per month. The Alzheimer’s Society also provides a rolling programme of Singing for the Brain, in locations across the Borough.
· Access to improved community personal support services and support for carers is crucial to living well with dementia (Objectives 6 and 7 of the National Strategy). Locally, respite services are available to individuals following an assessment of need, and the service can be provided in a range of settings, including the person’s own home, utilising a personal budget. A total of 59 people over 65 with a diagnosis of dementia have accessed a personal budget to purchase care and support.
· Further specific support for carers of people with dementia is provided by Crossroads, offering home based respite support for up to 80 carers.
· Objective 8 of the National Strategy sets out the requirements for improving the quality of care for people with dementia in general hospitals. Barking, Havering and Redbridge University Hospitals (BHRUT) have a named Clinical Lead for dementia, and an internal dementia care pathway is being implemented in all general inpatient areas. The Trust has appointed two dementia specialist nurses and there is extensive education and training programme in place for all staff, devised by NHS London.
· There is currently limited access to intermediate care for people with dementia, as set out in the National Strategy under Objective 9. Eight of the flats available in the Extra Care Housing facility at Paines Brook can accommodate the provision of either intermediate or respite care.
· With regard to Objective 10 of the National Strategy, and as referenced above, the joint development of an Extra Care Housing Scheme has been undertaken, and within that facility, five of the flats can accommodate tenants with more complex needs, including dementia.
· With reference to Objective12 of the national Strategy (End of Life Care), strategic implementation for this area is overseen by the BHR End of Life Steering Group. The group consists of key stakeholders from health and social care, both providers and commissioners.
The Board noted the report and made a number of comments as follows:
There should be earlier diagnosis which would make a difference to people’s lives, however, there should also be a focus on improving services and support within Havering.
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Population changes should also be taken into account so as to ensure needs are met. It was important to look at the framework and Dementia outcomes as there should be a measure of how local services are helping patients.
It was important to focus on people who attend their GP with memory loss – not all will have Dementia and some, if diagnosed, will not want to go further or others may be waiting for a specialist appointment. It was suggested that a survey of the 55 plus population be carried out so as to analyse the data. Population changes should also be taken into account so as to ensure needs are met.
The CCG had requested detailed performance data around services which would help in formulating a service specification.
Members of the Board thanked the author for an excellent report and the good work done thus far.