Meeting documents

The Health & Adult Social Care Select Committee carried out a review of Dementia Services in 2012 with recommendations being presented to Cabinet.  This item is an opportunity for Members to hear from representatives about the progress being made in Dementia Services.

Attendees:

Lin Hazell, Cabinet Member for Health & Wellbeing

Ms J Bowie, Director of Joint Commissioning, Adult Social Care

Papers:

Report attached

Intended outcome:

For Members to gain a greater understanding of the current services available for patients with dementia and their carers and to seek reassurance that patients are receiving the best possible care and that future demand on services can be met.

The Chairman welcomed L Hazell, Cabinet Member for Health and Wellbeing and Jane Bowie, Director of Joint Commissioning, Adult Social Care and Maxine Foster, Commissioning Manager, CCG.

L Hazell advised that due to increased numbers of people diagnosed with dementia, working together with the CCGs and Public Health was essential.

Ms J Bowie reiterated that there had been joint working between the CCGs and public health and social care.  There was a three year dementia strategy with five key themes:

• Improved Diagnostic Pathway and Diagnostic Rate
• Dementia Awareness
• Personalised Support and Independent Living
• Pre –Crisis Support
• Young Onset Dementia

There was a joint dementia board overseeing the implementation of the strategy and looking at an all aged mental health strategy to build on the work on dementia services.

The following points were made in response to questions from the Committee:

• Ms Bowie was asked what was meant by one of the challenges being around "Changing prioritisation of the importance of an early diagnosis".  Ms Bowie said there were two aspects:

• • The residual view of what was the value if there was no cure.  However, it was important to be diagnosed in order for interventions to be put in place and for family and friends to be able to make adjustments.
  • Focussing on the GP practices to improve and maintain their diagnosis rate.  Work had also taken place with Oxford Health Trust to provide capacity.
• One of the barriers to early diagnosis was identifying onset of dementia in young people.  For people in their 40’s the condition affected a different part of their brain and it was difficult for clinicians to formally diagnose dementia.  It could take up to five years for someone to receive a diagnosis of young onset dementia.
• For older people there was the stigma attached to the fear of having dementia diagnosed which could result in the loss of their driving licence and higher travel insurance costs.
• Ms Bowie confirmed the aim was for people to tell their story once but said that it was not always everyone’s experience.  Feedback was that professionals were not joined up in every case or shared best practice.  Ms Bowie agreed this needed to be addressed and improved.  There were some blockers on sharing information but there were  mechanisms which could be used to overcome the blockers.
• Ms Bowie said she was happy that the adult social care assessment dovetailed with the mental health trust and a structured and legally compliant process was followed to determine when a person should have their liberty denied due to dementia.
• Ms Foster provided an explanation on why all the GP practices in Chiltern CCG were dementia friendly but not all of Aylesbury Vale CCG was dementia friendly.  The difference was because there was a Quality Improvement Scheme in Chiltern CCG in 2016 to promote dementia and early diagnosis.  There were currently six practices working towards becoming dementia friendly within the Aylesbury Vale CCG.
• Ms Bowie confirmed that there was an overarching strategy board with officers from adult social care and the CCGs and that data sets were routinely used to develop the work.
• Ms Bowie offered to find out the percentage of BCC staff who had received the dementia awareness training.

Action:  Ms Bowie.

• In response to whether it would be beneficial to make a whole system presentation to the Local Area Forums (LAFs) to gain greater community involvement due to the end of the funding of the BCC project officer for Dementia Friendly Communities; Ms Bowie replied that they had looked at capacity within the Prevention Matters team and were working with the LAFs and Community Links Officers to see how support could be provided to individual areas.
• Ms Foster said there were a number of reasons for the stigmatisation of dementia:
  • There was not a word for dementia in some languages.
  • The cultural aspect was different within black, ethnic minority (BME) groups; however, those born in the UK, who were now supporting elderly parents, had a better understanding of dementia.
  • In some cultures people thought of their relative with dementia as "possessed".
  • There was a wide belief that having dementia meant you would go mad which was not the case.
• Ms Bowie added that there were dementia champions in the communities who were good examples of people with dementia living independently.
• Some memory clinics were delivered by the Alzheimer's Society and they did outreach work in the community.
• Ms Foster explained that there were two different types of memory clinic:
  • A memory support service which was county-wide and did a lot of outreach work.
  • Memory clinics which were delivered by Oxford Health.
  • The majority of dementia diagnosis’ were provided by a memory clinic.
• Investment had been made for five memory clinics in GP practices across the county and these had been very successful in de-stigmatising the situation. 
• L Hazell suggested inviting the Dementia Support Service to a Member briefing to help promote the dementia services.
• A tool called "DiADem" had been developed for more complex cases and was being used to diagnose patients in care homes.
• Ms Bowie said the team had projections on future numbers of dementia sufferers across the age ranges and that there were a number of strategies within Public Health to improve people’s health and wellbeing and enable people to live well in the community.  Public Health was working with housing to help people stay in their own homes and the Quality in Care team was making sure providers were aware of people’s needs.
• In response to being asked where the budget would come from to provide for the rise in the number of dementia sufferers, Ms Bowie advised that a Green Paper was due in summer 2018 on social care.  Review of resources for the health service was under consideration and any opportunities for consultation would be taken up.
• Ms Bowie agreed that some aspects of dementia could be offset if actions such as learning a new skill or keeping active were taken.
• L Hazell added that the strategies would be in place to keep the numbers down.  The level of understanding and the number of people with dementia had changed dramatically over the last few years.
• The Care Quality Commission (CQC) regulated the care homes and provided the designation of whether the home was a residential, dementia or nursing home.  The CQC carried out inspections to ensure care homes had performed to meet the registration standards. 
• The BCC Quality in Care team provided dementia workshops to provide training to care home providers.
• BCC monitored the contracts with the providers.
• The electronic app DiADem was launched two years ago and was available for GPs to download. 
• Work was taking place to overcome problems in sharing information with partners.
• The Quality in Care team monitors use of the DiADem app in care homes.
• The memory support service had carried out 140 screenings in care homes.
• Approximately 62-64% of GP practices were using the DiADem app.  However, GP practices had different operating systems within a practice which made it very difficult to actually collate data from the different sources.
• Ms Bowie agreed to keep the HASC informed of the Mental Health Joint Commissioning Strategy consultation and for one of the members of HASC to be involved in the consultation.
• The POPPI database was a national database which was established about five years ago.  A complex algorithm was used to produce the data which changed dependent on national research.  The algorithm was brought in line with the NHS algorithm in 2016.
• Ms Bowie confirmed that respite care and support was offered to carers of people with dementia.

The Chairman thanked L Hazell, Ms Bowie and Ms Foster and for their attendance.