Agenda item

(In attendance Sue Gratton, Deputy Associate Director, Integrated Commissioning, NHS Kent and Medway, Anne Tidmarsh, Director Older People and Physical Disabilities, Kent County Council and Evelyn White, Associate Director, Integrated Commissioning, NHS Kent and Medway)

(1)       Dementia is one of the main long term conditions of later life which has a huge impact on the capacity for independent living.  In the United Kingdom it was estimated to cost over £19 billion per year with an projected doubling of the number of people who have dementia in the UK over the next 30 years.  The report updated the Shadow Health and Wellbeing Board on:

(i)     needs analysis in relation to dementia in Kent;

(ii)   achievements to date;

(iii)gaps identified; and

(iv)  the Integrated Commissioning Plans for Dementia

(2)               The Board noted that the Prime Minister had recently published a “Challenge on Dementia” which sets down a number of areas for action to make life better for people with dementia and their carers.  The Challenge focussed on three key areas:

(a)   driving improvements in health and social care;

(b)   creating dementia friendly communities that know how to help; and

(c)   better research

(3)               The report before the Board sought to see that the Challenge was being addressed through the Commissioning Plans and what more could be done across Kent to meet the Challenge.  Whilst considerable progress had been made in redesigning the services in order to reinvest in more universal preventative and early intervention support there remained a significant challenge to ensure that the growing number of people who will develop dementia over the coming years will be well supported and can continue to enjoy life with their dementia.  The Plans were in line with the National Dementia Strategy and also take into account the Kent County Council Select Committee on Dementia.

(4)               The Shadow Health and Wellbeing Board noted that the work was being led through the Health and Social Care Integration Board. The Board’s role was important to ensure integration between health and social care but equally important was the joined up working with the independent and voluntary sector to ensure integrated care across all providers and all stages of the pathway of care.

(5)               The Chairman invited Roger Kendall representative of Kent LINk on the Shadow Health and Wellbeing Board to receive their report setting out their views on Dementia Services in Kent (May 2012).

(6)               Particular reference was made to a number of projects undertaken by Kent LINk in which dementia services had featured including:-

(a)   West Kent Enhanced Dementia Crisis (2009);

(b)   A User’s Perspective of Day Centres in East/West Kent (2009/10);

(c)   Monitoring Quality of Residential Homes in East Kent (2011);

(d)   Monitoring Quality of Residential Homes across Kent (2012); and

(e)   Care of Older People in Hospitals (2012)

(7)               The recommendations of Kent LINk which they would like to see the Shadow Health and Wellbeing Board taking into consideration were:

(a)   looking into further services for people with dementia, with a particular emphasis on how integration of health and social care services could help patients and carers; and

(b)   to consider leading on and working with others to raise public awareness and education in relation to dementia services.

(8)               The Shadow Health and Wellbeing Board noted that the vision for people with dementia in Kent is “that people with dementia receive timely diagnosis and support that promotes their independence and helps them ‘live well’ with dementia, and that all services and support are provide to the highest possible standards: promoting dignity, choice and respect”

(9)               The Board received a presentation on “Improving outcomes for People with Dementia” from Evelyn White, Associate Director Integrated Commission NHS Kent and Medway, Anne Tidmarsh, Director Older People Physical Disability, Kent County Council and Sue Gratton, Deputy Associate Director Integrated Commissioning, NHS Kent and Medway.

(10)          In a workshop session members of the Board addressed the following discussion items:-

(a)   Reading the paper and plan, does it cover what you think it needs to cover? If not what is missing and what are the barriers to delivering the plan?

(b)   How would you like to receive feedback on progress; do you agree with the timescales for the actions, if not what are the two or three key actions you would prioritise?

(c)   Paul Burstow mentions dementia friendly communities and increased funding for research in dementia – how could we take these areas forward?

(11)     The workshop discussions raised the following issues:

How do we raise awareness and create dementia friendly communities? What role could Parish Councils and the police play? In Holland they have built villages that are dementia proof.

Action: communities across Kent need to be profiled. Could this be piloted through the Kent Forum?

GPs need convincing of the argument for early diagnosis. GPs tend to focus on the drug and treatment aspect, but there is a social element too. Getting patients to have the tests for early diagnosis is also a challenge.

The Planning Framework needs to take into account dementia friendly communities and we as leaders should influence it. What role do Locality Boards play in this?

From a GP perspective, if undiagnosed patients are diagnosed earlier, can we cope before the capacity is there? Uncoded and undiagnosed. We need to map this. 

Access to drug treatment in East Kent is relatively poor. There needs to be a debate about efficacy.

Need to develop an investment plan for the year. Principle of investing in the community is good. The question is how successful we will be in doing this?

Will investment in prevention in the community make a difference? Financial savings will be reinvested in the community. CCGs may want to have a look at this. Particularly shift of resources from hospital beds into community.

Where should dementia services sit? In secondary or primary care? Keep dementia sufferers out of hospital (avoid crisis management where possible) by focusing on interventions that can be put in place in the home.

Emma Hanson has led the West Kent Crisis Service and has been very successful in a short time. There is evidence to support community based investment preventing people going into hospital. The West Kent service is direct access and available out of hours. Different practices between East and West Kent.

How do we spread the message of what works? How do we transfer good practice and deal with things that do not work well.

There needs to be clarity around budget implications for CCGs.

Actions:

Anne Tidmarsh to bring back to the Board progress on the above issues

Anne Tidmarsh to compile a stronger case of argument for early diagnosis which can be presented to GPs and the wider community.

Anne Tidmarsh to have further local discussions, particularly regarding the impact on individual budgets.

(12)          The Board noted the budget implications for Clinical Commissioning Groups (CCGs). Which it was important CCG Board should be encouraged to consider.