Agenda item

The Strategic Director for Adult Social Care and Health submits a report to provide an update to the Commission on the two LLR Joint Strategies for Dementia and Carers which are in the consultation phase.

The Commission is recommended to note the report and are invited to comment.

The Strategic Director for Adult Social Care and Health submitted a report to provide an update to the Commission on the two LLR Joint Strategies for Dementia and Carers which were in the consultation phase.

Bev White, Lead Commissioner, delivered a presentation on the draft LLR Living Well with Dementia Strategy 2019-2022 (attached to the minutes), and attention was drawn to the following points:

·         The draft Strategy had been through governance processes with partner organisations and consultation on the draft would begin the first week in April 2018;

·         The Strategy set out the ambition to support people to live well with dementia, in line with the national strategic direction, with reforms to be achieved by 2020;

·         Priorities identified were:

o   to improve health care

o   to promote awareness and understanding

o   research

·         The strategy was for people with memory problems or who had a dementia diagnosis, and support for families, carers and organisations;

·         Partner organisations would deliver individual action plans. LCC would also develop its own action plan, and would be brought to a future meeting of the Scrutiny Commission;

·         Plans would be overseen by the Dementia Programme Board;

·         The vision, guiding principles and aim of the strategy were outlined. It was noted the Dementia Support Service was one product of the Strategy;

·         Actions detailed in the Strategy were subject to consultation and still draft. Actions would drop down into individual actions plans, depending on the nature of the action and the organisation;

·         The pilot of actions with care homes sat under the ‘diagnosing well’ principle, and was a tool for care home staff to work with residents they thought might have dementia, and informed the Commissioners of what support was needed;

·         Included in the Strategic Action Plan, but if it dropped into LCCs action plan, the Local Authority Commissioners would need to work with the care home providers in the city;

·         Part of the Commissioner’s role was to work with contracts and insurance. Working in a difficult financial climate, it was essential to link up and make the best use of resources.

The draft LLR Carers Strategy 2018-2021 was presented (attached to the minutes), and the following points were made:

·         A link was included to the consultation website, which would run until 22 April 2018;

·         Consultation on the Strategy was hosted by Leicestershire County Council, who would provide information for the City to analyse;

·         LCC will develop a city wide action plan taking the actions contained within the Strategy and detailing how these will be delivered in the City. The action plan will also contain priorities for carers from other strategies, e.g. mental health.

·         It had been developed using survey and performance data and updates from the National Carers Policy Network, national and local good practice;

·         Authorities were waiting for the National Adult Social Care Green Paper which would include actions on carers;

·         The city’s Action Plan would be brought to a future meeting of the Commission to see how it was performing on actions;

·         The definition of a carer was provided, and guiding principles on the support for carers outlined;

·         Priority 1, Carer Identification, was a key theme, with difficulties in getting carers to recognise themselves as carers;

·         All priorities were draft and could be amended during the consultation process;

·         A final document would be launched September 2018.

The Commission welcomed the dementia toolkit for care homes and the further information that would be gained from its use. It was acknowledged the work in a care home was an exhausting role, and that care homes should ensure their staff were fully trained. Concern was raised that staff should not have to undertake training in their own time. It was noted that the fee for people in homes included training. The LLR Social Care Group gave free training, and was supported with funding from LCC.

Under the principle of Dying Well the Commission noted it was important to recognise that a person with dementia could still have choices on end of life care.  Members were informed it had been recognised that this work area was the least well developed locally  The Programme Board was ensuring support links between end of life and people with dementia were robust, and were confident the right people were on the group through CCGs, and had been given a fairly generous time scale, as it was the most under developed. End of life support was part of the conversation had with people admitted to care homes, and included end of life, for example, DNR, signed off by a clinician. Those conversations were had with the individual and supported by family.

It was noted that whenever someone was flagged to Adult Social Care as having dementia the authority would always assess the individual to see if they were eligible for support. Support for a carer was referred through the Care Pathway.

Detailed action plans would be developed to support the Strategies and would include more narrative. The delivery plan for the City Council might be jointly with CCGs, and would be brought to a future meeting of the Commission.

Officers were asked how much of a barrier was peoples’ inability to understand the process and get the support they needed. Members were told some people did not recognise that they had dementia, and it was usually noticed by others, for example, family members. Others just believed it was memory problems. One activity in recent years was a raising of awareness nationally about dementia amongst the general public, for example, a Christmas advert of a family getting together. If there was a problem, people should go to a GP who would run diagnostic tests and refer the patient to a clinic. Over 80% of people with suspected dementia in the City have been referred for a formal diagnosis– high compared to the rest of the country. It would be difficult to get to 100% diagnosis, particularly for those people who were living alone.

The LLER Dementia programme Board reports into the Sustainability and Transformation Partnership (STPnd had members attending the Dementia Programme Board also attend other workstreams of the STP. A lot of work on dementia was already being undertaken, for example making sure everyone knew what dementia was, with the memory pathway embedded across the area providing education for workers.

In response to Members’ questions, the following points were made:

·         In terms of autism, Adult Social Care were leading on the development of the Autism Strategy, and it was being written by officers in the same team of people who wrote the Dementia Strategy to help avoid duplication;

·         Officers were confident about the County’s consultation processes;

·         There were no problems with the current strategy having expired. The Department was waiting for the National Carers Strategy to be produced, and groups were continuing to provide support;

·         Getting people to identify as carers was difficult, as they were usually husband, wife, son or daughter. If a person was flagged up as a carer questions could be asked about what support they needed, if they were happy to continue, could they be referred to support services, have they access to benefits and receive support, for example respite care;

·         A problem noted was that being recognised as a carer did not always translate to another organisation, for example, the DWP or LCC. In GPs’ surgeries there were care navigators to help bridge the gap between organisations, which may help if say a carer wanted a tenancy amending;

·         Carer training was required to be delivered by organisations in communities. The new contract in 2019 would also require carer training to be delivered to all communities in Leicester;

·         LCC had carer-friendly policies for workers and a carer support group. Identified as a need was work on carer-friendly communities, which would be looked at in the Strategy. This could work through chatting, realising someone had not been seen for a while, for example, and in pharmacy or grocery shops noticing someone had not been there recently. Simple actions could have a profound impact;

·         It was essential that older carers of someone with disabilities had the difficult conversation about supported living for when the carer died, preferably when the child was at a young age. Very often people with disabilities were presented to the service in crisis because arrangements after the death of a carer had not been made;

·         The Carers Allowance was a government allowance received through different channels. Through Adult Social Care carers received benefits advice.

The Chair drew the discussion to a close, thanking officers for the informative discussion, and asked that the detailed action plans be brought to a future meeting of the Commission.

Councillor Cutkelvin suggested a recommendation to the Housing Scrutiny Commission around housing and tenancies, that it be recognised that there was a number of definitions for the term ‘carer’ between different organisations that could have a legal and financial impact on the carer with regards to financial benefits, and clarity was sought on the legal rights for tenants in the housing legal structure.

The Assistant City Mayor for Adult Social Care and Wellbeing noted the issue should be developed into a recommendation to the Housing Scrutiny Commission that there should be carers’ rights to have cross-over of a tenancy. Wording for the recommendation would be developed by the Chair with the assistance of the Scrutiny Policy Officer.

AGREED:

that:

1.    The two LLR Joint Strategies for Dementia and Carers be welcomed;

2.    Detailed action plans would be developed for the Strategies, and brought to a future meeting of the Scrutiny Commission;

3.    A recommendation be submitted to the Housing Scrutiny Commission to look at carers legal rights in the housing legal structure, and rights to have cross-over of a tenancy, wording to be developed by the Chair and Scrutiny Policy Officer.