Agenda item

The Strategic Director for Social Care and Education will provide an update on the Dementia Strategy.

Members of the Commission are recommended to receive the presentation and pass any comments to the Strategic Director for Social Care and Education.

The Strategic Director for Social Care and Education presented an update on the Dementia Strategy.

The Head of Commissioning for Social Care and Education introduced the report reminding Members of the background to the Joint Dementia strategy which was owned by the LLR Dementia Programme Board that sat under the All Age Mental Health & Dementia Design Group.

The purpose now was to update the strategy which had been in place since 2019 and Members attention was drawn to several key statistics in the presentation.

Members noted that:

·         Historically it was difficult to capture those diagnosed with dementia and locally huge improvements had been made on that with greater accuracy,  it was known that locally about 76% of people presenting with symptoms have a diagnosis of dementia.

·         The Covid pandemic had hugely impacted on diagnosis rates for dementia and those coming forward onto the pathway had dropped as direct result.

·         The strategic vision was for Leicester, Leicestershire and Rutland (LLR) to be places where people can live well with several guiding principles to help achieve that, namely – Preventing Well; Diagnosing Well; Supporting Well; Living Well and Dying Well. The aim was to create a care system that worked together to provide access to compassionate care and support through diagnosis to end of life for every person with dementia, their carers, and families.

There were several actions being taken towards Implementation and Achievement, i.e. Pathway - one action was to review and promote  a memory assessment pathway and referral processes as previously this was very fragmented, people could still enter the pathway at various points but work had been done to improve awareness of dementia so when anyone presents with concern about memory with medical services, when diagnosis given or dementia ruled out then that person is put on pathway which provides advice, guidance, support and residential care information.

Another action involved working with care homes to pilot and roll out the Dementia Friendly general practice template which was a diagnosis toolkit which would help a lot of those in residential care with dementia but no formal diagnosis.

Members noted that engaging people living with dementia and their carers was important as it helped inform the work, prepare services, and ensure the right support was in place for people with dementia and in terms of training, staff and facilities available to them. Attention was then drawn to a future piece of work to review current care and support standards used across LLR regarding nursing care and colleagues working within groups in LLR will move this forward to include in the new strategy.

Members discussed the presentation which included the following comments:

Dementia Cafes had operated in Leicester for several years but due to Covid they had been closed, these were a very useful tool for people giving them access to a lot of information as well as a sense of belonging and support. Members were pleased to note plans to reopen and start face to face services later this month, especially now that shielding had ended. Members were advised that during Covid providers had been doing a lot of virtual activities such as on Zoom, which were popular with some but not others so there had been alternative services offered.

In view of the numbers of people with dementia on the register and previous drive to recruit dementia specialist nurses it was queried what the position now was around that. The difference between nurses with dementia specialism and “Admiral” nurses was explained, an Admiral nurse was a dementia specific nurse, there were approx. 6-8 across Leicestershire and Rutland, these were nurse qualified but their roles differ, some were hands on practical such as in a hospital setting, one was known to work for LOROS, whereas others had more of an educational role. The Adult Social Care services linked with Admiral Nurses in terms of the support given to families. In Leicester the service had commissioned dementia support services, so Admiral nurses were not employed as part of that service. The number of Admiral nurses and their roles continued to be monitored.

Members enquired whether changes had been included in the strategy to combat some of the issues seen throughout the pandemic. It was advised that the LLR Dementia Programme Board were still meeting virtually and had discussed pressures faced by dementia people and carers and looked at alternative ways they could be supported. Steps were taken to try and mitigate the closure of dementia cafes by providing a virtual offer as well as telephone calls and where possible doorstep calls, however care home visiting has been difficult throughout the pandemic. Members noted that there was an awareness that people had not been attending GP practices and patients were saying that GP’s were not contactable, that was a barrier and challenge to diagnosis and more work was being done with local CCG’s to understand the numbers waiting to be seen. There was variation between practices, but we are now seeing surgeries opening. Additional resource had been put in place to tackle this and it was expected that clearing the backlog would impact on social care and other services but measures had been put in place to mitigate against this. In terms of the written strategy, at this point that hadn’t change although the response to issues has changed. Going forward society would be faced with Covid for a long term and similar situation may occur so learning how to handle such crisis would inform the strategy.

Members noted that the Leicestershire County Council had carried out a pilot on an improved dementia care model in several care homes, however this was just prior to Covid so work on that pilot was affected and the pilot had not yet been evaluated. It was expected that would resume once there was a return to more normality and details of the evaluation would be brought to a future meeting when available.

Members enquired whether there was data available that provided an ethnic breakdown on numbers of those with dementia as well as data specific to each ward. Officers indicated it may be possible to extract that information and provide some highlights around that to a future meeting.

In terms of engaging with local communities to raise awareness there was a heavy reliance on records kept by services but engagement was difficult in some areas if they haven’t given consent to be approached. As part of the strategy refresh an engagement plan would be developed to improve what we do.

Regarding those in the city who are providers for dementia Members were informed that Age UK were jointly commissioned, to provide the Dementia Support Service and the new service had just started from 1^st April.

Training was discussed and Members informed that there were periodical reviews of a range of training on offer to people delivering a service, this could be training directly given e.g. care home staff or to housing staff for awareness, so people could recognise if someone had an issue to be able to offer advice and encourage them to go to see GP.

Members expressed concern that services commissioned were often through national charities or larger organisations and suggested that more should be done to consider contracting with local smaller charities and groups who could deliver services at grass roots. Officers advised that the tender process stipulated what was required and anyone applying had to go through the procurement process and organisations were vetted, generally during tender the service added in an expectation to understand our local communities and how any prospective bidder would engage with our communities. The local authority had also launched a social value charter with key aim to support the voluntary sector.

The Chair thanked officers for the presentation.

AGREED:

1.    That the contents of the presentation report be noted,

2.    That Officers provide results/evaluation from the review of current care and support standards used across LLR regarding nursing care to a future commission.

3.    That Officers provide details of the numbers of dementia specialist nurses across LLR to be circulated to Members outside the meeting.

4.    That Officers provide details of the evaluation of the Leicestershire County Council pilot on an improved dementia care model to a future meeting when available.

5.    That Officers provide (if possible) extracted data showing ethnic, gender and age breakdown on numbers of those with dementia as well as data specific to each ward to a future meeting.

6.      That Officers share details of service provision from Age UK via a flyer to be circulated to Members outside the meeting.