Agenda item

Attending for this item were:

Worcestershire Health and Care NHS Trust (Provider)

Dr Bernie Coope, Clinical Director, Older Adult Mental Health Psychiatrist

Sue Harris, Director of Strategy and Business Development

Hilary Thorogood, Early Intervention Service Manager

Integrated Commissioning Unit (Commissioner)

Jenny Dalloway, Lead Commissioner – Mental Health and Dementia

The Committee (HOSC) had asked for an update on the provision of Older People's Mental Health Services within Worcestershire, including Dementia. This followed the HOSC's earlier overview of Mental Health Services and its discussion about the Mental Health Liaison Service.  The aim was to extend HOSC's understanding of mental health services provided in the County, the policy changes (past and future), the importance of interagency working across the system and how progress will be made to parity of esteem between physical and mental health.

Representatives from the service provider, Worcestershire Health and Care NHS Trust, and from the Integrated Commissioning Unit had been invited.

Dr Coope gave a presentation outlining:

·         What is dementia?

·         Looking back – what has changed?

·         What services are provided, who do they support, what do they do?

·         Current challenges

·         The future look

During the presentation he made the following main points:

In his view dementia was the single most important health issue affecting the County. Some of the facts around dementia were:

·         One third of the UK population would develop dementia

·         In the UK 1 in 14 people over 65 have dementia

·         Up to 70% of people in a care home have a form of dementia

·         People with dementia stay in hospital, on average, 5 days longer than those without dementia

·         The cost of to the UK is greater than heart disease, stroke and cancer combined, costing the UK economy over £26 billion per year

·         It was a condition whose diagnosis was feared more than cancer

·         Worcestershire has an estimated 8500 people living with dementia and this is forecast to increase by 40% over the next 12 years

·         Just over 50% of the local population with dementia have received a formal diagnosis

The most important question was what could be done to help a person living with dementia live as well as possible.  The focus was on:

·         Earlier access to services: there was investment in early diagnosis and advance care planning

·         Support for carers: Improvements made in carer involvement and support

·         Choice and integration: Importance of different support options including Home based care, respite, supported activities

People needed to be at the centre of decision making and it was essential to work together across professional and organisational boundaries, including voluntary and community groups and private sector providers; dementia was everyone’s business and a system wide approach was needed. 

The aim was for one care plan, a named care co-ordinator and care plans agreed in advance.  Dr Coope stressed the importance of early diagnosis, which was mostly carried out by the Early Intervention Dementia Service.  This could be challenging as some patients could not recognise that they had symptoms.

There were a variety of solutions across sectors to support people with dementia, including dementia care in acute hospital settings, assistive technology, home care solutions (including different housing options), and training for care home staff.  Access to specialist services such as the community mental health teams was also key.

A County-wide dementia strategy that clearly supports the “everyone's business” approach, and dementia awareness and training across the system were needed.

There were a number of challenges, including ensuring parity of esteem and embedding dementia care in physical health delivery, liaison in the acute setting and supporting care home staff to manage difficult/escalating behaviours.

The vision for the future was to build a dementia friendly community, have more accommodation and home based support options and increase capacity for out of hospital care.

During the ensuing discussion the following main points were made:

·         Members highlighted the difficulties for those caring for people with dementia, especially if there were long travel times to assessment and dementia units.  It was clear a diverse range of resources to support people were needed

·         In response to a question about why the numbers of people with dementia were increasing it was confirmed this was due to the increasing numbers of people living longer

·         The amount of care provided outside the NHS was highlighted, for example the Dementia Advisor service provided by Age UK.  It was noted that specialist mental health services were only needed by a small percentage of dementia sufferers, the bulk of support would come from other organisations

·         It was noted that loneliness and depression were also issues for older people and that mental health services were provided for these

·         Following diagnosis of dementia the GP would be able to closely monitor the patient, who would also have access to dementia advisers

·         There was some discussion about how Worcestershire compared with others and whether current provision and funding was adequate.  Worcestershire was further ahead in some areas – such as the Early Intervention Service, which started in 2010 and sees approx. 15 people per week – but there were no comparable performance data to benchmark against nationally. In relation to budgets, it was only possible to specify monies allocated for specialist mental health services – expenditure on people with dementia by care homes or domiciliary care providers was harder to calculate

·         There were some gaps in the system but care pathway planning was good

·         The funding challenges across the NHS were highlighted; the Trust's Cost Improvement Plan was needed as funding reduced across all areas of business by 4% p.a.

·         Members suggested that dementia awareness training was needed by all care home staff, and the example of Denmark and the Netherlands' dementia friendly communities were highlighted.

·         It was essential that all organisations and sectors worked together.

The Chairman asked for a briefing note to be circulated after the meeting giving details of the services that were commissioned locally.

The meeting was adjourned for 10 minutes.