Witnesses:
- Sinead Mooney –
Cabinet Member for Adults and Health
- Jane Bremner –
Head of Commissioning (Mental Health), Surrey County
Council
- Marion Heron –
Commissioning Manager for Dementia, Surrey Heartlands
CCG
- Kate Scribbins
– Chief Executive, Healthwatch Surrey
Key
points raised in the discussion:
- The Head of
Commissioning (Mental Health) and Commissioning Manager for
Dementia presented slides on the report (attached as Annex 1). The
Head of Commissioning highlighted that the Strategy had been
developed based on both the national and local context, as well as
feedback from residents. The consultation period was due to finish
later this month (January 2022) and the final Strategy should be
launched in April 2022. The Commissioning Manager shared the
preventing well ambitions which included work around enhancement of
post-diagnosis health support, whereby Age UK Surrey would run
courses on this. Primary Care Networks (PCNs) had been incentivised
to look at their case handling of patients with potential health
risks. With reference to the diagnosing well ambitions, it was
shared that the Alzheimer’s Society would now provide
services based on demand, to avoid a ‘postcode
lottery’. Management of demand in the future would need to be
revisited due to the consequences of an ageing population.
Regarding the living well ambitions, the Alzheimer’s Society
had been looking at areas where there were a lack of dementia
friendly communities and how they could be improved. A pilot in
East Surrey had been established to help expand crisis support
available to all affected parties. There had also been discussions
with the Police about identification of vulnerable people and the
support required.
Neil Houston left the meeting at 12.12pm.
- The Chief Executive
of Healthwatch Surrey welcomed the draft Strategy and appreciated
the input that Healthwatch’s insight on the topic was able to
have. Following Healthwatch’s extensive research, three
recommendations were made which included: building access to
dementia navigators and spreading resources equitably across
Surrey; the importance of informal support offered by local groups;
and empowering primary care to signpost effectively to the support
on offer. The Chief Executive shared that Healthwatch would like to
see the draft Strategy go further in terms of the areas covered by
their recommendations.
- The Chairman asked
about how it could be ensured that there wass an equitable
situation regarding PCNs. The Commissioning Manager explained that
the work of the PCNs was being shaped by their population
management work which would help with case handling. There was
still work to be done in this area, but changes were starting to be
made. Monitoring of the dementia registers and other relevant data
would help to track the progress of this work.
- With reference to a
question on the links between areas of multiple deprivation and
dementia sufferers, the Head of Commissioning shared that there was
a lack of focus on prevention for dementia specifically within the
Health and Wellbeing Strategy (HWS). A key driver for developing
the Joint Dementia Strategy was about reducing inequality. Work had
been undertaken with Public Health colleagues to incorporate a
prevention project into the HWS. It was important to bring in the
health and wellbeing of carers as well. The Member highlighted that
there was a lack of detail on prevention included in the report
which the Head of Commissioning took on board.
- The Chairman asked
about the strategy for monitoring engagement from residents and
stakeholders beyond the consultation period and the communications
programme which would run alongside this. The Head of Commissioning
explained that the Dementia Board would be monitoring delivery of
the Strategy, as well as the Mental Health Delivery Board and
Health and Wellbeing Board. The Chairman also asked whether there
were plans to develop further local dementia partnership boards
across Surrey. The Commissioning Manager responded that there were
boards established in Guildford and Waverley which met every
quarter. The work on dementia friendly communities was likely to
identify the areas that may need to establish a board going
forward.
- Responding to a
question on support for relatives of a dementia sufferer in the
end-of-life phase, the Commissioning Manager explained that the
admiral nurse roles work very closely with the families providing
clinical support to manage the situation in the home setting. The
Head of Commissioning added it would be useful to learn from
colleagues regarding other health conditions to see if learning
could be made.
- A Member asked about
the involvement of PCNs in the Strategy so far and the plans to
work with them going forward. The Commissioning Manager said that
the clinical lead in the team was instrumental in moving work
forward with PCNs, such as challenging behaviours around dementia
which exist. There was a push to diagnose as early as possible to
ensure that plans were already in place to manage their care. The
Member also asked about engagement with BAME residents. The
Commissioning Manager shared that following workshops last year
(2021), it was found that short videos about dementia needed to be
made in different languages to ensure accessibility for different
cultural groups.
- A Member raised the
issue of preparation with reference to lasting power of attorney
and understanding what should be included. The Head of
Commissioning highlighted that issues related to this had been
picked up in the consultation period which would be addressed
further in the revised Strategy. The Commissioning Manager
explained that the anticipatory care model would help going forward
to increase support for newly identified groups.
- A Member asked about
the involvement of Councillors to share messages about prevention
of dementia. The Member shared information regarding the positive
impacts of participating in moderate exercise regularly in terms of
prevention and reducing demand on ASC services, as well as the
importance of communicating this information to residents. The Head
of Commissioning explained that involvement with the Health and
Wellbeing Communications Team was vital to the delivery of
prevention information. The Member also asked about the work with
local organisations for communication, such as dentists and
pharmacies. The Head of Commissioning agreed that the participation
of these organisations was crucial. The Member queried whether the
Alzheimer’s bus was going to any more towns across Surrey,
andhe Head of Commissioning said they would get back to the Member
with this information in due course. The Chairman added that it
should be ensured that those with sensory difficulties could be
reached using the appropriate messaging. The Head of Commissioning
highlighted the need for a clear and comprehensive communication
plan for all aspects of the Strategy which would be accessible to
all residents.
- The Chairman asked
about the governance structure of the Strategy, as well as where
the authority would lie between partners and the monitoring
process. The Head of Commissioning explained that as dementia was a
cross-cutting issue, it was crucial to involve key partners, such
as the Mental Health Delivery Board, to provide governance and
oversight. The Health and Wellbeing Board would have ultimate
authority and oversee the implementation as well. The Chairman also
queried how messages around identifying early signs of dementia
would enter the general public discourse. The Head of Commissioning
responded that this would be a part of the larger communications
programme for the Strategy. The Commissioning Manager added that
during the pandemic, a tool called Forget Me Not was developed by
secondary care and shared with GPs to help them triage
cases.
- In response to a
question on the mechanisms surrounding feedback, the Head of
Commissioning assured the Chairman that the feedback about LD&A
would be incorporated as part of the formal consultation and
analysis. There was commissioning representation from across the
board involved in the draft Strategy. The Chairman sought further
information on the relationship between other health issues, such
as a urinary tract infection, with dementia. The Commissioning
Manager explained that it was known that people with dementia would
have a longer length of stay in hospital and would have more
frequent visits to the hospital. The issue surrounded the impact of
acute infection on the brain and consequential, behavioural
changes. This would need be incorporated into the prevention
messaging.
- A Member suggested
that the wider rollout of a scheme similar to the blue badge for
carers would be extremely helpful for them. The Head of
Commissioning said that they were unaware of this currently but
would look further into this. A Member added that there were
carers’ passes available in Guildford, but this was not well
advertised. This went further than a blue badge as it could be used
when the carer was parking without the person they cared for as
well.
Actions/requests for further information:
i.
Information on the Alzheimer’s bus and its
potential future plans to travel to other locations in Surrey to be
shared with the Select Committee.
Recommendations:
The
Select Committee welcomes the priorities and intentions laid out in
the Strategy and recommends:
- That the final
Strategy and action plan include:
–
An emphasis on prevention and details on what plans
will be put in place for communicating with residents to ensure
that they are educated at the earliest possible stage about ways to
prevent dementia.
•
Further to this, details on what communication plans
will be put in place across all five areas and how these will be
appropriately resourced.
–
A commitment to the undertaking of regular
performance monitoring and creation of appropriate KPIs to help
monitor progress.
–
A commitment to the development of effective
governance and oversight arrangements, and an assurance that these
will be as streamlined as possible.
–
Plans to develop dementia- and carer-friendly
communities, and details on how these will be developed.
–
How feedback from residents will be regularly
captured and learnt from so the Strategy can be appropriately
updated over the next five years.
- That the Council,
Surrey Heartlands and the Surrey facing places of the Frimley
Integrated Care System commit to appropriately accommodating all
partners involved and ensure that they receive the support needed
to help deliver the Strategy’s aims
- Furthermore, the
Select Committee requests that a follow-up report on the Strategy
is added to its forward work programme for the first quarter of
2023, and that this report provides an overview of the
Strategy’s implementation to date, details on performance
monitoring and governance arrangements, and feedback from
residents.