Agenda item

Purpose of the report: This report presents the Joint Health and Social Care Dementia Strategy for Surrey (2022-2027) for the Select Committee’s views and input during the consultation period, which runs until 21 January 2022.

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:

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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:

1. 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.

2. 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

3. 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.