Agenda item

Purpose of the item: The Committee has asked to review the progress made to implement the joint health and social care dementia strategyfor Surrey, 2022-2027. The Committee would like to see a focus on ensuring sufficient preventative measures are being provided to reduce dementia, as well as improving the dementia care pathway for the Surrey population. The Committee wish to understand what developments have been implemented across Surrey.

Witnesses

Mark Nuti, Cabinet Member for Health and Wellbeing, and Public Health

Jane Bremner, Head of Commissioning, Mental Health

Simon Brauner-Cave, Deputy Director of Mental Health Commissioning, Surrey Heartlands, Integrated Care System (ICS)

Damien Taylor, Community Transformation Lead for Older Adults, Surrey and Borders NHS Partnerships Trust (SaBP)

Negin Sarafraz-Shekary, Public Health Principal, Cardiovascular Disease Prevention

Key points raised during the discussion:

1.    Officers provided the Committee with a presentation prior to the discussion, which outlined the context of the dementia strategy; interventions and programmes of support in place to enhance prevention and reduce risk factors; dementia diagnosis rates; support groups; Technology Enabled Care and Homes (TECH); support for carers; and end of life care support.

2.    The Chairman noted that several links in the report did not work and asked for links to be re-sent to the committee.

3.    A Member asked what was being done in Surrey around prevention among adults with learning disabilities and how it could be promoted in the community other than online such as on social media. The Community Transformation Lead for Older Adults explained that there were several accessible resources offered, particularly around brain health, healthy eating and lifestyle. These resources were often provided when an individual was referred into services. If an individual had a specific specialist learning disability health need, there was a healthy group run by the multidisciplinary team which could offer referrals to dietetics.

4.    The Public Health Principal added that everyone from the age of 14 with a diagnosed learning disability were eligible to receive an annual health check, providing an opportunity to identify early risk factors around healthy eating, sexual health, alcohol etc. A lot of work to raise awareness was happening across primary care to increase that opportunity and ensure parents were aware. Public Health developed two bespoke ‘making every contact count’ courses for people and carers of people with learning disabilities. One course was around healthy eating, and the other course was around alcohol, to help ensure a tailored approach for people with a learning disability.

5. The Cabinet Member for Health, Wellbeing and Public Healthhighlighted that prevention in Public Health was about living better and healthier. Less alcohol, less smoking and more exercise, for example, could help prevent the onset of dementia in later life. Everyone had a responsibility to look after themselves and be advocates to the public to improve messaging.

6. A Member raised concerns about reaching the target audience of people in their 30s, 40s and 50s with messages about lifestyle choices and its impact. The Member questioned if messaging was also reaching young people who played contact sports such as football and rugby, highlighting the potential damage these sports could cause. The Member felt messaging was not currently getting through to these groups.

7. In addition, the Vice-Chair felt that prevention was key, and that education around lifestyle choices and links to dementia should occur at school-age; to make young people aware of the impact of choices such as smoking and alcohol, noting it could also help young people look out for signs of dementia in family members. The Vice-Chair referred to Public Health’s stop smoking support specifically around the 15 hundred referrals and asked if further information could be shared with the committee in the future around how many people were smoking in Surrey and whether they were light smokers or heavy smokers.

8. The Cabinet Member for Health, Wellbeing and Public Health brought attention to Active Surrey which worked with young and older people around improving physical activity and that sport was not for everyone and was generally about exercise, which meant different things to different people acknowledging that the message was difficult to get across and everyone had a responsibility in communities to promote it. Regarding smoking, SCC had one of the lowest Public Health grants in the country and did what could be done with this and were quite successful. The smoking rate was dropping in general across the country and hoped that the new legislation coming forward, including around vapes, would help to reduce smoking rates further.

9. A Member asked what work was being undertaken to help people to make and maintain certain lifestyle adjustments that helped to reduce the risk of dementia, even with Alzheimer’s risk-genes, and if it was possible to monitor if this helped prevent dementia from progressing.

10. The Member also raised that one of the greatest risk factors predisposing certain people to Alzheimer’s disease was age, and Surrey had a large aging population. The Member asked what preventative steps and developments were being undertaken to reach people earlier and what developments were occurring within Surrey.

11. The Member raised concerns around diagnosis and specifically those that fall outside of the normal range for diagnosis, high-functioning, intelligent people that noticed a cognitive decline and experienced distress as a result, but despite seeing a GP about this decline did not receive a formal dementia diagnosis until reaching the normal level for a diagnosis. The Member asked how this group was being supported, noting the distress it could cause for the individual and families.

12. The Public Health Principal explained that education and reaching out needed to start from an early age with children as risk factors manifested across a life course. The healthy school approach in Surrey provided that opportunity for conversations around healthy lifestyle approaches, but more could always be done. Public Health had several campaigns to raise awareness of risk factors, such as communication around smoking cessation which had been successful, and the ‘know your numbers’ campaign which raised awareness of blood pressure risks. Interventions were in place to reduce the risk of dementia’s risk factors, especially vascular dementia, such as the NHS Health Check, targeted at people from the age of 40 to identify those with high blood pressure, atrial fibrillation and high cholesterol to identify these conditions at an earlier stage. There was a collaborative group which brought together alcohol and drug misuse as a partnership and worked with key stakeholders to raise awareness. Public Health was also working on prevention and raising awareness of excessive alcohol intake and for example, using the Making Every Contact Count programme and sharing intelligence to improve understanding of those more at risk and how to reach out to communities that were less likely to engage well. Regarding upcoming interventions, Public Health was working towards having a healthy aging programme in place, in collaboration with adult social care and the NHS. NHS Places had several initiatives around frailty, and there was an opportunity to ensure a coordinated approach to healthy aging that captures reducing risks, and that people on a dementia pathway had support in place. Public Health monitored the effectiveness of its interventions, but a clinical research and trial setting on intervention would be required to assess if Public Health’s interventions were specifically reducing the risk of dementia. Several clinical trials were happening nationally to improve understanding.

13. Regarding those experiencing distress from a mental health perspective, the Community Transformation Lead for Older Adults explained that Surrey and Borders Partnership NHS Trust (SaBP) would suggest interventions through primary care talking therapies. Research conveyed that outcomes for older adults, therapeutically, were better in those areas. As it progressed, SaBP would undertake secondary services memory assessments, if required. Distress for carers could often be worse at times, so it was important to take a holistic ‘Think Family’ approach to ensure all needs were being met.

14. The Deputy Director of Mental Health Commissioning added that Surrey Heartlands ICS had started discussions with their talking therapy providers around ensuring people that had dementia risk factors such as depression, were in a talking therapy service, that work was done to explore physical activity opportunities more formally as part of the offer. This was being done in partnership with Active Surrey to help make a real difference. The Member raised concern that this was not currently being put into practice and asked how we spread the word that this was a possibility. The Deputy Director of Mental Health Commissioning clarified that the work he described had just begun as part of the recommissioning of the talking therapy services and agreed that more could be done in relation to physical activity and talking therapies and within their Primary Care Network (PCN) level support and GP Integrated Mental Health Service (GPimhs) and is where efforts would be focused going forward.

15. The Chairman asked about comorbidities such as heart disease, high blood pressure, diabetes and severe arthritis which could lead to a worsened state of dementia. The Chairman asked what actions were being taken in those areas to recognise dementia could be an outcome and to help manage and prevent this. The Public Health Principal explained that management and detection of hypertension, cholesterol, atrial fibrillation and diabetes were key targets in the NHS long term plan. Dementia had been mentioned in Surrey Heartland’s clinical strategy and extensive work with the Clinical Cardiovascular Group was undertaken which looked at reducing and improving the management and detection of hypertension, diabetes, and cholesterol. Work was also done with colleagues in primary care to address this. There was a national target in hypertension detection and management of 80% for those eligible to be treated. Surrey was meeting or close to meeting the national target of 80% for treating the elderly population aged 60 and above which was encouraging. Work was in progress to improve management of cholesterol and atrial fibrillation. Previously, there had been simple interventions such as a pulse check at flu vaccination clinics to help identify high dementia risk populations and raise awareness, which was covered in the NHS long-term plan. Public Health raised awareness about those risk factors through their campaigns and collaborative work around the data to ensure it is correctly targeted and looking at reducing inequalities especially looking at more deprived and key neighbourhood areas to ensure that targeted interventions were in place.

16. A Member asked about what assistive devices were being provided for people with dementia to use at home that prevent falls, for example, such as Technology Enabled Care (TEC). The Head of Commissioning for Mental Health explained that community equipment services provided devices such as grab bars. Motion sensors were well-utilised and helped to identify high-use areas in the home. working with partners at Mole Valley Life, a risk assessment could be offered in the homes to reduce trip hazards, and responder services could visit the home and ensure modifications could occur. Other technology included smart plugs, smart video ring doorbells and assistive technology such as voice-controlled reminders for example, which supported those living with dementia at home.

17. The Member asked what TEC was being developed that aligned with AI and whether there were any innovative technologies being developed. The Head of Commissioning for Mental Health explained technology partners would know more detail of how TEC worked with AI. AI was utilised by some of their providers to contact individuals and send reminders, such as when to take medication, and that some level was built into new technologies so consideration of how to maximise this so people could achieve what they want to get out of it, like smart home TEC for example.. It was mentioned that the technology strategy was in development, due to go to Cabinet in  2025 and would be a good source of information.

18. A Member raised that safety concerns increased as age and dementia progressed and asked what the data conveyed about people living in Surrey with dementia that are monitored and do we have any corresponding statistics in terms of safety issues, what was being done to ensure that the technology linked with the TEC, informed on what worked, what was being trialled and what the overall picture was. The Head of Commissioning for Mental Health outlined that it was perhaps not known what the dementia insights were specifically around technology, as the technology was focused on the individual’s circumstances and personal needs. Professional assessments and judgement was relied on to identify the technology best for the individual on a case by case basis There were technologies to raise an alarm, monitor movement and to prompt and remind. Some technology used images of family members and carers to remind individuals of daily tasks which was a newer inovative approach, and whilst not yet commonly available, was part of the strategic forward planning with regards to TECH.

19. The Member asked if they considered there to be  any risk of resistance arising from the public around that technology approach. The Head of Commissioning for Mental Health noted that perhaps different people would feel differently about the approaches, and it was difficult to know. Opportunities to try out the technology could be a good idea initially and could help reduce any fear around it.

20. A Member referred to the ‘Connect to Support Surrey’ website, noting it had a range of organisations listed that offered support and was impressive and asked if there were any plans to develop the strategy or develop this support for families within Surrey. The Head of Commissioning for Mental Health explained that mapping and updating of all their support groups were updated regularly and enhancing that from work arising from their health place partnerships colleagues was kept up to date. Work was ongoing across the system.

21. The Vice-Chair raised the importance of recognising how prevalent dementia was in society, and admiration of the important work being undertaken in this area, such as developments in the technological advances and AI to support people living with dementia recognising how much this disease affects so many in society.

The Cabinet Member for Health, Wellbeing and Public Health left the meeting at 1.08pm

22. Regarding the report’s reference to two new roles appointed for running the dementia information project the Member asked what investment was planned for that purpose for the communication strategy and whether Key Performance Indicators (KPIs) were in place and what they were so we could understand and monitor what was being undertaken. The Head of Commissioning for Mental Healthconfirmed there were KPIs attached to the project, such as around establishing contact with 90 of the organisations on the support map, and then identify two champions within each Surrey borough. This work was ongoing. There was a network in place to support those champions, where everybody had access to the same information, communication and advice for people with dementia and for carers. With regards to the communication strategy, they were linking up with Communication and Engagement colleagues to get the message out and through statutory body mechanisms and working with voluntary sectors, Action for Carers, and Healthwatch Surrey Luminus for example.

23. The Member asked if the were any geographical holes in their coverage. The Head of Commissioning for Mental Health raised she was not aware of any.

24. The Chairman noted that the report referred to further work being planned to analyse dementia diagnosis rates by GP practice level to further explore and act on any unexpected variation, particularly within Surrey’s priority populations, and 21 priority areas of communities with identity and geography which were often overlooked and most at risk of experiencing poorer health outcomes. The Chairman asked what was being done in how we are communicating, specifically targeted to those priority populations, and how was that work being measured. The Deputy Director of Mental Health Commissioning explained that the work Surrey Heartlands Integrated Care Board (ICB) was going to do around looking at the GP practice level and Primary Care Network (PCN) level together with primary care colleagues had not yet started but was planned work. The priority populations would be built into that work, and there was an opportunity to plan this thinking going forward.

25. In terms of how Public Health shared information with the population, the Public Health Principal explained that all information about the health and wellbeing and services offered was on the ‘Healthy Surrey’ website. Regarding how SCC targeted key neighbourhood areas and population groups, the health and wellbeing index was closely monitored, in terms of some of the key indicators that were in the health and wellbeing strategy and could also be looked at by place and key neighbourhood area. In terms of population characteristics, this was more challenging due to a lack of data, but the indicator could still be utilised. A lot of work was already happening in place based partnerships and working out some tangible actions that could be done. A key thing was about coordinating efforts, but the health and wellbeing index was a good tool.

26. The Chairman raised the importance of measuring how well communication exercises reached people. The Public Health Principal added there were several ways to evaluate communication campaigns, for example the number of ‘clicks’ onto websites could be measured, and sometimes hotspot areas could also be measured and perhaps in the future AI technology could support this area. .

RESOLVED:

1. The report identifies that Priority Populations such as BAME may have different levels of the risk factors for Dementia. Gaining a better understanding on the prevalence of the risk factors and Dementia in the priority populations and the 21 Priority Areas is recommended and consideration of population appropriate health actions to reduce health inequalities.

2. There is a need to better understand why levels of diagnosis within Surrey are higher and it is recommended that more research is undertaken to establish why the numbers are higher.

3. The effectiveness of communications around reducing the risk factors for Dementia is critical. Measurement of the effectiveness of communications and their ability to change behaviours is recommended.

4. Enhanced training and support for Carers is recommended.

5. It is recommended that information is produced to support community leaders and especially councillors in supporting carers with what information is available for them, and the research needs to look at priority areas as part of that.

Actions/requests for further information:

• Democratic Services to check that all links in the report work and send to the committee.

In relation to the ‘stop smoking’ support, there was a request to share figures on the population of smokers in Surrey and possibly information on whether they are light smokers/ heavy smokers, and to share further information on the education around smoking and why this was not being done at an earlier age.