Agenda item

A themed meeting based on the following questions:  

·         How is your organisation equipped to meet the needs of dementia patients?

·         How do you work with other healthcare providers to ensure the best care for this group of patients?

Representatives from Rotherham's local health trusts will give presentations to answer the key questions above, with each presentation being followed by questions from Panel and LINk members.

-          Dominic Blaydon, Programme Manager – Long Term Conditions, NHS Rotherham

-          Jan Smith, Assistant Director, Older People’s Mental Health Services, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust

-          Trisha Bain, Deputy Chief of Quality and Standards, Carol Lavelle, Project Lead, InterQual The Rotherham NHS Foundation Trust, Jane Chantler, Business and Service Manager HealthCare For Older People

-          Steve Page, Director of Standards and Compliance, Yorkshire Ambulance Service NHS Trust

Consideration was given to the submitted report which explained the approach and background to a themed scrutiny meeting on Health Services provided to people with dementia.

In late November 2009, the Care Quality Commission issued guidance on Scrutiny’s involvement in the assessment of health and adult social care in 2009/10.  It gave a deadline for OSC comments relating to NHS providers of the end of January 2010.

The scope for making comments was very broad, but it had been decided to use services provided to people with dementia as a focus for discussion as it had recently been in the news (both locally and nationally) and would illustrate how well local health services were provided for vulnerable patients.

Representatives from the four local health trusts (NHS Rotherham, Rotherham Foundation Trust, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust and Yorkshire Ambulance Service) gave presentations that answered the following questions:

• How is your organisation equipped to meet the needs of dementia patients?
• How do you work with other healthcare providers to ensure the best care for this group of patients?

The first presentation was made by Dominic Blaydon, Programme Manager  - Long Term Conditions in respect of Older People’s Mental Health.  The presentation drew specific attention to:-

• Population profile
• OPMH profile
• Predicted service costs
• Investment profiled
• Summary of Strategy
• Reconfiguration and Investment
  • Memory Service
  • Mental Health Liaison
  • Dementia Care Service
  • Community Mental Health Team
  • Day Services

A question and answer session ensued and the following issues were raised and discussed:-

• What work was being undertaken in preparation for people under the age of 65 with dementia?  Confirmation was given that as part of the strategic development, the Young Onset Dementia Service had been set up
• Reference was made to a service which was available in parts of South Yorkshire in respect of memory prompts for people with dementia to remind them to take medication.  It was queried as to whether this was a service which Rotherham provided.  It was confirmed that Crossroads provided a medication management system to a limited number of people with dementia but it was not something which was provided across the borough.
• It was felt that it was imperative for people to remain active after retirement as statistics showed that people were prone to suffering from dementia once their mind becomes inactive.  It was agreed that work needed to be done to look at ways of reducing the likelihood of this occurring.
• How could members of the public refer someone whom they were concerned was suffering from dementia?  It was suggested that the first point of call would be to alert Social Services.

Jan Smith, Assistant Director, Older People’s Mental Health Services, RDASH gave a presentation in respect of Specialist Dementia Services.

The presentation drew specific attention to:-

• National Dementia Strategy
• Dementia Specialist Services
  • Memory Clinic
  • Day Services
  • Liaison Services
  • Modernising Inpatient Care

·        Partnership working to implement the National Dementia Strategy

A question and answer session ensued and the following issues were raised and discussed:-

• It was suggested that RDASH consider working with the charity “Lost Chord” which provides interactive musical sessions to stimulate responses from dementia sufferers.
• Were there any patients with dementia on the autistic spectrum?  It was suggested that as few older people with autism would have been diagnosed in childhood (the usual time for diagnosis) accurate figures would be difficult to obtain.
• Whether the preventative measures that were currently in place were effective.  It was confirmed that they had a massive impact on the number of beds required in respect of people with dementia
• How effective was engagement with the BME Community?  Confirmation was given that it was difficult to engage with this group, but that it had been identified as an important objective within the Dementia Strategy.
• What measures were in place to prepare people coming up for retirement to keep active?  It was confirmed that there were a number of activities undertaken across the country to keep people active as a preventative measure.
• Whether there were any plans for introducing early screenings to detect the onset of alzheimers.  It was confirmed that no work was currently being undertaken but it was agreed that it was an area which needed to be considered.

Trisha Bain, Deputy Chief of Quality Standards, Carol Lavelle, Programme Manager and Jane Chantler, Business and Service Manager, gave a presentation on improving care for patients with dementia.

The presentation drew specific attention to:-

• Why this matters?
• Our approach
• Making the strategy into a tangible entity: collaboration across community healthcare
• What were the key emerging themes?
• Providing excellence:
  • Objective 8 – improved quality of care for people with dementia in general hospitals
  • Objective 2 – Good quality early diagnosis and intervention for all

• Training for staff
• Ongoing activity and collaboration
• Summary

A dementia information diary was circulated to members and a comment was made that this had been produced in 2006 and not been updated since.  It was confirmed that an updated version would shortly be going to print.

Reference was made to the new wards being built specifically for Alzheimers patients and a query was raised as to how much consultation had taken place on their design.  Confirmation was given that all partners and carers would be involved in the consultation process.

Steve Page, Director of Standards and Compliance, Yorkshire Ambulance Service gave a presentation on meeting the needs of patients with dementia.

The presentation drew specific attention to:-

• YAS Vision and Aim
• Quality of Care in YAS – Clinically focussed, continuously improving
• Meeting the needs of patients with dementia
• Meeting the needs of patient with dementia – safeguarding vulnerable adults
• Working with other healthcare providers
• Opportunities

Reference was made to the Service’s response to end of life care plans and ‘do not attempt to resuscitate orders’, and a query was raised as to how this would affect people who had made living wills.  It was confirmed that it was not always possible to know this information but that work was being undertaken to enable information such as this to be shared in the future.

Members queried what information was communicated by the ambulance service to A & E on arrival with a dementia patient.  Confirmation was given that a full assessment was made of the patient when they first arrived and this was transferred to the staff in A & E on arrival, but that it was important to first eliminate the possibility of delirium due to high temperature.

Members asked whether the patient transport service could be improved to benefit people with dementia.  It was felt that there was some scope to enhance the training given to ambulance crews and collaborative work needed to be undertaken with other colleagues and partners in mental health.

Kath Henderson from Rotherham Community Health Services gave a presentation on the provision of services for people with dementia.

The presentation drew specific attention to:-

• What is Rotherham Community Health Services (RCHS)
• The Objectives for RCHS
• Learning Disabilities Service Care of Patients with Dementia
• Community Older People’s Services
  • Specific Services
  • Non Dementia Specific
  • Falls
  • Care Home Liaison Service
  • Intermediate Care

Reference was made to people claiming disability benefit and a query was raised as to whether RCHS would refer people to the benefits system.  Confirmation was given that they would work closely with the Local Authority and if they could not assist would link patients to the people who were in a position to give best advice.

A suggestion was made that protective clothing be given to old people who were susceptible to falls in order to cushion the weaker parts of their body.  

A query was raised as to whether the two funded Intermediate Care posts were adequate to meet the needs of all dementia patients.  It was felt that there was always need for more posts in this area of work.

At the Chair’s request, Christine Dickinson, LINk Co-ordinator, explained that the Rotherham LINk had been asked to undertake a survey to identify the needs of dementia patients in care homes.

Resolved:- (1) That the Panel agree to support the LINk’s survey work in care homes and ask for the findings to be brought to a future meeting

(2) That the information gathered at this meeting form the basis of the Panel’s submission to the Care Quality Commission relating to its assessment of NHS providers in 2009/10.