Agenda item

The update on this report was provided at the meeting by Dr Angela Bhan. 

The report for the integration of health and social care for people with dementia and cognitive impairment was drafted jointly by the Director of Commissioning and the Clinical Commissioning Manager from Bromley CCG. 

Members were reminded that the Board had agreed to prioritise dementia, based on the needs of the local population and on the JSNA (Joint Strategic Needs Assessment). The work on improving dementia services in Bromley would be driven by the JICE, overseen by the HWB, and funded via the BCF.

The HWB were reminded of the large numbers of people in Bromley with dementia, and that numbers were projected to increase. It was estimated that by 2030 there would be 6,151 people living in Bromley with dementia.

The Board heard that in the short term it was important that:

1.  Support be given to Local Care Networks

2.  Consideration be given to investing in the specialist services provided by Oxleas

3.  Reductions be made in the number of admissions to Care Homes and Hospitals

It was suggested to the Board that it should look at developing a specific vision for improving dementia care in line with BCF plans.

Dr Bhan outlined the proposed HWB Strategy Outcomes for dementia:

·  Early intervention diagnosis for all

·  Improved quality of care for people with dementia in hospital

·  Strategies to enable better living at home and in care homes

·  Reducing the use of anti-psychotic drugs

·  Improved community personal support services

The Board were reminded that an investment plan had been agreed through the BCF for £1m per annum for the next two financial years for dementia services.

Dr Andrew Parson stated that dementia was a big challenge in Bromley due to the aging population, and stressed the importance of developing an adequate dementia register. He also expressed the importance of the need to support staff around the use of anti-psychotic drugs, and the need to boost primary care responses with good referral times and after care support.

The Committee heard that early diagnosis was beneficial as the various options in terms of treatment could be examined earlier; it was felt that a holistic approach was important, and that there should be more co-ordinated help from the voluntary sector.

A Member drew the Board’s attention to studies undertaken by the World Health Organisation that demonstrated the efficacy of non-medical means of intervention that had been shown to help, and these included memory training, exercise and the avoidance of unnecessary drugs. 

A Member expressed the view that what was required was to examine root cause analysis, which would probably reveal that GP’s do not have the time to make proper early dementia diagnoses.

Dr Bhan responded that what was required was to make more effective use of the excellent services and resources that were already in existence, e.g., Local Care Networks. She also expressed the view that work should be undertaken to examine how GP’s could be enabled; it was suggested that it may be a good practical step if GP surgeries appointed a “dementia champion”.

The Assistant Director for Adult Social Care informed the Board that a Dementia Stakeholder event had recently been held to identify who was doing what, and that this information was being collated and disseminated. 

There was some discussion that went on concerning the secondary care provision provided by Memory Clinics, and it was noted that Bromley was under performing against the national dementia diagnosis target of 67%-- at 49.99% in London, when measured in January 2015. The Board heard that the current level of demand for assessment, diagnosis and follow up treatment was unsustainable within existing resources, and this would be more so if the target of 67% was achieved.

In view of these issues it was proposed that Oxleas would reconfigure current staff and services to integrate with the re-introduction of a NICE compliant post diagnostic pathway, which would include cognitive stimulation and other prescribed interventions. The Board also heard that as part of the new service model, it was intended that an outreach function to GP localities would be set up to assist with screening and post diagnostic support.

RESOLVED:

(1) that the Dementia and Cognitive Impairment report be noted

(2) that the HWB agree to support plans for BCF funding to be diverted to the Bromley Health and Social Care Dementia Pathway, and that this process would be overseen by the CCG Chief Officer and by the LBB Executive Director of Health and Care Services via the JICE

(3) that the Assistant Director (LBB) of Adult Social Care, update the Board when the data from the Dementia Stakeholder event was available for dissemination.