Agenda item

Dementia Care Services Consultation - Update

Minutes:

 

Joe Slater, Chair of the Joint Clinical Commissioning Group Specialist Dementia Committee and Debbie Nixon, Chief Operating Officer, Blackburn with Darwen Clinical Commissioning Group (as lead CCG for mental health commissioning, acting on behalf of all CCGs in Lancashire) attended the meeting to provide members with an update on the current position regarding the outcome of the dementia care services consultation which took place in 2013. A number of appendices were attached to the report:

 

  • Appendix A – Recommendations of the NHS Lancashire Cluster Board following the analysis of the consultation responses.
  • Appendix B – Option Appraisal Report of the Joint CCG Specialist Dementia Committee.
  • Appendix C – Press release from Blackburn with Darwen CCG stating the recommendations of the Lancashire CCG Network.

 

Dr John Knapp, Consultant Psychiatrist and Dr Amanda Thornton, Clinical Director for Adult Community Network also attended the meeting to provide information from a clinical perspective.

 

A PowerPoint was used to give some background to the current position. It included a brief summary of the reasons behind the proposed changes to dementia care services, the consultation options, action following the consultation and the final outcome, which was to proceed with the construction of 'The Harbour' – a 30 bed dementia inpatient unit at Blackpool. The presentation also set out details of the number of patients expected to receive care at each of five different layers. This was intended to illustrate the relatively small proportion of dementia sufferers expected to be admitted to The Harbour:

 

·  specialist dementia unit (The Harbour) – 159

·  specialist community services – 6,700

·  nursing and care homes – 6,824

·  general hospital, - 9,493

·  living in the community – 18,679

 

The presentation also listed possible solutions to concerns raised about travel difficulties to the single site at Blackpool (see below). A copy of the presentation is appended to these minutes.

 

Members raised a number of comments and questions and the main points arising from the discussion are summarised below:

 

·  Concern was expressed about the methodology used to determine the preferred site and in particular that there was no weighting applied to the different categories of voters; it was suggested that if votes from 'advisory groups' had been weighted the scores under the heading 'access' would have been considerably lower.

·  In response members were assured that the methodology used had mirrored that used previously by the Technical Appraisal Group and that the Joint Clinical Commissioning Group had agreed by consensus that The Harbour be progressed as the site for specialist inpatient dementia services. There had been no sense that anyone involved with the decision had been uncomfortable with the outcome.

·  The Committee was reminded that expectations were that fewer than 1% of dementia sufferers would require the type of specialist inpatient care that was to be provided at The Harbour and that people generally accepted there was a need to travel to receive such specialist care. The majority of people would receive care locally through a developing raft of community services.

·  Debbie Nixon agreed to provide a further breakdown of the figures relating to the different layers of care by district or CCG area.

·  In response to a suggestion that demand on dementia services could double by 2025 members were assured that there was an ambition to reduce further the need for specialist beds by effective community services that would identify cases of dementia at an early stage and provide effective care to prevent the need for a specialist hospital admission.

·  It was acknowledged that many people were living with mild dementia at home or in care homes who went undiagnosed, and those diagnosed represented 50%-60% of the total number of sufferers. However, those in need of specialist care would be easily identified by their behaviour and therefore judgements about the number of beds required at the most severe end of the scale could be made.

·  The Committee was assured that a significant amount of rigour had gone into modelling the assumptions and there was confidence that fewer beds would be needed in future as early diagnosis and treatment improved. There would be significant developments in a range of specialist community dementia teams.

·  There was recognition that people who currently occupied beds did not necessarily need them and even a very short hospital admission could well be detrimental to their condition. It was intended to provide specialist support in the community. For example a dementia specialist supporting a care home would be able to understand issues contributing to distress and advise about a fairly simple un-met need such as a familiar radio station, or the removal of a mirror, to help settle the patient.

·  Dr Knapp used some case studies to illustrate the complex nature of caring for older people who might be suffering from a range of physical and mental issues affecting their health and wellbeing. It was important therefore to have relevant highly-trained professionals co-located on one site and available to provide specialist care on a daily basis. There was a changing cohort of patients needing specialist care and co-location of services could only be justified if there were sufficient numbers being treated on one site. Length of stay would be kept as short as possible through a whole-team approach – an average stay of 50 days was expected.

·  The location of a 30-bed unit on one site also gave additional flexibility in terms of providing adjacent single gender wards according to need; mixed wards presented a challenge in accommodating those patients who were uninhibited.

·  A career in dementia care was not seen as an attractive option. It was felt that in order to recruit and retain skilled staff it would be important to provide care across a whole range of services for older people.

·  In response to a question whether deliverability of The Harbour had been a dominant feature in choosing it as the preferred site, the Committee was assured that the most important elements were clinical quality and patient safety. It was emphasised that there had been a decision to 'proceed at risk' with building work at The Harbour pending the outcome of the final decision and that there was now a desire to move forward as quickly as possible.

·  The Committee accepted the decision that specialist services be provided from one site and that the choice had been The Harbour, however transport to The Harbour from across Lancashire had been, and remained a matter of much concern to members. Transport had been referred to in the presentation in which it had been reported that:

 

"Extensive engagement with carers over summer 2012 generated the following possible solutions:

v  Private family areas and flexible visiting,

v  Private family areas with internet and telephone contact points,

v  Assistance with travel costs and concessionary travel,

v  Overnight stay facilities in or close to the hospital,

v  Arrangements for  consistent advocacy,

v  Volunteer driving scheme to include carers, and

v  Support of voluntary sector in helping carers with travel and maintaining contact."

 

·  Debbie Nixon explained that travel was a complicated issue; there was no legal duty on the NHS to provide transport, however it was an important concern which needed to be addressed. A number of options were being explored, including use of volunteers. The NHS was trying to be as creative as possible. Members made the following points which Debbie agreed to feed back to a meeting of the CCG Network to be held on Thursday 30 January 2014:

v  It was acknowledged that dementia patients and their relationships could very quickly decline if they lost contact with loved ones and familiar surroundings. The need to ensure that transport provision was adequate was most important from the patient's perspective.

v  It was considered important also to ask carers and relatives for details of their travel needs; it was suggested that there might not always be a need for carers to travel daily as they might see a hospital stay as an opportunity for some respite for themselves and it was important not to make them feel that they were expected to visit daily. Dr Thornton welcomed this suggestion which would be taken back as an action item.

v  The maps provided within Appendix B to the report (the Option Appraisal Report) suggested that travel to The Harbour on public transport could be achieved within a maximum of 75 minutes from anywhere in the county. This journey time was regarded as very doubtful.

v  It was noted also that the maps also did not include travel time from all areas - Morecambe was cited as an example and the member for Lancaster East requested that travel time from the north of the county to The Harbour be included on the map.

v  It was acknowledged that only a relatively small number of dementia patients would receive care at The Harbour, but it was felt very important that their needs and the needs of their carers and families in terms of dealing with transport and access difficulties be adequately addressed.

v  Debbie Nixon would write back to this Committee informing members of the outcome of the CCG Network meeting.

 

·  In response to a question whether there would be enough highly trained staff to provide the range of community services planned, it was explained that the Better Care Fund provided a focus on frail, older adults. Work was ongoing on an integrated offer for this group of people in order to provide appropriate, joined-up care.

·  Resources would need to be carefully managed, for example a consultant psychologist might themselves see 30 patients or alternatively use that time to train 300 psychiatric nurses working in care settings to deliver cognitive behaviour therapies instead.

·  It was agreed an effective communication strategy was essential to ensure that people who needed support knew how to access it; the carer of a dementia sufferer would themselves be vulnerable. It was explained that the NHS provided only part of the pathway of care, and partners were working together to ensure communication was effective.

 

 

Resolved: That,

 

  1. It be noted that The Harbour, Blackpool had been chosen as the site for the 30 bed, specialist dementia inpatient unit for Lancashire;

 

  1. The comments made by the Joint Lancashire Health Scrutiny Committee about access and transport issues be reported by Debbie Nixon to the CCG Network;

 

  1. A series of briefings on integrated community based services and the dementia pathway be arranged for county councillors. Invitations to be extended to district and unitary councillors in Lancashire also.

 

 

Supporting documents: