Agenda item

Report of the Divisional Director, Strategic Commissioning.

The Chair invited Councillors Vina Mithani and Chris Mote, who had both served on the scrutiny review panel, to introduce the item. 

Councillor Mithani outlined the findings of the review and the recommendations arising, one of which concerned refreshing the joint dementia strategy between the Council and the CCG.  She explained the examples of good practice from other boroughs which had been observed by the review panel.  Councillor Chris Mote spoke of his personal experiences recently of a family member with dementia receiving treatment at Northwick Park Hospital.  There had been gaps in the information provided and a lack of coordination between agencies; he also considered that the whole “journey” of the person with dementia was not addressed well enough and opportunities were thereby missed, for example, by not coordinating hospital discharges and care at home.  He had also encountered a reluctance among some medical professionals to share information with family members even in a case where a Power of Attorney was in place. 

Councillor Mithani argued for better integration of services across different agencies to meet the needs of patients more effectively and to make better use of resources.  She suggested that more could be done to spread awareness in certain communities, including by visits to places of worship and faith groups; these could complement initiatives undertaken by Public Health England.  She referred to the plight of very elderly carers who were faced with difficult, highly emotional situations of their loved-ones’ dementia.  Councillor Chris Mote added that, with so many different languages spoken in the Borough, more needed to be done to get messages across to all communities. 

Javina Seghal, Chief Operating Officer of the NHS Harrow CCG, thanked the councillors  for their rich narrative of issues arising from the scrutiny review, including the important reflection of personal experiences.  She referred to the positive atmosphere for and attitude to partnership working in the Borough, and to the active engagement of Members and officers of the Council with the CCG to develop better coordination and integration of services.  The intention was to report to the Health and Wellbeing Board on plans and specific proposals, and these would include provision for dementia sufferers and their families.  The CCG’s performance framework included targets on this area of work. 

Lennie Dick, Head of Mental Health Services at the CCG, addressed the meeting, having tabled a document summarising key information and issues. He referred to the national target of maintaining a diagnosis of at least two-thirds as part of the Prime Minister’s dementia challenge 2020.  The rate in Harrow had been doubled in recent years to reach 64% though there had been some modest slippage in the last year; performance was monitored by an inter-agency group of stakeholders.  Mr Dick confirmed that the refresh of the dementia strategy would be brought to the Sub-Committee’s next meeting.  This would address the challenge of improving awareness of and access to services.  In the interim, some new resources had been applied to improve the diagnosis rate and a further increase was anticipated before the end of the year.  He outlined the principal challenges in the improvement of services and the key risks, along with possible mitigation measures.  also listed a range of initiatives which had already been introduced.  Mr Dick concluded by assuring the Sub-Committee that the points raised in this meeting would be addressed in the revised strategy. 

Javina Seghal added that some 500 additional referrals per year were required to bring the dementia diagnosis rate in the Borough up to the national target.

A Member asked about the 10-week waiting list for memory assessment and queried how this related to performance elsewhere.  Mr Dick said he could provide this information separately.  He confirmed that the relevant staff team numbers had been increased and home visits prioritised.

In response to the Member’s question about visits to assisted housing accommodation, Dr Dilip Patel, Clinical Director, Mental Health at the CCG, advised that funding had been mad available for advanced nurse practitioners to visit vulnerable patients, particularly those who had been discharged from hospital, and their care plan template included dementia checks.  GP training also addressed these issues.  Dr Patel felt it was important that relevant professionals regarded the challenge of dementia more broadly, as being about the overall well-being and life experience of those with the condition, rather than purely about clinical diagnosis and medical treatment alone.  He appreciated the points made about increasing awareness and understanding in certain communities where there was a reluctance to be open about dementia as it was wrongly associated with madness.  Dr Patel hoped that referrals would become easier and quicker following a decision not to require MRI scans at that stage.  He referred to positive partnership meetings to improve coordination and some new initiatives such as the dementia café which made services more accessible for many sufferers. 

In response to a Member’s question about the difficulty in accessing relevant advice and information via the Council website, it was confirmed that this was being addressed. 

A Member referred to the fact that there was only one Milmans facility near the Borough border; he had discussed the provision of “Admiral Nurses” with the Council’s social care managers in the context of developing a dementia “hub” in the Borough.   He also underlined the importance of the housing element of the scrutiny review panel’s work.

In response to another Member’s question about the NHS health check, it was confirmed that this now included dementia risk assessment for those in the 45-65 age range. 

Lennie Dick confirmed that the CCG would take on board all the points raised by councillors, including the accounts of personal experiences of relevant services.  The revised strategy for the period to 2021 would be reported to the Sub-Committee at its next meeting.

The Chair thanked the CCG representatives for their contributions to this item.

RESOLVED:  That the report and the contributions from Members and the representatives of the NHS Harrow CCG be noted.