Agenda item

The report seeks to provide an update on the Dementia Strategy 2023-28 and an overview of the dementia advisors and community services contracts as well as an update on the dementia diagnosis rates in Wiltshire.

The Chairman welcomed Jo Body (Senior Commissioner), Alison Elliott (Director – Commissioning) and David Leveridge (NHS) who were in attendance to give an on update on the Dementia Strategy 2023-28, following consideration by the committee in June 2023.  The report also included an overview of the dementia advisors and community services contracts and an update on the dementia diagnosis rates in Wiltshire.

Summarising the more detailed presentation included in the agenda pack, the following was highlighted:

·             That dementia was a national challenge with approximately 950,000 people living with dementia in the UK costing £25 billion per year.  Supporting a person to live at home for as long as possible was less expensive than a care home admission and better for a person’s quality of life but this was only possible due to the huge caring contribution made by unpaid carers and specialist support offered by providers;

·            The Wiltshire Dementia Strategy for 2023-28 was an all age, joint strategy supporting people with dementia and their carers – there was a One Council approach with dementia being everybody’s business, not just social care;

·            The priority outcomes included preventing well, diagnosing well, supporting well, living well and dying well;

·            There were 55 actions identified in the Strategy and after consideration of the themes, 8 priority actions were identified;

·            Two community based contracts were being delivered by Alzheimer’s Support – Dementia Advisors and Dementia Community Services.  Whilst the Council hold contractual responsibility for these, they were funded jointly with the Integrated Care Board and the contracts commenced on 1 April 2024;

·            The Dementia Advisors Service provides signposting, information and support for eligible people with/have a suspected diagnosis and their carers who live in Wiltshire.  There were 5 key elements – information, identify needs, support plan, reviews and carers support;

·            Dementia Community Services deliver 800+ session/groups with over 8500 attendees.  The key aims are supporting an active lifestyle, reduce isolation and to provide practical and emotional support; and

·            The present waiting time for a GP referral to a Avon and Wiltshire Mental Health Partnership (AWP) memory nurse is 6 weeks, with a further 3 months wait for consultation and diagnosis.  The Memory Service works closely with Alzheimer’s Support to ensure a speedy referral to Dementia Advisors.

The Committee asked the following questions which included but were not limited to:

·            I think highly of the service that Alzheimer’s Support provides but feel that there is just not enough of it – what are the Dementia Advisors going to do to address the wishes and needs of their users?  It was noted that there were follow on reviews with all those users that are referred to them.  The Dementia Advisors give support and signpost them to additional support and services and they can access to find help in specific areas.  There was data available to give details of how many users receive the help and support they need.

·            Aware that there no support sessions for those dealing with the early stages of dementia to go to but there are groups and activities for those who are more advanced with dementia.  It was noted that there comes a point when a person’s dementia is too advanced for them to be able to sustain their attendance at support/activity group when they have to move to a care home or get sectioned.  Officers agreed to consider the issue of a lack of early support and would look at this through their priorities.   It was also noted that there was advanced dementia support from the AWP if the user was eligible for social care needs and this would also consider the use of technology enabled care to so that they could stay at home for as long as possible.  It was further noted that there was new work ongoing to reduce the risks of dementia in first place and it was hoped that they would see cognitive change work being carried out earlier to support healthy aging approach.

·            Regarding the support sessions/activities it is noted that you are aiming for 1000 per year which would mean around 20 activities – aware that there are only 4 activities listed in the Salisbury area – are they others, how will you increase the number and access those find it difficult to engage.  It was noted that the Council were working with Alzheimer’s Support to find out what they offer as the data for their activities is shared with the Council.  It was acknowledged that it was a stretch target to deliver what was set out in the contract but they would also work with other partners who may be delivering already in areas that Alzheimer’s Support cannot reach, by all working together they would aim to reach the target.

·            The diagnosis process for someone who is showing signs of dementia can take some considerable time with waiting weeks to get a GP appointment and then waiting for an assessment.  There is medication available to those in the early stages of dementia to slow it down to improve the quality of life for some time.  Whilst that information is available it is difficult to find out how to access it which is challenging.  It was noted that the dementia diagnosis process can be lengthy and the aim was to bring down wait times for patients to move through the process in shortest time possible and effectively using the right tests.  Public engagement was important as some were leaving it too late to seek help.  It was hoped that more would come forward at an earlier stage so the treatments can start working.  It was highlighted that within the priority actions information and awareness for the general public was highlighted.

·            It is important for the Committee to be aware of developments within the strategy what is being brought forward to progress it – we need to know about the organisations and infrastructure in place.  It was noted that this was a valid point and that the service would be putting smart targets on the 8 priority actions to be delivered by 31 March 2025 which could then be shared with the Committee.

·            The dementia roadmap is brilliant but am concerned that not everyone who receives a diagnosis gets good support following this.  Some are not aware of the types of dementia and are not all directed to the Dementia Advisors (who do great work).  How was the service working with GPs to ensure that everyone receives the same support following a diagnosis?  It was noted that the Officer had looked through the contract mobilisation where they get details of the dementia referrals by area and GP surgery and her ICB colleague also has data on referral rates for all GP surgery’s and they would marrying this data up with what they receive from Alzheimer’s Support and overlaying it so they would have a much better picture going forward and go on to build up much strong relationships with GPS where they need to and share best practice. 

·            In Bradford on Avon there is a huge range of activities and support for those with dementia and training for businesses etc.  Do Alzheimer’s Support reach out proactively to town councils, parish councils and voluntary groups to create similar synergies in other Wiltshire areas?  It was noted that Bradford on Avon and Calne are best practice exemplary towns who do an amazing job regarding dementia support.  Officers look to utilise and learn from their best practice and how this could be spread across the county but of course they are limited with who is willing to take this on.  It was highlighted that a Community Champion can help bring in voluntary sector support and that Officers were working with Area Boards to increase the number of Carers Champions to assist with meeting the needs of people living with dementia and their carers and encourage engagement with others.

·            The Council had a Dementia Friendly campaign a number of years ago – perhaps consideration could be given to resurrecting the campaign from May 2025 with the new Council in place working with Area Boards to bring in dementia services to communities where they may be forgotten in areas. It was noted that there were examples of good practice and from the AWP and the Council perspective they were working hard to meet needs but agreed that they had not maximised Councillor support and the use of Area Boards was a helpful point in raising awareness across the county. 

·            When the Committee received a Dementia Strategy progress update in June 2023 they asked if the strategy foresaw the utilisation of screening programmes and the possibility of using disease-modifying treatments. Was there an update on this?  It was noted that there were a number of new treatments available but that they were not yet approved for NHS use there could be private use.  There was no changes to the screening as yet.

The Chairman thanked Officers for the update and particularly the dementia diagnosis rates. He asked if in future reports, the numbers of those diagnosed, as well as the numbers anticipated, could be shown against percentage of that tranche of the population (over 65 years old) to support contextualisation. 

Resolved:

That the Health Select Committee

1.          Receives an update report around March 2025 to include:

a.      Demonstrating the implementation of the Dementia Strategy 2023-2028 (highlighting any key changes if required), including the eight key priorities listed in paragraph 40 of the report;

b.      A year’s overview of delivery of the KPIs set for the Dementia Advisor Contract;

c.      A year’s overview of delivery of the KPIs set for the Dementia Community Services contract.

2.          Receives a link to the Roadmap and Support Village, to be shared with their constituents. 

3.          Invites officers to carry on engaging with Area Boards, including considering the possibility of running the Wiltshire Dementia Friendly campaign again in the next council. This may also be an opportunity to further promote information with regards to waiting time process for diagnosis and information to encourage people to come forward at the earliest stage possible, in line with priority 1.