Agenda item

A discussion item on Coventry and Warwickshire’s Dementia Strategy.

Claire Taylor from WCC Strategic Commissioning and Sharon Atkins from Commissioning at Coventry City Council gave a joint presentation to the Board to accompany a circulated report and appended draft Coventry and Warwickshire Dementia Strategy.

Following an extensive period of stakeholder engagement and further development of the strategy, Coventry and Warwickshire’s Living Well with Dementia Strategy would go through formal approval processes at both councils in June/July 2022. Subject to those approvals, the strategy would be published and shared widely. The associated strategic delivery plan would include a range of actions to be undertaken across Coventry and Warwickshire, as well as actions specific to each area. The delivery plan for year one was currently being developed, with many of its actions underway already. The financial implications stated that many of the ambitions and priorities would utilise existing partner resources or involve bids for funding. WCC had allocated funding of £60,000 per annum to support development and implementation of the Dementia Strategy in Warwickshire.

The presentation outlined the process for developing the year one delivery plan and invited comments and suggestions to support development and delivery of the plan for 2022-2023.

Members of the Board made the following points:

·       Amongst the South Asian community, dementia was not understood. There was a need to bear in mind health inequalities and to focus activity based on the data available. More information was sought about where people presented. An offer from CWPT to work together, especially to make its units and estate more dementia friendly.  It was welcomed that prevention was at the heart of this strategy. Sharon Atkins provided further information about the funding available to address inequalities and an initiative in Coventry to provide additional support for the South Asian community. There was knowledge of which groups were less likely to access support and the offer to work with CWPT was welcomed.

·       Councillor Seccombe was mindful that some people did not want a diagnosis, were fearful of it or could not see what difference a diagnosis would make. There were many different types of dementia with patients having varying needs. More information was sought about training, which was very important, especially for those working in a care environment. It was noted that the strategy had a lot of priorities and was questioned how people could be held to account with there being so many priorities. In response, the target within the plan (and that set by NHSE&I) was for 66.7% of people thought to have dementia to receive a diagnosis. This had not been achieved to date. Further points acknowledging the differing views of patients regarding diagnosis or perceived benefits and the support available.

·       It was questioned if GP doctors were involved in the diagnosis aspects. There had been a scheme for GPs to be trained and provide community-based assessments, which was working well prior to the pandemic. GPs were now instructed not to participate in such initiatives which was a frustration. Reference was made to an assessment project in care homes for people who did not need GP interventions, and this was going well.

·       A concern about the additional distress caused for dementia patients waiting outside hospitals due to ambulance handover delays.

·       Training for care home staff was raised, especially for end-of-life care and how to speak to dementia patients appropriately. Increasingly with care being provided at home this extended to domiciliary care staff too. Such staff were working under significant pressure. The views of patients at the end of their life may differ from those of family members. Reference to the measures of success within the strategy and whether this included the numbers of staff having dementia training for the end-of-life care pathway. A refresh of the dementia friendly communities would be welcome. Officers replied that ‘training well’ had been kept as a separate priority. There were five objectives which addressed many of the points raised by Board members. Details were provided of how this would be delivered across a range of providers and other partners. Having prioritised the objectives, the detail would now be added on how this would be delivered over the coming years and some work had already commenced. There was a range of training from awareness raising through to a specialist training offer.

·       There was a training need for people to assist dementia patients in the community, including those discharged from hospital. This was acknowledged within the strategy but could be made more specific. A particular challenge was domiciliary care staff turnover. It would be possible to include a training requirement in providers’ contracts. Reference was made to the dementia bus and a simulation used to give people an understanding of what dementia was like. It was acknowledged that training levels for staff in dementia care homes were not required to the level that would be perceived. An accreditation scheme was being considered where staff had to be trained to a prescribed level to receive the accreditation.

·       Reference was made to the fitter futures programme, with a personal example used to show how this wasn’t working despite considerable efforts from a local GP surgery. A parallel was drawn to other services considered not to be working, including those referenced during this debate. The Chair noted the points raised. She agreed that there was both a need to focus on dementia and to take dementia into account when providing all services.

·       Councillor Roodhouse said he would welcome the reinvigoration of dementia friendly communities and linked to that a separate conversation on how to engage elected members and their communities. He spoke further about end-of-life care, the variation in premises accommodating residents with dementia and also staffing ratios. He then commented about the future design of care homes, the conversations needed when people were no longer able to stay at home and needed residential or nursing care, as well as the impacts for the family members caring for them. These areas could provide measures of success for the strategy.

·       Sharon Atkins acknowledged the points raised and gave examples of care homes within the County which had good models of care and were not necessarily more expensive.  

·       The Chair drew the debate to a close, noting that an action plan was being produced. She stated that when looking at measures and outcomes it was helpful to show the impacts of the work undertaken. This would demonstrate how it had improved services for people with dementia and their carers. It was requested that a copy of the final action plan be circulated to the Board and that a follow up presentation be provided at the appropriate time showing the work undertaken during the first year of the strategy and the difference it had made.

Resolved

That the Health and Wellbeing Board:

1.     Endorses Coventry and Warwickshire’s Living Well with Dementia Strategy, prior to its submission for final approval to Cabinet.

2.     Comments on the development of the year one delivery plan as set out above.