Scrutiny & Overview

Dementia Strategy

Thursday, 18 April 2019

Our Vision:

“People will be supported to live active lives in

caring communities enabling people to live fulfilling

lives independently at home for as long as possible.

When care is required people will only have to tell

their story once. Information will be provided to

enable people to make the right choices regarding

services for them”

Way forward:

We know from the experience of other areas that:

• By providing support earlier to people that have a higher risk of dementia we can potentially delay the

onset of the disease

• By providing the community support and community services that people with dementia want and need,

we can improve their quality of life while reducing emergency hospital admissions and premature

admission to care homes, i.e. deliver better services in a more cost-effective way

• By supporting the families and carers of people with dementia we can help people to remain independent

for longer.

The case for cost-effective services and support with a Primary Care focus is built, not just on the delivery of

treatment interventions in a community setting, but on a network of support that covers the breadth of health

and social care services.

These range from intensive home treatment services to the use of home adaptations and telecare equipment,

of which there are many available and which can bring savings. We know that we need to use a long-term

conditions approach as the majority of people with late onset dementia will have other chronic physical health

problems and or comorbid mental health problems, and the progressive nature of dementia means that most

people will have changing health and social care needs that need reviewing over many years.

Hounslow Model:

1. Dementia Friendly

Hounslow

2. Future proof strategy

3. Robust pathway

1. Dementia Friendly Borough

• Commitment to the Hounslow Dementia Friend Programme

• Play apart within the Hounslow Dementia Alliance Group

• Raise the awareness of Dementia across LB Hounslow

• Take Measures to support Dementia within your business area

2. Strategy

•Develop Partnership working across LB Hounslow

•Underpins operational activity

•Ensures that services within LB Hounslow play are role

•Puts people at the heart of what we do

• Balances limited resources to achieve best outcomes

•That services provided are aligned for best outcomes

•Provides a clear forward thinking approach

• that provides clarity around roles and responsibilities

•That the bar is raised with raising awareness

•That the bar is raised for services offered

3. Pathway

• That has a ‘approach once style’

• That is collaborative

• That ensures resources are utilised well

• Ensures that skill sets of staff are high

• That provides a quality services across the spectrum

• That services provided are Agile and flex to demand

Objectives:

This Dementia Strategy sets out our three year vision for people with dementia and their carers in the

London Borough of Hounslow. It will look at all aspects of dementia care and services, from prevention

to end of life care, to ensure that:

✓ opportunities to prevent certain forms of dementia are maximised;

✓ community understanding of dementia is improved;

✓ the Local Authority and Clinical Commissioning Group (CCG) are prepared for the future

✓ needs of people with dementia;

✓ Hounslow becomes a dementia friendly community that enables people with dementia to stay

living independently in the community for longer;

✓ carers of people with dementia are given the support they need;

✓ people with dementia are able to live well in Hounslow

✓ Ensure Demetria is a golden thread within other key policies and stratergies

Framework:

The overarching purpose of this strategy is to understand the current experiences of people with dementia, to identify what we

already have in place that is working well, and to identify what we still need to do to improve the outcomes for older people with

dementia and their carers.

This strategy has been developed to begin a process of a planned and co-ordinated approach to the delivery of a range of

services to support people with dementia and their carers.

There are a number of national strategic drivers that have helped to shape the strategy. These include:

• The National Dementia Strategy, ‘Living Well with Dementia’ (2009) sets out a vision that services and society should

transform their approach and attitudes to enable people with dementia and their carers to live well with dementia, no matter

what the stage of their condition or where they are in the health and social care system. This approach is inclusive of all

types of dementia in all groups affected, including people under the age of 65.

• ‘Quality Outcomes for People with Dementia: Building on the Work of the National Dementia Strategy- the

updated implementation strategy for the 2009 strategy,

• ‘The Prime Minister’s Challenge on Dementia – Delivering Major Improvements in Dementia Care and research

which explicitly described the imperative for the Coalition Government in terms of dementia

• NHS England Dementia Pathway Transformation Framework

Strategic Priorities:

Prevention:

• Raising the awareness & understanding

• Wellbeing Health Promotion, Prevention, delaying onset

• Dementia Friendly Communities

• Reduce and delay demand for care – promoting a recovery focussed model across health and social care pathway

Key Actions:

Cascade a local public information campaign, training and awareness raising.

Making Health & Wellbeing everybody's business

Include dementia in local strategic planning.

Include early identification of dementia as a priority for health and social care services.

Promotion of principles of Primary Care Dementia

Ensure services are available for frail elderly, including those with early stages of dementia, giving them access to services that promote health and wellbeing and reduce social isolation.

Create healthy communities –harnessing local community assets to supportpeople and their carers

Publicise ‘Dementia Friends’, ‘Dementia Champions’ and ‘Dementia-Friendly Communities’. Through the Hounslow Dementia Friends Programme

To work with local groups, organisations and agenciesto develop dementia alliances which will improve the lives of people with dementia’

Include early identification of dementia as a priorityfor health and social care services.

Recognition andIdentification:

• Early Detection

• Making Every contact count

• Recognition and Referral including in acute hospital settings

• Mild Cognitive Impairment and Subjective Cognitive Impairment

Key Actions:

Agree a consistent referral pathway for Primary Care.

Set targets for increasing diagnosis rates so that professionals recognise its importance.

To develop a screening tool

To ensure that professionals across all sectors of health and social care are aware of the early signs of dementia and feel confident to use the dementia screening tool and know where/how to signpost/refer appropriately.

Ensure that professionals working in specialities with higher dementia risk factors are regularly screening patients for dementia.

ensure access to high quality learning and support opportunities in dementia for professionals including those who work within LD, substance misuse services.

Work towards an integrated care plan

GPs and other professionals to be proactive in identifying high-risk groups, including excessive and long-term alcohol use and learning disabilities

Providing comprehensive advice & information people

Assessment andDiagnosis:

Early Support and Treatment for Patients and Carers/Families

Key Actions:

Ensure that clinical pathways between primary andsecondary care are factored into the overall dementia pathway

Ensure that there is consistent access to post-diagnosis support, including access tothe appropriate practitioners to develop support plans, wherever and throughwhatever route the person is diagnosed.

Ensure people newly diagnosed with dementia are offered treatment whereclinically appropriate in a timely way.

Ensure carers are offered have an assessment of his/her own emotional, physical andsocial needs and a care plan developed with them which will identify appropriateinterventions and support to assist them with their role as a carer.

Living & Supporting:

Community inclusion, feelingvalued, living normally

Planning for the future and personalisation

Support along the journey

Staying safe and secure at home

Safeguarding

Active therapies, community assets

The Right MedicationSupport for families and carers including respite services and day services

Key Actions:

Assist people with dementia and their family/ carers to access support to maintain quality of life.

Engage people with dementia and their family/ carers in commissioning decisions.

Working with local communities and encouraging them to be more visibly welcoming to people with dementia.

All people with dementia to have access to support to offer help and guidance with navigating care and other services.

People with dementia to be able to create their own life diary and to be involved in ongoing care planning, including advanced care planning.

Commission services taking into account dementia is a long-term condition and ensuring service provision has an appropriately wide range of options to suit the needs ofindividuals.

Ensure that all those who have had, or are receiving, a diagnosis are able to access specialist dementia advice and information.

Ensure that all those with a diagnosis of dementia and their carers are able to access ongoing support.

Living & Supporting: Key Actions:

Increased access to carer education, whether through formal courses, a dementia adviser or attendance at structured support groups such as dementia cafés.

Ensure support is available for people who are unable to accept or acknowledge the impact of their diagnosis.

Ensure ‘joined up’ assessments between health and social care.

Ensure access to reablement services.

Identify other non-dementia specialist services that could support people who havedementia with other aspects of their health and social care needs.

Ensure everyone who is appropriate is offered ‘antidementia’ drugs.

Practitioners to have increased awareness of how to recognise and manage pain relief.Carers’ assessments to be offered to all carers.

Assist carers to develop Informal peer networks and to Engauge with formal existing networks

Assist ex-carers to become mentors.

Make safeguarding everyone's business

Increasing Care:

Good care in general hospitals

Living well with support and care

Managing changes in behaviour

Specialist mental health care

Living well with dementia in care homes

End-of-life care

Key Actions:

Hospitals will ensure all wards and services are dementiafriendly.

Workforce will have appropriate knowledge and skills around dementia.

Access to personal budgets and continuing healthcare for those who qualify.

Access to advice to families/carers on managing behavioural and psychological symptoms of dementia.

Develop appropriate learning programme for care home staff so that they are able to

recognise the symptoms of dementia and how to manage it in that environment.

Good service specifications defining the range and quality of care that should be delivered and a clear quality and monitoring framework in place that supports the delivery of person-centred comprehensive care.

Agree care planning that includes end-of-life care planning for all people withdementia.

Providers will have the skills to work with people in the development of future andend-of-life plans.

Provide improved access for people with dementia to palliative care services.

Improve the treatment and management of pain for the person with dementia.

Increase availability of counselling services to support the carer in preparing for anddealing with the death of their oved one

Be a friend

What we’ve done so far:

➢ Launched a memory café in collaboration with Sheltered Housing

➢ Raised the profile and understanding of dementia through dementia friend sessions

➢ Asked for commitment from our organisation, partners, communities & local businesses

➢ Revised our healthy & happy activity programme to be inclusive of those living with dementia

➢ Registered as an action alliance & submitted our action plan

➢ Started work internally, local business and communities to help shape further offerings and explore the possibilities

➢ Roll out of a new community dementia service outreach service (‘Dementia Connect’)

➢ Ensured that dementia membership is introduced to key activities such as disability community forum & Hounslow Health & wellbeing board

➢ Working towards a multi agency reporting framework

➢ Responded to what people living with dementia and their carers have said

➢ Started working at a pan London level to tackle trends and concerns at London wide level

➢ Utilised resources & estates to provide more services and offerings

➢ Provided a constant communications to residents of the condition

➢ Develop & mature the Hounslow Dementia Action Alliance

➢ Generated 501 dementia friends across Hounslow

➢ Started conversations around longer term goals

➢ Developed our strategy and offerings in collaboration

➢ started to look at how digital offerings can be used to tackle isolation

➢ Working to provide a wider variety of activity based offerings

➢ Ensure that dementia is reflected within other relevant strategies

What needs development:

➢ We would like to turn our memory café into a social enterprise which creates employment opportunities and promotes open spaces

➢ A continued education programme which is developed and rolled out to schools and youth groups

➢ For Hounslow Action Alliance to be self sustainable and keep the call to action alive

➢ Maximise on possible income streams to enhance digital offerings

➢ Raise the profile of Young onset Dementia and record local levels of young onset

➢ Develop services such as waste and recycling to support those living with dementia

➢ Be recognised as a ‘Dementia Friendly’ borough and retain the status year on year

➢ Work with HR to ensure that employees diagnosed with dementia or supporting someone with dementia are well supported and reasonable adjustment is made

➢ That an enhanced and collaborative pathway is developed across the council and its partners

➢ That information and guidance is developed and is accessible

➢ That those living with dementia are able to live well and prevented from hospital admission

➢ That someone only tells their story once

➢ Create more local dementia champions to support local awareness

➢ Continued listening and responding to residents

➢ Twined companionship offering with out of London boroughs to tackle isolation and increase engagement

➢ Increased with minority groups (homeless, cultural, LGBT, etc) to ensure services are targeted and residents are well supported

Response to targeted Questions: Good & Shared practise: Practises up and down the country have been explored and some invaluable guidance has been shared particularly from Richmond, York, Bristol City Council, Hammersmith & Fulham City Council.

Practice and areas that have been explored are: • Integrated pathways • Demetria Hubs • Dementia friendly communities • Assistive technologies • Policy and strategy • Wondering protocols Everything Hounslow has been working towards has been benchmarked against other authorities but tailored to a local need

Trend setting: Other authorities ranging from, West Berkshire, Surrey County Council, Lewisham have reached out to us for best practice and guidance around the Hounslow Dementia Friend programme.

The working supporting the Dementia Programme was also highlighted in recent feedback from a peer review carried out of Adult Social Care as being creative and collaborative.

Hounslow have been commended by the Alzheimer's Society for the unique and collaborative approach taken over the last year and has referred other authorities to us for guidance on best practice around start up dementia friendly communities and our notable artwork branding.

Hounslow have taken a very unique approach with our refreshed community dementia service (Dementia Connect) which is currently being rolled out. The refreshed service aims to reach a wider population of residents that are unable to travel across the borough to access services. The new community services is made up by • Roaming Dementia information Hubs • Dementia Advisory Support • Keeping in touch Service (telephone support Service) • Side by Side (matching like minded volunteer and resident living with dementia) • Peer Support

Dementia Liaison Nurse Service:

Hounslow want to take a more preventative approach for those living with dementia so with that in mind the programme has been designed to generate a more community based approaches with clear priorities of what we need to do across the spectrum to support people to live well with Dementia and reduce social isolation.

Its worth noting that there is a Integrated Community Response Service (HRCH) which is commissioned by LB Hounslow with the aimof preventing residents from being admitted to hospital if they don’t need to be and ensure that if patients do need to have a stay in hospital, that they are discharged as soon as possible to continue their care at home and supports adults who have been discharged from hospital and require access to health care professionals. The team is made up of a GP, nurses, occupational therapists, physiotherapists, support staff, social workers, pharmacist and a handyman and has just appointed an Enhanced Dementia Practitioner.

Response to targeted Questions:

National: • 850,00 people live with Dementia in the UK • 225,000 people will develop dementia per year (averaging 1 person every three

minutes) • 40,000 of which are living with early onset (under the age of 65) • Only 42–49% of people with dementia receive a diagnosis and this is often too late to

enable them to plan their support and care needs.• Dementia is now the leading cause of death in the UK and 1 in 3 people over 65 years of

age will die with a form of dementia• 70 per cent of people in care homes have dementia or severe memory problems

• Over 25,000 people from black, Asian and minority ethnic groups in the UK are affected• More women than men are diagnosed with dementia each year • Dementia has become the leading cause of death among women in the UK• Estimated that by 2025 there will be 1 million people living with dementia in the UK • Estimated that by 2051 there will be 2 million people living with dementia in the UK• Over 700,00 people in the UK care for a friend or family member living with Dementia • 1 in 3 young people will know someone living with dementia

National Notable Statistics:

Local Notable Statistics:

Next Steps:

Dementia Friendly Communities: Dementia Strategy:

Dementia Pathway: Dementia Connect Service:

Action: Timeline:

Launch of HDAA May 19

Apply for DFC Status July 19

Education & awareness

Ongoing

Community Development

Ongoing

Action: Timeline:

Consultation May-June 19

Refinement July 19

Cabinet Aug 19

Implement October 19

Review October 20

Action: Timeline:

Scoping March 19

Workshop's April-May-19

Process design June-July 19

Consultation August 19

Pilot/refine September 19

Implement October-November 19

Review October-November 20

Action: Timeline:

Launch July 19

Copy rights of the London borough of Hounslow