Agenda item

To provide an update on plans and solutions to support people with dementia in the Borough as part of the multi-agency Ageing Well Strategy.

Cllr Pippa Connor opened this item by highlighting three specific areas that the Scrutiny Panel would like to hear further information on which were a) details of the budget for the Ageing Well Strategy, b) which organisations received money from this budget, and c) the outcomes that were delivered and how these were measured.

Paul Allen, Head of Integrated Commissioning, then introduced the report on dementia services, noting that it provided an update to the previous report to the Panel at the December 2022 meeting and comprised of three main areas:

• Improving awareness-raising and progress towards a dementia-friendly Haringey;
• Improving diagnostic rates and onward connection to services;
• Improving services for people living with dementia.

On the first area around awareness-raising, Paul Allen said that actions taken since the last report had included appointing a dementia coordinator and relaunching the Dementia-Friendly Haringey Alliance, which had recently had a successful conference. The priority on support for under-served communities had included work through the community ambassador network to spread awareness about spotting the signs and symptoms of dementia and encouraging people to approach their GP for help earlier. An Ageing Well guide was also being developed and funding had been obtained for a training and awareness raising programme on ageing well with a specific module on dementia.

On the second area around diagnostic rates, Paul Allen said that actions taken had included working with GP practices and NHS Trusts to improve diagnostic rates by getting the basics right, including through initial screening. There had been some work with the Dementia Reference Group to develop a dementia chart which describes some of the things that people might expect in accessible language including advice on where to turn if problems escalate. An enhanced health and care homes model and collaboration between primary care community health and care homes had been worked on as around 70% of the care home population had dementia to some extent.

On the third area around improving services, Paul Allen said that support available at acute Trusts had been improved through initiatives such as an assessment unit for frailty. Support in the community was being improved through the ‘hub-and-satellite’ model set out in the report which involved the Haynes Dementia Centre, the Grace Organisation and other community resources.

Laura Crouch, Senior Services Manager for Community Provisions, Day Opportunities and Shared Lives, spoke about the ‘hub-and-satellite’ model explaining that the Haynes Dementia Centre was the centre for expertise for dementia in the Borough and that the aim was to develop that expertise elsewhere in the community. There were links developed by the dementia coordinator with Priscilla Wakefield House and other housing associations where dementia-friendly activities (knitting, drama, art therapy, etc.) were being held in the common room areas. They were also looking to expand the Singing for the Brain programme to other parts of the Borough as this was now oversubscribed at Alexandra Palace. There were conversations ongoing with Tottenham Hotspur Football Club about the possibility of obtaining some community space for this.

With regards to the initial questions posed by Cllr Connor about budget and outcomes, Paul Allen said that the Ageing Well Strategy was wider than the dementia issue as it also covered areas such as managing frailty and end of life care. The overall strategy also involved multi-agency working so it was difficult to attribute a single figure to this. However, the Better Care Fund (BCF) plan put a large amount of its £37m budget towards the Ageing Well Strategy. There were also other funders, for example the assessment unit for frailty referred to earlier was funded through acute investment as part of wider contracts. Also included were other services with a community health element. Paul Allen said that he could pull this information together if required but it wouldn’t necessarily be fully comprehensive. (ACTION)

On outcomes, Paul Allen said that he could share some of the outcome metrics that had been established. For individual services this included statistics on the number of people engaging and the type of activities they were doing, along with wider system measures such as reducing the number of times people have required emergency admissions to hospital. From 2019/20 to 2022/23 there had been a 22% reduction in over-65s going into hospital and an 8% reduction in those who stayed longer than a day. This improvement seemed to be occurring in both more deprived and less deprived areas. The performance framework could be shared with the Panel (ACTION).

Paul Allen and Laura Crouch then responded to questions from the Panel:

• Cllr Iyngkaran asked about waiting times from diagnosis to referral to the Memory Service at St Ann’s Hospital as there were some backlog issues. Paul Allen explained that this service was provided by Barnet, Enfield & Haringey Mental Health Trust to provide a formal diagnosis once a GP had identified cognitive impairment. He acknowledged that there was a waiting list, though waiting times had recently improved with further improvement still needed. He added that post-diagnostic support needed to be built up so that the service was able to release patients at an earlier stage. Cllr Connor requested that the latest details on the waiting list be provided to the Panel. (ACTION)
• Asked by Cllr Iyngkaran for further details about raising awareness in under-served communities, Laura Crouch said that they had already identified the relevant community groups and that the dementia coordinator role was to build links with those groups. A dementia awareness pack specific to the Borough was being developed which would target specific groups where appropriate and would include an easy-read version and translated versions. Prior to the pandemic, dementia-friendly awareness training had been delivered to Homes for Haringey staff with over 600 participants, leading to an increase in dementia referrals from maintenance staff and community-facing officers. There was now an intention to proactively deliver similar training to community groups across the Borough, supported by the dementia co-ordinator.
• Cllr O’Donovan asked about the work of the Grace Organisation which provided day opportunity services in the east of the Borough, including details of their funding and the expansion of their offer. Laura Crouch explained that the Grace Organisation was a third party charity that took referrals from professional including GPs and social workers or through self-referrals. People could also pay a small fee to join their luncheon club. The Grace Organisation provided services for people with learning disabilities and older/isolated people as well as for the dementia community. It worked alongside the Haynes Centre to improve dementia friendly practices and activities.
• Cllr O’Donovan noted that the Equality Impact Assessment referred to better awareness and support being needed for African, Caribbean and Asian groups and suggested that the Irish community should also be included in this due to the evidence that they were overrepresented in terms of poor health, including dementia. Cllr Mason added that people with limited financial resources should also be considered as they may sometimes find it more difficult to access services. (ACTION)
• Asked by Cllr Mason about support for carers, Vicky Murphy, Service Director for Adult Social Care, explained that the Council provided a carers’ offer under the Care Act and a small budget for them to get help and support could be provided as part of the Care Act assessment. There had also recently been consideration of how to strengthen the carers’ offer, supported by the development of the locality working approach, so this was in progress. Jon Tomlinson, Senior Head of Brokerage and Quality Assurance, added that there was £200k from the Better Care Fund (BCF) available in the current financial year which could be used for carers’ support and so the aim was to speak to carers in localised settings to get a sense of their priorities. Advice and support often tended to come out as a high priority but there may be other priorities highlighted that could strengthen the offer. Cllr Mason suggested that opportunities for carers to meet and support each other could be an important priority area.
• Beverley Tarka, Director for Adults, Health & Communities, said that, as President of ADASS (Association of Directors of Adult Social Services) she had identified support for unpaid carers as her top priority, acknowledging the significant contribution that they made and challenging all local authorities to develop a response in addition to what they were already doing. She emphasised the importance of working alongside carers to identify what was important to them. £25m of additional national funding was expected soon for carers’ support.
• Noting the good work of the Haynes Centre in the west of the Borough, Cllr Brennan asked whether a similar centre could be established to serve the east of the Borough. Laura Crouch said that the focus was on the ‘hub and spoke’ model development which involved identifying other places where dementia activities could be developed in more localised communities. There were also some well-established groups and services in the east of the Borough.
• Helena Kania asked about the support for families of people with dementia to navigate the financial support available to them as this could be a complex area and entitlements could vary for different conditions. Vicky Murphy said that the Connected Communities service and other navigators across the system supported people in obtaining the financial support that they were entitled to. She added that benefits such as attendance allowance should be assessed according to the level of need regardless of diagnosis, for example by assessing mobility needs.
• Asked by Helena Kania about the current situation with carers’ assessment waiting times, Vicky Murphy said that she did not have the figures to hand but would provide these to the Panel (ACTION). She added that ADASS had recently published their spring seminar report in which the figures for outstanding assessments were really positive for Haringey.
• Cllr Peacock spoke about the dementia activities that she helped to support including singing at Park Theatre, swimming, the Singing for the Brain group and dementia meetings at the Phoenix Group. She highlighted the importance of accessible locations with suitable parking facilities. She also explained the difficulties of encouraging some people with dementia to engage with activities as, for example, when moved to sheltered housing, some people tended to stay in their flats due to frailty or sickness. She added that was variation of need because there were different types of dementia and the support required. In response, Jon Tomlinson said that commissioning should be seen as a vehicle for getting the things that people in the community said that they needed the most. The first steps for this were to meet some of the more established groups to get a sense of the biggest issues for them but also then look to invite other members of the community and hard to hear groups to make sure that they picked up all the issues that people wanted to raise.
• Asked by Cllr Peacock about respite for carers, Vicky Murphy said that this could be provided through a direct payment or by commissioning that service. This would also be an issue addressed through the carers and commissioning strategy work that had been discussed. She added that, by moving to the locality approach, she hoped that there would be a front door service that carers could use directly.

Cllr Connor thanked officers for their report and summarised the requests/recommendations from the Panel as:

• Further details on the budget for the Ageing Well Strategy, which organisations received money from this budget, the outcomes that were delivered and how these were measured.
• Details of the waiting list for the Memory Service to be provided.
• For the Panel to continue to be updated on the work with carers to understand their priorities for the use of the BCF funding.
• Details of carers’ assessment waiting times to be provided. (ACTION)

Cllr O’Donovan added that he would like to see further explanation of how the Grace Organisation were being supported to spread their service offer to the local community. (ACTION)