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)