Agenda item

To provide an update on plans to support people with dementia in the Borough.

Report to follow.

The report for this item was presented in two parts, with the first part on community aspects introduced by Laura Crouch, Senior Services Manager at the Council, and the second part on NHS and partnerships introduced by Tim Miller, Assistant Director of Place, Integration, Transformation & Delivery (Haringey) at the NCL ICB. Also in attendance was Sade Olutola, Service Lead for Haringey Mental Health Services.

Slides presented by Laura Crouch covered the following points:

• An increasingly ageing population was expected to lead to increased demand for dementia services in the future with more people and more complex diagnoses. There were around 2,300 residents in Haringey thought to be living with dementia in Haringey in 2023/24, around two-thirds of which had been diagnosed with the condition.
• To prepare for the increased demand, it was necessary to look beyond traditional care models and to maximise community strengths, partners and resources. A dementia co-ordinator post had been created to enable partners to engage, network and create a more accessible and robust Borough.
• A set of Dementia Friendly Haringey Priorities had been developed through a number of sessions and activities across the Borough, involving carers, professionals and people with a diagnosis of dementia. These priorities included that Dementia Friendly Haringey will be a place where people with dementia and their carers:

o   Will be respected and experience a greater level of dementia awareness in the community.

o   Will have greater access to health and social care support services.

o   Will have access to a range of local social activities.

• 30 local services and organisations had signed up to a minimum of two actions to make their services more dementia friendly. These included GP practices and care providers.
• A list of key achievements on the ‘Greater Level of Dementia Awareness’ programme of work was provided (also available in the supplementary agenda papers) which included:

o   Funding for carers in a creative group.

o   A new ‘Singing for the Brain’ session twice per month at Tottenham Hotspur Stadium.

o   Nine dementia-friendly events with 40-50 attendees at each.

o   An uptake in referrals, walk-ins and signposting.

o   New dementia-friendly webpages had recently gone live.

o   Delivery of training for GPs, including double appointments for those with a diagnosis of dementia and phone calls in the morning to remind patients of their booked appointments.

o   Improvement of long-term cognition from new community activities in partnership with Jacksons Lane.

• New events were taking place at the Haynes Dementia Hub. Independent networks were being developed and activities such as carers’ lunch clubs and an evening-based carers group, led by carers, was due to be launched soon. SEN students were gaining qualifications and work experience in the kitchens and other activities. The next wave of social care workers were being actively trained to be dementia-friendly in their practices.
• The assessment and referral pathways were now working well and the localities model had enabled people to be seen more quickly.
• A communications plan was being developed with the Grace Organisation and it was hoped that they could be supported further and built into what was being delivered Borough-wide.
• The Dementia Reference Group was continuing to grow and was attended by carers and people with dementia.
• The Learning Disability Partnership team was working across localities to identify, track and support those with a dementia diagnosis and those at higher risk. People with learning disabilities and especially people with Downs Syndrome were more likely to be affected by dementia and at an earlier age. A social component of that offer was being developed including a nostalgic music and dance group, chair-based exercises and a new memory café to be hosted at Winkfield Resource Centre.
• There were a range of core goals for 2024/25 to deliver on what the groups were saying that they wanted to see in the community. The aim was to create a Borough that was capable and adaptable in a demanding social and financial climate.
• A Dementia Friendly Parks Audit had been conducted and actions were being considered to make the signage more dementia friendly in Finsbury Park and Downhills Park, make seating more accessible and review the paving and walkways. A similar process would also be conducted with the leisure centres.
• Partnerships were being developed across the North Central London (NCL) area, especially with young onset dementia, and by looking at programmes of activities across NCL where referrals could be made.
• Members of the Panel were invited to sign up for the new Dementia-Friendly pledges and training which was now being delivered.

Laura Crouch then responded to questions from the Panel:

• Asked by Cllr Peacock about swimming facilities for people with dementia in Haringey, Laura Crouch reiterated the commitment to carry out an audit of facilities at leisure centres and said that this process would include dementia-friendly swimming.
• Cllr Peacock expressed concerns about the condition of the toilets at the Tom’s Club at Chestnuts Community Centre. Laura Crouch agreed to provide this feedback to the organisers. (ACTION)
• Cllr Peacock commented that attendance at Singing for the Brain at Tottenham Hotspur Stadium was poor and that it should be advertised more prominently. She added that it could also be confusing to find the correct room. Laura Crouch noted that it had taken some time to negotiate the space for this and so the room location had been changed a few times. However, a new designated area near the café had been requested so that attendees would not have to walk so far. The team was also looking for other venues in the area that could also host these sessions. Laura Crouch agreed to pass on the feedback on low numbers and promoting the sessions. (ACTION) She added that there would be further opportunities for digital advertising through the new dementia-friendly web pages. New printed leaflets about services were also being circulated in the community including to libraries and GP practices.
• Cllr Peacock informed the meeting that there was a new proposal to start a dementia café at the Tottenham Sports Centre.
• Asked by Helena Kania how service provision would be able to keep up with the expected rising demand in future, Laura Crouch said that there was a focus on building up community resources and that the whole dementia-friendly programme aimed to make more places accessible across the Borough. The team had been working closely with the Cypriot Centre on hosting events and there had also been discussion on working with Grace Organisation as previously mentioned. She added that a drop-in service was offered so that people could drop in and attend activities when they wanted to rather than requiring a full-time space. There was also no current waiting list for people referred into the service.
• Helena Kania expressed concern about the transport options available for people who wanted to attend the dementia centres. Laura Crouch responded that each service had its own transport method, mainly using minibuses with some use of taxis and cars. The Haynes Centre was currently able to pick people up from across the Borough and this was done on a needs basis with independent travel encouraged where possible.
• Asked by Cllr Iyngkaran about the organisations that had signed up to the dementia-friendly actions, Laura Crouch said that this included around 12 GP practices so far, noting that this was quite a detailed process to set up with good achievable targets. The initial areas had been targeted with the aim of building up clusters of GP practices over time and to spread this across the Borough. She added that GP-specific dementia-friendly training was having the biggest impact and so they were working with local health providers to release more GPs and other health professionals to attend training sessions. Cllr Iyngkaran suggested that other parts of the Council, including perhaps the Public Health team could use their links to help promote this initiative with GP practices. Will Maimaris, Director of Public Health indicated that he would be happy to look at how his team could help with this. (ACTION) 
• Cllr Opoku suggested that dementia-friendly policies could be built into the premises for all new or expanded GP practices. Laura Crouch noted that she always promoted dementia-friendly, accessible and autism-friendly practices when meeting with the Haringey GP Federation or with the ICB. Tim Miller confirmed that the work on dementia-friendly practices was supported by the ICB and the Haringey GP Federation. He added that there was a clinical lead GP for the west of Haringey who had done a lot of work in this area. Cllr Connor suggested that an update to the Panel in 8-9 months’ time on how this work with GP practices was progressing would be welcomed. (ACTION)
• Helena Kania requested figures on dementia service users. Laura Crouch said that there were currently 40 regular attendees at the Haynes while the Tom’s Club tended to have around 60-70 people at each session. There was also a small group of regulars attending the drop-in activities. In the past 12 months there had been 27 referrals received, of which 16 had been offered places straight away. Cllr Connor suggested that an update on the figures to the Panel in 8-9 months’ time would also be useful. (ACTION)
• Cllr O’Donovan commented that, in his experience of attending the dementia events and activities, it brought together people who were living with dementia and their carers with professionals to discuss issues and problems and also facilitated valuable activities. He also highlighted the barriers for some people in obtaining a diagnosis and reaching support services because of issues with isolation and stigma or with dementia not being quickly identified. He also highlighted the waiting times for the Haringey Memory Service as another barrier. It was noted that Tim Miller would address these points in his presentation.

Slides presented by Tim Miller covered the following points:

• The Haringey Memory Service was the key service for dementia diagnosis and post-diagnostic support in the Borough and was well connected and integrated with the Haynes Centre and with the dementia navigators and other dementia roles.
• The quality standard for referral to the service (typically from a GP) to completion of a diagnostic assessment was 6 weeks. Performance on this had recently been relatively stable and well-performing, comparing well to neighbouring boroughs. Those with longer waits would typically be up to 3 weeks longer due to logistics or capacity issues but there were not any hidden long waits.
• There was a measure used across the country on the number of people thought to have dementia compared to the number of confirmed diagnoses in order to see how well dementia was being detected and assessed for. Haringey performed slightly better than the London average on this measure with 66.3% of the expected number of people with dementia assessed and diagnosed. This was still a significant gap but was in line with what was seen nationally.
• The merger of the two Mental Health Trusts in NCL (Barnet, Enfield & Haringey Mental Health Trust and Camden & Islington NHS Foundation Trust) had been planned for some time and was expected to be completed in November 2024. As a result of this, the older people services would be generally moving towards a needs-led approach that was age-cohort based and this would further support people with the right care from the right teams. He also noted that there had been a lack of responsive crisis support for older people with dementia compared to working-age adults with mental health conditions and that a benefit of the merger would be a more consistent model of care that would see dementia crisis teams being introduced in Haringey.

Tim Miller and Laura Crouch then responded to questions from the Panel:

• Cllr O’Donovan highlighted the rise in dementia rates, particularly in minority communities, and noted that issues of stigma may be preventing people from presenting to services. Laura Crouch highlighted the networks being developed with the Cypriot Centre and other local groups and added that there had also been some success at the Black Health Fair this year. The team had been invited to present to the diversity leads who link in with local community/religious leaders and the aim was to find community-based facilitators to help communicate key information, including about services. Cllr Connor noted that, in terms of outreach, the Panel had previously spoken about the centre of excellence approach provided by the Haynes Centre but that the concern had been whether this was being duplicated across the Borough. It would therefore be useful for the Panel to receive further updates on the progress on this, including in relation to the Cypriot Centre, the Grace Organisation and any other organisations that would be involved in this kind of outreach. (ACTION)
• Referring to the figures on the 6-week wait quality standard, Cllr Iyngkaran welcomed the improvement from April 2023 to October 2023 but noted that there had been some slippage since then. He also requested details on the longest wait times. Sade Olutola responded that there had been some logistical challenges including some periods of staff sickness, cancellation of appointments due to clashes with other medical appointments for service users and requests for postponement of appointments from carers due to other commitments. She added that resources had been put in place to get this process back on track. She also noted that the longest current wait time was 12 weeks but that this resulted from the individual being hospitalised due to an unrelated issue.
• Cllr Connor highlighted a previous recommendation of the Panel which was to establish a secure online portal to enable service users, carers and social workers to be able to quickly access documents relating to assessments and care plans. Laura Crouch responded that the recent focus had been on rolling out the localities model and making sure that there were good customer-facing spaces across the Borough. The next phase would be to consider the digital approach on dementia. Tim Miller added that a digital portal would be challenging to implement with information across different sectors that would need to be pulled together. One area that had been discussed was having a named professional that would be the main contact for an individual (and their carer/family), based on their needs and their relationship with services, as a point of contact and advice. While he acknowledged that this was a different solution to the digital portal, it did have the potential to address some of the same issues such as on personalised and up to date information. He added that the NHS was ambitious about what could be achieved through the NHS App in terms of medical records and how this could be enhanced in future. However, this was still at the stage of testing and learning how these technologies could work for patients. He added that there was a technology provider called Patient Knows Best that worked in this area which may be of interest to the Panel. Cllr Connor requested further information to be provided in a future update to the Panel on how the named person approach would be introduced and how individuals and their families would be able to access details on care plans and other relevant information. (ACTION)
• Cllr Opoku added that there were plans to expand the Universal Care Plan (a shared care planning system) in areas such as sickle cell disease and that it would be helpful to input into this process to enable dementia to also be included in future. (ACTION)
• Cllr Brennan highlighted the importance of directly involving the individual experiencing dementia in the process of shared records and any digital offer. Laura Crouch noted that the ongoing wider digital work was being designed to be accessible for people with neurodiverse needs. This would be an easier pathway for people to follow in the way that events were advertised and there would also be a reminder text service for events where people had expressed an interest.
• Asked by Cllr O’Donovan asked about outcome measures, Laura Crouch said that feedback was gathered after all events and compiled into a monthly dementia-friendly report. Data was also collected on the number of attendees at activities, referrals being made and the type of phone calls/contacts made.