To receive evidence fromthe following groups and organisations on their perception of services that are provided to support vulnerable people with long term conditions:
· Age Concern
· The Alzheimer’s Association
Minutes:
The Panel received evidence from Jennifer Strathearn from Age Concern and Julie-Ann Philips from the Alzheimer’s Society Haringey.
Age Concern
Ms. Strathearn reported that she was providing a new service on behalf of Age Concern, which involved acting as an advocate in cases where elderly patients from Haringey were subject to delayed or failed discharge. This covered situations where patients did not want to go to where they had been allocated or where they had been unable to find accommodation. Sometimes people could not afford care or found it hard to accept it. Local authorities were fined £120 per day unless for delayed discharges, unless they were the fault of the NHS. In addition, she could provide benefits advice. Advocacy was currently only available in hospital and was provided at both the North Middlesex and the Whittington.
Mr. Brown commented that it was known that there were gaps in this particular area. This was especially true of the Whittington Hospital, which had experienced problems with patients refusing to move out of the hospital. The service had been established using pooled budget money with the North Middlesex and the Whittington and services were commissioned jointly with them. The objective of the service was to try and assist in resolving difficult issues, where an impasse had been reached.
Ms. Strathearn reported that clients sometimes told advocates things that they had not mentioned before and which could make a difference. Older people were sometimes suspicious of professionals and were therefore likely to be more open with independent people. In addition to addressing delayed and failed discharges, advocates could also help to prevent readmission to hospital. For instance, preventative action could be taken to reduce the risk of falls. Older people sometimes found it hard to accept that life had changed following hospitalisation and could have the mistaken expectation that they would be able to continue their life as it had been before.
Referrals generally came from the Integrated Care and Discharge teams of each hospital. She normally just talked just to the patient but could also involve family members, if they were available. She frequently came across people who had no support at all and, in such circumstances, could provide practical help including benefits advice. She could also refer people onto other services, as appropriate.
Alzheimer’s Society
Ms. Philips reported that the Alzheimer’s Society was a small, national charity. They provided a number of services within Haringey including advocacy, a drop in facility and a café. There were approximately 1400 people in Haringey with dementia. Significant numbers were treated at St. Ann’s. There was a high prevalence of vascular dementia within the Borough.
Dementia could present problems if people were admitted to hospital. They could, for instance, refuse to get into an ambulance. Dementia also affected those who cared for people with the condition. Carers could, however, play a key role in helping to keep people out of hospital.
The Panel noted that the volume of people attending Accident and Emergency was such that it was often not possible to deal with anything other than the immediate issue. The North Middlesex Hospital did not currently have psychiatric cover for older people, which was a significant factor in the admission of a number of people to hospital. The lack of service meant that the issue was not being picked up. There had previously been an informal arrangement between the Mental Health Trust (MHT) and the hospital which the MHT had now decided to withdraw from. Formal arrangements were in place in other hospitals.
Ms. Philips commented that there was now a lot more awareness of dementia. Older people generally saw hospital as a safe place to go. Accident and emergency (A&E) was often seen as a safe haven. However, A&E took a long time to deal with people and, more often then not, did not have the full history of patients.
Professor Proctor reported that hospitals frequently had several different case notes for the same person. The NHS suffered from poor information systems. Episodes rather then individuals tended to be the primary basis upon which record keeping was based. The problem was very difficult to resolve. Current systems were designed to react to rather then prevent ill health. A massive system change was needed. Mr Brown reported that efforts were being made to enable A&E staff to have read only access to Adult Services data. This would assist A&E staff by flagging up potential issues. However, systems needed to be configured so that people did not end up in A&E in the first place.
MS Philips felt that there was a particular problem with out-of-hours care. People with dementia were particularly prone to wandering and other problems at night. She felt that provision of a 24 helpline and training on dementia for relevant health staff would assist. Medicines could assist in stabilising the condition and addressing challenging behaviour. There was a need for improved respite care. In addition, she felt that there was a need for better integrated day care and training for carers.
Mr Brown commented that the majority of respite care was provided for carers looking after people with dementia. £1/2 million was currently spent on such facilities. People with dementia were normally dealt with via mental health services at St. Ann’s. However, there was a lack of medical facilities there. Most people needed both medical and care services.