Agenda item

To consider an interim progress report on the dementia scrutiny review.

Consideration was given to the Interim Progress Report on the Dementia Review, in particular to the information gathered at the formal meeting held on 1 September and from the informal evidence gathering session on 22 September 2008, together with the issues arising.

The Chair referred to the informal evidence gathering session when Members had identified several issues that needed further exploration. At that time it had been decided to address these by consulting and receiving evidence from the following:

(a)   Yorkshire Ambulance Service (YAS)  - A representative had been invited to attend the meeting to present their experiences in relation to dementia patients accessing secondary care.

Mike Wright, the Locality Manager from YAS, thanked the Committee for the opportunity to contribute to the review. He stated that, ambulance personnel, as usually the patient’s first line of contact after the GP, received very little guidance in relation to patients that were affected by dementia.

He stated that when responding to 999 ambulance calls personnel were often unaware of what type of call they were attending as only basic information had been obtained. Crews analysed each case and situation on arrival but they were trained to obtain as much information from those at the scene as possible, which included relatives and carers. He confirmed that ambulance personnel did not receive specific training on dementia but that with information received they also had to be aware of potential abuse cases. He stated that staff were trained on the requirements of the Mental Capacity Act 2005 and the new Safeguarding Adults policy, which would be ratified shortly by the Trust Board. He confirmed that crews were instructed to contact Social Services if they felt that an elderly patient was at risk and this would be done by way of a form.  He stated that every situation was different and that crews learnt by experience over a period of time.

He pointed out that

·        Crews were only with patients for a short period of time compared with other health professionals.

·        Any training was good but that personnel had to learn a great deal of information in a very short period of time.

·        Very few complaints were received in this area.

·        Although staff were experienced they could miss signs if patients had trauma or were dehydrated

·        Length of training for qualified paramedics: this could be undertaken in two ways the first by Technical entry which comprised an 8 week training scheme followed by 1 years probation or secondly with a 2 year study course which was equivalent to the technical entry followed by more advanced training but it was confirmed that this was still less training than that received by a nurse.

·        Confirmed that relatives/carers were always encouraged to travel with patients in the ambulance and that this included staff in residential homes accompanying residents.

The representative of the Alzheimer’s Society referred to the specialist training their Society provided which she felt could be useful to ambulance personnel.

Members referred to the fact that people were living longer and that with an increased elderly population and an increased incidence of dementia that there was possibly a need for more formal training for ambulance staff. Mike Wright confirmed that if funding was available and time set aside for such training that he would welcome this.

(b)   York Hospital front line staff – It was reported that Members of the Committee had visited front line staff at York Hospital on 6 October 2008 when they had spoken to 3 members of staff from the Trauma and Orthopaedic Unit.

Notes of the comments made in relation to their experiences of caring for patients suffering from dementia who accessed secondary care were circulated at the meeting (copy attached to these minutes). 

Arising out of consideration of this document Members made the following comments:

·        Concern that those who worked on the elderly wards did not receive additional training in caring for patients with dementia;

·        Unfortunate that a forum arranged on mental health issues had been cancelled at short notice due to staff unavailability. The Chair confirmed that the Matron had confirmed that she would examine issue this outside of the scrutiny review;

·        Of the twelve benchmarks of ‘essence of care’ significant developments had been made in all areas apart from mental health.  Officers confirmed that this was a national initiative and that improvements were to be made locally in this area. It was confirmed that this point would be examined further when formulating the recommendations;

·        Minor text amendments would be made to the notes from the visit prior to the documents inclusion in the final report.

(c)   The North Yorkshire and York Primary Care Trust (NYYPCT) – Representatives of the PCT were in attendance to update Members on training issues and the status of the Psychiatric Liaison Service.

Members were reminded that it had been reported at the informal evidence gathering session that York Hospital together with colleagues in the PCT had investigated the possibilities of a “psychiatric liaison service” which had unfortunately been stalled due to lack of funding. A pilot of the scheme had produced some clear anecdotal evidence on the benefits of such a service.

Representatives of the PCT at the meeting reiterated the point that earlier work had shown that reductions could be made in patient’s length of stay with the use of a liaison service. They confirmed that they fully supported the scrutiny review, as they were aware of gaps in the service. They also confirmed that anecdotal evidence had provided clear evidence that there was a need for the service to be used before and after hospital admissions. They pointed out that were also problems with the availability of resources for training. They made the final point that staff were also wary of over diagnosing or making too early a diagnosis of dementia in patients and that this was a very fine line.

Members questioned the possibility of pooling training resources with Bootham Hospital. The PCT representatives confirmed that there were no problems with staff accessing training at other venues the only issues related to the suitability of different courses for staff at different levels.

(d)   Local Medical Committee (LMC) – The LMC had been contacted to see whether it would be feasible to include in GP notes details of named carers and to flag this information up when admitting dementia sufferers to hospital for secondary care.

Details of the response received from the Director of YOR Local Medical Council Limited were circulated at the meeting. He explained that a “shared care record system” did exist but that the software used in York and Selby was unpopular with the Strategic Health Authority (SHA). He confirmed that GP’s were resisting intense pressure from the SHA to change to an alternative system. He went on to confirm that every GP had a database of patients with dementia and that GP’s should be carrying out an annual review of carer contact details.

Members expressed concern that the SHA should be attempting to change the excellent EMISWEB intranet system used by GP’s and pointed out that a compatible IT system should be used across all agencies.

(e)   National Dementia Strategy for England update September 2008

This update was circulated to Members at the meeting and informed Alzheimer’s Society staff in England about work in progress on the Dementia Strategy.

Members agreed that they now had sufficient information to produce recommendations for the draft final report and following further discussion it was

RESOLVED:     (i)That a further informal session of the Health Scrutiny Committee be arranged for Tuesday 21 October at 4.30pm to make appropriate recommendations to be included in the draft final report;

(ii)       That the documents circulated at today’s meeting be received for inclusion in the draft report;

(iii)     That the Committee’s thanks be conveyed to the Scrutiny Officer for the expeditious production of the notes made following the visit to York Hospital, earlier in the day.

REASON:            To progress this review.