Agenda item

To consider the final draft report from the Dementia Review.

Members considered the final draft report on the Dementia Review whose aim had been to look at the experience of older people with mental health problems (and their families/carers) who accessed general health services for secondary care in order to identify where improvements may be required. The report set out six draft recommendations for consideration.

The Chair reported that the Committee had also considered the addition of a seventh recommendation concerning the befriending service. The Head of the Neighbourhood Pride Unit gave members further details of these services and confirmed that Age Concern had now written to all wards to inform them they would not be seeking funding from 2009/10 onwards from ward budgets.

A representative of Age Concern, confirmed that although this service had not been found to work through the Ward Committee’s, befriending services would continue through Age Concern and the Alzheimer’s Society.

Consideration was also given to the following documents circulated at the meeting:

• ‘This is Me’ leaflet prepared by the Alzheimer’s Society which included information on individual patients;
• Details of the befriending services supported by the Ward Committee process and the Ward Committee Local Improvement Schemes process;
• Sections from the NHS ‘Essence of Care’ document which detailed patient focused benchmarks for clinical governance. It was reported that this document formed part of healthcare training, which was then cascaded down to all staff.

Members and partners made the following comments;

·        The experiences of patients were often different to those commented on by staff and that there may be a need to revise the preamble to paragraph 6 of the report to reflect this.

·        A member of the Hospital Trust confirmed that they welcomed the opportunity to take part in the review and that they now wished to take the Committee’s recommendations forward in partnership with the Local Authority and the PCT.

·        Concern was expressed that funding was not to continue for community outreach workers through  Ward Committees.

Following further discussion the Chair thanked all the individuals and partners who had attended meetings and participated in the review for their support.

RESOLVED:    (i) That the final draft report including the following recommendations as amended be agreed: ^1.

1.That the York Hospital Trust, in liaison with other appropriate service providers* be urged to develop and implement the Psychiatric Liaison Service (Annex A). The development of this programme to be a benchmark for training and support for staff working with dementia patients who access secondary care.

*The Yorkshire Ambulance Service is to be included amongst the service providers, whilst acknowledging the unique nature of their role.

REASON:To enable the development of the Psychiatric Liaison Service to progress.

2.That all service providers be urged to review their arrangements for staff training in relation to recognising and working with those with an underlying condition of dementia. Any such review should include:

oPromoting the use of Link nurses and investigating the possibility of nominating Link clinicians within defined staffing groups.

oInvestigation of the large gaps in training.

o The utilisation of the variety of sources for training provision including the Alzheimer’s Society and other voluntary sector organisations.

o Investigation into the pooling of resources between service providers.

REASON:To ensure that all staff are adequately trained to care for the needs of dementia patients accessing secondary care.

3.That secondary care provider clinicians be urged to acknowledge the positive contributions that can be made by a patient’s carer to that patient’s ongoing programme of treatment (whilst recognising the issues surrounding patient confidentiality). Clinicians are also urged to take the following into consideration:

oWhere it is recognised that there may be an underlying mental health condition to provide written details of any medication and/or treatment plans to the patient.

oThe issue of carers’ information being logged on a patient’s notes to be encouraged as good practice and an ongoing dialogue between medical practices and the York Carer’s Forum to be maintained to allow for effective databases to be kept.

REASON:To ensure that carers are involved as much as possible whilst still recognising the need for patient confidentiality.

4. 

a.     That all service providers be urged to work with the relevant voluntary organisations (Alzheimer’s Society, MIND, Age Concern, Older People’s Assembly etc) to develop new initiatives and to promote the awareness of dementia. This to include the preparation of an information leaflet aimed at families/carers detailing hospital procedures and contact staff.

b.     That commissioner and service providers discuss the ‘This is Me’ initiative further with the Alzheimer’s Society with a view to adopting it within their individual organisations. The Committee wished it to be known that they were very impressed with this particular initiative.

REASON:To promote and increase dementia awareness and to encourage positive initiatives to be widely and effectively used.

5.That York Hospitals Trust, where possible, be urged to adopt a flexible approach during a dementia patient’s stay in hospital, for example flexibility in hospital visiting hours and flexibility at mealtimes to allow carers to assist patients with eating.

REASON: To involve carers during a patient’s stay in hospital to assist them in settling into an unfamiliar environment.

6.That all relevant parties be urged to resolve the ongoing issues surrounding the implementation of a universal ‘Shared Care Record System’ (Annex C refers).

REASON:To resolve ongoing issues.

7.     That a six month progress report be compiled in conjunction with the Local Authority, PCT, York Hospital Trust and the Ambulance Trust. 

REASON:   To update the Scrutiny Committee on progress made in relation to their recommendations.

(ii)               That the preamble to paragraph 6 (Evidence received from carers) be amended to read “Information was received from several relatives and carers and although this evidence reflected both positive and negative experiences inevitably the report has had to focus on the areas where it was felt attention was required”. 

REASON:   To ensure that the final report gives a fair reflection of the evidence received.

(iii)             That the following documents be included as evidence in the final report:

·        Extract from the NHS ‘Essence of Care” document.

·        This is Me’ leaflet prepared by the Alzheimer’s Society.

REASON:            To support the Dementia Review final report.