Wednesday 5th June 2013
Purpose of meeting: To co-ordinate the implementation of the older people’s mental health and dementia joint commissioning intentions / service model.
Chair: Dr. Aryan Lawe
Present:Alison Kirby,Nicola Gower, Dr Andrew Crombie, Dr.SreeMohana-Murthy, John Chalmers, Bernie Kennedy, Jo McilMurray, Donna Johnson, Graeme Markwell, Gill Thompson, Maggie Conway, and Lena Coupland
Apologies: Dr Jeremy Isaacs, Lucie Waters, Graeme Markwell and Louise Briggs. EglionnaTreanor (received after meeting)
1. / Introductions and apologies / Action2. / Matters Arising
Minutes from last meeting (Wednesday 6thFebruary 2013)were agreed as accurate.
Items not already covered by the agenda were discussed in matters arising.
Rolled over from Sept 12 – Community Development Worker – progress report. NG will provide an update at the next CRG
Social Care restructure- Kerry Stevens is linking in with the MH Trust, the first phase of re-locating the social care team from Springfield happened 2 weeks ago, with the new structure planned to be operational from Dec 13. No operational issues so far have been raised with the interim arrangement. NG flagged that the restructure plans to a wider Access Team is the change that will need to be focused on to ensure protocols are in place between OA CMHT and social care. Annabel Parker to be invited on to the CRG to give progress reports on this change.
AK gave an update on the Health & Wellbeing Strategy and stressed that two actions have been highlighted within this strategy, the implementation of MAS and production of the dementia guide.
LC attended on behalf of GM and updated the group on the Public Health dementia report which has now been formally approved and can be widely circulated. Copies were circulated in advance of this meeting. With regard to the OA CMHT functional needs analysis there has been information governance issue with retrieving the performance data from EMIS to inform this report. / NG
GT
3. / Performance & Delivery
Local & National Dementia Target
AK gave the background to the national dementia target and its application locally. Originally the national target for diagnosis rate had been set by Wandsworth at 51%, however, the rate achieved as of March 2013 was 49%, it was therefore decided locally to set a more challenging stretch target of 55% for 2013-14. BK asked if all Practices recorded dementia codes the same? AL responded that EMIS uses free text and picks up key words that reflect any diagnosis of dementia, many of which are recorded/audited through the dementia register. BK also raised her surprise at the continued and inappropriate use, particularly in some forms of communication of the term senile dementia and wanted to know who is coding as senile? CRG agreed that this term was not acceptable and would seek ways to ensure this stops. AL updated the group that coding could be more accurate in primary care and could be achieved through targeted education and gave an example from NHS London of an audit clean-up which if put into practice locally could be a fairly straightforward initiative that would immediately assist in increasing the local diagnosis rate. SMM outlined the current process -RiO is coded to GP surgery and copy sent to each GP Practice. NG stated that the MH Trust Performance Team could put a request into IT to perform a retrospective search query to generate a list of people diagnosed with dementia by each Practice to be cross checked. AL met with Anna Trela(Clinical Information Facilitator) for this audit exercise and it was agreed that she be contacted again to establish the resource and permission requirements to undertake this task.
AK updated on the setting of the local target for dementia which needed to be linked to the WCCG Operating Plan for 13-14, of which, dementia is a high priority. The local target has been set as:
75% of people diagnosed with dementia in the MAS from September 13-14 whose individual needs are assessed and whose care plan states how these needs will be met.
Numerator – Number of people with an assessment of individual needs and a care plan addressing identified needs
Denominator – Number of people diagnosed with dementia in 13-14 (by MAS)
AK concluded that dementia is high profile with the WCCG, which is positive but that will need to be an increase in reporting. WCCG have established a Delivery Board in which all investments made for 13-14 have to regularly report their set of performance metrics. In addition, dementia is to be reported to the WCCG Board in September and to Management Team in August (MAS progress report) and again 3 months after MAS commencement date.
West Wandsworth Clinical Cabinet (WWCC):
NG and Jane Farrell reported to WWCC in March 2013 on a number of issues raised in November 2012. Feedback was improvements had been made in some areas and request that the MH Trust report back to WWCC in July on progress on outstanding actions and the results of an audit the MH Trust agreed to conduct in May 2013 / NG
GT
4. / Service Developments
Memory Assessment Service
GT updated the group on the background and actions taken place since the last CRG. In summary, MAS pilot has been agreed for 2 years with MH Trust as Provider. Additional investments have been made and will be monitored by the WCCG Delivery Board. GT took the group through the pathway. SMM raised that the Recovery College were offering a programme which appeared to be the same as the proposed 4 week psycho-education programme being designed for MAS. NG offered to find out the details on this programme and feedback to GT/AK to make changes in pathway if appropriate. DJ updated the group that in Sutton there had been a trial of Life After Diagnosis (LAD), which runs the same time and day as CrISP programme (which has just been commissioned in Wandsworth). DJ to find out the details and update AK.
BK raised concern about people accessing and being diagnosed through MAS with co-morbidities, as these were generally high within the 75+ population and didn’t feel this had been represented within the MAS pathway. AL outlined that one of the services that has and will be working closely via the development of a joint protocol with MAS is Senior Health Medicine. BK asked about people who were not currently under Consultant caseloads, there needs to consideration of the big picture and its application. AK responded that there would be another layer under this high level pathway which would have more detail and this is a pilot and may bring out aspects that have not been previously considered. BK to submit feedback on this point to AK/GT for consideration during MAS implementation.
SMM also stressed the application of co-mental health diagnosis which needs to be also fed into the implementation process.
AL agreed with the points being made on co-morbidities and dementia and awareness of diagnosis across all professional but at this moment in time there wasn’t the facility to send letters to every service the person has come into contact with to update. BK suggested that following diagnosis an alert could be placed on RiO as most healthcare professionals access this system. This is to be explored by Implementation team. Another suggestion was to pass a list on to a regular basis to MDT, but the information governance was unclear on this proposal. NG to look into this as a possibility and update AK/GT.
GT concluded that there would be 5 sub-groups to the implementation of MAS, operational, HR/recruitment, communication, infrastructure and estates, which have set tasks to deliver to ensure MAS goes live from September 2013.
Distressed Reactions (DR) Service Pilot
AK gave the background to the DR pilot to be set up in 3 care homes and that the previous Psychology Lead had left the Trust in January 2013 hence the lack of movement on this workstream. Clinical Psychologist has been appointed at Band 8a and is to start in July and will pick up the DR pilot as part of their core work. AK stressed that this pilot is the second highest priority for the CRG and as such has secured additional investment for additional resources/MDT input into the pilot, which is to be discussed at a meeting on 12/6. AK outlined that the investment could be used to extend the scope to include specialist MH day centres, as the OACMHT specification covers the formalising of provision to these centres but a need has been identified to support day centres to manage and provide strategies/interventions fordistressed reactions. Progress to be given at next CRG
AL raised the needs of carers within this pilot and AC agreed this was a key area. A discussion was held on the different set of support needs for carers both in and out of care homes. AL also stated that Practices now keep a carers register and are actively performing health checks as standard for carers. BigWhiteWall organisation was raised which is an online facility offering psychology interventions for mild anxiety/depression in which Wandsworth have just been re-commissioned to provide a number of referrals to this service. It was agreed to explore if this is a valuable additional intervention to be offered as part of MAS pathway. It was agreed that the pilot needs to reflect both support for carers and the opportunity to up skill carers to deal with behaviour and coping strategies to manage distressed reactions on an individual basis as well as the provision of generic information.
JC raised that there needed to be more focus on skills and training requirements for paid home carers and this needs addressing. Discussion on a time limited intervention with OT assistance. This is to be scoped as a consideration for dementia strategy funding.
AC added that there needs to be closer working with CSW and needs to be part of the new Psychologists remit.
Speech & Language Therapy Pilot
JM gave both the background and findings of the pilot carried out at Ashmead and Heritage care homes by 2 WTE S<s to the Group as recorded in the executive summary tabled in advance of the meeting. Key points were that the focus was on swallowing as opposed to communication due to resource implications and the higher risks involved with people with swallowing difficulties, lack of knowledge about S<s (no previous service for people diagnosed with dementia) and support needs of staff in care homes. JM added that it had been difficult within the pilot to measure the financial benefits. AK added funding has been approved to re-focus the pilot on high risk patients in care homes and extend to include people requiring S< within their own homes, which will start to measure the impact on reducing acute admissions. JM stated that positive feedback had been received from carers at home about having information and strategies through this pilot.
BK highlighted the links with the Access to wellbeing findings. JM raised the number of people referred for swallowing difficulties who required input from OT and Physiotherapists. AK responded that Public Health lead is undertaking a Care Home needs assessment which is exploring these needs. JC added that care homes and support/ intervention requirements need to bespoke, with care homes being looked at individually to address the differences in needs at each. JC recommended that JM attend the next Care Home Provider Forum and present the pilot findings and the plans for the extended pilot to the forum. Update to be provide at next CRG.
JM raised that within the findings there was a clear need to work closely with Pharmacy. AL asked how home referral were made? JM responded these had not been advertised during the pilot due to capacity but the extension should have a broader referral criteria than the initial pilot. AL outlined the obvious financial incentives for care homes through the identification of cheaper fluids and these levers should be used to increase buy-in from care homes. BK asked if there was a model in place for Care Homes that outlined the must and should do, which are monitored and make the care homes more accountable for their practices? JC outlined the use of service reviews and CQC in monitoring practices, but agreed that there needed to be a home by home approach to this. MC added that social workers not always best placed to access environmental issues and that an OT would be better placed to carry out in care homes. JC agreed, again stressing the need for individual care home profiles to inform environmental needs/actions and change sin practices.
Day Services
This item had been partially covered under the distressed reactions discussion. AK stated that the formalising of the core functions and tasks to be performed by OA CMHT are being incorporated into this specification. In addition, JC asked if the situation still remained that people are not being supported appropriately within day centres and explained the resource allocation system (RAS) operating and impacting on day centre provision and attendance. JC has produced a paper and distributed to Senior Management team for action but to date has not had a response. CRG agreed to comment on this paper and support the need for change within commissioning of day centres. GT to include a section on impact of day services within the CCG Board report on dementia due in September. JC to circulate the day services paper to CRG members. / NG
DJ
BK
GT
NG
Meeting attendees to update
GT
MC/JC?
JM/JC
GT
JC
5. / CRG Community Event
AK briefed the group on the opportunity to hold a community event in conjunction with Lifetimes. CRG needs to decide on what we want to engage the community and voluntary sector on as the criteria for this event is at least 50% of attendees will be from this sector. AK/GT made a series of suggestions, in which GT will circulate to the group for comments and preferences. DJ suggested setting up a working party to plan this event and volunteered to be on the group as did BK, GT to set up. Proposed date for this event is November 2013. LC commented that the MH CRG were due to hold their event in October. GT to ask GM for details on the proposed focus of this event to avoid duplication / GT
GT
6. / St George’s Dementia Strategy Group
JI sent an email to GT to provide an update for this item. In summary, SGH didn’t achieve full compliance with the 2012/13 dementia CQUIN but did achieve partial compliance (recommending onward referral to memory clinics after discharge). Now focusing on 2013/14 CQUIN which requires ongoing screening at 90% compliance, staff training in dementia (targets being set) and implementation of carer’s questionnaire (which has been piloted). JI expressed CRG assistance in building a line of communication between JI and the commissioners in relation to discussing the CQUIN targets. AL to raise this with CQUIN Lead and at the next CRG Leads meeting / AL
7. / Alzheimer’s Society
DJ circulated a project implementation plan for commissioned services in 13-14 with list of services, milestones and timescales. In addition, a map of the borough with Alzheimer’s Society services plotted on was distributed and staff structure, CRG agreed this was a really useful document and should be circulated wider. AL asked if the map would be included in the dementia guide, but the group felt that this was a live document and would be subject to constant updating but it could be placed on the website. Agreed these tools to be used within the GP awareness sessions during MAS implementation.
DJ outlined that the Information Worker has produced a resource pack for GPs and asked AL to review the content for this audience.
Summary sheets including achievement of performance metrics for the dementia adviser and dementia support worker were distributed and discussed. The differences and access eligibility routes for these 2 posts were outlined, with the DA providing information and signposting to PWD who have just received a diagnosis and the DSW for carers and PWD who may need more in depth support or help obtaining a diagnosis. DJ highlighted an issue with lack of walk ins at Brocklebank for DA.
DJ has circulated a second draft copy of the Dementia Guide to AK/GT and JC for review and comment. Meeting to be set up with Commissioners for feedback.
DJ to send copy of supporting material to AC for onward circulation to OACMHT, to circulate electronic copies of all the reports to the group and to give JC contact details for Barbados Overseas Nursing Association. / AL
GT
DJ
Date of next meeting: To be confirmed
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