Agenda item

To consider the following items in relation to dementia:

• Building Based Services – report of the Strategic Director People;
• National Dementia Strategy, response of Cheshire East to the Strategy – presentation;
• Assistive Technology – report of the Strategic Director People;
• Carers Issues;
• Admiral Nurses

The Committee considered various items relating to dealing with dementia:

      The Council’s response to the National Dementia Strategy – Jill Greenwood, Service Manager (Dementia) briefed on dementia - dementia caused a progressive decline in many areas of function including skills needed to carry out daily activities.   As well as emotional impact, the financial cost was estimated at over £50 billion a year in the next 30 years.  In 2009 in Cheshire East the total number of people aged 65 and over was 68,000 and of these 4810 were predicted to have dementia (of which 3153 were female).  This figure was expected to grow by 88 % by 2030.  The predominant users of Adult Social Care were people with mental health needs and home care was the largest component of community services provided for the over 65s.  The Care Service Efficiency Delivery (CSED) programme was aimed at providing a fully integrated pathway.  An audit of current services and how needs were met had been undertaken and current work was looking at future demographic need, any gaps in service delivery and joint working possibilities.  Workshops on the programme had been held and well attended.  Gaps in service included – crisis response/home treatment – 24 hour service, intermediate care (step up and step down service), lack of awareness/stigma, enhanced support for carers and clients.  A draft strategy with options and resource implications would be produced for consultation prior to adoption and implementation of the final strategy. 

      Alongside the development of the new strategy other work was             underway including - to develop staff to undertake new and different      roles, provision of a new dementia unit at Lincoln House, Crewe (to       include a first stop shop including advice and information and a carers            café), introduction of a dementia website for Cheshire East    (Demenshare) to be launched on 5 July 2010. The Demenshare project      was a partnership involving the Council, Age Concern Cheshire,           Alzheimers Society, the Primary Care Trust and Opportunity Links and           was an online resource that would enable people affected by dementia      across Cheshire East to share and exchange their experience and       knowledge.

      Sandra Shorter, Manager of Provision of Adult Social Care, briefed on the role of Community Support Centres in Transforming Adult Social Care - she explained the distribution and usage of the current beds at the Centres including vacancy rates.  The in-house provider service had been renamed Care4CE (Careforce) and had three strategic priorities – reablement, complex needs and market cover.  The existing service was to be transformed to meet these priorities.  This would require having buildings that were fit for purpose, flexible well trained staff and viable cost effective services.  The current position was tired and out of date buildings, lean staff structures, under-occupancy at the Centres and high unit costs.  A short term solution was to reduce spare capacity and increase cost effectiveness by rationalising a number of centres – by integrating the services of both Santune House and Lincoln House at Lincoln House (and thereby closing Santune House) and closing a second centre; investing in a purpose built dementia unit, enhanced staffing at remaining centres and more integrated working between Centre and community based staff.  The Cabinet had approved a recommendation to undertake an exercise seeking views on the closure of provision at Cypress House.  There were a number of reasons for this proposal including feedback from the previous consultation, the experience of upgrading old buildings, existing partnership arrangements with the health service, size of service and availability of alternative provision including Extra Care Housing, day services and bed provision. 

      The Committee considered the report to the Cabinet on the Dementia Strategy.  The report outlined that the strategy was to focus on the service to be delivered rather than actual buildings.  The aim was to provide services in a different way not to reduce the services available.  Part of the strategy was to close those Community Support Centres that were particularly problematic and located very close to another such Centre or significant facility such as extra care housing and to recycle the resources, subject to a robust business case, into the development of new services particularly for older people with dementia.  The future service model currently proposed involved:

      - Two main specialist centres for dementia – one each in the north and              south of the Borough;

      - Two main specialist centres for Adults with severe and complex

        conditions – one each in the north and south of the Borough;

      - New facilities to provide both short stay residential and nursing care in

        seamless, integrated and co-located services between the Council      and PCT;

      - Investment in Assistive Technology to enable people to stay in their     own homes for longer, funded from existing resources;

      - Investment and acknowledgement for carers and respite, funded from             existing resources;

      - Maximising use of underutilised external provision;

      - Maximising use of Extra Care Housing developments in the Borough.

      The report outlined existing provision in Community Support Centres   and usage which over all five centres showed an average vacancy rate        of 21%.    This had resulted in the proposed closure of Cypress House   as an initial response prior to further work to develop the future service            model as outlined above.

      Jon Wilkie, Project Manager, Assistive Technology, briefed on a proposal to introduce an Adult Social Care wide strategy to support the integration of assistive technology into support planning for vulnerable people.  Assistive Technology was defined as “any item used to increase, maintain or improve the functional capabilities of individuals with cognitive, physical or communication disabilities”.  Assistive Technology could help with prevention by raising the level at which people needed social care.  It could also help with reablement by supporting effective assessment and prevent unnecessary admissions to care placements.  It could help support people to regain skills which could help them remain in their own homes for as long as possible and increase their independence.  This was what most people wanted and was less costly than admission into permanent care.

     Various examples of the technological solutions available were

     reported to the Committee along with information leaflets and

     case studies.

      Councillor Beard provided a brief summary of the role of Admiral Nurses.  The organisation had been in existence for 20 years and provided specialist Dementia Nurses.  Many people with dementia were cared for most of the time by family who were unpaid and often suffered with depression.  It was suggested that a presentation on Admiral Nurses could be made to a future meeting.

            Members, in discussing the presentation, raised the following points:

      Whether savings proposed as part of the budget could be achieved;

      Whether there would be sufficient social workers to carry out assessments in future;

      Whether closure of facilities would mean that people would spend a lot of time travelling.  In response, the Committee was advised that people tended to want to remain in their own homes and access existing facilities in their own communities;

      When in-patient care was required whether there would be sufficient capacity. In response, the Committee was advised that in severe cases of dementia, nursing care would be required.

RESOLVED:  That

(a)  the presentations and information on dementia and dementia services be received and noted;

(b)  the specific proposals outlined at the meeting as part of the Council’s dementia strategy be supported;

(c)   a presentation be made to the next meeting of the Committee on Admiral Nurses and the role of Admiral Nurses also be referred to the Cheshire and Wirral Partnership NHS Foundation Trust for information and advice;

(d)  the role and support to Carers be considered further at a future meeting; and

(e)  information on how the budget savings could be achieved be circulated in writing to the Committee members.