Annual Showcase

June 19th 2019

Duke of Edinburgh

Student volunteering project

Lucy - Whitecross School, Year 9.

https://youtu.be/rZFo7-N0W-U

Welcome & Introductions

Ewen Archibald - Head of Community

Commissioning and Resources Adults

and Communities Herefordshire

Council

Working with communities

Highlights from 2018-19

Results of Voting for our

priorities in 2019-20

0 50 100 150 200 250

Mental health

Prevention

Reasonable adjustments

Men's health

Oral health

Digital technology in health & social care

Votes on Healthwatch Priorities for 2019-20

236

151

52

42

29

34

Total

votes

544

Our Main Projects for 2019-20

1. Mental Health

2. Prevention & Self-Care

3. Reasonable Adjustments

4. Men’s Health

NHS Long Term Plan Engagement

Results

Why? The NHS published a 10 year plan in January 2019. Our

health & care system across Herefordshire and Worcestershire

wanted the views of the public to shape the implementation of

this plan.

What did we do? • Out of hospital local care

• Emergency services

• Specialist services

• Prevention & self-care

• Health inequalities

• Learning disability & autism services

• Mental health care for children

& young people

• Mental health care for adults

528 people responded to 8

online surveys from 15th

March – 1st June 2019

1,182 people took part in

focus groups 15th March – 3rd

June 2019

Major themes

Out of hospital local care• Ensure there is appropriate resource

and capacity in the community to deliver this model of care

• Integrated patient record systems for services

• Improve timely discharge coordination

• Increase access to the GP

Emergency services• Improve health education for self-

care• Simplify and publicise information

about the options available for urgent same day care

• Multi-disciplinary teams in community hubs

• Increase access to GP’s

Specialist services• Consider patient population and

transport options when choosing locations

• Specialists could travel to smaller hospitals for Pre and post op

• Seamless transitions between specialist centres and local aftercare

• Utilise the expert patient model

Prevention & self-care• Make support groups more attractive

and accessible• Educate families through schools• Address low level prevention of

mental ill health• Doctors should be more direct with

patients about the need to change lifestyle

Major themesMental health care for adults

• How and who defines a crisis?• Increase access. Accessible 24/7 service• Improve integrated working between

services• Clear information about where to go for

help• Place of safety available 24/7• Train all professionals in mental health

Health Inequalities• Increase free access to sports• Increase services to 24/7, increase

access to GP’s and promote what is available in alternative formats.

• Target resource in disadvantaged areas• Community work to identify groups at

risk, early intervention

Learning disability and autism services• Quick access to early diagnosis• Listen to family and carers• Reasonable adjustments in GP

surgeries• Increase awareness of these conditions

in general public• Multi agency approaches to

coordinated care and support

Mental healthcare for children & young people

• Improve waiting times for all levels of support and increase times to 24/7

• Make use of peer support models • Tackle bullying• Reduce stigma and increase resilience in

schools• Increase whole family support• Improve transition from children to

adult services

What did young people say?

What should the NHS do to help mental health

for young people?

What can schools and colleges do to help the

mental health of young people?

NHS Long Term Plan – Next Steps

Jade Brooks Director of Operations Herefordshire

Clinical Commissioning Group

The NHS Long Term Plan and the Next Steps

Find out more: www.longtermplan.nhs.uk

Background

In June 2018, the Prime Minister made a commitment that the Government would provide more funding for the NHS for each of the next five years, with an average increase of 3.4% a year.

In return, the NHS was asked to come together to develop a long term plan for the future of the service, detailing our ambitions for improvement over the next decade, and our plans to meet them over the five years of the funding settlement.

That plan has now been published.

Delivering the ambitions of the NHS Long Term Plan

To ensure that the NHS can achieve the ambitious improvements for patients, the NHS Long Term Plan also sets out actions to overcome the challenges that the NHS faces, such as staff shortages and growing demand for services, by:

1. Doing things differently

2. Preventing illness and tackling health inequalities

3. Backing our workforce

4. Making better use of data and digital technology

5. Getting the most out of taxpayers’ investment in the NHS

Clinical Priorities

In Herefordshire, we will:

• Work with our partners, e.g. Herefordshire Council, to tackle some of the most significant causes of ill health, such as help people stop smoking, overcome drinking problems and avoid Type 2 diabetes, with a particular focus on the communities and groups of people most affected by these problems.

• Speed up Cancer diagnosis to 28 days from referral to diagnosis.

• Further develop programmes of improvement in Cardiovascular disease, Cancer, Maternity, Mental Health, Stroke, Diabetes and Children and young people’s health.

Primary and Community Services

In Herefordshire, we will:

• Form five Primary Care Networks serving 30-50k people

• Actively manage population health and target support where needed.

• Develop multi-disciplinary teams in community services, offering rapid response to those that need it.

• We are working across Health and Social Care as statutory agencies to improve collaboration across local community services.

• This recognises that more people should receive earlier support to keep well and self-manage, and people should receive support to recover at times of ill-health.

Mental Health Services

In Herefordshire, we will continue:

• Grow range of mental health services and offer improved access for people

• Continue to improve dementia care

• Improve crisis care (and early intervention)

• Develop mental health support for children and young people

• Greater access to talking therapies for people with mild and moderate mental ill-health.

Acute Services

In Herefordshire, we will:

• Continue to look at ways to reduce pressures on Accident and Emergency Department

• Continue to improve Same Day Emergency Care (diagnosis and treat on the same day and discharge where appropriate to home or other place of care)

• Change how and where outpatients services are delivered

• Continue to reduce people waiting long times for treatments

Making better use of digital technology

The NHS will:

• provide more convenient access to services and health information for patients, with the new NHS App as a digital ‘front door’;

• provide better access to digital tools and patient records for staff.

• Locally, we are supporting community services to use the same system. Digital enabled care will develop from 2020. This will include GP consultation via telephone or online. Extra support to residents in care homes and advice to care home staff.

• Continue working with Herefordshire Council and community services to make the most of assistive technology to support people within their own home.

Refreshments & Networking

What impact are we having for

people?

https://youtu.be/LCWWIG3Rhes

Dementia Engagement Report

Amy Chandler – Healthwatch Engagement Officer

Outline of the Project

Main Focus

• Experience of the journey from diagnosis / What to expect

after diagnosis / Experience across the whole pathway and

living with the condition

Additional Focus Point

• The public’s general awareness of dementia / raising

awareness and reducing stigma / Barriers to people

seeking help with onset of memory issues and considering

diagnosis

Additional Focus Point

• People with a learning disability who have dementia

Findings

• Overall – generally positive comments

• Support following diagnosis

• Respite

• Carers

• Social care

Challenges with Engagement

• Some people living with advanced dementia aren’t

able to comment about their experience, so we relied

on family members or carers. Family members are

harder to reach if people living with dementia are in a

care home.

• The condition is still a difficult subject to talk about

• Accessing people who don’t want to access support

groups

• There doesn’t appear to be a simple leaflet or

communication which can highlight the benefits to an

early diagnosis to the public

Recommendations

• A single point of contact

• Varied methods of trusted information for families/carers

• Campaign to highlight benefits of an early diagnosis

• Easy information on planning for RESPECT care (Lasting Power of

Attorney, social care funding / CHC)

• Expanding on Dementia friendly communities (Hairdressers,

shops, banks etc)

• Increase in Meeting Centre models in areas such as Bromyard,

Ledbury & Hereford

• Support with form filling /education sessions for carers

• Thinking about respite in alternative ways

Herefordshire and Worcestershire’s Living Well with Dementia Strategy 2019-2024 Update

Healthwatch June 19th 2019

Presented by

Jacinta Meighan-Davies

Clinical Programme Manager

Herefordshire CCG

Jacinta.meighan-davies@herefordshireccg.nhs.uk

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Links to further information about the different types of dementia are provided at the end.

‘Dementia describes a set of symptoms that include loss of concentration and memory problems,

mood and behaviour changes and problems with communicating and reasoning. These symptoms

occur when the brain is damaged by certain diseases, such as Alzheimer’s disease, a series of small

strokes or other neurological conditions such as Parkinson’s disease’ ‘Prime Minister’s Challenge

on Dementia 2020’ Prime Minister’s Challenge on Dementia 2020

Dementia is most common in people over the age of 65 but there are also a smaller cohort of

people who develop ‘young onset’ or ‘working age’ dementia from as young as 35.

For most people the cause is unknown but there are some known causes or risk

factors such as:

• Diseases and infections that affect the brain e.g. Alzheimer’s disease or meningitis

• Pressure on the brain e.g. brain tumour

• Lack of blood and oxygen supply to the brain e.g. stroke and head injuries

• Cardiovascular insufficiencies.

There is clear evidence that the earlier into the disease that dementia is

diagnosed the better the outcomes for those with the illness and their

informal carers, it will help with decision making and preparing the

individual and their family for choices they will need to make in the

future.

2. What is dementia?

In Herefordshire and Worcestershire 1 in every 15 of population over 65 years have

dementia 62% female: 38% male

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• There are currently

12,456 people living with dementia across

Herefordshire and Worcestershire (this

number is set to increase to 18.669 by 2035).

• 592 of these people have early onset dementia.

It is estimated that there are

84,985 carers across H&W .

187,878 Herefordshire population

3,116 thought to have dementia

2966 are over 65 years

150 young onset

April 2019, 58.85% of the over 65 years had a confirmed

diagnosis of dementia

Strategy Development - The journey so far….

• Previous strategies Herefordshire & Worcestershire• NHSE Reviews 2017/18 • Dementia Diagnosis National Ambition • Dementia Needs Assessment• *Engagement survey (over 90 responses)• *Engagement workshop (80 attended)• Healthwatch engagement and feedback• Carers Support• Policy and wider strategy • Endorsed by STP and HWB Boards • *Follow up Workshop to support action prioritisation ( 57 attended)• Education Event May 14th ( 105 attended) resulted in pledges from attendees

Included people with dementia, their carer’s, members of the public, volunteers, professionals and organisations involved in research, education and the care and

support for people affected by dementia

Ensuring there have been no missed opportunities for feedback32

Early diagnosis and access to support for those living with dementia and their carers remains a priority for

Herefordshire and Worcestershire. Our Strategy sets out our ambition to support people to live well with

dementia.

It reflects the national strategic direction outlined in The Prime Minister’s Challenge on Dementia which

details ambitious reforms to be achieved by 2020.

The Strategy is informed by what people have told us about their experiences either as a person living with

dementia or as a carer and is written for those people; specifically those with memory concerns, those with a

dementia diagnosis, their families and carers, communities and organisations supporting them.

Herefordshire and Worcestershire Dementia Strategy 2019-2024

Our vision is that in Herefordshire and Worcestershire people affected by dementia can live well through the

following guiding principles:

Our new strategy focuses on people and patients so that every person with dementia, their carers

and families have access to and receive compassionate care and support not only during

diagnosis but after diagnosis and through to end of life.

Preventing

Well

Diagnosing

Well

Supporting

Well

Living

WellDying

Well

This strategy has been guided by principles developed by NHS England in their transformation

framework. This ‘Well Pathway for Dementia’ is based on NICE guidelines, the Organisation for

Economic Co-operation and Development framework for Dementia and the Dementia

I-statements from The National Dementia Declaration.

3. Vision, guiding principles and aim is dementia?

Person attending a Memory Morning Drop In “It was a friendly setting where I was able to talk freely about my concerns without family members talking for me.”

Person with LD and dementia “I do like the signs and I want to put my photo on my bedroom door.”

“Having support from a DA has reduced my anxiety and made me feel that I am not so dreadfully alone”

“People really like the meeting centre as it runs for a good amount of time. For one gentleman, it gave his wife (carer) a break and he wishes there was more things like it where he could go on other days of the week.” Family carer of person with LD

“There is a definite change where my learning disabled daughter lives. I observe the person who has learning disability and dementia now listening to music through headphones, and the environment is dementia friendly. The rugs and patterns are all gone; the carers have really embraced the learning. The impact on other people who have a learning disability who live there is that they are more relaxed. They have stopped telling her to be quiet.”

“memory clinic referral went smoothly along with appointment was an overview of what to expect .. experience was good, ongoing support excellent we have a remarkable CDN”

“Thank you so much for all the help you have given over the years. We would have been lost without you.“ “'As always your support and

advice is very much appreciated. You are such a help for people like us as individuals, and for the community as a whole”

Local Picture: What people have told us

Local Picture - what could be better?

Don’t forget that those with a diagnosis of dementia may have other health issues , pathways must accommodate this as risk of overshadowing can occur without proper integration

We need to keep talking about dementia and all risk factors associated with it … Knowledge is Power

( Carer) “Professionals need to understand dementia can make people intolerant of waiting; noisy places but few have taken this on board”

“Hard to find affordable, short-term, ad hoc respite – mother is settled at home and it would be better if someone could come to the home even if it was just for a few hours.” -Family member

Reach out to communities to address their negative attitudes towards living next door to someone with dementia & how they can support them – its not all about the staff/professionals. We all have a role to play in addressing stigma

Dementia can be a very lonely place, encourage open discussion and easier access to help available so that people are not scared of diagnosis and feel confident to make the necessary adjustments to live well

“We need more drops-ins”. Lots of groups in the area but not enough coordination between them, for example, everything seems to happen at the same time/day.

Support staff to develop knowledge skills and confidence in advanced care planning at an appropriate time for the person and their carer, and managing end of life when the time comes

You will need to train your workforce to attune to the needs of younger, physically fitter people being diagnosed with dementia. How will they wish to be supported by you? People will expect to stay active, working and engaged in their community

Dementia Healthcare in Herefordshire

• March 2019

Healthwatch Herefordshire dementia engagement work has helped to:

• Build further awareness and created opportunities to talk about dementia and listen to local communities

• Inform us about local experiences

• Provide greater understanding about the practical day to day support people say is most important to them

• Validate feedback and experiences

• Confirm priorities for action within each of the well pathway areas

• Ensure we maintain a county focus on local challenges

• Confirm we have a good platform for the future

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Well Pathway Delivery Plans

39

Preventing

Well

Diagnosing

Well

Supporting

Well

Living

WellDying

Well

Stakeholders have identified Top 3 priorities in each of the well pathway stagesaddressing stigma and fear; workforce development; information for all; carers support and advanced care planning

Healthwatch Herefordshire Recommendations

• Campaign to promote prevention messages (Preventing Well)

and the benefits of an early diagnosis Diagnosing Well

• A single point of contact Diagnosing Well , Supporting Well

• Varied methods of trusted information for families/carers Living

Well, Supporting Well

• Information: advanced care planning; RESPECT (Lasting Power

of Attorney, social care funding / CHC) Living Well, Supporting Well

and Dying Well

Healthwatch Herefordshire Recommendations

41

• Increase access to Meeting Centre (Bromyard, Ledbury &

Hereford) Living Well, Supporting Well

• Support with form filling /education sessions for carers Living

Well, Supporting Well

• Thinking about respite in alternative ways Supporting Well

• Expanding on Dementia friendly communities (Hairdressers,

shops, banks etc.) Living Well, Supporting Well

9. H&W Dementia Strategy Delivery Plan 2019 – 2024 P

reve

nti

on

Dia

gno

sin

g

Sup

po

rtin

g

Livi

ng

Dyi

ng High Level Actions

Outcomes

X x x x Ensure lifestyle interventions (e.g. MECC, NHS Health

Checks, workplace initiatives) and communication

campaigns maximise the opportunity to reduce risk factors

and raise the prevention message around dementia (e.g.

using Public Health Dementia Risk Reduction Toolkit

messages

A campaign to highlight the benefits of an early

diagnosis and advice on prevention – to get more

people to seek help if they notice symptoms so

that support can be put in place

X X X X

Ensure carer support is tailored to their needs Consider ReSPECT ToolAssess usage and need for respite bedsEnsure commissioned carer support services are evidence based and service monitoring captures delivered activity.

Explore opportunities to deliver respite in alternative ways, such as

people going into homes to sit with people with dementia to give carer’s

regular short breaks to avoid reaching a crisis poin

Carers participate and discuss contingency and ACP planning and completion of (ReSPECT forms ReSPECT Tool )

Carers have access to information, advice and support to assist

them in their caring role, enabling them to look after their own

health and wellbeing, including support with form filling and

education sessions for carers

X X Continue to create responsive community services which promote reablement and effectively manage crises for people affected with dementia either at home or in a care home Review and implement Enhanced Health in Care Homes Vanguard Learning Guide

Neighbourhood and Locality teams have access to Hospital avoidance service (out-reach support)Specialist advice and support when managing a crisisGood Quality flexible home care services available to help dementia patients maintain independence and reduce social isolationA network of support for care homes facilitates advanced dementia care planning including palliative care and End of Life careNon-clinical community support is key to enabling people to remain at home within their communities. Wide promotion of the Dementia Wellbeing Service and easy access through the Wellbeing Hub.

Continue to support Meeting Centre models in areas across the county

Wider benefits of Healthwatch feedback

• Discussed with colleagues: implications for wider policy and strategy: public health; adult social care; Community Hubs; Housing; frailty; Aging well strategy; palliative care; End of Life; urgent care & advance care planning

• Dementia Programme Board and Partnership

• Admiral Nurses

• Care Home Support Teams; Specialist Mental Health team

43

Continue to work together to reach, involve and support people affected by dementia

• Recommended Summary Plan for Emergency Care & Treatment (ReSPECT)

Copy from GP

• www.respectprocess.org.uk

• Advanced Care Planning

• NHS Continuing Healthcare and NHS Funded nursing care

44

Dementia Strategy Key Messages

• Focus on prevention – greater emphasis onprimary prevention of dementia

• Continue to build dementia-friendlycommunities in collaboration with keypartners in localities and neighbourhoods

• Identify passionate multi-agency leadersand champions who will work together tosupport delivery of this strategy withinlocality and neighbourhood teams

• Support the expansion of the MeetingCentre Model which nurtures communitypartnership to support access to user-leddementia friendly community facilities

45

Dementia Strategy Key Messages• Endorse and support the Dementia Action

Alliance movement to address stigma and fearand create dementia friendly communities &environments

• Recognise, value and support carers enablingthem to do their role

• Build on identification and diagnosis –including underrepresented groups

• Develop and implement Advance CarePlanning to inform palliative care needs andimprove dementia end of life care andsupport in the community

• Awareness; Information, Education, Trainingfor All to achieve informed, caring andcompassionate communities

46

Dementia Friendly Herefordshire and Worcestershire

The well-being and

quality of life for every

person affected by

dementia to be

uppermost in the minds

of all health and social

care professionals

•

Next steps Partners have contributed to shaping the strategy further ready for a launch late summerPartners align final strategy with their local priorities and take through their governance processes Partners to sign up to pledges to take actions forward over next 5 years.

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Dementia in Herefordshire

Questions?

Question & Answer Session

Thank you!