Agenda item

27.1     The Committee considered a report by the Assistant Chief Executive to provide an update on a) plans to reconfigure East Sussex dementia assessment beds; and b) on recent performance and new developments in diagnosis.

27.2     Martin Packwood, Head of Joint Commissioning (Mental Health), East Sussex County Council; and Dr Mokhtar Isaac, Clinical Director East Sussex, Sussex Partnership NHS Foundation Trust (SPFT); provided the following responses to the Committee’s questions about the dementia assessment bed reconfiguration plans:

·         The reason for the delay in the implementation of the reconfiguration of dementia assessment beds is that the project has had to pause twice in order to build a stronger consensus between stakeholders. In the long term, the project has to command the confidence clinically of SPFT and the CCGs.

·         The first pause was made in order to carry out clinical engagement with SPFT to ensure that the Trust was absolutely content with the proposed numbers of beds, and the proposed levels of reinvestment in community services that would be made using the savings generated through the closure of existing bed capacity.

·         The second delay was due to decision to engage with partners – such as Healthwatch and Care for the Carers – to ensure that the proposed site – St Gabriel’s Ward at Conquest Hospital – was the most inclusive and appropriate site for the long term inpatient dementia care. 

·         The reason that it will take two years to implement the reconfiguration is that the St. Gabriel ward will be refurbished into a purpose built dementia intensive care unit. This will be, effectively, a new build that will require significant capital planning and expenditure.

·         Significant interim refurbishment of the Beechwood Unit in Uckfield has been undertaken to ensure that it is safe and effective enough to deliver services whilst the St. Gabriel Ward is redeveloped.

27.3     Martin Packwood, and Kim Grosvenor, Dementia Programme Lead, HWLH CCG; provided a presentation on the Memory Assessment Services in East Sussex. They provided the following information in response to questions:

Golden Ticket

·         Golden Ticket is a new model of care being piloted in the HWLH CCG area. The Golden Ticket pilot included 40 patients living in their own homes with their carers. However, the principals of the Golden Ticket – to support dementia patients throughout the dementia journey – will also apply to patients in nursing and residential homes. In addition, some of the interventions for the 40 pilot patients have been delivered to nursing homes in the Buxted area; and the CCG is working with the Care Home In-reach Team and the GPs who do home visits to care and nursing homes to raise awareness of the Golden Ticket programme.

·         At the start of the Golden Ticket pilot, each of the 40 patients and their carer was visited in their own home by a GP to explain the purpose of the project and the organisations involved in delivering it. All patients had to sign a document to say that they were happy to be visited and that their information would be shared with the list of providers involved in the Golden Ticket pilot.

·         The reason why health and social care professionals visited patients in their capacity as part of the ‘Golden Ticket team’ – and not in the capacity as an employee of the organisation they were employed by – was in response to patient and carer feedback that said the complexity of being visited by a multitude of different people and having to tell their story more than once was an inconvenience that they wanted to see eradicated in the future. The health visitor would still introduce themselves and their role and reason for being there; and the system is being robustly monitored.

·         There will be an intensive evaluation of the Golden Ticket pilot from December 2015 to March 2016, and the full business case will go to the HWLH CCG Governing Body in April or May 2016. The full business case will include a plan for the roll-out of the Golden Ticket programme in two phases. The first phase will probably involve the roll out of the Golden Ticket to specialist GPs within the ‘communities of practice’ areas of the High Weald Lewes Havens area who can help advise other GPs. The model will be refined over next few months, but the first phase is expected to be rolled out by September 2016 and the second phase – to the wider GP community – by March 2017.

·         HWLH CCG is committed to continue providing the same level of support to the 40 patients and their carers beyond the end of the pilot – including some of the community aspects of care that they are receiving.

·         The voluntary sector organisations working with the CCGs as part of the Golden Ticket are equal partners with shared responsibility and have been set up with NHS email accounts so that information can be shared securely. The voluntary sector staff are located in the practice where the programme is being piloted acting as an ‘eyes and ears’ of the community.

Integrated Community Care Ltd

·         Integrated Community Care Ltd (ICC) is a GP-led service for diagnosing dementia in the rest of East Sussex. Guidance for diagnosing dementia had previously recommended only secondary care older people healthcare specialists, geriatricians, and neurologists should diagnose dementia. However, whilst the ICC was in the pilot phase, the HR CCG and Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG) commissioned the development of a national diploma in dementia diagnosis that the five GPs who now run the ICC all completed. There are now 14 GPs who have achieved the diploma, as well as nurses and pharmacists, and there are more applicants on the way.

·         The HR CCG and EHS CCG have commissioned for the past three years a Care Home In-reach Service from SPFT comprising specialised psychiatric nurses for dementia and a psychiatric staff grade doctor. The service goes in to care homes to disseminate good practice, increase awareness, train staff, and help to develop individual care packages for particularly challenging clients.

27.4     The Committee RESOLVED to that it had considered and commented on the report, its appendices, and the presentation.