Leicester City Council

Our vision is for all people with dementia and their family carers to be able to continue to live a full, active and independent life in the community. To do this we will provide local leadership to organisations within Leicester to create an environment which is supportive of the needs of people with dementia and their family carers. We have jointly signed up to a Strategy for Dementia with our partners in Leicestershire and Rutland. A partnership approach will mean a seamless service for people with dementia and their carers, efficiencies in service delivery and the sharing of good practice. High quality services will be commissioned based on evidence of need and of what works best for those living with dementia and their family carers.

Updated:
24 August 2017
Location:
East Midlands
Sectors:
Communication, Care, Local Authorities
Local Alliances:
Leicester, Leicestershire and Rutland Dementia Action Alliance , City of Leicester Dementia Action Alliance

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

1. The National Dementia Declaration lists a number of outcomes that we are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers? 

Our vision is for all people with dementia and their family carers to be able to continue to live a full, active and independent life in the community.  To do this we will provide local leadership to organisations within Leicester to create an environment which is supportive of the needs of people with dementia and their family carers.  We have jointly signed up to a Strategy for Dementia with our partners in Leicestershire and Rutland.  A partnership approach will mean a seamless service for people with dementia and their carers, efficiencies in service delivery and the sharing of good practice.  High quality services will be commissioned based on evidence of need and of what works best for those living with dementia and their family carers. 

Success will mean that the stigma attached to dementia is decreased; that people feel empowered to seek help early; will know where to go for support and what services to expect; will have access to high quality care and support; and that professionals feel well informed.

2. What are the challenges to delivering these outcomes from the perspective of your organisation? 

Key challenges for Leicester are: 

Winning the hearts and minds of all stakeholders about what is possible for people with dementia and putting them in control of choices about how they wish to live their life. Ensuring that staff working across the City Council and its partner organisations has the appropriate skills and knowledge to enable them to serve all citizens, including those with dementia.   The impact on health and social care as a result of the savings which must be made to public sector finances. The need to maintain and improve joint working arrangements with NHS partners for commissioning and delivery, at a time when these partners are undergoing significant structural change.

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

  

2. Actions

  • Take forward four themes

    Take forward four themes each of which has been translated into work streams, each with its own action plan:

    • Early diagnosis and access to care and support services 
    • Improved experience of general hospital care and the management of physical health needs of people living with dementia 
    • Improved quality of care in residential care homes 
    • Personalisation of care and living well with dementia in the community 
    Status:
    Implementation

    2013 - Fourth Quarter Update

    In progress

    2013 - Third Quarter Update

    In progress

    2013 - Second Quarter Update

    In progress

    2013 - First Quarter Update

    New member

  • Taking forward Dementia Stategy in Leicester

    With partners we  developed and supported a Dementia Strategy 2011 – 2014 that coverered the Leicester, Leicestershire and Rutland local authority areas. In 2014 we participated in work to develop a successor to this strategy under the banner of the Better Care Together strategy and this work is ongoing.

    Status:
    Planning

    2014 - First Quarter Update

    Work is ongoing to deliver the actions from the previous LLR strategy.  A dementia lead is to be appointed to take forward the Better Care Together dementia programme.  Once the appointment is made, workstreams will be set up and and the work will move forward. 

  • Leicester City Action Plan 2016 - 2017

    Dementia is one of the biggest challenges facing our health and social care economy. Dementia affects people of all ages; however, the greatest prevalence is in older people. In Leicester, we face the future challenges of an aging population and in turn a greater number of people living with dementia. As dementia has an impact on more and more families across the city, our health and social care system will be under greater pressure, so it is important that we plan for increased demand and better support for people living with dementia and their carers.

     

    Leicester’s Joint Strategic Needs Assessment[1] reminds us that Leicester is a vibrant multi-cultural city. About 47% of Leicester residents aged 18 and over are from black and minority ethnic communities.  The majority of the Leicester black and ethnic minority population is from South Asian ethnic backgrounds.  In addition, the council estimates that the local Somali community comprises about 10,000 people.  There are between 6,000 and 8,000 migrants of working age from Poland, Portugal, Slovakia, Latvia and Lithuania, including 1,000 - 2,000 people from the Slovak Roma community.

     

    There are high levels of deprivation and health inequality in Leicester. Leicester is ranked 25th worse out of 326 local authority areas in England on the English Indices of Deprivation 2010. 41% of Leicester’s population live in the most deprived 20% of areas in England and a further 34% live in the 20-40% most deprived areas. Only 1% of Leicester’s population live in the 20% least deprived areas. This means that the numbers of people who are eligible for the council to fund their care and support will be higher than many other areas of the country. Areas of the city that have lower levels of deprivation are likely to have higher numbers of people who self fund. In addition, the number of people, particularly older people, who have multiple morbidities, including dementia, is set to rise steeply.

     

    We estimate that about 3,000 people aged over 65 in Leicester live with dementia. This is forecast to increase to about 4,500 people by 2030. It is estimated that about 30% of local people aged over 65 are from black and minority communities.  This means that about 850 people living with dementia are from black and minority ethnic backgrounds. We need to make sure that services meet the needs of these communities.

     

    With a high performing diagnosis rate of 88.4% of the predicted population, as at January 2016 there were 2,345 people with a diagnosis of dementia on GP registers with under 100 of these being adults of working age. There are about 800 new cases of dementia a year being diagnosed. We know that the needs of people with early onset dementia (under 65 years old), and with learning disabilities who develop dementia, differ radically from those of older people with dementia. We need to ensure that services meet the needs of these people. The prevalence of dementia for people with a learning disability is significantly higher than that of the general population and, with extended life expectancy, the number of people with learning disabilities who develop dementia is increasing. Again, this has important implications for how services are developed to ensure that they meet need.[2]

    Our vision is for people in Leicester is to live well with dementia. This supports the national and sub regional agenda for dementia services. The LLR Joint Dementia Strategy 2011 – 2014 identified a number of areas for improvement that have delivered more community services and increased diagnosis rates amongst other achievements. This action plan aims to build on this and together with the Better Care Together programme with Health, aims to continue to plan and implement a range of improvements.  This action plan will be updated to reflect progress on Better Care Together actions as they develop. 

     

    We will promote a better public and professional knowledge about dementia to remove the stigma that is currently associated with it, offer early diagnosis and intervention, and ensure quality accessible services that effectively meet the needs of people with dementia and their carers. People with dementia benefit from specialist care which acknowledges their need for dementia friendly design and support. Leicester would like to see the development of additional community services that can offer support to people with dementia and their carers in local areas.

     

    We are particularly interested in seeing the development of a range of local services that can support people from black and ethnic minority communities who develop a dementia, as our experience shows that these groups are much less likely to seek support from statutory services. We also recognise that support delivered by the black and ethnic minority communities themselves is the most effective intervention. We would also like to see communities become dementia friendly too, recognising that the majority of people with dementia live in the community and access universal services which need to be made dementia friendly.

    We know from work locally and nationally that if we have the right services in place in the community we could prevent some of the very distressing and expensive episodes of care that people with dementia and their carers experience. People with dementia, their carers and their families, agree with us. Even without the demographic growth predicted, we are facing reduced public funding, which makes the current levels of costs unsustainable. Large-scale transformation of the current dementia care system is therefore required so that we can live within our means. To achieve the good quality services that people with dementia and their carers need and deserve we must continue to work together with a wide range of partners –across the health, social care, voluntary and private sectors. Despite the challenges of financial pressures in today’s health and social care economy, we remain committed to developing a strategy and delivering this action plan and giving people with dementia the care and support they need to enable them to live life to the full.

     

    As a multi-agency strategy is developed across the wider partnership, Leicester City Council has drawn up this action plan to describe its strategic direction for the next 12 months. Our action plan is based on a series of nine outcomes or Quality Statements that have been identified nationally through the work done on the Prime Minister’s Challenge on Dementia. Our action plan also reflects the local CCG’s commissioning intentions 2016/17.

    [1] https://www.leicester.gov.uk/media/178814/overview-and-summary-report-jsna.pdf

    [2] http://www.poppi.org.uk/index.php

    Status:

    2016 - Second Quarter Update

    New Action

  • Quality Statement - I was diagnosed early

      What Do We Want to  Achieve? Good quality early diagnosis

    What Will We Do to Achieve   This?

    Continue   to support the LPT Memory Assessment service and identify opportunities to   work with partner agencies to identify people with dementia through screening   for example. 

    To   include an emphasis on ensuring that these interventions meet the needs of   local diverse and BAME communities and under-represented groups – including early   onset dementia and people with a learning disability

     Monitor   the current pathway and modify where appropriate with a view to achieving the   most appropriate model and capacity

     Timescale - Throughout 2016

     Partner Organisations - CCG, LPT, LCC - CMT & Commissioning, Voluntary sector

    What Have We Already  Achieved?

    LCC Dementia Care Advisors (DCA’s) are already well connected to the memory service.  Some Primary Care professionals are also aware and referring.

    Commissioning staff are linked to DMU to explore under representation in BAME communities and will assist with the planned research project.

     

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Action

  • Quality Statement - I understand so I make good decisions and provide for future decision making

    What Do We Want to Achieve?

    Easy access to care, support and advice following diagnosis

    What Will We Do to Achieve This?

    Conclude the review the Dementia Care Advisor service so that there is sufficient staff resource to offer all people with a diagnosis of dementia a named contact

     Ensure robust links to Memory café’s, peer support groups and other dementia services

     Continue to operate the Shared Care Agreement for the managements of patients with dementia.

    Timescale - throughout 2016

    Partner Organisations

    LCC - CMT & Commissioning, Voluntary Sector, Primary & Secondary Care, LPT

    What have we alaredy acheived?

    Review concluded and service operating model being reviewed to improve the pathway.

    DCA’s well connected to all community services; signposting of people with dementia and their carers is effective.

     A Shared Care Agreement has been established between primary and secondary care which enables a patient once titrated to receive on-going care with their own GP rather than secondary care.

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Actiion

  • Quality Statement - I get the treatment and support which are best for my dementia and my life

    What do we want to acheive?

    An informed and effective workforce

    What will we do to acheive this?

    On-going workforce learning and development for staff in all settings including care homes to support service delivery and environmental improvements

     Support to general medical practice with upskilling staff and provision of information regarding the management of dementia to support the Shared Care Agreement.

    Timescale - Throughout 2016

    Partner Organisations - LSCDG, Voluntary/Private Sector, Primary Care

    What have we alaredy acheived?

    Provider forums continue to promote training and this is monitored through the QAF process.

    Training and dementia awareness sessions have been routinely rolled out across primary care since 2014

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Action

  • Quality Statement - Those around me and looking after me are well supported

    What do we want to acheive?

    A range of support services for people with dementia and carers

    What will we do to acheive this?

    Work with training and provider organisations to identify carers’ training and support needs by working with VCS and making use of feedback from the Carers’ Survey 2014/15

    Continue to promote Assistive Technology as one method of support

    Provide carers with a break whilst the person with dementia benefits from contact and meaningful activity in their home or elsewhere

     Ensure that carers receive a carers assessment as a matter of course

    Ensure that all services meet the needs of local diverse and BAME communities and under-represented groups – including early onset dementia and people with a learning disability.

    Timescale - Throughout 2016

    Partner Organisations

    LCC Commissioning, CMT, Voluntary Sector

    What have we already acheived?

    Current Dementia Service contract includes a training element for carers of people with dementia.  The Carers Survey has been analysed and messages from it are being fed into the local carers’ action plan.

    AT opportunities are frequently presented at dementia cafes and information days; AT is an offer made by DCA’s when assessing a service user.

     Analysis of Care Act requirements regarding carers’ assessments shows that performance can improve here and an action plan is being put together.

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Action

  • Quality Statement - I can enjoy life

    What do we want to acheive?

    Improving awareness and understanding

    What will we do to acheive this?

    Work towards Leicester becoming a Dementia Friendly City including  recruiting 500 Dementia Friends from City Council staff.

     Raising Dementia Awareness amongst the public and businesses – various events and promotion.

     Raising awareness of dementia amongst Leicester’s diverse communities – various events and promotion.

     Exploring joint working with higher education providers to develop skills within the wider health and social care workforce.

    Explore how Schools can become involved in raising dementia awareness

    Support the LLR Dementia Action Alliance to help engage with a range of partners and sectors across the sub region

    Develop a Leicester Dementia Action Alliance to engage with a range of partners and sectors across the City, which will be the vehicle for promoting dementia awareness locally.

    Explore the development of a local Dementia Action Forum – a group of customers and carers who will provide a voice to support local planning and development

    Identify key contacts in higher education to explore how to raise dementia awareness amongst students.

    Timescale - Throughout 2016

    Partner Organisations

    Dementia Action Alliance partners, Workforce Development, Higher Education providers, Schools, Other LCC Depts., CCG & Health Providers, Business community

    What have we alaredy acheived?

    Over 400 Dementia Friends already recruited and a series of awareness sessions are in place to meet the 500 target by March.  Sessions will continue thereafter on a regular basis although staff resource to deliver these is an issue post OR.

     The LLR Dementia Action Alliance (DAA) raises awareness of dementia across numerous organisations across the city although engaging business remains problematic.

     Representation of organisations on the LLR DAA is growing but needs to be broadened.

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Action

  • Quality Statement - I am treated with dignity and respect

    What do we want to acheive?

    Review specific workforce learning and development for staff in care homes and other settings to support the delivery of care

    Consider the commissioning of a residential and nursing care home to University of Stirling standards

    Complete the evaluation of the Hospital Liaison Service operated by the Alzheimer’s Society and commissioned by UHL at LRI and Glenfield Hospitals to inform future recommissioning

    Continue to implement the QAF (Quality Assurance Framework) for care homes

    Timescale - Througout 2016

    Partner Organisations

    Workforce Development, Contracts and Assurance, ASC,  Transformation, Property Services, UHL, 

    Provider forums continue to promote training and this is monitored through the QAF process.

     

     

    A Dementia specific specification for residential care has been developed to support the core contract for residential care.

     

    A Hospital Liaison Service was funded by the Alzheimer’s Society and rolled out by UHL in 2013/14.  This supports the planned and unplanned admissions of people with dementia and supports their timely discharge with on-going support and signposting where necessary.

     

    What have we already acheived?

    Provider forums continue to promote training and this is monitored through the QAF process.

    A Dementia specific specification for residential care has been developed to support the core contract for residential care.

     A Hospital Liaison Service was funded by the Alzheimer’s Society and rolled out by UHL in 2013/14.  This supports the planned and unplanned admissions of people with dementia and supports their timely discharge with on-going support and signposting where necessary.

     QAF being rolled out across all homes.

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Action

  • Quality Statement - I know what I can do to help myself and who else can help me

    What do we want to acheive?

    Promote local information about dementia services

    What will we do to acheive this?

    Review the Dementia Page on the City Council’s website to offer a user friendly information portal

     Audit LCC information about dementia and address and gaps

    Timescale - throughout 2016

    Partner Organisations

    Commissioning, Corporate Communications & Marketing, Voluntary Sector

    What have we already acheived?

    Work is underway to update dementia pages on the LCC website.

     An audit of information has taken place and work will begin in 2016 to link this with the ASC advice, information and guidance offer.

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Action

  • Quality Statement - I feel part of the community and I’m inspired to give something back

    What do we want to acheive?

    Provide peer support

    What will we do to acheive this?

    Continue to support the development of additional memory café’s or peer support groups

     Refer customers to the Dementia Support Service and other services

    Timescale - throughout 2016

    Partner Organisations

    Commissioning, VCS, LAT, CMT, LPT, CCG

    What have we already acheived?

    Memory cafes, activity groups, peer support groups, training for carers are delivered through the Dementia Support Services contract (Alzheimer’s Society).

     Befriending is also available locally via the Alzheimer’s Society.

    Age UK offer several day services and activity groups.

     A growing number of independent memory cafes are setting up with advice for the Alzheimer’s Society.

     The Leicester Ageing Together (LAT) programme also offers a range of services for people with dementia.

     Referrals are made into these services by DCA’s and other staff.

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Action

  • Quality Statement - I am confident my end of life wishes will be respected, I can expect a good death

    What do we want to acheive?

    Good quality end of life care for people with dementia

    What will we do to acheive this?

    Continuation of Advanced Care Planning for patients at end of life.

    Ensure that conversations about advanced care planning happen in a timely way and are captured in appropriate care plans.

    Making sure that people at the end of life have access to palliative care

    Exploring how carers can access training around Power of Attorney, advanced care planning and end of life care

    Timescale - throughout 2016

    Partner Organisations

    CMT, Primary & Secondary Care, LOROS, Carers Organisations, VCS

    What have we already acheived?

    Policy & Practice around EOL care is embedded in services.

     A regional EOL group meets and has attendance from local statutory agencies.

     EOL policy and practice is promoted through provider forums.

    Status:
    Being implemented

    2016 - Second Quarter Update

    New Action