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nhs Managers

Professor Alistair Burns National Clinical Director for Dementia. nhs Managers.net. Dementia Timeline. National Dementia Strategy February 2009 Antipsychotics Report “Time for Action” November 2009 Public Accounts Committee January 2010

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nhs Managers

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  1. Professor Alistair Burns National Clinical Director for Dementia nhsManagers.net

  2. Dementia Timeline • National Dementia Strategy February 2009 • Antipsychotics Report “Time for Action” November 2009 • Public Accounts Committee January 2010 • National Clinical Director (NCD) appointed (DH) February 2010 • General Election May 2010 • Prime Minister’s Challenge March 2012 (3 groups, plus updates) • NHS England launched April 2013

  3. Easy to remember D Diagnosis E Early identification M Management of symptoms E Effective support for carers N Non drug treatments T Treatment of medical conditions I Information A At, and towards, end of life

  4. Dementia “i” statements • I was diagnosed in a timely way • I know what I can do to help myself and who else can help me • Those around me are well supported and are in good health • I get the treatment and support, which are best for my dementia, and my life • I feel included as part of society • I understand so I make good decisions and provide for future decision making • I am treated with dignity and respect • I am confident my end of life wishes will be respected. I can expect a good death. • I know how to participate in research

  5. Dementia • Diagnosis • Post diagnostic support for people with dementia and carers • Care in Hospitals • Care in Homes • Care at home • End of life Care • Appropriate use of antipsychotics • Prevention

  6. Dementia CQUIN: FAIR (Find, Assess and Investigate, Refer) All emergency admissions aged over 75 Dementia pathway No known dementia Known dementia 3 Diagnostic review, if indicated Clinical Diagnosis of delirium Referral no yes Positive 1 Diagnostic assessment Feedback to GP Inconclusive Has the person been more forgetful in the last 12 months to the extent that it has significantly affected their daily life? yes 2 Negative Care as usual no 3 1 2 Find Assess and Investigate Refer

  7. Dementia CQUIN 2013/14 Success  over 4,000 referrals a month Original indicators, from 2012/13, still in place – Find, Assess, Investigate and Refer This now triggers 60% of the payments Two new elements to the CQUIN for 2013/14 10%: Clinical leadership for dementia and appropriate training of staff 30%: Ensuring that carers of people with dementia in hospital feel adequately supported Implementing the CQUIN will help address some of the issues in the RCPsych Report.

  8. Participation in the audit Who was invited to participate? • All general acute hospitals, or those providing general acute services on more than one ward that admit people over the age of 65, in England and Wales • Number of hospitals participating • 98% (210/215) of eligible hospitals in England and Wales • Representing 100% of Trusts/Health Boards • Data collection • Data were collected between April and October 2012 • 210 organisational checklists were submitted • 7987 case notes were submitted (from 206 hospitals)

  9. Audit themes • Governance • Assessments • Antipsychotic prescription: protocol and practice: • Liaison psychiatry services • Hospital discharge and transfers • Information and communication • Staff training

  10. Staff training There is notable improvement in the number of hospitals having a training and knowledge framework in place. Further improvement could be made in the provision of dementia awareness training in induction programmes. • Key findings: • 78% of hospitals have a training and knowledge framework or strategy that identifies necessary skill development in working with and caring for people with dementia. In the first round of audit, under a quarter of hospitals had this in place. • 41% hospitals do not include dementia awareness training in their staff induction programmes.

  11. All NHS staff ……… will go through a dementia awareness programme (foundation level) March 2014 • 100,000 staff have foundation level training by March 2014 • All NHS staff that look after patients with dementia will receive foundation level dementia training. This will programme will: • Enable staff to spot the early symptoms of dementia • Know how to interact with those with dementia • Signpost staff to the most appropriate care: it will be backed up with more in-depth training of expert leaders and staff working with people with dementia • 4. The training should also raise awareness of the increased likelihood of mental health problems in those people with long-term conditions Our Mandate Specific to Dementia

  12. Conclusion • Welcome increase in key items measured • Improvement still required in many factors affecting care • Raising quality of care remains a national strategic priority • 79% of Acute Trusts have signed up to the Dementia Action Alliance “The Right Care” call for action • Future round of audit will take place.  We recommend including: • perspective of people with dementia and their carers on involvement in care and discharge, and the quality of communication with staff; • staff perspective on training provision and support available to provide good quality care.

  13. The opportunities: innovation Integrated Care, Dudley Health Checks, Southwark Dementia Friendly Hospitals, Bradford Anchor Trust Carers in Surrey Crawley Dementia Action Alliance Northfleet School Dementia Friends Education and Training British Transport Police Gnosall

  14. Share knowledge, innovation and learning www.dementiapartnerships.com

  15. Dementia Diagnosis and post diagnostic support Sliding doors - Mr Smith aged 79 What can happen……. Becomes distressed and agitated one Saturday night Seen by on call GP and admitted to hospital Diagnosed with delirium secondary to UTI History of two years memory loss, wife not managing well Sedated on admission, discharged to care home

  16. Dementia Diagnosis and post diagnostic support Sliding doors - Mr Smith aged 79 What can happen……. Becomes distressed and agitated one Saturday night Seen by on call GP and admitted to hospital Diagnosed with delirium secondary to UTI History of two years memory loss, wife not managing well Sedated on admission, discharged to care home What could happen……. Identified as having dementia two years ago Supported by a Dementia Advisor Wife notices he is “not himself” one Tuesday GP who knows him visits and prescribes antibiotic for a UTI Recovers – no need for hospital admission

  17. So…………………. • Awareness of dementia is at its highest • Diagnosis rate needs attention • Support is the key • Early vs timely diagnosis: benefits • Recast dementia as a Long term condition managed in primary care • Population screening not appropriate • Dementia rarely travels alone • Primary care memory services • Prevention • Three things to do

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