A whole system perspective

1. The Balance of Care Groupin association with Lincolnshire Partnership Trust, Lincolnshire PCT, United Lincolnshire Hospitals NHS Trust, Lincolnshire County CouncilTackling Dementia Care as a Whole SystemTom Bowen, Paul Forte & Dr Chris FooteNAO Conference, London, 12 July 2007

2. A whole system perspective Pre admission Pre admission Admission Diagnosis Treatment Discharge Re-admission Social details alone, carers, residence Risk factors: age, drugs, co-morbidities, psychiatric/ dementia, falls Preventative care Disease managementManaged populations Source of referral Time Waiting time Route Decision maker Reason for admission Alternatives to acute admission setting Discharge planning Delays in planning Delays in execution Alternative sites for discharge Admission diagnosis Inpatient diagnosis Delays in diagnosis Chronic disease Alternative access for diagnosis Delays in therapy Alternative settings for therapy (especially rehab) ‘Revolving door’ Avoidable e.g. chronic disease management Alternative sites for readmission

3. The Lincolnshire bed usage survey • To identify the number and types of inpatients currently receiving hospital care (acute and non-acute) who might potentially have: • been treated elsewhere and avoided admission • required admission, but could now be treated elsewhere • particular emphasis on people with dementia

4. The Lincolnshire bed usage survey • To identify the number and types of inpatients currently receiving hospital care (acute and non-acute) who might potentially have: • been treated elsewhere and avoided admission • required admission, but could now be treated elsewhere • particular emphasis on people with dementia • Point prevalence survey on 29 November 2006 • All medical and orthopaedic inpatients (667) • All intermediate care inpatients (121) • All OPMH inpatients (75)

11. Appropriateness Evaluation Protocol On admission • Severity of illness eg unconscious, unable to move (fall), acute bleeding • Intensity of service eg surgery + general anaesthesia, regular monitoring, IV therapy On day of care • Medical services • Nursing services • Patient condition eg acute confusion, other acute states, coma, fever

15. Some Key Points • 111 out of 863 patients surveyed (13%) had a recorded dementia diagnosis • 65 were in acute hospital • There may be substantial under-diagnosis or under-recording of dementia • Majority of acute hospital patients with dementia were outside AEP criteria on the day of the survey • Potential alternative care settings cover a wide range of services, specialist coordination may be needed • Demand for rehab support for people with dementia