Always A Last Resort?

1. Always A Last Resort? The prescription of anti-psychotic drugs to people with dementia in care homes

2. Imagine what life in a care home might be like....

3. Who ran the inquiry? • Why it was necessary? • What questions did the inquiry explore? • The key findings and recommendations. • Policy developments resulting from the inquiry. • What next?

4. Informal parliamentary group made up of MPs and peers interested in dementia. • Created in June 2007. • Run in partnership with Alzheimer’s Society. • To raise awareness amongst parliamentarians and to influence legislation and policy making. • Meets several times a year and undertakes parliamentary inquiries. www.alzheimers.org.uk/appg

5. First inquiry of the APPG:The use of anti-psychotics for people with dementia in care homes (Jan to April 2008) • Drugs developed to treat psychotic symptoms of schizophrenia. • Widespread prescription off-licence to people with dementia in response to behavioural and psychological symptoms • Serious concerns about widespread use, appropriateness and safety. • Two thirds of residents in care homes have dementia.

6. InquiryThemes • Why are people with dementia prescribed these drugs in care homes and how widespread is their use? 2. To what extent is the use of the drugs appropriate? 3. What are the alternatives to anti-psychotic drugs? 4. What steps should be taken to ensure the appropriateprescription of anti-psychotic drugs?

7. Inquiry Themes • Why are people with dementia prescribed these drugs in care homes and how widespread is their use? • 70 written evidence submissions • Two oral evidencesessions in House ofCommons 2. To what extent is the use of the drugs appropriate? 3. What are the alternatives to anti-psychotic drugs? 4. What steps should be taken to ensure the appropriateprescription of anti-psychotic drugs?

9. Key findings • Why prescribed and how widespread? • Often prescribed as first resort, to manage symptoms of dementia • Up to 150,000 prescribed in total. • To what extent is the use of the drugs appropriate? • At least 70% of prescribing is probably not appropriate. • Symptoms may be result of unmet need such as boredom or pain. • Prescription also the result of factors such as lack of staff training, low staffing levels, not involving carers in decision-making. • What are the alternatives to anti-psychotic drugs? • Only appropriate as a last resort, in times of severe distress or critical need. • Small changes, for example person-centred approach with tailored care plan; rich and stimulating care home environment. • Psychological interventions, for example multi-sensory stimulation; music and dance therapy.

10. Key recommendations: What steps should be taken to ensure the appropriate prescriptionof anti-psychotic drugs? Overall recommendation: The National Dementia Strategy for England must include an action plan to reduce the number of prescriptions.

11. Further recommendations • Dementia training should be mandatory for all care home staff. • Care homes must receive effective support from external services, with regular, pro-active visits to the home • All care home staff must have Mental Capacity Act training, which should include the use of anti-psychotics for people with dementia • Protocols for prescribing, monitoring and review must be introduced. • National and local audit of the prescription of antipsychotic drugs.

12. What happened next? Policy implications

13. Targeted campaigning Ivan Lewis, Parliamentary Under-Secretary of State for care services in 2008

14. National Dementia Strategy for England, Feb 09 • The Government’s 5 year plan for improving quality of life for people with dementia and their carers in England. • Provides guidance for commissioners and providers explaining the key outcomes to be achieved with recommendations on how to achieve them.

15. National Dementia Strategy Objective 11: Living well with dementia in care homes “One issue that is of particular concern is the use of anti-psychotic medication in care homes for the management of behavioural and psychological symptoms in those residents with dementia. Those who have criticised current practice include the Parliamentary Accounts Committee, the Alzheimer’s Society and the All-Party Parliamentary Group on Dementia”.

16. Objective 11 recommends that the mental health care for residents should be improved by minimising the use of anti-psychotic drugs by: • Detailed specialist assessment of health needs following admission • Six-monthly mental health reviews • Access to specialist advice between reviews • Formulate and deploy non-pharmacological recommendations • Specialist input into decision-making concerning the initiation, review and cessation of anti-psychotic medication • Rapid specialist response to problems as they occur in care homes.

17. DH review • In response to widespread concern, the Department of Health announced a review of the issue alongside the Strategy. • A full public report on the use of anti-psychotic drugs for people with dementia of all ages, in all care settings, is expected in 2009.

18. What next? • Continue lobbying to ensure review is delivered in Spring/summer 09. • Work to ensure policy is put into practice. • New inquiry into the skills of the dementia workforce.

19. Any questions? Louise Lakey,Senior policy officer Louise.lakey@alzheimers.org.uk