Meeting the Dementia Challenge : Tees, Esk and Wear Valleys NHS Foundation Trust

1. Meeting the Dementia Challenge : Tees, Esk and Wear Valleys NHS Foundation Trust Sharon Tufnell Service Development Manager Mental Health Services for Older People

2. Introduction • Overview of Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) • Mental Health Services for Older People ( MHSOP) • Dementia Care Pathway • Clinical Path for Behaviours that Challenge

3. Overview of TEWV • We provide a range of mental health, learning disability and substance misuse services for the 1.6 million people living in County Durham, the Tees Valley, Scarborough, Whitby, Ryedale, Harrogate, Hambleton and Richmondshire. • We deliver our services by working in partnership with seven local authorities and Clinical Commissioning Groups, a wide range of voluntary organisations, as well as service users, their carers and the public.

4. Overview of TEWV • Our services are spread over a wide geographical area which includes coastal, rural and industrial areas. • Our mission : To improve peoples lives by minimising the impact of mental ill health or a learning disability.

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6. Our Goals 1To promote excellent services, working with the individual users or our services and their carers to promote recovery and well being. 2 To continuously improve the quality and value of our work 3 To recruit, develop and retain a skilled work force. 4 To have effective partnerships with local, national and international organisations for the benefit of our customers. 5 To be an excellent and well governed Foundation Trust that makes best use of its resources for the benefit of our communities

7. Our five values are: • Commitment to quality • Respect • Involvement • Wellbeing • Teamwork

8. Mental Health Services for Older People 3 Localities • Durham and Darlington • Tees wide • North Yorkshire

9. Mental Health Services for Older People • Services for people with mental health problems- both “functional” and “organic” • Up to 80% of our work is with people with dementia and their families • We also work with people with Young Onset Dementia and their families

10. Mental Health Services for Older People Services for People with Dementia • Memory Services and Clinics • Community Mental Health Teams • In Patient Wards • Care Home Liaison • Acute Liaison

11. Dementia Care Pathway – Main Need/ Diagnostic Associated Clinical Link Pathways Falls Behaviours that Challenge

12. The Pathway aims to have…… • Agreed standard of care • The right people • Doing the right things • In the right order • At the right time • In the right place • To the right people • With the right outcome • All with the attention on the user experience

13. Scope of the DCP • Begins pre diagnosis for people with cognitive deterioration where dementia is suspected. • Other reasons for presenting symptoms e.g. delirium have been ruled out. • Includes all individuals regardless of age, gender, ethnic background or culture, but does currently exclude those with a diagnosed learning disability

14. DEMENTIA CARE PATHWAY ALGORITHM REFERRAL ASSESSMENT Diagnostic Formulation DIAGNOSIS TREATMENT Non-Pharmacological Approaches Cluster 18, Cluster 19, Cluster 20, Cluster 21 TREATMENT Pharmacological Approach For all clusters as required REVIEW DISCHARGE

15. Assessment • Comprehensive assessment • FACE risk assessment • Mental health clustering tool ( CROM) • SWEMWBS ( PROM) • Addenbrookes Cognitive Assessment ( ACE 111) • Neuroimaging • Bristol Activities of Daily Living Scale • Neuropsychology assessment if required • Multi- disciplinary assessment if required • Offer carer assessment

16. Non- Pharmacological Treatments • All patients are offered an intervention plan that is person- centred and needs led to promote independence and maintain function according to cluster group • CARE CLUSTER – 18 (Cognitive impairment- Low need) • CARE CLUSTER- 19 (Cognitive Impairment or Dementia Complicated – Moderate need) • CARE CLUSTER – 20 Cognitive Impairment or Dementia Complicated (High Need) • CARE CLUSTER – 21 Cognitive Impairment or Dementia (High Physical or Engagement)

17. Non- Pharmacological Treatments Psychological interventions eg Cognitive Stimulation Therapy, education and support Lifestyle interventions eg activity scheduling , coping strategies Physical interventions eg health promotion, Carer interventions eg carer support

18. Pharmacological interventions

19. Information in the Dementia Care Pathway • There is a lot! Includes: • Its Normal to forget • Diagnostic information • Medication Information • This is Me • Advanced Statements and Decisions • Lasting power of attorney (LPA) for Property and Affairs, or a Personal Welfare (Health & welfare) LPA. Plus much more!

20. Behaviours that ChallengePerson centred Clinical link pathway The Clinical link Pathway is aimed at all service users in Mental Health Services for Older People who present with challenging behaviours. It therefore encompasses people with dementia and people with functional mental health problems. The Clinical link pathway starts at the point where behaviours that challenge are identified and ends at the point where the problem is resolved or managed effectively

21. Comprehensive MHSOP Assessment - Diagnosis related pathway Preventative approaches Behaviour changes / develops Interim Plan • Assessment of Challenging Behaviour Formulation Non Pharmacological Interventions Pharmacological Interventions • Evaluation

22. We are currently seeking consultation on the Behaviours that Challenge Clinical link Pathway Please see Sharon Tufnell during the event if you would like to comment.

23. Evidence • CSIP (2005) ‘Everybody’s Business – Integrated mental health services for older adults: a service development guide.’ London: DH • DH (2009) ‘Living well with Dementia – a national Dementia strategy.’ London: DH • NICE/SCIE (2006) ‘Dementia: Supporting people with Dementia and their carers in health and social care.’ London: TSO Time of Action report (DoH, 2009) • Cochrane Review – Functional analysis-based interventions (Moniz-Cook et al, 2009) • British Psychological Society – Alternatives to antipsychotic medication (Brechin et al, 2013) • Alzheimer’s Society – Optimising treatment & care for people with BPSD (2011) • Meeting needs & reducing distress – Challenging Behaviour in NHS settings (2013)

24. Thank You! Any Questions?