Dementia Leading for Improvement

1. DementiaLeading for Improvement Geoff Baines Associate Director 9 December 2010

2. NHS White Paper • Equity and excellence: liberating the NHS, July 2010 • Move from centralised top down – devolved local • From targets to outcomes • Regional performance management to local transparency • State dependency to ‘Big Society’ • Importance of GP’s, local needs and accountability

3. National Strategy • Living Well with Dementia: A National Dementia Strategy Feb 2009, 17 objectives • 2009, South West Dementia Partnership developed • Initial priority, peer review of dementia services in 14 localities May – June 2009

4. Progress in the South West over the past 15 months Work has focused on raising awareness and building capacity but we need a greater emphasis on delivering improved outcomes

5. The National position June 2010 Operating Framework, dementia care one of two areas not being given sufficient local priority • “PCTs and their partners should publish how they are implementing the National Dementia Strategy to increase local accountability for prioritisation.”

6. National Position cont.. September 2010 DH published Quality outcomes for people with dementia four priorities. • good-quality early diagnosis and intervention for all; • improved quality of care in general hospitals; • living well with dementia in care homes; and • reduced use of antipsychotic medication

7. Early intervention for all (1) Diagnosis rates for 2009-10 are c40% of the estimated prevalence Memory clinics vary greatly in capacity and are usually insufficient to support early diagnosis

8. Early intervention for all (2) NHS in South West is at the national average for prescribing drugs to delay symptoms of Alzheimer’s but there is great variation between PCTs

9. Early intervention for all (3) • NAO in 2010 concluded that the NHS in the SW has the largest “diagnosis gap” between capacity and need of any region • Two key strands • Memory clinics: • All PCTs have established memory clinics but are insufficient capacity - some have not specified levels of activity • Each locality should have at least one accredited memory clinics • GP education and awareness: • 4 GP leads are being recruited • GP training programme with South Central being designed

10. Care in general hospitals • Patients with a co-morbidity of dementia have longer lengths of stay, more clinical incidents and more ward moves than patients with the same physical health needs • In the South West, Alison Moon, Chief Nurse at UHB, has led a project to produce standards on care in general hospitals that will be available in January for local self assessment • All hospitals are identifying an executive and clinical lead

11. Care homes • SW Dementia Partnership is developing a “kitemark” for care homes to indicate expertise on caring for people with dementia • Four councils (BANES, Wilts, Plymouth and Dorset) and two care home providers already committed

12. Antipsychotic Prescribing Professor Banerjee published a report in 2009 concluding that there was inappropriate prescribing of antipsychotic drugs This concluded that prescribing could reduce by 2/3rds which would • Reduce preventable deaths (estimated at 1800 per annum) • Reduce complications (1600 vascular events, half being serious) • Save money (wider issue of improved medication in care homes estimated at £4.2m in SW) The Minister of State has made a commitment that the NHS will deliver a 2/3rds reduction by November 2011

13. Antipsychotic Prescribing The NHS in the South West has started work on ensuring prescribing follows NICE guidelines and there is support for managing challenging behaviours • Audit of prescribing in mental health providers will be concluded by January 2011 • PCTs are undertaking a range of local audits over the next 15 months • Support material to help with managing challenging behaviours was shared in October

14. Antipsychotic Prescribing Though NHS in South West has the lowest levels of prescribing in England, there is still a two fold variation The problem with the data is that antipsychotics are used for people with dementia and with schizophrenia

15. The Dementia Declaration Forty national organisations have signed up to the Dementia Action Alliance and made a declaration supporting seven “outcomes” that have been developed with people with dementia and their carers • I have personal choice and control or influence of decisions about me • I know that services are designed around me and my needs • I have support that helps me live my life • I have the knowledge and know-how to get what I need • I live in an enabling and supportive environment where I feel valued and understood • I have a sense of belonging and feel a valued part of family, community and civic life • I know there is research going on that delivers a better life for me now and hope for the future

16. Leadership Challenge • Leading Improvement a major challenge • Not only due to the increasing need • Also the scale of quality and productivity improvement required • Leadership capacity at local level is vital • Role of GP consortia rapidly crucial • Maintaining passion and inspiration will contribute to success