Improving general hospital care for people with dementia:

why, how and with whom?

Nye HarriesNye HarriesDH SWDH SW

Dementia care in acute hospitalsDementia care in acute hospitalsRoyal College of Psychiatrists Royal College of Psychiatrists 1 1 identified that on identified that on average in a 500-bed district hospital:average in a 500-bed district hospital:

330 beds will be occupied by older people 330 beds will be occupied by older people 220 of these will have a mental health disorder220 of these will have a mental health disorder of which of which 102 will have dementia102 will have dementia (depression and delirium form most of the (depression and delirium form most of the remainder)remainder)

1. Who Cares Wins: improving the outcome for older people admitted to a general 1. Who Cares Wins: improving the outcome for older people admitted to a general hospitalhospital, Royal College of Psychiatrists, 2005, Royal College of Psychiatrists, 2005

Who care winsWho care wins on outcomes on outcomes

Research studies cited in the RCP report highlight Research studies cited in the RCP report highlight a range of important outcome measures for this a range of important outcome measures for this group: group:

increased mortalityincreased mortality longer lengths of hospital stay longer lengths of hospital stay greater rate of institutionalisation in a care home greater rate of institutionalisation in a care home following their acute stayfollowing their acute stay

National Dementia Strategy Objective 8: National Dementia Strategy Objective 8: Improved quality of care in general hospitalsImproved quality of care in general hospitals

To improve the quality of care and health To improve the quality of care and health outcomes for people with dementiaoutcomes for people with dementiaTo provide a comprehensive mental health To provide a comprehensive mental health assessment and advice on planning of care.assessment and advice on planning of care.Develop explicit care pathwaysDevelop explicit care pathwaysSenior clinician leadSenior clinician lead

Includes community hospitals too!Includes community hospitals too!

NAO estimate excess cost over £6 million NAO estimate excess cost over £6 million pounds per year per acute hospital.pounds per year per acute hospital.

One SW review site (2009): data showed that One SW review site (2009): data showed that FNOF with dementia diagnosis had 25% longer FNOF with dementia diagnosis had 25% longer stay in hospitalstay in hospital

Dementia is a know risk factor for delayed Dementia is a know risk factor for delayed transferstransfers

Financial & performance impactFinancial & performance impact

Typical problems in the acute settingTypical problems in the acute setting..

Recognition of dementia.Recognition of dementia.Majority unknown to mental health services.Majority unknown to mental health services.Crisis admissions.Crisis admissions.Discharge planning, limited options for Discharge planning, limited options for rehabilitation, intermediate care, step down beds rehabilitation, intermediate care, step down beds to facilitate discharge home.to facilitate discharge home.Poor risk assessment false assumptionsPoor risk assessment false assumptions

Problems...Problems...

Poor recognition and care, with higher risks Poor recognition and care, with higher risks in hospital of :in hospital of :

– Malnutrition & dehydrationMalnutrition & dehydration– Inadequate pain reliefInadequate pain relief– Over sedationOver sedation– Poor end of life carePoor end of life care

Improving general hospital care : Improving general hospital care : key challengeskey challenges

Seeing dementia/cognitive impairment as a Seeing dementia/cognitive impairment as a whole Trust issue, not just elderly carewhole Trust issue, not just elderly care

Securing executive sign-upSecuring executive sign-up

Making the link with the Trust “performance” Making the link with the Trust “performance” agenda – LoS. Demonstrating the value of agenda – LoS. Demonstrating the value of effective pathways, input of liaison .effective pathways, input of liaison .

Ensuring good data – eg clinical coding Ensuring good data – eg clinical coding

Breakdown of RUH Inpatient Bed Breakdown of RUH Inpatient Bed Days by age cohort, 2008 / 09Days by age cohort, 2008 / 09

Age 0-156%

Age 16-6428%

Age 65-7928%

Age 80+38%

RUH inpatient bed days by age for RUH inpatient bed days by age for Surgery/Ortho/MAU/Gen Med: 2008/09Surgery/Ortho/MAU/Gen Med: 2008/09

Number ofBedDays

General Surgery

Orthopaedics A&E General medicine

80+

65-79

16-64

0-15

What levers could help you?What levers could help you?Extra focus on LoS reduction in 2010/11Extra focus on LoS reduction in 2010/11

Sharing data from the new national audit Sharing data from the new national audit

C-QUIN, with commissionersC-QUIN, with commissioners

Trust Quality AccountsTrust Quality Accounts

Sharing data from the new audit Sharing data from the new audit

Patient Related Outcome Measures (PROMs)Patient Related Outcome Measures (PROMs)

Who are your potential allies?Who are your potential allies?

Director of Nursing & Chief ExecutiveDirector of Nursing & Chief ExecutiveLINKsLINKsCouncil Overview & Scrutiny Council Overview & Scrutiny CommitteeCommitteeTrust Non-ExecutivesTrust Non-ExecutivesAlzheimer's SocietyAlzheimer's SocietyCommissionersCommissioners

www.southwestdementiapartnership.org.uk

..

Thank youThank you

nye.harries@dh.gsi.gov.uknye.harries@dh.gsi.gov.uk