The Bradford Experience towards the target 67%

Dr Sara Humphrey

GP Westcliffe Medical Practice

GP with a Special Interest in Older People-BTHFT

Clinical Specialty Lead Older People & Stroke Bradford District & City CCGs

GP Advisor Yorkshire & Humber Dementia SCN

11/12/14

Bradford Districts CCG

• 41 Practices with 58% of the Bradford LA population

• 330,115 people

• 48,341 or 14.6% are >65yrs.

• 6.9% are >75 yrs. ( UK average 7.5%)

• The average annual growth rate in our > 75 yr. population is projected to be 1.5% annually from 2011 to 2020

• We had 2499 people on our Dementia QOF registers at the end of November 2014

-15000 -10000 -5000 0 5000 10000 15000

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

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55-59

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65-69

70-74

75-79

80-84

85-89

90-94

95-99

100-104

105-109

110+

Female Male

Bradford district CCG age profile

Bradford City CCG

• 28 Practices with 21% of the Bradford LA population

• 118,567 people

• 6878 or 5.7% are >65 yrs

• 2.8% >75yrs ( UK average 7.5%)

• We had 309 people on our Dementia QOF registers at the end of November 2014

-10000 -8000 -6000 -4000 -2000 0 2000 4000 6000 8000

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90-94

95-99

100-104

105-109

110+

Female Male

Bradford City CCG age profiles

Change since 2009

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

2009-2010 2010-2011 2011-2012 2012-2013 Nov-14

Bradford District CCG

Bradford City CCG

• So what makes the difference?

What makes the difference?

Convincing CCG Boards & Governing bodies (as well )as GPs and Primary Care why a diagnosis of Dementia is important

• Access to Rx, Services and Support

• Planning for the Future-Advances Care Plans& POW

• Research

• Extra support in hospital reducing length of stay

• Carer Support

• Medication/Pharmacy support

• Reduces future care costs

What makes the difference ?

Commissioner led reviews of the Memory Service and Dementia Provision

Reports on Dementia Services in Bradford

• Local Reports

• Emerging from the shadows 2008 BMDC& B&A PCT

• Meeting Changing Expectations – NHS Bradford & Airedale and City of Bradford MDC 2010

• Review of ‘Memory Assessment and Treatment services’ & ‘ Acute & Care Home Liaison June 2013

• Dementia Needs Assessment LA 2014

What makes the difference?

Long Established Dementia Strategy Group-covering providers , commissioners & the third sector

Dementia Strategy Group

• A group covering Bradford & Airedale CCG

• Representation from CCG’s, Public Health, Acute Hospital Trusts, Care Trust ,Local Authority & the Third Sector

• Responsibility to deliver National Policy & reporting to the Health & Well Being Boards

What makes the difference?

Strong local clinical & managerial leadership for each of the partner organisations!

Partners in Dementia Care

• Dr. Sara Humphrey Clinical Specialty Lead BD& BCCCGs

• Dr. Chris Harris, Waheed Hussain CCG Board Members

• Mick James-Head of Service Improvement (MH) CCG

• Simon Baker –LA

• Andrew O’Shaughnessy –PH Consultant

• Dr. Andy Clegg –Care of the Elderly Consultant BTHFT

• Dr. Gregor Russel –Old Age Psychiatrist BDCT

• Danielle Wood Dementia Lead Nurse BTHFT

• Bradford District & City CCG development of the Specialty Clinical Leadership posts in

• -Palliative Care

• -COPD

• -Women’s health

• -Childrens

• -Older People/Stroke /Dementia-Me

What makes the difference?

Excellent clinical relationships between local commissioners and providers

• Joint clinical development of pathways of care for primary care , intermediate care hospitals & the acute trust

• Pathways that cross organizations & reduce the ‘noise in the system’

What makes the difference?

Using local CQUIN levers to improve Dementia Care in Provider organizations

Improving general hospital care

• Holistic care for dementia patient in acute hospital setting Local CQUIN for BTHFT

• Integration of communication & care between BTHFT & BDCT re the frail elderly with cognitive impairment / dementia , to prevent admission via appropriate & relevant assessment & signposting to facilitate early discharge where appropriate

• Integrated care for people with dementia Local CQUIN BDCT

• Better integrated pathway to support those patients identified via the acute dementia CQUINS having a diagnosis of suspected dementia.

Improving Support & Care after diagnosis

• Better integrated pathway to support those patients identified via the acute dementia CQUINS having a diagnosis of suspected dementia. BDCT Care Trust CQUIN

• To improve dementia patients’ & their carers experience by ensuring that safe & effective care is given, communication channels are clear, & cross boundary working is achieved across mental health, community & acute sectors, resulting in a better quality of life for both inpatients & outpatients under the care of the local health economy

What makes the difference?

Memory clinics in community settings reducing Stigma associated with traditional mental health sites

What makes the difference?

100% Uptake of the Dementia DES in both Bradford City & District CCG

High Uptake (100% and 86%+) of the new Dementia ES

• 100% Uptake

• Clinical Sessions at CCG forums explaining the back ground of the DES/ES/How to make it work and to road show System One resources developed to ‘make it work’

• Emails encouraging practices to sign up prior to the dead line!

• Offers of support/email/phone to those that needed it

What makes the difference?

One Screening tool across Primary Care for the last 8 years

• 6 CIT used consistently across primary care since the days of the Dementia Collaborative

• Easy to use and understand

• Available on System One

• Used as part of the referral forms

• Only difficulty is that it is not used in the hospital

What we still need to do!

• Consider more culturally sensitive tools for use in patients who’s first language is not English

• Ditto for Learning Disability patients & patient with aphasia etc

• and Build these into our clinical systems

What makes the difference?

Development of Clinical Resources with in our System One Computer System

• Developed with the local CSU

• All the information in one place

• Dementia DES

• Integrated Care Pathways for Dementia

• Antipsychotics in Dementia

• Advanced Care Plan Template

What makes the difference?

-Dementia included in other work streams-Self Care, Urgent Care, End of Life & Integrated Care Work streams

• Last year we successfully petitioned the CCG to include patients with Dementia in the Risk Stratification and Care Planning ES & designed System One Templates to help clinicians navigate through what good care should look like

What makes the difference?

Education and Awareness Sessions

• Clinical Commissioning Forum Sessions 2012/2013/2014

• Education for Care Homes 2012

• BDCT Educational Events 2013/2014

• Integrated Care Event 2014

• Presentation to Bradford DCCG Governing Body 2013

• Presentations to Bradford City& District Boards 2014

What makes the difference?

-Coding Audits

• Bradford was used to develop the Dementia Data Quality Toolkit with the CSU

• Previous coding audits on anticholistesterase medication

• Just starting a coding reconciliation audit between memory clinic registers and those in primary care

What makes the difference?

Investing in support services for dementia patients and their Carers.

• Professional and Patient Website ( part of BDCT)

• Developing a Carers Website

• Dementia Friendly Communities

• Dementia Advisors

• Dementia Cafes

• Self Care

• In conclusion there are a lot of factors working together &raising prevalence rates cannot be seen in isolation and must be part of an over all plan to improve care for dementia patients and their carers