nhsManagers.net
Professor Alistair BurnsNational Clinical Director for Dementia
Dementia Timeline• National Dementia Strategy February 2009
• Antipsychotics Report “Time for Action” November 2009
• Public Accounts Committee January 2010
• National Clinical Director (NCD) appointed (DH) February 2010
• General Election May 2010
• Prime Minister’s Challenge March 2012 (3 groups, plus updates)
• NHS England launched April 2013
D DiagnosisE Early identificationM Management of symptomsE Effective support for carersN Non drug treatmentsT Treatment of medical conditionsI Information A At, and towards, end of life
Easy to remember
Dementia “i” statements
• I was diagnosed in a timely way• I know what I can do to help myself and who else can help me• Those around me are well supported and are in good health• I get the treatment and support, which are best for my dementia, and my
life• I feel included as part of society• I understand so I make good decisions and provide for future decision
making• I am treated with dignity and respect• I am confident my end of life wishes will be respected. I can expect a
good death.• I know how to participate in research
Dementia
• Diagnosis• Post diagnostic support for people with dementia and
carers• Care in Hospitals• Care in Homes• Care at home • End of life Care• Appropriate use of antipsychotics• Prevention
Known dementia
All emergency admissions aged over 75
Dementia pathway
Care as usual
Has the person been more
forgetful in the last 12 months to the extent that it has
significantly affected their daily life?
No known dementia
Diagnostic assessment
Dementia CQUIN: FAIR (Find, Assess and Investigate, Refer)
Feedback to GP
Positive
Inconclusive
Negative
Diagnostic review, if indicated
1
2
3
21 3
Referral
Find Assess and Investigate Refer
Clinical Diagnosis of delirium
no yes
no
yes
Dementia CQUIN 2013/14• Success over 4,000 referrals a month • Original indicators, from 2012/13, still in place – Find,
Assess, Investigate and Refer• This now triggers 60% of the payments• Two new elements to the CQUIN for 2013/14• 10%: Clinical leadership for dementia and appropriate
training of staff• 30%: Ensuring that carers of people with dementia in
hospital feel adequately supported• Implementing the CQUIN will help address some of the
issues in the RCPsych Report.
Who was invited to participate?
All general acute hospitals, or those providing general acute services on more than one ward that admit people over the age of 65, in England and Wales
Participation in the audit
Number of hospitals participating
98% (210/215) of eligible hospitals in England and Wales– Representing 100% of Trusts/Health Boards
Data collection
Data were collected between April and October 2012 210 organisational checklists were submitted 7987 case notes were submitted (from 206 hospitals)
Governance
Assessments
Antipsychotic prescription: protocol and practice:
Liaison psychiatry services
Hospital discharge and transfers
Information and communication
Staff training
Audit themes
Staff training
There is notable improvement in the number of hospitals having a training and knowledge framework in place.
Further improvement could be made in the provision of dementia awareness training in induction programmes.
Key findings:
78% of hospitals have a training and knowledge framework or strategy that identifies necessary skill development in working with and caring for people with dementia. In the first round of audit, under a quarter of hospitals had this in place.
41% hospitals do not include dementia awareness training in their staff induction
programmes.
Our Mandate Specific to Dementia
1. All NHS staff ……… will go through a dementia awareness programme (foundation level) March 2014
2. 100,000 staff have foundation level training by March 20143. All NHS staff that look after patients with dementia will receive foundation
level dementia training. This will programme will:• Enable staff to spot the early symptoms of dementia• Know how to interact with those with dementia• Signpost staff to the most appropriate care: it will be backed up with more
in-depth training of expert leaders and staff working with people with dementia
4. The training should also raise awareness of the increased likelihood of mental health problems in those people with long-term conditions
Conclusion
Welcome increase in key items measured
Improvement still required in many factors affecting care
Raising quality of care remains a national strategic priority
79% of Acute Trusts have signed up to the Dementia Action Alliance “The Right Care” call for action
Future round of audit will take place. We recommend including:
– perspective of people with dementia and their carers on involvement in care and discharge, and the quality of communication with staff;
– staff perspective on training provision and support available to provide good quality care.
The opportunities: innovationIntegrated Care, Dudley
Health Checks, Southwark
Dementia Friendly Hospitals, Bradford
Anchor Trust
Carers in Surrey
Crawley Dementia Action Alliance
Northfleet School
Dementia Friends
Education and Training
British Transport Police
Gnosall
Share knowledge, innovation and learning
www.dementiapartnerships.com
Dementia Diagnosis and post diagnostic supportSliding doors - Mr Smith aged 79
What can happen…….
Becomes distressed and agitated one Saturday night
Seen by on call GP and admitted to hospital
Diagnosed with delirium secondary to UTI
History of two years memory loss, wife not managing well
Sedated on admission, discharged to care home
Dementia Diagnosis and post diagnostic supportSliding doors - Mr Smith aged 79
What can happen…….
Becomes distressed and agitated one Saturday night
Seen by on call GP and admitted to hospital
Diagnosed with delirium secondary to UTI
History of two years memory loss, wife not managing well
Sedated on admission, discharged to care home
What could happen…….
Identified as having dementia two years ago
Supported by a Dementia Advisor
Wife notices he is “not himself” one Tuesday
GP who knows him visits and prescribes antibiotic for a UTI
Recovers – no need for hospital admission
So………………….
• Awareness of dementia is at its highest • Diagnosis rate needs attention • Support is the key • Early vs timely diagnosis: benefits • Recast dementia as a Long term condition managed in primary care• Population screening not appropriate• Dementia rarely travels alone • Primary care memory services • Prevention
• Three things to do