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8/7/2019 Dementia - Leading for Improvement
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DementiaLeading for Improvement
Geoff Baines
Associate Director
9 December 2010
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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 GPs, local needs and
accountability
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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
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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
PCT Performance Assessment Framework - ementia, 2010-11
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The National position
June 2010 Operating Framework, dementia
care one of two areas not being given
sufficient local priority
P s and their partners should publishhow they are implementing the NationalDementia Strategy to increase localaccountability for prioritisation.
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National Position cont..
September 2010 DH published Quality
outcomes for people with dementia
four priorities.
good-quality early diagnosis andintervention for all;
improved quality of care in generalhospitals;
living well with dementia in care homes;and
reduced use of antipsychotic medication
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Presc ribing of Acetylchloninesteras e Inhibitors (Drugs for Dementia
Cost per 1000 Cost Based Astro PU
Financial Year 2008/2009
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Donepezil Hydrochloride Galantamine Idebenone Memantine Hydrochloride Rivastigmine
arly intervention for all (2)NHS in South West is at the national average for prescribing drugs to delay
symptoms of Alzheimers but there is great variation between PC s
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NAO in 2010 concluded that the NHS in the SWhas the largest diagnosis gap betweencapacity and need of any region
wo key strands Memory clinics:
All P s have established memory clinics but are insufficientcapacity - 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 entral being designed
Early intervention for all (3)
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Patients with a co-morbidity of dementia havelonger lengths of stay, more clinical incidentsand more ward moves than patients with the
same physical health needs In the South West, Alison Moon, hief Nurse at
UHB, has led a project to produce standards oncare in general hospitals that will be available in
January for local self assessment All hospitals are identifying an executive and
clinical lead
Care in general hospitals
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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
Care homes
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Antipsychotic Prescribing
his concluded that prescribing
could reduce by 2 3rds which would Reduce preventable deaths (estimated
at 1800 per annum)
Reduce complications (1600 vascularevents, half being serious)
Save money (wider issue of improvedmedication in care homes estimated at4.2m in SW)
Professor Banerjee published a report in 2009 concluding that
there was inappropriate prescribing of antipsychotic drugs
he Minister of State has made a commitment that the
NHS will deliver a 2 3rds reduction by November 2011
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Antipsychotic PrescribingThe NHS in the South West has started work on
ensuring prescribing follows NI E guidelines
and there is support for managing challenging
behaviours Audit of prescribing in mental health providers will be
concluded by January 2011
P Ts are undertaking a range of local audits over the
next 15 months Support material to help with managing challenging
behaviours was shared in October
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Antipsychotic Prescribing
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Tho gh NHS in So th West h s the owest eve s of prescribing in Eng n there is
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The prob emwith the t is
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for peop e with ementi n
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The Dementia DeclarationForty national organisations have signed up to the Dementia Action Allianceand made a declaration supporting seven outcomes that have been
developed with people with dementia and their carers
1. I have personal choice and control or influence of decisions about me
2. I know that services are designed around me and my needs3. I have support that helps me live my life
4. I have the knowledge and know-how to get what I need
5. I live in an enabling and supportive environment where I feel valued
and understood
6. I have a sense of belonging and feel a valued part of family,
community and civic life7. I know there is research going on that delivers a better life for me
now and hope for the future
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Leadership Challenge
Leading Improvement a major challenge
Not only due to the increasing need
Also the scale of quality and productivityimprovement required
Leadership capacity at local level is vital
Role of GP consortia rapidly crucial Maintaining passion and inspiration will
contribute to success
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