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