NORTHUMBERLAND, TYNE & WEAR

NHS FOUNDATION TRUST

Improving the Northumberland Dementia Pathway

Russell Patton, Group Director, Urgent Care

St George’s Park Male Acute

Female Acute

Older People Functional

Older People Dementia

Stepped Care

St George’s Park – current inpatient provision

Mother and Baby

NTW Northumberland Dementia Provision

Inpatient services in Northumberland are currently provided

across two wards at St Georges Park; Cresswell (24 beds),

and Druridge (24 beds)

• Cresswell – provides assessment and treatment for

older people with mental health problems arising from

organic disorders.

• Druridge – provides specialised longer term care for

people with severe mental illness and challenging

behaviour arising from an organic disorder.

Community Services are provided through:-

• Community Mental Health Teams - multidisciplinary teams

coordinating a persons assessment and care. The teams currently

provide assessment and diagnostics and well as managing people

with complex needs

• The Community Teams access the Day Hospitals (Morpeth, Alnwick

and Berwick) which provide enhanced assessment, management and

treatment

• A Challenging Behaviour Team works with the community teams

and care staff providing support and education for people who

experience severe challenging behaviour to remain in their homes

(domestic and care homes)

Organic Pathway - Costs

• Reference Costs - Once a year all NHS hospitals submit the cost of

their services to the Department of Health. The DoH then compare

the returns and publish the results of the comparisons

• NTW has a high reference cost due to the significant transformation

taking place across all of our services

• As an organisation we have reviewed the cost and activity within our

organic clusters and the following graphs highlight NTWs position

against four similar organisations nationally (Pennine, TEWV,

Bradford & 2gether)

• Reference costs are a comparison of service cost efficiency it does

not account for the quality of care and intensity of treatments

Occupied Bed Days per 100k of

population

Review of Inpatient Activity

• Utilisation of the 48 inpatient organic beds has always been low, with a maximum average usage of 31 patients during 2012/13

• The further development of our community infra structure and more efficient and effective inpatient care delivery has seen average occupancy continue to drop

• Of the current inpatient population (27) 7 patients have agreed discharge plans which will be initiated over the next month to 6 weeks.

• Requests for admission to hospital remains low

• Service Model Review Undertaken - advocated a model

based on fewer, but better clinically resourced inpatient

facilities to meet the needs of our service users.

• A key driver associated with SMR was timely access and

discharge across both inpatient and community services

• Proposal will assist Clinical Commissioning Group (CCG)

to met the national target of 67% of people with dementia

diagnosed – current performance - 45%

• Care delivered as close to home for as long as possible

• Challenging Behaviour Team

Local strategies / Priorities / Memory

Management

Rationale for change • Service development within older peoples services over the past 10

years has seen a change in the profile of where people receive their

care and support

• Increased support to people living in care homes and their own home

has and continues to reduce the need for admission into hospital as they

receive their care and treatment in familiar environments.

• Community support will have a positive impact on the average length of

stay

• The development of a Specialist Memory Management Services will

support the early diagnosis and support for individuals. This will release

more “time to care” for mainstream CMHTs

• Development of and improved access to dementia drugs has resulted in

more people living well for longer with their dementia without requiring

intensive support

Transforming Community

• Consolidate 2 wards into 1 which will enable

more focussed clinical interventions to take place

• Greater staff to patient ratio with significant input

from qualified practitioners into a skilled specialist

multi disciplinary team

• Significant re-investment into the broader organic

pathway particularly – memory management

• Contribute towards the broader transformational

change agenda eg enhanced challenging

behaviour teams and Universal Crisis Services

Proposal

Expected Outcomes

• Improved earlier interventions and quality of care for our

patients with dementia

• Greater opportunities for care within the patients own

domestic settings

• Improved safety systems linked to greater community and

inpatient alignment. PCP model will reduce the need for

hospital admission and support appropriate discharge

earlier thus reducing length of stay

• Improve care provision via improved staff to patient ratio’s

• Reduced number of patient incidents

• Robust memory assessment process to treat earlier and

reduce need for costly interventions later in course of

illness

Any questions ?