National Dementia Strategy • 5 minute presentation on the National Dementia Strategy http://www.alzinfo.co.uk/NDS/NDS.html
What is dementia? • Is it the same as Alzheimer’s disease? • No! • Dementia is the family name for a number of conditions, of which Alzheimer’s disease is the most common
So what is dementia? • An acquired impairment • Global cognitive functions (memory plus) • Self-care and day-to-day function • Clear consciousness • Usually progressive • Behavioural and psychological symptoms may include wandering, aggression, apathy, hallucinations, loss of inhibitions, repetition etc.
Essential National key priorities • Good quality diagnosis and intervention for all • Improved community personal support services • Implementing the Carers Strategy • Improving quality of care for people with dementia in general hospitals • Living well with dementia in care homes • An informed and effective workforce for people with dementia • A Joint Commissioning Strategy for dementia Joint strategic needs assessment by PCT’s and LA’s to determine local priorities
Demographics The numbers for younger onset dementia suggest to be small data taken from PANSI 09 - 55, 15 - 55, 20 – 58, 25 – 63 and 2030 – 62.
Geographical % breakdown of patients on dementia register As of Nov 09 – 898 patients on the Dementia Register of which Todmorden Health Centre is the largest in terms of registered users 90 to date.
Review of Dementia Services Survey in Calderdale – JULY 2008 SWYMHT carried out a review in July 2008 with the help of the Clinical Governance Support Team (CGST) to further understand the needs for service users and carers in Calderdale. Aim • The aim of the survey was to ascertain services users and carers views about the provision of services for Dementia in Calderdale. Conclusion • The most often cited area of concern was inappropriate help in the early stages of seeking help. Within this there appears to be two main issues: • Recognition of problems and action taken within Primary Care • The quality of information and support on offer. • Worth noting that concerns were raised at the lack of support at weekends and in the evening. Recommendations • More work is required to engage with people diagnosed with dementia. • Maintain access to good quality day respite • Improve support offered to Primary Care to encourage earlier referral to specialist services for diagnosis and care. • Engage the Calderdale’s Older Peoples Partnership Board in identifying ways to improve the information and support available at early stages of seeking help • Raise issue of support at weekends and evenings within Putting People First workstream currently implemented by LA
Calderdale Dementia Care Pathway Overview PRIMARY CARE Signposting or treat for “other condition” SECONDARY CARE Memory service manages medication Record possibility of dementia and diarise to recall Arrange services at day hospital In-reach to hospital/ care homes Treat as required Refer to CMHT for support CMHT provides therapy/support GP visit Client or carer concerned about memory or behaviour issues Do tests and diagnose (may involve consultant) Pass to community matron for support Refer to consultant for specialist treatment SOCIAL SERVICES Client or carer concerned about being able to cope with cognitive impairment Arrange admission to MH ward for assessment/treatment Assess client and carer and agree IB/DP/package eligible Arrange service (brokerage or client/ carer does their own) Contact to social services eligible Planned admission (general need) Triage signpost Arrange discharge Home support/ re-ablement/AT Day care (inc flexible options) Intermediate care End of life care Third sector advise on available help Care home (general or EMI) Respite (flexible) Housing Rapid response Services under contract to LA Emergency (arrive A&E by self, ambulance, police) Nursing home Information, welfare advice, practical support Transport/leisure Other continuing care options Welfare benefits Enquiry Support groups Ambulance THIRD SECTOR STATUTORY SERVICES OTHER SERVICES NOTE: important for other services (eg welfare benefits, housing) to trigger further action
Information Gaps • Numbers of people from minority ethnic groups • Numbers in specialist secondary treatment • Numbers in general hospital • Numbers living alone • Younger People <65 ?
Progress to date • Four PENPAL sessions have been held; two in January and two in February. These sessions were led by a consultant psychiatrist within South West Yorkshire Partnership Foundation Trust (SWYPFT); the aim was to raise awareness amongst GPs and Practice Nurses which emphasized on early diagnosis, medication and services available within Calderdale. Both sessions were well attended positive feedback. • Refresher training is currently being planned for care home staff as well general nurses on wards. A toolkit has been developed which outlines the training needs thought is still been given on how to best utilise this, ideas include a training champion or look at best practice methodology.
Progress to date • A dementia lead within Calderdale and Huddersfield Foundation Trust has been identified who will be working closely with the steering group and the project manager to take this agenda forward. • Quick wins have been identified which will promote public awareness around dementia. These included a radio campaign, using Calderdale Call, Internet, NHS choices this is still at an early stage of development. This campaign will possibly begin with Calderdale Call which is currently being developed with the support of communications team. • During the summer of 2009 a Dementia Network Group was established which incorporated service users, carers, NHS, Local Authority and third sector. This was a valuable piece of work which highlighted the areas of work the Calderdale people wanted services to improve on. We are planning a follow up event which is likely to be held in July with Angela Monaghan being the guest speaker
Success Stories • Alzheimer’s Dementia Network Café • Joint Care Home Liaison Team • SWYPFT Life Story Journals which promote personalised care • Successful recruitment of the community development workers • Following YHIP’s peer review reference was made to Calderdale’s outstanding jointly commissioned care home process. The specialist care home liaison team provide an excellent example of how NHS Calderdale and the Local Authority integrated day services to allow for increased capacity
Next Steps The below five key areas of work have been identified for the strategy. This will ensure all 17 objectives are addressed within the National Dementia Strategy: • Understanding the potential impact on services of the predicted increase in numbers of people with dementia • Public awareness towards dementia • Working with carers and people with dementia to develop new services and also improve communication regarding changes in service provision • Individual budget scheme • Training for staff, carers and service users The National Dementia Strategy stipulates lack of knowledge around dementia. One of the key messages in the strategy is the need for better education and training for professionals’ evidence would suggest Calderdale is no exception. This will be addressed as above as well as specific work already underway with Penpals.
High level project plan • Coincide a local awareness campaign with the national campaign – On going • By the end of March complete Action Plan which will meet the objectives of the NDS • By the 1st April have a draft strategy in place • April – May – Approval of strategy by Cabinet / PCT board • May – Implementation of Action Plan • July – 2nd National Awareness campaign being launched. Calderdale will hold a similar event by holding the 2nd Dementia Network group.