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The 9th Darzi Clinical Pathway Group. Mike Rochfort Programme Lead: Older People’s Mental Health. Care Services Improvement Partnership West Midlands. Why a ninth dementia group?. The annual national cost of dementia care Direct cost to the NHS is £3.3 billion

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the 9th darzi clinical pathway group

The 9th Darzi Clinical Pathway Group

Mike Rochfort

Programme Lead: Older People’s Mental Health.

Care Services Improvement Partnership

West Midlands

why a ninth dementia group
Why a ninth dementia group?

The annual national cost of dementia care

Direct cost to the NHS is £3.3 billion

Overall annual economic burden is £14.3 billion i.e. £25,391 per head

This exceeds combined costs for stroke, heart disease & cancer

Dementia in the West Midlands rising to 38% increase over next 13 years; 154% over next 43 years

YOD 3 times higher among Asian communities

why a ninth dementia group1
Why a ninth dementia group?


Long Term Conditions


End of Life

Mental Health

overview of current problems
Overview of current problems

There is no overarching “dementia" service

Mental Health Services Older Adults

Primary Care

Social Services

Mental Health Services Working Age Adults

Care Homes

Independent Sector

Voluntary Services

Charity services

overview of current problems1
Overview of current problems

Unacceptably low rates of identification (approximately 50% never receive a diagnostic assessment)

Reactive style → crisis situations → inappropriate use of resources (crisis admissions; inappropriate admissions)

Exclusion from crisis resolution / assertive outreach team support

Different funding sources along different care pathways

No advanced care planning for end of life

Insufficient investment in prevention e.g. ARBD

inadequate staff training

carers in west midlands
Carers in west midlands
  • Intimate carers ↓
  • single households ↑

Carers in west midlands

  • Very little in home supportand in home respite care
  • Asian & Afrocarribean carers are reluctant to ask for support
  • carer awareness of where and how to access information on Dementia and Dementia services was low

Ipsos MORI 2008


Approximately 80% of respondents knew “a little” to “nothing at all” about symptoms of Dementia, services for Dementia & the different types of DementiaIpsos MORI 2008


By 2012 all people with a suspected or confirmed diagnosis of Dementia will access an integrated, seamless, proactive and high quality locality based service that encompasses all the expertise to meet needs of the people with Dementia and those of their carers. The emphasis will be on personalisation & choice.

eight standards
Eight Standards

Health and social care jointly plan and commission a service for people and their carers with Dementia which provides seamless, integrated and proactive care

The specified services for Dementia interface with services available for all other long term conditions and those for Older people

Interventions are available closer to home with home as the base starting point

The employed workforce will be competent to address physical and behavioural symptoms

Sources of Intimate carers will be adequately resourced

Each Dementia service will have a PathwayNavigator or Agent available throughout the disease process

Existing disease registers in GP practices will be used to trigger preventative actions for defined types of Dementia

Minimum core standards of competency for Dementia care will be used to underpin all education programmes for staff working alongside people with Dementia

the dementia pathway
the dementia pathway

Prevention (primary & secondary)

Tackling ageism & stigma

Awareness raising – start in schools

dementias and disease progression until death;

likelihood of dementia and other long term conditions – the issues

Info to be available at different sources using a variety of methods

Long Term Conditions

Dementia Pathway Coordinator

  • Early Intervention
  • Diagnosis
  • GP screening & subsequent referral for specialist assessment.
  • Primary Care Liaison workers.
  • Memory Assessment Service (single access point)
  • Dementia register.
  • Preassessment counselling.
  • Multidisciplinary specialists.
  • Diagnosis: old age psychiatrist; geriatrician; Neurologist; GPwSI
  • 3. Ongoing Person & Carer
  • Centred Care
  • Integrated CMHT
  • Advocacy
  • Respite Care
  • Intermediate Care
  • Crisis Intervention
  • Young Onset Dementia team
  • Outpatient/Community Clinics
  • Hospital Liaison team
  • Planned Inpatient Admission (assessment & Continuing Care)
  • Social Services
  • Palliative Care
  • Bereavement
  • End-of-Life care
  • Carer Support
  • Residential/Nursing care
  • Psychological Services
  • Long-term Conditions

Person with Dementia

Early Intervention

2. “Looking to future” clinic

While Capable: includes, end of life care, benefits, lasting power of attorney, living wills, advanced care planning, advocacy requirements, driving, genetic counselling, etc

Royal Colleges, Department for Education, Public Health

Specialist Dementia Service

Expert carer programmes

Person with dementia

dementia pathway coordinator
Dementia Pathway Coordinator

Agent to the person with dementia

Accessed after receiving a diagnosis

Coordinate complex care situations

Involved until death & beyond

Pathway/s navigator

Primary care

Specialist health care

Social services

Third sector


Knowledge of individualised budgets

13 outcome measures
13 Outcome measures

Early detection programmes in primary care as a QOF target

Time to specialist assessment = 18 weeks

Dementia database

Unplanned (crisis) admissions

Access to appropriate neuroimaging

Rates of prescribing of dementia drugs

Assistive Technology & Telecare

Unsupervised prescription of sedative psychotropic drugs

Access to nonpharmacological therapies

Provision of mental health support in general hospitals

Availability of out of hours specialist care

Expert carer support programmes

Place of death and relationship to patient’s wishes

recommendations national
Recommendations - National

Hard hitting national public health alcohol misuse campaign targeting young people as well as adults

Raise awareness of dementia in school curriculum and public domain with emphasis on:


Attitudes, discrimination, abuse

Early symptoms

Prevention & life styles

Effective interventions

A programme of “expert speakers" to raise awareness

recommendations regional
Recommendations - Regional

Appoint Regional Dementia Chair to oversee funding, implementation & development of new Dementia Pathway

Implement Joint Commissioning by April 2009.

Develop joint audit/service effectiveness tools & joint learning (primary & secondary care)

Coordinating a review of YOD service provision by April 2009

Piloting of regional primary care dementia quality indicators by Oct 2009

recommendations pct local authorities
Recommendations - PCT & Local Authorities

mapping and benchmarking of dementia services by Oct 2009

PCT and Local Authority commissioners to monitor and review their services every 2 years

Every PCT must commission a Memory Assessment Service with an integrated health and social care team by 2010.

By 2010, all people with dementia admitted to a general hospital will receive care from staff who have received appropriate and ongoing training in dementia care. A dementia lead (usually a geriatrician) will be nominated & a Hospital Liaison team commissioned.

recommendations pct local authorities1
Recommendations - PCT & Local Authorities

Separate dementia from functional inpatient mental health provision by April 2010

Setup Dementia Coordinator role for new Dementia pathway by April 2010

Identify funded pathway to swiftly access MRI volumetry (hippocampal segmentation), I-FP-CIT (DaT-SCAN), & PIB PET scans (where appropriate) by April 2010

Shared Care Protocols for dementia drugs by April 2009

Appoint/contract named consultant & commissioner for YOD

Clarify pathway for ARBD with emphasis on recovery/neurorehabilitation

recommendations pct local authorities2
Recommendations - PCT & Local Authorities
  • Commissioning specialist input into Care Homes by April 2009.
  • Improving in home care by 2010 through:
    • Mandatory accredited dementia training for formal carers
    • adhering to agreed minimum care standards
    • audit of carer satisfaction
    • availability of appropriate respite care
  • user & carer involvement in service planning & inspection (health & social care) by April 2009
  • providing culturally sensitive proactive support for minority group carers by 2010
recommendations regional1
Recommendations - Regional

Workforce Deanery to undertake the following training:

New Roles:

Primary care liaison workers

Dementia pathway coordinators

Mandatory Training:

Basic e.g. residential care, ambulance

General e.g. acute hospital staff, GP

Specialist e.g. consultants, mental health staff, GPwSI