Dementia Management- Commissioning integrated

Care

Dr Dee Gallop-GP & Associate Clinical Director Lincolnshire Foundation Partnership Trust

Colin Warren – Head of Commissioning Mental Health Services, South West Lincolnshire Clinical Commissioning Group

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Acknowledgement

This presentation is supported by an honorarium from Lundbeck Pharmaceutical Company

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Introduction Dementia is a syndrome caused

by several illnesses characterised by progressive functional decline in – Memory Reasoning Communication skills ability to carry out daily activities independently

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Introduction contd.

Associated behavioural and psychological symptoms include; Mood changes (often prodromal)

Depression Psychosis Aggression Wandering

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Demographics

Approximately 750,000 are known to have the condition in the UK – numbers are predicted to double in the next 30 years

Costs are estimated at £17 billion and rising to over £50 Billion by 2025

60,000 deaths a year are attributable to dementia

33% of all people with dementia live in care homes

66% of people living in care homes have dementia 5

Lincolnshire -estimated prevalence of Dementia

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Drivers

Living Well with Dementia – The National Dementia Strategy

Quality Outcomes for People with Dementia

NICE – quality Standards for Dementia Care

NHS Operating Framework 2012/13

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Residential Care Homes No requirement for trained nurses Staff to patient ratio is variable

especially at night Some companies have structured

training programmes and activity co-ordinators

Changes in mental or physical health or development of BPSD often leads to unplanned admission to both general and mental health acute services

Loss of current placement can follow

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Nursing Homes Provide –

Long term care Respite care 30 day reablement programmes Daycare Mix of trained and untrained staff in variable ratios

Often minimum required staff to patient ratio (variable)

Diverse skills and aptitudes High staff turnover Inconsistent links to other health and social care professionals e.g. GP support

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Dementia and QIPP Implementation of NDS through efficiency

savings. Quality – early diagnosis; better care in

Acute Hospitals; review of discharge and readmission; support to care homes

Innovation; Joint working with Primary care, Acute hospitals, Mental Health Trusts and Social care.

Productivity – facilitating timely discharge could save £50 million nationally. Better management of patients in acute hospitals potential savings of £6 million. Reducing Antipsychotic medication potentially saves £55 million per annum, prevent 1800 deaths and 1620 CVA’s

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Commissioning Support

Joint Health Commissioning Panel for Mental Health -In collaboration with RCP and RCGP have produced commissioning support guides for Clinical Commissioning Groups- Dementia guide will assist in delivery of the National Dementia Strategy

Alzheimer’s Society – report that many care homes do not provide the level of one to one person centered care that is required. External specialist support is also highly variable.

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Lincolnshire Care Homes Review of each cluster (pre CCG

boundaries) of admissions to acute hospital from care homes (2010).

Top 10 homes identified in each area

Majority of patients were admitted

Most attended out of hours Dementia/Alzheimers disease was

the most common co-morbid condition at presentation12-22% of all cases.

41% of admission to older adults wards in Mental Health were from Care Homes (2010-2011)

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Lincolnshire Care Homes Current initiatives – Workforce

training and development “Making a Difference “

Telecare Project – My Amego Survey of Antipsychotic

prescriptions (2011) Follow up audit 2012 Development of awareness and

education programme Workshops on intermediate care

liaison service and development of reablement models

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Lincolnshire Care Homes All Clinical Commissioning

Groups have initiated care home projects

The Bromhead charity Care Homes Project

SWL CCG Care homes review (Baker & Raybould)

Acute care pathway development

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Lincolnshire Care Homes Reablement workshops – held in

each quadrant of the county with the aim of improving the liaison between acute mental health liaison services ,the hospital care team and current intermediate care services both health and social care

Improving awareness of each service their roles and responsibilities and developing the processes to support seamless integrated patient care. 15

Lincolnshire Care Homes Scoping of resource gaps,

knowledge and skills Establishing the baseline to

inform performance frameworks and assist in evaluation of the changes

Linking across to the acute care pathway for dementia to inform development and delivery

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Lincolnshire Care Homes SWL CCG Project – reviewed Care

homes in the cluster and determined that there were a number of main issues for unplanned admissions Catheter care – usually replacement

Falls/fainting Poor advice e.g. 999 call UTI’s and other common infections

Lack of advanced care planning and crisis management

Palliative care is inconsistent

Heart failure and COPD

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Lincolnshire Care Homes SWL CCG Project – Proposed

solutions Care homes pathway Single point of access Mobile outreach team – assess

in the community, MDT to include –

ECP, Social Worker, Mental Health Intermediate Care, access to GP advice through own GP or Urgent Care Centre as appropriate

Advanced care planning18

Lincolnshire Care Homes SWL CCG Project – Proposed

solutions Regular health care reviews by GP

Take note of LTC management Pharmacy reviews to support medication management

Improved liaison between care professionals to support admission avoidance and facilitate earlier discharge to usual place of residence.

New pathway goes live April 2012

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Lincolnshire Care Homes In Summary – Care homes require

professional support to develop advanced care plans

Crisis management should seek to address those issue that are amenable to care in the care home – Mobile outreach team (or equivalent)

Mental Health services should be engaged and integral to the service

The care homes workforce needs education and training to support people with Dementia – Making A Difference

Care pathways should offer integrated and seamless care

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A Final Thought

We cant increase the years of life for our patients with dementia but we can increase the quality of life in those years

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Questions?

Any Questions?

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