SANDWELL DEMENTIA STRATEGY. Final Draft: March 2010

Transcription

1 SANDWELL DEMENTIA STRATEGY Final Draft: March 2010

2 Foreword A joint vision for Sandwell has been agreed as follows: By 2012 all people with a suspected or confirmed diagnosis of Dementia and older people with mental health issues 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 and choice In keeping with the Mental Capacity Act, capacity will be assumed unless evidenced otherwise. If we are successful in delivering the National Dementia Strategy locally in 5 years time the following outcomes will be in place : Better information about how to prevent dementia (vascular type) from doctor/practice nurse When someone has a memory problem they feel able to approach their GP and the GP knows what to do rule out what it isn t and refer for diagnostics Robust information and support after diagnosis so the person and my carer know where to get help when we need it Carers get good advice, support and breaks If the person needs acute or other physical health care this is good quality and delivered quickly The can live independently for as long as possible The person can choose where they die and give advance directives If the person needs 24 hour care, it will be of good quality and they won t be subject to inappropriate prescribing For people who have other mental illnesses, known as functional mental disorders, they will be able to access the full range of primary care, stepped care and required specialist mental health services based on need and not age. Carers will receive appropriate assessment of their need, support, education and respite breaks. To deliver these aspirations, this Strategy necessarily focuses on Dementia as a major theme, as this is the condition that accounts for around 80% of the mental health problems affecting older people. However it attempts to address other conditions, notably depression and other less common conditions which, for a smaller number of older people, have a significant impact on their lives and those of their carers and families. These are often called functional mental disorders. It should be noted that the arrival of New Horizons and the Inequalities Legislation that is forthcoming will require partners to refresh CAMHS and Adult Mental Health Strategies for these other conditions, to remove the age discrimination currently inherent in the system. Locally, this seems pertinent to crisis resolution and home treatment services. C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 2 strategy final (2) (3).doc

3 This Strategy has been shaped over time by Sandwell MBC and Sandwell Primary Care Trust with the involvement of a range of local stakeholders, including the Sandwell Mental Health and Social Care NHS Foundation Trust, the Third Sector, and people with mental health problems and their carers, as part of the Right Care, Right Here initiatives and the Strategic Model of Care. All 3 Practice Based Commissioning Clusters have identified this work as a priority for 2010/11. It lays out what the local authority and NHS will do, together with other key stakeholders, (such as the third sector) for older people with mental health problems. The Policy Context The policy contexts for this strategy are both national and local. In addition there are a number of performance requirements and expectations set both nationally and locally, linked to these policy imperatives, which have also shaped our approach. National Five overarching national policies govern this strategy. Putting People First was published in December 2007 and relates principally to Adult Social Care. It sets out proposals for the way social care services should develop using four cornerstones: Choice and Control (including Individual Budgets), Early Intervention and Prevention, Universal Services and Social Capital. These elements challenge us to have a broad and innovative approach to develop and take forward the necessary range of services, opportunities and activities to meet the needs of people with mental health difficulties which we intend to rise to in implementing this strategy. World Class Commissioning is an approach to commissioning health services which was introduced in It provides a foundation by which the performance and effectiveness of Primary Care Trusts are judged. Its four key elements are: a vision for world class commissioning, a set of world class commissioning competencies, an assurance system and a support and development framework. Together with the NHS Operating Framework and Vital signs these approaches influence priorities and outcomes for both the NHS and Social Care. High Quality Care for All (2008) was the culmination of a far-reaching review of the NHS (the NHS Next Stage Review). Led by Lord Darzi, an overriding vision, and imperative of the review is that the NHS should work in partnership to prevent ill-health and to provide care that is personal, effective and safe. In preparing this strategy we have worked together to establish an approach to creating a care pathway to achieve the Putting People First and Darzi objectives. C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 3 strategy final (2) (3).doc

4 Living well with dementia: a National Dementia Strategy was published in January It groups 17 objectives under 3 key themes Raised Awareness and Understanding, Early Diagnosis and Support, and Living Well with Dementia. Although this Sandwell strategy does not have an exclusive focus on dementia, it does deal with this subject very substantially. In so doing, we have aimed to address the DH and West Midlands Strategic health Authority requirement to have a local dementia specific strategy. New Horizons: A shared vision for mental health, supersedes both National Service Frameworks and was published in February It describes a cross-government program of action with twin aims. These are to improve the mental health and well-being of the population and to improve the quality and accessibility of services for people with poor mental health. Its four guiding values and six key themes are consistent with the elements of the three documents described above and provide an important context for this strategy. Its whole life approach, encompassing well-being as well as illness, prevention and health promotion as well as treatment, and on multi-agency commissioning and collaboration as well as value for money, provide an important policy direction for our approach. It replaces both National Service Frameworks and means that commissioning of mental health services for those with functional mental disorders will require review to remove age barriers particularly for Crisis Resolution/Home Treatment Services and accessing psychological therapies. Regional As part of the Quality, Innovation, Productivity, Prevention and Partnership (QUIPPP) initiatives in the NHS, NHS West Midlands hosted a regional event in October 2009 which concluded that there will be a collective commitment supported by NHS West Midlands to implement prevention and early identification in dementia services, in the community, prior to a diagnosis of dementia being made along the pathway. As part of this, initiatives need to be integrated to those operating in primary care in cerebral-vascular disease prevention and alcohol harm reduction to identify people at risk, using risk stratification processes, to promote wellness. Local The Dementia Services Strategic Model of Care (SMOC), which covers the Heart of Birmingham as well as Sandwell, was developed and extensively consulted upon as a workstream of the Right Care Right Here project in response to a Strategic Health Authority requirement. People told us that they wanted: early assessment and intervention in the community accessibility to an assured pathway of care with post-diagnostic advice and support for those with dementia and their carers from diagnosis right through until death; C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 4 strategy final (2) (3).doc

5 engagement with BEM communities a jointly commissioning service system ; a single care record to facilitate co-ordinated care. Stakeholders told us they wanted additional things addressed in this Strategy. These include: ensuring better knowledge through accessible, high quality information; service development and improvement to ensure a comprehensive range of services to meet the changing physical and mental health needs of service users and their carers, who can themselves be older and frail; workforce development to ensure a skilled and capable workforce reduction in the use of anti-psychotic medication for those who have dementia Under the Mental Capacity Act, capacity is assumed unless evidenced otherwise The NHS Sandwell 2010/11 Operating Plan proposes nine strategic goals. These goals deliver the vision of reducing the health inequalities gap in Sandwell. Relevant to this Strategy, these include: Improvement of the mental health and wellbeing of the Sandwell community and develop the support we provide through our mental health services. Improvement of provision of services for older people where there is currently a gap. Support to carers. Working with partners to reduce the harm caused by rising alcohol consumption and abuse as part of the Local Area Agreement commitment. Under QUIPPP priority 12, Medicines Management will ensure appropriate medication review of people in care homes. Across Older people s mental health services - Sandwell PCT and MBC will improve support in the community and in hospital to comply with national good practice requirements as demand rises, including early diagnosis and support, crisis response, ongoing support and continuing healthcare services at home for people with dementia The PCT, in collaboration with Sandwell MBC, will re-commission carers services to deliver a breaks service to ensure carers are offered a break from direct responsibility of supervising or caring for their loved one, by providing a service to that person. Such services may be provided in the home or elsewhere. The Care Quality Commission has supported the intention of NHS and MBC Sandwell to develop plans by June 2010 on how the needs of people who have Younger Onset Dementia and their carers will be met and there is evidence that C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 5 strategy final (2) (3).doc

6 dementia cafes are found to be particularly helpful. Currently the diagnostic service is purchased from Birmingham and Solihull Mental Health Foundation Trust. As part of Admission Avoidance work in 2010/11, Crisis response is currently included with the new PCT Care Management Service Specification, which will be commissioned from Sandwell Community Health Care Services in 2010/11. Further development will include the exploration of the potential integration of other services such as the Short Term Assessment and Re-enablement Services (STAR) and PBC initiatives and ensuring that these services, and those for End of Life, are able to meet the appropriate needs of those with mental health problems. Locally, as part of research and evaluation, NHS Sandwell has submitted an HTA bid to evaluate the use of assistive technology, in collaboration with the MBC, other PCT s, and Universities. If successful this will provide an evidence base for beneficial interventions through Assistive Technology, taking further the original research published by John Woolham for Northamptonshire County Council and will be linked into the Regional NHS West Midlands work. Currently the STAY team offers monitors to the families of people with dementia to promote independence. Nationally Facts and Figures There are approximately 820,000 people living with dementia in the UK In just 30 years, the number of people with dementia is expected to double to 1.4 million The national cost of dementia is about 17 billion per year In the same 30 years, the cost will treble to over 50 billion per year Dementia is predominantly a disorder of later life, but there are at least 15,000 people under the age of 65 who have the illness Acute Hospital lengths of stay average a week longer for people with Dementia or other mental health problems Its incidence and prevalence rise exponentially with age It affects men and women in all social groups People from all ethnic groups are affected by dementia. The current number of people with dementia in minority ethnic groups is quoted by Dementia UK at around 11,000 with 6.1% having a younger age of onset, compared with only 2.2% for the whole UK population. Depression among BME elders is associated with chronic health problems, increasing age, poor housing, low family support, female gender, poor fluency in English and poor socio-economic status. C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 6 strategy final (2) (3).doc

7 For minority ethnic groups there are particular issues that prevent access to treatment ranging from stigma, to lack of understanding of mental illness and lack of culturally appropriate services. The level of UK diagnosis and treatment of people with dementia is generally low compared with the EU Research by the Alzheimers Research Trust (ART) estimate that 163,000 cases of dementia occur in England and Wales each year 1/3 of people who have dementia live in care homes, approximately 201,000 people. The other 2/3 of people live in the community largely looked after by the 476,000 or so informal carers in England (National Audit Commission Press Release 4 July 2007). A co-resident carer exerts a 20-fold preventive effect on entering a care home. Spending is late for health and social care too few people are being diagnosed early enough and early interventions that are known to be cost effective and improve quality of life are not being made widely available leading to crises developing and having more severe impact A 5 year delay in the onset of dementia can result in a 50% reduction in dementia prevalence (Jorm (1987) the Prevalence of Dementia). Informal care costs 5.2 billion, mostly borne by families carer support reduces care homes placement 557 days/18 months saving for social care of 26k per person p.a. roughly. Carer support and counselling at diagnosis reduces care home placement by 28%, with a median delay to placement of 557 days (circa 18 months) compared with those not receiving this intervention. (Clinical and Health Economic Case for Early diagnosis and Intervention services in Dementia, DH 2009) One third of acute hospital admissions are caused by breakdown in carer arrangements. Older people with dementia make up half of those whose discharge from hospital is delayed (National Audit Commission Press Release 4 July 2007). Older people occupy some 60% of acute hospital beds, with 40% of those occupied by people who may have dementia (Improving Services and Support for People with Dementia Summary) 50% of those with mild cognitive impairment will develop dementia so require regular review. Luce and co-workers (2001) quoted in NICE Assumptions used in establishing a population benchmark found that around 57% of people attending had probable or possible dementia with the remainder having other conditions or cognitive deficits that did not meet the criteria. Banerjee and coworkers (2006) in same NICE document quoted that 63% in an 18 month period referred had some form of dementia. Differential diagnoses included mild cognitive impairment and depression. The proportion of people attending a memory assessment service who have conditions other than dementia is around 46%. C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 7 strategy final (2) (3).doc

8 Minimum expected rate of referral to a memory assessment service is considered at 0.19% For a standard primary care trust population of 250,000, the average number of people requiring referral to a memory assessment service would be 475 per year. For an average practice with a list size of 10,000, the average number of people requiring referral to a memory assessment service would be 19 per year. Nationally a communications campaign will start early March and all website information has been drawn together on 10% of dementia in over 65 s and 12% in under 65 s is related to harmful alcohol use. The National Service Framework for Mental Health, published in 1999 excluded mental health services for older people which were, instead, included in the National Service Framework for Older People published in An audit of age discriminatory policies in the NHS, following publication of the NSF (older people) has been effective in reducing direct age discrimination in healthcare, except in the case of older people s mental health services which often remain separately organised and under resourced. (Commission for Healthcare, Audit and Inspection, 2006). Patterns of mental disorder vary substantially with age. The prevalence of schizophrenia and other psychotic disorders declines substantially in older age but the prevalence of anxiety, depression and other neurotic disorders remains high. Ageism and age discrimination in mental health care in the United Kingdom ; A review from the literature commissioned by the Department of Health, carried out by the Centre for Ageing, 2009). Regional Picture for Dementia The NHS West Midlands Darzi pathway is a clinically led pathway and quotes the cost of inappropriate use of unscheduled admissions in acute settings costing 32 million across NHS West Midlands scheduled to rise to 38 million by NHS West Midlands has been prioritising a number of actions through a Regional Steering Group with the Department of Health West Midlands, Skills for Care and ADASS : In 2007/08 12,500 emergency admissions for people with dementia took place into Acute hospitals. Improving the quality of care in Acute Hospitals is a regional priority, through working with New Cross in Wolverhampton, to develop outputs and care bundles which include the built environment with a hope that these be developed across all Acutes. Narrowing the gap between prevalence and diagnosis rates. Dementia registers have only been in QOF for two years. As the prevalence in dementia is predicted to steeply increase as the population ages, registers would need to grow by 12% each year to reduce the gap between prevalence and diagnosis by To close the gap by 2030 C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 8 strategy final (2) (3).doc

9 would require a 6% increase in GP recorded prevalence in the West Midlands (Dementia Clinical Pathway Group Metrics Baseline Report, Paul Seamer, July 2009) Carers need for support. 15,000 carers in the West Midlands received a specific carer s service in 2006/07, equivalent to 10% as a proportion of all clients receiving a community-based service. The national average is 12%. Younger Onset Dementia review across the area with a view to service development Education and Workforce developing both core dementia competencies plus those for new roles A good death advanced directives while capacity exists and services which facilitate end of Life in the community Reduction in use of anti-psychotics Quality Peer Reviews Digital Media Services as a platform for staff and public to view materials. Sandwell Objective 16 in the National Dementia Strategy suggests a clear picture of research evidence and local needs. Sandwell is spread over six towns within the Black Country. The total population of Sandwell (2009) is 287,600 of which there are 46,200 people 65 and over. There is a diverse population with 20% being from black and minority (BME) ethnic groups. It is estimated that Sandwell s population of older people (65+) will increase by 27.7% by The population of older people will increase over the life of this strategy to 48,600 (5.2%) but will increase over the next 20 years by 27.7%. Approximately 12,000 people receive health and social care services in Sandwell, of which it is estimated that 8,400 are older people. Sandwell has over 30,000 unpaid carers who either supplement these services or who provide alternative care. Detailed demographic information is contained in Appendix One. Only 44% (1600) of the expected numbers of people with dementia have received a diagnosis which means that 56% of people are denied the opportunities for care co-ordination, advanced care planning and other support offered in a dementia care pathway. 49% of those who are diagnosed live in care homes in Sandwell much higher than the national average. The CBSA estimate that the payment by results costs for admissions of people with dementia in 2007 for Sandwell was 2.2 million. Sandwell PCT has the C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 9 strategy final (2) (3).doc

10 highest emergency admission rates in the West Midlands at 315 per 1,000 people with dementia. There are approximately 80 people under 65 years in Sandwell diagnosed with dementia of which a number are people with a learning disability. Only 30 of these are in contact with any services. Sandwell commissions YOD diagnostic services from BSHMHFT for some of its residents, and others are seen in local services in the SMHSCFT. Based on the ART data, an incidence rate of 845 new cases of dementia will occur in Sandwell each year (this is not a actual increase as it needs to be adjusted to allow for people with dementia dying). Data obtained from the North East Public Health Observatory in 2008 suggest the following numbers for other functional mental health problems Neurotic disorder cases 34,809 All Phobia cases 3,524 Those with depression 4,105 Generalised Anxiety 8,518 Mixed anxiety/depression 20,950 Panic Disorder 361 Psychosis 2381 Where we spend the money in Sandwell As the pie chart demonstrates below, the specialist spend in secondary mental health care and in social care for older people with mental health problems is overwhelmingly in heavy end services, such as inpatient and continuing care beds and residential and nursing homes. Similarly social care spend is predominantly in residential or nursing home provision, echoing the figures given above that 49% of those who have a diagnosis in Sandwell live in 24 hour care. C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 10 strategy final (2) (3).doc

11 2009/10 expenditure on specialist OPMH 1% 1% 1% 1% 10% 26% 44% Residential Nursing Day Care Home Care Direct Payments Extra Care hospital beds liaison memory 3% 13% Summary Predominantly dementia services in Sandwell are a late intervention, heavy end service predominantly tied up in hospital or 24 hour care beds. This Strategy will attempt to move efforts upstream to support people and their carers earlier through timely diagnosis, good support and advice post-diagnosis, including support for carers and use of Assistive Technology and other mechanisms in the statutory and voluntary sector, to support the following pathway and implementation priorities.. C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia 11 strategy final (2) (3).doc

12 Proposed Sandwell Dementia Care Pathway Raising awareness& understanding, early diagnosis and support Living well with dementia Awareness, understanding & prevention (Primary & Secondary) Tackling ageism & stigma Awareness raising schools Dementias and Disease progression Likelihood of dementia and other LTCs Info to be available at varying sources using a variety of methods Referred by: Family/friend/ neighbour A&E Person with Ambulance Service Dementia Primary Care Team Other Referred by: social services GP care management History Already eligible for Examination social care because of Tests need but not diagnosis Carer Support & Advice Intermediate Acute hospital Care LINK TO IC LINK TO STAR, STRATEGY RAID, Care at Home Hospital Greenhaven Avoidance CCARS CCars Specialist Dementia Services Pathways Help to carers Carers assessments Support groups Alzheimer s Society Information Advice Respite care LINK TO CARERS STRATEGY Help to Stay Prevention Independent when Strategy eligible for Social Care Financial Advice Social Care/ Occ Therapy/ Personalisation Equipment Care Coordination, info Services & Advice Primary Care OPMH Fieldwork Interventions Assistive Technologies Continence Continence Service Service Voluntary sector Voluntary sector services services Advance Directives e.g. Extra Care EOL care Housing Challenging Behaviour Advise & Liaison Service to Care Homes and Acute Hospital End of Life Care LINK TO EOL CARE PATHWAY

13 PRIORITIES and IMPLEMENTATION PLAN Outcome Policy Driver Priorities Actions/Commissioning Intentions Age discrimination New Horizons 2009 removed from services Increased public and professional awareness and understanding of dementia Commission for Healthcare, Audit and Inspection 2006 National Dementia Strategy Objective 1 Older people with functional mental health problems access mental health services based on need not age Older people with mental health problems are able to access talking therapies in line with Sandwell PCT Direction of travel document and draft Wellness strategy The public will be more aware and understand dementia and mental health better including how to delay onset Bed reduction programs in SMHSCFT used to drive service redesign to achieve this outcome in secondary MH services in partnership with NHS Sandwell as Care Clusters develop IAPT and psychological services commissioned by NHS Sandwell to include improved access for older people Public Awareness, Health Promotion and Prevention Stay Healthy, Stay Safe and Stay Independent led by NHS Sandwell When Year 1-5 Year 1-2 Reduce the stigma, concerns and fears of mental health issues and Include in vascular screening, alcohol reduction and CHD activities as part of risk stratification in C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia strategy final (2) (3).doc 13

14 dementia primary care Assessment of risk and promotion of healthy lifestyles People with dementia from all parts of the community are able to access early diagnosis to promote independence National Dementia Strategy Objective 2 Identification of people with memory problems G.P. s supported to screen and refer appropriately as part of primary mental health care development G.P. involvement via PEC and PBC clusters together with LTC and primary mental health care developments Year 1 Year 1 Pre-Assessment counselling provided about purpose and opportunities of memory assessment Year 1 Memory Assessment takes place within 4 weeks of g.p. referral Pump-priming in Year 1 and CQUIN for Year 2 developed with NHS Sandwell supports SMHSCFT to streamline specialist pathways to reduce waiting times in line Year 2 C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia strategy final (2) (3).doc 14

15 People who might have dementia are identified for further review by Memory Assessment Services with regional Care cluster developments and expand services with ring-fenced provision for YOD Year ½ People who have dementia receive appropriate, information, advice and support following diagnosis National Dementia Strategy Objectives 3, 4 and 5 Greater development in voluntary sector of appropriate support for individuals and groups including carers, e.g. Information, signposting services, education and Advice Cafes Use of Mental Capacity Act legislation enshrines rights of people with dementia As universal Third Sector services are reviewed, by MBC and NHS Sandwell, ensure inclusion in mainstream services of OPMH to optimize wellbeing Review third Sector OPMH services with a view to ensuring that resource cafes, sitting services, peer support and befriending are available Years 1/2 National Dementia Strategy Objective 10 Assistive technology and accommodation strategies include people with Review OPMH Fieldwork Team with a view to recommissioning some of its functions to support C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia strategy final (2) (3).doc 15

16 dementia and their carers enhanced care coordination and liaison specialist care co-ordination available for those whose condition is more developed through relevant health or social care professional Carers of People who have dementia receive appropriate, information, advice and support National Dementia Strategy Objective 7 Implement New Deal for Carers including assessment, support and improved short breaks as part of Joint Carers Strategy Review third Sector OPMH services with a view to ensuring that resource cafes, sitting services, peer support and befriending are available Years ½ Reduce/remove inappropriate prescribing of antipsychotic drugs to people with dementia NICE Guidance G.P s challenge and reduce repeat prescriptions for these interventions Ensure needs are aligned with personalisation as Personal budgets roll out PEC and Medicines Management lead on audit and intervention actions Year 1 Specialist MH services assist primary care to locate suitable alternative CQUIN Year 1 incentivizes review by specialist staff of C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia strategy final (2) (3).doc 16

17 pharmacotherapy where indicated in line with NICE Guidance antipsychotic prescribing in MH by SMHSCFT linking to Care Cluster developments Year 1/2 Good care home liaison and workforce development Ensure comprehensive liaison service commissioned across care homes, physical health services, extra care, acute hospitals and end of life services People with dementia who have physical health problems receive appropriate interventions National Dementia Strategy Objective 9 Ensure needs of people with dementia taken into account in Falls Strategy Intermediate care services are improved for people with mental health problems Influence Falls Strategy development Influence Intermediate Care Strategy to ensure needs of OPMH are met in these services with appropriate liaison Year 1 Year 1 People with dementia are Ensure comprehensive liaison service commissioned across care Year 1 C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia strategy final (2) (3).doc 17

18 not inappropriately admitted to Acute Hospitals in as a crisis measure homes, physical health services, extra care, acute hospitals and end of life services Personal Home Support Service takes into account needs of people with mental health problems CSED redesign of Council Home Support Services takes account of liaison and needs for complex interventions People with dementia who need Acute Hospital treatment receive a good quality of care to enable them to return home National Dementia Strategy Objective 8 No more than 2 moves when in hospital Acute staff are supported to deal with people with complex needs Personal budgets for those with longer-term home support needs made available Ensure comprehensive liaison service commissioned across care homes, physical health services and acute hospitals hospital to assist people to return to place of origin post-admission in a timely way Year 1 Discharge 2 days postmedical fitness to place of Utilise CQUIN and Quality Schedules to support Years 1/2 C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia strategy final (2) (3).doc 18

19 origin workforce development and capital alterations People with YOD or who have learning disabilities or who are HIV+ receive appropriate diagnosis, post-diagnostic advice and support and good care including re-ablement People who live in residential and nursing homes have a good quality of care Regional Priority together with National Dementia Strategy requirement to jointly commission systems to meet needs, Objective 15 National Dementia Strategy Objective 11 Develop plan collaboratively to develop services for people who develop dementia at a younger age, and their carers Influence all above initiatives to ensure the needs of these groups from ethnic minority groups, or those who have learning disabilities, HIV or substance misuse problems receive appropriate services Care homes have skilled and competence workforce Review YOD contract with BSMHFT and consider opportunities in the Black Country for local services with other PCT s Providers will undertake appropriate training needs analysis and arrange appropriate inputs to meet training requirements Year 1 People with Dementia have a good death experience National Dementia Strategy Objective 12 End of Life and out of hours services supported to manage people with Liaison as noted above commissioned to include end of life services and care C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia strategy final (2) (3).doc 19

20 mental health needs in the community so people have a choice homes. Care homes supported to manage the end of life medical issues for their residents who have dementia and who are dying Workforce development addressed in care homes as above C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc 8 1 Dementia strategy final (2) (3).doc 20

21 The Approach People who use services and their carers have been clear about their experiences and their priorities. Commissioners and providers need to work together, moving past historical tensions, to deliver a whole system of care that meets those priorities over the 5 year period. Workstreams will be developed to progress the following priorities and will report to the OPMH Joint Commissioning Group : 1. Information metrics to measure impact of interventions to address those priorities and the Productivity and Value for Money requirements Year 1 2. Workforce development both specialist and non-specialist across health, social care, statutory and voluntary sector Years Care pathway development with clinicians and user/carer and stakeholder involvement in service redesign across the whole pathway with the development of relevant service specifications to re-design services Years Public Awareness as part of a general Public Health campaign in Year 2. Financial Resources Information published by the Kings Fund budgets and Sandwell 18 th Annual Report, Cares well in Sandwell, both suggest that Sandwell s investment in adult mental health per head of population is lower than the national average. Older people clearly did not receive the adult investments arising from the NSF so is worse placed, which is leading to the themes listed above of late intervention which is crisis-driven. Applying the World Class Commissioning cycle, we will be exploring existing commissioned services, from a value for money perspective to both NHS and MBC Sandwell, to ensure that the outcomes of the service are in line with the strategic outcomes of Right Care, Right Here; the Strategic Models of Care as well as the outcomes sought in this Strategy. We aim to adopt a re-commissioning and service re-design approach wherever possible. Any new investment will be on a clear Invest to Save basis, where health and social care impact of newly commissioned services are clearly captured so that investment can shift to appropriate areas in Year 3/4.

22 Proposed Performance Indicators for Dementia for 2010 The Department of Health is developing with the CQC a set of metrics including Patient Recorded Outcome Measures, so the measures of success may change. Performance Indicator Threshold Method of Measurement e.g. Quarterly reporting; Exception reporting. All older adults are under SAP Timeliness of completion of social care assessment (NI 132) Timeliness of provision of care packages or other support and care plans (NI 133) Timeliness of reviews completed for people diagnosis with dementia (D40) numbers of people identified and diagnosed with dementia more commensurate with likely demographics (i.e. narrowing the gap between prevalence and diagnosis) Numbers of adults supported to live independently with one of these diagnoses (NI 136) Numbers of acute hospital unplanned admissions for people with one of these diagnoses (New) the establishment of memory services which see all people with Systems requirements C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc

23 dementia irrespective of age / ability/ ethnic origin/ location (equality in services) people with young onset dementia are able to access appropriate specialist services people with a learning disability and at risk of developing dementia have access to appropriate specialist services dementia cafes are established care is closer to home people are able to access services in the community in which they live Length of stay in Acute hospitals for these diagnoses benchmarked against the norm Numbers of moves within Acute hospitals Delayed transfers of care for people with one of these diagnoses (NI 131) Numbers admitted to residential or nursing home care from Acute Hospital reduce appropriate support / counselling is give to people with dementia / their carers early on in diagnosis strategies are in place to engage with local BME communities people with dementia and their carers C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc

24 supported to make advance decisions/ end of life plans people in later stage of dementia able to access end of life care Workforce training plans and percentages trained collected through Quality Review process Numbers of carers taking assessments and care plans (NI 135) Personal Budgets for people with this diagnosis (NI 130) Personal Budgets for carers of people with this diagnosis Respite breaks for carers of those with dementia Audit of psychotropic medication evidences reduction Numbers of people reviewed by specialist MH services who are prescribed antipsychotics Numbers of people with this diagnosis offered intermediate care and risk stratification (NI 125) Numbers of people with this diagnosis offered intermediate care and risk stratification People with LD and dementia assessed and diagnosed in Memory clinics Waiting times for Memory Assessments Qualitative outcomes C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc

25 patient and carer experience including dignity and respect (NI 127 and NI 128) Number of people with early diagnosis of dementia known to adult social care in settled accommodation (NI 149 extension) Number of people with dementia enable to die at home (NI 129 extension) Number of users and carers with dementia whose personal outcomes have been met (3 personal outcomes) % of people with dementia who have a safeguarding protection plan in place % of people with dementia who access advocacy services % of people with dementia who access IMCA % of people with dementia who access IMHA % of people with dementia who have authorised DOL s Increased public awareness & understanding of dementia Increased professional awareness & understanding of dementia Diagnosing dementia After diagnosis people are signposted to the C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc

26 appropriate services in line with the care pathway C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc

27 REFERENCES Department of Health documents as follows : Putting People First World Class Commissioning High Quality Care for all : the NHS Next Stage Review by Lord Darzi Living Well with Dementia : A National Dementia Strategy, Jan 2009 National Audit Office Clinical and Health Economic Case for Early Diagnosis and Intervention in Dementia, 2009 Improving Services and Support for People with Dementia Summary National Audit Commission Press Release, July 4 th, 2007 Ageism and age discrimination in mental health care in the United Kingdom ; A review from the literature commissioned by the Department of Health carried out by the Centre for Ageing, 2009 NICE Luce and co-workers (2001) quoted in NICE Assumptions used in establishing a population benchmark Banerjee and coworkers (2006) in NICE Assumptions used in establishing a population benchmark Jorm (1987) The Prevalence of Dementia : a quantitative integration of the literature, in Acta Psychiatrica Scandinvia, 76, pp Seamer, P., (July 2009) West Midlands (Dementia Clinical Pathway Group Metrics Baseline Report C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc

28 Appendix One Detailed Demographic details The projected growth in the population of older people in Sandwell ,300 42,000 48,900 % Increase on 4.2% 21.4% ,900 6,600 10,100 % Increase on 11.9% 71.2% 2009 Total ,200 48,600 59,000 % Increase on 5.2% 27.7% 2009 These projections show a modest growth to 2015 but a substantial increase, particularly in the over 85 population to Although this strategy covers a five year period it must also lay the foundations and set the direction in the longer term. Increases in the Incidence of Mental Ill-health Information on dementia prevalence (65+) shows the following increases: ,847 1,890 2,227 % Increase on 2.3% 20.6% 2009 % of population 4.6% 4.5% 4.5% 85+ 1,382 1,531 2,309 % Increase on 10.8% 67.1% 2009 % of population 23.4% 23.2% 22.9% Total 65+ 3,229 3,421 4,536 % Increase on 5.9% 40.5% 2009 % of population 7.0% 7.0% 7.7% C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc

29 These figures need to be adjusted with figures for people under 65 with young onset dementia (estimated at around 80 known cases in 2009 but likely to be at least twice this figure when undiagnosed cases are included). Information on older people with depression (mild to moderate) is as follows: ,469 3,577 4,197 % Increase on 2.3% 20.6% 2009 % of population 8.6% 8.5% 8.6% % Increase on 10.8% 67.1% 2009 % of population 9.2% 8.9% 8.5% Total 65+ 4,010 4,166 5,060 % Increase on 5.9% 40.5% 2009 % of population 8.7% 8.6% 8.6% Information on older people with severe depression is as follows: ,032 1,080 1,256 % Increase on 4.7% 21.7% 2009 % of population 2.6% 2.6% 2.6% % Increase on 11.7% 71.3% 2009 % of population 3.9% 3.9% 3.9% Total 65+ 1,262 1,337 1,650 % Increase on 5.9% 26.8% 2009 % of population 2.7% 2.8% 2.8% C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc

30 The increases in numbers in each age band for both dementia and depression are broadly consistent with the population growth, i.e. prevalence rates are consistent. It should be noted that figures for dementia and depression are not exclusive and many people may have both these conditions. Information on other conditions (e.g. OCD, psychoses, etc.) is not available. [NB these need to be obtained and included if possible] It must also be noted that these figures are based on national, not local data. C:\Users\mark\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CMZV03JP\SMH-CORP-TB Enc Dementia strategy final (2) (3).doc