Dementia Programme Kevin Mullins Head of Mental Health Services

Transcription

1 Dementia Programme Kevin Mullins Head of Mental Health Services

2 NHS Mandate 2016/17 Overall 2020 goals Measurable on all areas of Prime Minister s challenge on dementia 2020, including: Maintain a diagnosis rate of at least two thirds Increase the numbers of people receiving a dementia diagnosis within six weeks of a GP referral Improve quality of post-diagnosis treatment and support for people with dementia and their carers 2016/17 deliverables: Maintain a minimum of two thirds diagnosis rates for people with dementia Agree an affordable implementation plan for the Prime Minister s challenge on dementia 2020, including to improve the quality of post-diagnosis treatment and support. 2

3 CCGIAF: Dementia Indicators 1. Estimated dementia diagnosis rate (65+) March 2016 data: CCGs assessed against static thresholds for each rating Rating Proportion of CCGs with rating Description Top performing 19% At, or above national target Performing well 36% 41% No more than 10 percentage points below target Greatest need for 4% More than 10 percentage points below target 2. % of people having a care plan review in preceding 12 months (14/15 data): CCGs put in ranked order of performance and assessed relative to each other Rating Proportion of CCGs with rating Description Top performing 25% This half of the Performing well 25% CCGs are doing ok for this indicator Greatest need for 25% 25% This half are not doing ok for this indicator Aggregating the indicators The table to the right shows how the assessments against the two indicators are aggregated. For example, a CCG rated as having the greatest need for against both indicators will receive an overall rating of Greatest need for. Care plan review Top performing Performing well Top performing Top performing Top performing Performing well Greatest need for Performing well Top performing Performing well Diagnosis rate Performing well Greatest need for Greatest need for Greatest need for Greatest need for

4 Overview of performance The key themes explaining underperformance in these CCGs include: Pathway issues which have led to long waits from referral to assessment in memory clinics; Inappropriate referrals which further compounded pathway issues and long waits; Coding issues where practice registers have not been up to date with the cleansing of their registers to identify cases both within primary and across secondary care; Data reporting issues via the CQRS; Undiagnosed cases in care homes. National Dementia Outliers Mar-16 Apr-16 May-16 Total no. of CCGs below ambition Adrift by 5% or more Adrift by 10% or more North Dementia Outliers Mar-16 Apr-16 May-16 Total no. of CCGs below ambition Adrift by 5% or more Adrift by 10% or more Midlands & East Dementia Outliers Mar-16 Apr-16 May-16 Total no. of CCGs below ambition Adrift by 5% or more Adrift by 10% or more London Dementia Outliers Mar-16 Apr-16 May-16 Total no. of CCGs below ambition Adrift by 5% or more Adrift by 10% or more South Dementia Outliers Mar-16 Apr-16 May-16 Total no. of CCGs below ambition Adrift by 5% or more Adrift by 10% or more 0 2 1

5 Improvement offer Level 1 Level 2 Level 3 Level 1 general advice available to all CCGs Continuation of the support already available to CCGs e.g. Publication of monthly diagnosis rates and letter to CCGs from NCD Publication of supporting dementia metrics on PHE Fingertips tool Additionally: Repository of best practice examples Letter to CCGs from panel chair (also used to communicate support offer) Face to face meeting with senior policy advisor from Alzheimer s Society Level 2 targeted support available to those CCGs that need to make an In addition to level 1: Continued support from NCD to discuss individual CCG concerns about dementia leadership, disseminate best practice and provide advice Peer support - buddying system to pair CCGs needing to improve with high performing CCGs. This will facilitate sharing best practice and collaborative learning. Level 3 - bespoke support available to those CCGs with the greatest need to improve In addition to levels 1 & 2: Intensive support - NHS England will work closely with NHS Improvement to provide intensive support to the CCGs that need to make the greatest Resources will be available to support at least one new CCG per month for the remainder of 2016/17, with 2017/18 subject to programme budgets Comprises pre-visit discussions, a visit to carry out a diagnostic review to ascertain whether there are any system/process issues, and subsequent discussions with the CCG to develop recovery strategies with ongoing support

6 NHS ENGLAND TRANSFORMATION FRAMEWORK THE WELL PATHWAY FOR DEMENTIA PREVENTING WELL DIAGNOSING WELL SUPPORTING WELL LIVING WELL DYING WELL Risk of people developing Timely diagnosis, integrated care Access to safe high quality health & social People with dementia can live normally in People living with dementia die with dementia is I was plan, diagnosed and review in a care for people with safe and accepting dignity in the place minimised within first year I am treated dementia with and dignity carers & Those communities around me and of their choosing I was given information about reducing my personal risk of getting dementia STANDARDS: Prevention (1) Risk Reduction (5) COMMISSIONING GUIDANCE: timely way I am able to make decisions and know what to do to help myself and who else can help Diagnosis (1)(5) Memory Assessment (1)(2) Concerns Discussed (3) Investigation (4) Provide Information (4) Care Plan (2) respect I get treatment and support, which are best for my dementia and my life Choice (2)(3)(4) BPSD (6)(2) Liaison (2) Advocates (3) Housing (3) Hospital Treatments (4) Technology (5) Health & Social Services (5) Develop commissioning guidance based on NICE guidelines, standards and evidence-based best-practice. Agree minimum standard service specifications, set business plans, mandate and resources. Work with ADASS, PHE & other ALBs on co-commissioning strategies to provide an integrated service. MEASUREMENT: looking after me are supported Develop Quality, Access and Prevention metrics to form the basis of the CCG assessment framework. Identify data sources and agree with HSCIC, et al on the extraction processes. TRANSFORMATION, Set profiled ambitions RESEARCH, for each metric, INNOVATION, to form the TECHNOLOGY, basis of the transformation PATIENT ENGAGEMENT plan. AND BEST-PRACTICE: Transformation: using CCG scorecard to set & achieve a national standard for Dementia services. Intervention: Intensive Support Team to provide deep-dive support and assistance for CCGs that fall short. I am confident my end of life wishes will be respected I feel included as part of I can expect a good death society STANDARDS: STANDARDS: STANDARDS: STANDARDS: Integrated Services (1)(3)(5) Supporting Carers (2)(4)(5) Carers Respite (2) Co-ordinated Care (1)(5) Promote independence (1)(4) Relationships (3) Leisure (3) Safe Communities (3)(5) Palliative care and pain (1)(2) End of Life (4) Preferred Place of Death (5) References: (1) NICE Guideline. (2) NICE Quality Standard (3) NICE Quality Standard (4) NICE Pathway. (5) Organisation for Economic Co-operation and Development (OECD) Dementia Pathway. (6) BPSD Behavioural and Psychological Symptoms of dementia.

7 Getting there Programme Aim: Establish an evidence-based treatment pathway for dementia, to be implemented by 2020 National Collaborating Centre for Mental Health commissioned to design pathways for a range of mental health areas and dementia Expert Reference Group convened to advise and guide this process Publication expected Autumn

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9 Dementia pathway Evidence-based treatment pathway for dementia Timeliness of diagnosis Care plan, agreement, initiation & review Care across the domains of the well-pathway Rationale for implementing a standard Implementation guide due to be published autumn winter 16/17 Incorporating: Technical guidance eg on clock starts/stops for assessment/treatment Quality standards & self assessment Workforce requirements Metrics 9

10 Implementing the pathway On-line self-assessment tool to be deployed Autumn-Winter 2016 Annual assessment required from all providers? MSNAP Alignment CQC Alignment CCGIAF Alignment Potential baseline data collected via a survey in May

11 Costed implementation plan Builds on implementation guide for pathway Where are we now? Where do we need to be? Identify/quantify the gap What do we need to do to fill the gap What are the costs/benefits? 11

12 Next steps Secure clearance & publish the guidance Undertake audit of service standards via CCQI Develop a more coherent view on most effective service models Establish formal governance & engagement processes Continue to scan horizon and look for opportunity to drive implementation 12

13 Thank You & Questions? Kevin Mullins 13