Dr Belinda McCall Consultant Geriatrician

Transcription

1 Dr Belinda McCall Consultant Geriatrician

2 Overview Background to our service Project Initial service provision Further developments Benefits of a geriatrician Questions

3 Background National Dementia Strategy Living Well with Dementia Key themes: Increase awareness Early diagnosis and intervention Good quality care for all

4 Needs Assessment Healthcare for London Dementia Services Guide estimated for Lewisham: 1,781 people with Dementia in Forecast 1,657 by 2021, a reduction of % (952) estimated to have mild dementia. 32% (559) estimated to have moderate dementia. 13% (222) estimated to have severe dementia. 1.2% (48) estimated to have early onset * dementia ( Early onset are those aged 30+ to 64) As such Lewisham has not commissioned to accommodate an increase in Dementia prevalence.

5 Previous referral pathway Seen by GP Referral to University Hospital Lewisham Geriatrician led CT/ Bloods/ ECG available on the day Supported by Alzheimer's society representative Referral to Community Mental Health Team Psychogeriatrician led Mutlidisciplinary not specific for memory

6 Gaps in previous provision Accessing community services (housing, leisure, libraries, etc) Assessment delays Communication with carers and preparing them for the future Coordination of services Inconsistent end of life services GP involvement/engagement Inflexible unresponsive services Information for carers/service users following diagnosis Insufficient numbers of day centre places Incompatible IT systems Multiple assessment and access points/duplication of systems People accessing services too late Professional disciplines working in silos Personalisation varies across services Systems complicated for service users/cares to navigate Training carers skills for coping Training whole system for staff on working with people with Dementia

7 July 2010 Stakeholders event Crystal clear communication Joined up and connected services Comprehensive services, community activities and peerled resources Choice enabled and supported at every stage Rich lives with opportunity for activity Independence at home Respect and safety in the community True partnership of staff, service users and carers - experts by experience and by training - in care planning, service development and service delivery

8 Project objectives In line with the National Dementia Strategy and in order in meet its 17 objectives Lewisham s goal is for people with dementia and their family carers to be helped to live well with dementia, no matter what the stage of their illness or where they are in the health and social care system. The vision to achieve this is to: encourage help-seeking and help-offering (referral for diagnosis) by changing public and professional attitudes, understanding and behaviour make early diagnosis and treatment the rule rather than the exception; and achieve this by locating the responsibility for the diagnosis of mild and moderate dementia in a specifically commissioned part of the system. This will first, make the diagnoses well, second, break those diagnoses sensitively and well to those affected, and third, provide individuals with immediate treatment, care and peer and professional support as needed enable people with dementia and their carers to live well with dementia by the provision of good-quality care for all with dementia from diagnosis to the end of life, in the community, in hospitals and in care homes

9 Funding The investment to fund new Dementia service in Lewisham has come from two sources: New investment provided by the Department of Health in in which NHS Lewisham was allocated a total of 907,060 but was non recurring investment. De-commissioning 800,000 reoccurring money from existing mental health investment - specialist Continuing Healthcare Unit Dementia health and social care support service is available for all people/carers diagnosed with Dementia regardless of whether they are Fair Access to Care Services (FACS) or Care programme approach (CPA) eligible

10 Dementia pathway Voluntary Sector service and GP referral Memory Service - Assessment, Diagnosis and Treatment Voluntary Sector Provider Memory Service / Community Mental Health Team End of Life

11 Policy and evidence base for integrated care model Clear Government direction to increase integration King s Fund and Nuffield Trust joint report 05/01/12 NHS Confederation and Association of Directors of Adult Social Services (ADASS) joint statement 10/01/12- "The time for talking about integration is over. This second joint publication shows our commitment as associations to finding ways through the many barriers that can prevent the integrated experience of services that the public should expect.

12 Assessment, Diagnosis and Treatment service Commissioned from South London and Maudsley NHS Foundation Trust (SLaM) and Lewisham and Greenwich NHS Trust. The main purpose of the services will be to provide: Single point of access referral point for a single seamless service Early identification of people with a possible diagnosis of dementia A high quality service for the assessment, diagnosis and management of dementia until end of life Support and advice for carers and patients about dementia and the range of services available within the borough Assessments available at home, hospital outpatients and Community Mental Health Team base Nearly 400 referrals in the first nine months of the service (average of ten per week)

13 The Assessment Team Multi-disciplinary from statutory and non statutory providers: Administrator (South London and Maudsley NHS Foundation Trust (SLaM)) Team manager (SLaM) 2 x band 6 community practitioners (SLaM) Consultant psychiatrist (SLaM) Consultant geriatrician (Lewisham and Greenwich NHS Trust) Assistive technology Occupational Therapist (SLaM) 5 x Dementia advisors (MindCare) Carer Support Worker (Carers Lewisham) Pharmacist (NHS Lewisham) Social Workers (London Borough of Lewisham and SLaM) GP lead (NHS Lewisham) Rest of the Memory team is under the existing Community Mental Health Teams (CMHTs)

14 Integrated Lewisham memory service Through preliminary triage, patients benefit from consultation with the appropriate doctor/ practitioner for their respective conditions allowing both time/ money savings as they consult a single rather than multiple doctors. In multiple settings- at home, in the community, in the acute hospital Neuropsychological assessments are conducted by clinical psychologists upon doctors requests. Avoids one size fits all solution- although assessments are standardised in all areas

15 Integrated Lewisham memory service Weekly MDMs with consultant psychiatrist, consultant geriatrician, occupational therapist, pharmacist, nurses, psychologist and dementia advisors Same day CT head scans at UHL clinic Early assessment and treatment

16 Voluntary sector Dementia health and social care support service for all people diagnosed with Dementia regardless of whether they are FACS or CPA eligible information on Dementia and support the wellbeing of Dementia patients from diagnosis to end of life (Ensure advance directives are completed) Provide one-to-one and facilitate group support including befriending services Dementia Carer Support Worker Dementia Carer Support Worker who will ensure carers are recognised and supported across the borough All carers have an assessment of need Psychological support available To ensure that carers are actively involved in service

17 Assistive Technology (AT) Extending provision of AT for clients with Dementia regardless of FACS or Approach CPA eligibility Commission an AT specialist assessment and review post which will also deliver training on AT. Pharmacy Pharmacist available for GPs to refer to in order to review medication Pharmacist available for all residential and nursing homes in order to review medication PCT Medication Management Team working with domicilary care providers Particular focus on antipsychotic prescribing Training Specific training opportunities for all staff within multiple agencies/ domains

18 Launch Event 21 st February 2011

19 Developments for Lewisham memory service Highly commended at 2012 HSJ integrated service awards Provision of training to Lewisham Residential care homes and nursing homes Nurse consultant appointed for UHL site Identify known LMS patients on admission Coordinate care Education Clinics

20 Benefits of a geriatrician Most patients can be seen by either speciality- some benefit from specific comprehensive Geriatric assessment Physical reviews medication reviews/ advice Cardiovascular risk assessments ECG reviews- pre ACI assessment Vascular dementia risk factors Closer links to acute hospital inpatient services

21 Feedback on having a geriatrician from team A lot of the people we see are the old old and it was very helpful to look at their cognitive impairment in the context of complex physical health problems and poly pharmacy That balance between the medical and mental health perspectives was very helpful to tease out issues when considering dementia Interpreting complex medical results ie ECGS and looking more closely at head scans

22 Feedback cont.. More informed discussion about those potential neurological problems presenting as dementia particularly in younger people which is always a worry More attention if needed on medical problems which could be presenting like a dementia Thinking about biochemistry blood tests that may need further investigation.

23 Questions?