1 Barnes D and Lombardo C (2006) A Profile of Older People s Mental Health Services: Report of Service Mapping 2006, Durham University.

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Silvia Moody
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The Natioal Audit Office udertook a self-assessmet cesus of Commuity Metal Health Teams for Older People (CMHTs) betwee September ad December 2006.

1 The Natioal Audit Office udertook a self-assessmet cesus of Commuity Metal Health Teams for Older People (CMHTs) betwee September ad December The overall fidigs are preseted i the Natioal Audit Office report Improvig Services ad Support for People with Demetia. Summary fidigs, icludig locally bechmarked results by idividual team, will be set to those teams that respoded to our survey withi a few weeks of our report s publicatio. The Natioal Audit Office received 371 resposes to its cesus of CMHTs, a respose rate of 75 per cet of all teams as listed i the Departmet of Health s older people s metal health mappig exercise. 1 The deadlie for the survey was 22 December Bares D ad Lombardo C (2006) A Profile of Older People s Metal Health Services: Report of Service Mappig 2006, Durham Uiversity. NatioNal CeNsus of CommuNity mental HealtH teams for older PeoPle dementia services survey results

2 Key fidigs Sectio 1: Geeral iformatio Fifty-six per cet of CMHTs cosidered themselves to be itegrated ad 47 per cet had a joit maagemet structure per cet had some form of joit health ad social care fudig arragemets i place. The umber of people aged 65 ad over i the populatio area covered by the teams raged from 1,000 to 235,000 with a mea umber of 21,822. The umber of people with demetia uder the care of CMHTs as at 1 November 2006 raged from 5 to 1500 with a mea of 275. Cotrary to good practice guidace 3 some CMHTs had o access to the skills of key health ad social care staff. See Table A. Sevety-six per cet of CMHTs worked closely with a memory cliic, ad 83 per cet worked closely with a day hospital. The mea total budget for CMHTs was 512,000 (however oly 182 teams respoded to this questio). A A umber of CMHTs could ot access skills of key recommeded health ad social care professioals Health/Social Care Professioal Commuity support or Support Time 51 & Recovery (STaR) worker Team leader/admiistrator/maager 36 Cliical psychologist 29 Social Worker 25 Occupatioal Therapist 5 % of CMHTs with o access to their skills Forty-two per cet of CMHTs estimated that they spet betwee 41 per cet ad 60 per cet of their budget o demetia care. Thirty-two per cet estimated this at betwee 61 per cet ad 80 per cet of their budget. Sectio 2: Iformatio ad advice to people with demetia ad carers B O commuicatig a diagosis of demetia see Table B. CMHTs do ot always tell the perso with suspected/cofirmed demetia their diagosis Approach to commuicatig diagosis of demetia % of CMHTs Always tell service user as soo as 11 demetia is suspected Always tell service user, but oly whe 29 diagosis is defiitely cofirmed It varies i some cases, may decide 60 ot to tell the service user C Where a service user was iformed of their diagosis, 70 per cet of CMHTs did ot sed the service user a letter about the diagosis, or they oly did so i a miority of cases. Niety-eight per cet of CMHTs had a idetified key worker or care maager for each perso with demetia uder their care ad 66 per cet of CMHTs had doe work to raise public awareess of demetia. May CMHTs did ot have a policy o the sort of advice ad iformatio they should be givig to people with demetia ad their carers. See Table C. May CMHTs had o policies o the iformatio or advice to give to people with demetia ad their carers Iformatio/advice o the followig areas % of CMHTs with NO policy o this area Uderstadig the likely progressio 53 of the disease Uderstadig the optios available 49 for ogoig care i the commuity Uderstadig what support etworks 48 are available Uderstadig what fiacial etitlemets 47 or beefits there are Preparig for losig metal capacity 44 (for example, makig livig wills) How to get a review of a care package 38 Iformatio about how to apply for 36 cotiuig NHS care Who to cotact if they eed help 28 2 Joit maagemet structure meas someoe maagig a team of both social care ad health professioals. 3 The Royal College of Psychiatry (2004) Raisig the Stadard. Specialist services for older people with metal illess Report of the Faculty of Old Age Psychiatry Natioal Cesus of Commuity Metal Health Teams for Older People Demetia Services Survey Results

3 Sectio 3: The provisio of demetia services Sevety-eight per cet of CMHTs had a defied care pathway for people with demetia ad 87 per cet had a protocol for the diagosis, treatmet ad care of people with demetia; however half of CMHTs said these protocols were ot always adhered to. Forty-six per cet of CMHTs were usig the Sigle Assessmet Process (SAP) documetatio for people with demetia; 91 per cet were usig the Care Programme Approach (CPA) documetatio ad 18 per cet were usig the Effective Care Coordiatio (ECC) documetatio. CMHTs were preseted with a rage of idetified barriers or bottleecks to deliverig effective care for people with demetia. They were asked to assig each barrier/bottleeck a score betwee oe (lowest) ad seve (highest) i terms of how importat a barrier they felt is was ad how well they were achievig agaist it i their local area. Average scores are preseted i Table D. D Importace of ad achievemet agaist barriers faced by CMHTs i deliverig effective care for people with demetia Barrier/bottleeck Average ratig by CMHTs (1-7) Importace as a Achievemet i barrier your area Lack of care home beds/places Lack of social services respite places Lack of rehabilitatio services Difficulty dischargig from acute psychiatric wards No services for youg oset demetia Lack of joit fudig betwee health ad social services Lack of joit workig betwee health ad social care agecies Poor uderstadig by GPs Poor uderstadig by social services Lack of joit workig betwee other orgaisatios Difficulty dischargig from acute physical wards Lack of joit workig betwee maagemet of acute ad metal health trusts Lack of joit workig betwee geriatric ad metal health specialties Lack of a day hospital/outreach services Lack of access to geriatric healthcare services Waitig time to obtai a MRI/CT sca (or other barriers to early diagosis) Iappropriate admissios to acute physical wards Iappropriate admissios to acute psychiatric wards No memory cliic Natioal Cesus of Commuity Metal Health Teams for Older People Demetia Services Survey Results

4 There was a geeral cosesus o what would geerate fiacial savigs ad what would lead to o savigs/ icreased costs for the NHS ad social care i the provisio of demetia services, see Tables E ad F. CMHT coordiatio was deemed to be good or excellet with local authority social services i 83 per cet of cases, 74 per cet with primary care ad 72 per cet with volutary sector orgaisatios. 64 per cet had little or o coordiatio with ambulace services, 50 per cet with youger adult psychiatry services ad 49 per cet with elderly care medicie. Twety-ie per cet of CMHTs had formal outreach arragemets with ursig/residetial care homes (59 per cet had iformal arragemets). Nietee per cet had formal outreach arragemets with A&E departmets (25 per cet had iformal arragemets). Fifty-eight per cet of CMHTs worked with acute trusts to maage discharge arragemets; 61 per cet were aware of a discharge coordiator i each acute trust with which they work. The majority of CMHTs felt joit workig betwee differet agecies would brig major beefits i terms of improvig demetia care. See Table G. CMHTs had a mixed respose to what the impact of better idetificatio ad diagosis of demetia would have o the costs icurred by differet groups. See Table H. F Factor Mai factors which CMHTs believe would geerate o savigs/icrease costs i demetia care to the NHS ad social services % of CMHTs agreeig Improved memory cliic provisio 41 Earlier diagosis ad itervetio 33 Idetifyig demetia i people with 33 other illesses ad fidig suitable facilities for them More local authority beds/places 30 Joit fudig betwee health ad social services 25 G The extet to which CMHTs believe joit workig betwee differet agecies ca brig beefits i terms of improvig demetia care Area % of CMHTs % of CMHTs believig joit believig joit workig would workig would brig major brig some beefit here beefit here Geeral support ad well-beig for people with demetia Avoidig uecessary acute bed use Staff morale Early itervetios for people recetly diagosed with demetia E Factor Mai factors which CMHTs believe would geerate savigs i demetia care to the NHS ad social services % of CMHTs agreeig H The impact that CMHTs believe better idetificatio ad diagosis of demetia will have o costs to differet groups Improved discharge procedures from 81 acute psychiatric wards Improved discharge procedures 79 from acute physical wards Better joit workig 77 More support for people i their ow homes 75 Home treatmet teams 75 Group % of CMHTs % of CMHTs believig costs believig costs will icrease will decrease Memory cliics Old age psychiatrists/cmht Social services GPs Nursig/residetial care homes People with demetia/carers Natioal Cesus of Commuity Metal Health Teams for Older People Demetia Services Survey Results

5 I CMHTs were asked to state the umber of idividual places they had for people with demetia i various care settigs. Average umbers of places are show i Table I. Care settig The average umber of idividual places available locally for people with demetia Average umber of places Nursig/residetial care homes 120 Day cetres 34 Log stay metal health wards 19 Acute trusts (specialist demetia services oly) 17 Demetia assessmet/admissio wards 16 Rehabilitatio services 7 Itermediate care 7 The average waitig time for a CT sca for patiets with suspected demetia was 7.36 weeks, for a MRI sca it was 10 weeks. Sectio 4: Therapies ad itervetios I terms of prevetio, less tha half of CMHTs regularly offer ay itervetio to prevet demetia. See Table J below. CMHTs have a clear preferece for particular itervetios i screeig, diagosis ad assessmet of demetia, with MMSE the most popular. See Table K opposite. The majority of CMHTs regularly use choliesterase ihibitors to treat early ad mid stage Alzheimer s disease but ot other forms of demetia. See Table L opposite. The majority of CMHTs do ot use mematie to treat demetia. See Table M opposite. Structured group cogitive stimulatio for demetia was used regularly by 36 per cet of CMHTs i early stage demetia, by 33 per cet i mid stage ad by 20 per cet i late stage. Aroud oe fifth to oe third of CMHTs used atipsychotic drugs regularly for people with demetia ad mild behavioural disturbaces or mild psychotic symptoms. This icreased to betwee two thirds to three quarters for people with demetia ad severe behavioural disturbaces or psychotic symptoms. J Itervetios offered by CMHTs to people i all care settigs i their area to prevet demetia Itervetio Yes, used Oly used No Do t kow regularly occasioally Advice or treatmet for hypertesio or other vascular risk factors Statis No-steroidal ati-iflammatory drugs Geeral populatio screeig Hormoe replacemet therapy Geetic cousellig Vitami E Natioal Cesus of Commuity Metal Health Teams for Older People Demetia Services Survey Results

6 K Itervetios offered by CMHTs to people i all care settigs i their area for the screeig, diagosis ad assessmet of demetia Itervetio Yes, used Oly used No Do t kow regularly occasioally Mii Metal State Examiatio or MMSE Physical assessmet Memory cliic assessmet for those with mild cogitive impairmet Occupatioal therapy assessmet of fuctioal ability CT sca GP assessmet of cogitio Abbreviated Metal Test Score (AMTS) MRI sca Cambridge Cogitive Examiatio (CAMCOG) item Cogitive Impairmet Test (CIT) Alzheimer s Disease Assessmet Scale (ADAScog) miute scree L Use of choliesterase ihibitors by CMHTs to treat demetia Choliesterase ihibitor for: Yes, used Oly used No Do t kow regularly occasioally Alzheimer s disease i early stage Alzheimer s disease i mid stage Alzheimer s disease i late stage Other forms of demetia i early stage Other forms of demetia i mid stage Other forms of demetia i late stage M Use of mematie by CMHTs to treat demetia Choliesterase ihibitor for: Yes, used Oly used No Do t kow regularly occasioally Alzheimer s disease i early stage Alzheimer s disease i mid stage Alzheimer s disease i late stage Other forms of demetia i early stage Other forms of demetia i mid stage Other forms of demetia i late stage Natioal Cesus of Commuity Metal Health Teams for Older People Demetia Services Survey Results

7 CMHTs use a wide rage of treatmets for o-cogitive symptoms. See Table N. N CMHTs use a wide rage of treatmets for o-cogitive symptoms Treatmet Yes, used Oly used No Do t kow regularly occasioally Choliesterase ihibitors for Alzheimer s disease Atidepressats Behavioural therapy Choliesterase ihibitors for other demetias Therapeutic use of music ad/or dacig Palliative treatmets Multi-sesory stimulatio Massage Aromatherapy Pet-assisted therapy Whe it comes to supportig people with demetia to stay at home, isufficiet fudig prevets 23 per cet of CMHTs from providig respite care, 20 per cet from providig extra care housig ad 19 per cet from providig day care. See Table O. O Itervetios provided by CMHTs to support people with demetia to stay at home Itervetio Yes No, service is No, service is ot available available but isufficiet fudig to provide it % % % Commuity psychiatric/metal health urse Meals of Wheels Occupatioal Therapy Regular eeds assessmet District urse Day care Commuity support workers Respite care Specific home care provisio from a dedicated team Telecare Extra care housig Natioal Cesus of Commuity Metal Health Teams for Older People Demetia Services Survey Results

8 Sectio 5: Traiig ad huma resources P Most CMHTs provide traiig i demetia care (largely iformal with some formal) to healthcare staff, carers ad people with demetia. See Table P. Most CMHTs provide some sort of traiig i demetia care Traiig provided by % of CMHTs % of CMHTs CMHT to: providig providig iformal formal traiig traiig Self-care Iformal/family carers Nursig or residetial care home staff Primary care staff, such as GPs ad practice urses Commuity based ursig Geeral hospital staff Traiig to geeral hospital staff is less commo, with 36 per cet of CMHTs providig o traiig at all to these staff. Domiciliary care staff receive less traiig from CMHTs. See Table Q. R Almost half of CMHTs feel that ursig staff i acute secodary care are iadequately traied regardig the treatmet, care ad support for people with demetia. Over a third felt the same about medical staff i acute secodary care ad homes care social services workers. See Table R. CMHTs geerally believe that workers i their local area are adequately traied regardig the treatmet, care ad support of people with demetia Traiig provided by Traiig is Traiig is CMHT to: adequate or iadequate better % % Commuity based ursig staff: 98 2 Commuity psychiatric/ metal health urses Staff i ursig/residetial 97 3 care homes Commuity based ursig staff: District urses Primary care staff, such as GPs ad practice urses Home care social services workers Medical staff i acute secodary care Nursig staff i acute secodary care Q Domiciliary care staff receive less traiig from CMHTs tha healthcare staff, carers ad people with demetia Traiig provided by % of CMHTs % of CMHTs CMHT to: providig providig iformal formal traiig traiig Local authority staff Volutary sector staff Agecy staff Some 90 per cet of CMHTs make us of the specialist kowledge ad skills of Alzheimer s Society staff ad other volutary bodies such as Age Cocer. Natioal Cesus of Commuity Metal Health Teams for Older People Demetia Services Survey Results

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