Professor Alistair Burns
National Clinical Director for Dementia
nhsManagers.net
Dementia Timeline
• National Dementia Strategy February 2009
• Antipsychotics Report “Time for Action” November 2009
• Public Accounts Committee January 2010
• National Clinical Director (NCD) appointed (DH) February 2010
• General Election May 2010
• Prime Minister’s Challenge March 2012 (3 groups, plus updates)
• NHS England launched April 2013
Easy to remember
D
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A
Diagnosis
Early identification
Management of symptoms
Effective support for carers
Non drug treatments
Treatment of medical conditions
Information
At, and towards, end of life
Dementia “i” statements
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I was diagnosed in a timely way
I know what I can do to help myself and who else can help me
Those around me are well supported and are in good health
I get the treatment and support, which are best for my dementia,
and my life
I feel included as part of society
I understand so I make good decisions and provide for future
decision making
I am treated with dignity and respect
I am confident my end of life wishes will be respected. I can
expect a good death.
I know how to participate in research
Dementia
• Diagnosis
• Post diagnostic support for people with dementia and
carers
• Care in Hospitals
• Care in Homes
• Care at home
• End of life Care
• Appropriate use of antipsychotics
• Prevention
Dementia CQUIN: FAIR (Find, Assess and Investigate, Refer)
All emergency admissions aged over 75
No known dementia
Diagnostic
review, if
indicated
Clinical Diagnosis
of delirium
no
Dementia pathway
Known dementia
3
Referral
yes
Positive
1
Has the person
been more
forgetful in the last
12 months to the
extent that it has
significantly affected
their daily life?
yes
Find
2
Inconclusive
2
no
1
Diagnostic
assessment
Assess and Investigate
Negative
Care as
usual
3
Refer
Feedback to
GP
Dementia CQUIN 2013/14
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Success  over 4,000 referrals a month
Original indicators, from 2012/13, still in place –
Find,
Assess, Investigate and Refer
This now triggers 60% of the payments
Two new elements to the CQUIN for 2013/14
10%: Clinical leadership for dementia and appropriate training
of staff
30%: Ensuring that carers of people with dementia in hospital
feel adequately supported
Implementing the CQUIN will help address some of the issues
in the RCPsych Report.
Participation in the audit
Who was invited to participate?
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All general acute hospitals, or those providing general acute services on more than one ward that admit people over the age
of 65, in England and Wales
Number of hospitals participating
 98% (210/215) of eligible hospitals in England and Wales
– Representing 100% of Trusts/Health Boards
Data collection
 Data were collected between April and October 2012
 210 organisational checklists were submitted
 7987 case notes were submitted (from 206 hospitals)
Audit themes
 Governance
 Assessments
 Antipsychotic prescription: protocol and practice:
 Liaison psychiatry services
 Hospital discharge and transfers
 Information and communication
 Staff training
Staff training
There is notable improvement in the number of hospitals having a training and
knowledge framework in place.
Further improvement could be made in the provision of dementia awareness training
in induction programmes.
Key findings:
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78% of hospitals have a training and knowledge framework or strategy that identifies
necessary skill development in working with and caring for people with dementia. In
the first round of audit, under a quarter of hospitals had this in place.
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41% hospitals do not include dementia awareness training in their staff induction
programmes.
Our Mandate Specific to Dementia
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All NHS staff ……… will go through a dementia awareness programme
(foundation level) March 2014
100,000 staff have foundation level training by March 2014
All NHS staff that look after patients with dementia will receive foundation
level dementia training. This will programme will:
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Enable staff to spot the early symptoms of dementia
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Know how to interact with those with dementia
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Signpost staff to the most appropriate care: it will be backed up with more
in-depth training of expert leaders and staff working with people with
dementia
The training should also raise awareness of the increased likelihood of mental
health problems in those people with long-term conditions
Conclusion
 Welcome increase in key items measured
 Improvement still required in many factors affecting care
 Raising quality of care remains a national strategic priority
 79% of Acute Trusts have signed up to the Dementia Action Alliance “The
Right Care” call for action
 Future round of audit will take place. We recommend including:
– perspective of people with dementia and their carers on involvement in
care and discharge, and the quality of communication with staff;
– staff perspective on training provision and support available to provide
good quality care.
The opportunities: innovation
Integrated Care, Dudley
Health Checks, Southwark
Dementia Friendly Hospitals,
Bradford
Anchor Trust
Carers in Surrey
Crawley Dementia Action
Alliance
Northfleet School
Dementia Friends
Education and Training
British Transport Police
Gnosall
Share knowledge, innovation and learning
www.dementiapartnerships.com
Dementia Diagnosis and post diagnostic support
Sliding doors - Mr Smith aged 79
What can happen…….
Becomes distressed and agitated
one Saturday night
Seen by on call GP and admitted
to hospital
Diagnosed with delirium
secondary to UTI
History of two years memory
loss, wife not managing well
Sedated on admission,
discharged to care home
Dementia Diagnosis and post diagnostic support
Sliding doors - Mr Smith aged 79
What can happen…….
What could happen…….
Becomes distressed and agitated
one Saturday night
Identified as having dementia
two years ago
Seen by on call GP and admitted
to hospital
Supported by a Dementia
Advisor
Diagnosed with delirium
secondary to UTI
Wife notices he is “not himself”
one Tuesday
History of two years memory
loss, wife not managing well
GP who knows him visits and
prescribes antibiotic for a UTI
Sedated on admission,
discharged to care home
Recovers – no need for hospital
admission
So………………….
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Awareness of dementia is at its highest
Diagnosis rate needs attention
Support is the key
Early vs timely diagnosis: benefits
Recast dementia as a Long term condition managed in primary care
Population screening not appropriate
Dementia rarely travels alone
Primary care memory services
Prevention
• Three things to do