Our ref: IJC/JH/RG
26 November 2010
To:
Chief Executives of Strategic Health Authorities
South West Strategic Health Authority
South West House
Blackbrook Park Avenue
Taunton
Somerset
TA1 2PX
Tel: 01823 361000
Fax: 01823 361141
Email: go@southwest.nhs.uk
http://www.southwest.nhs.uk
Copy: Deputy Regional Directors for Social Care
David Behan, Director General for Local
Government and Partnerships
Alistair Burn, National Clinical Director for
Dementia
Dear Colleague
Optimising Appropriate Prescribing of Antipsychotic Drugs to People with Dementia
As members of the Department of Health’s National Dementia Strategy Programme Board,
we have been discussing approaches to help the local NHS and partner organisations make
progress with reducing the inappropriate use of antipsychotic medication. This is in line with
the recommendations made in Professor Sube Banerjee’s report1 Time for Action, which
estimated that there are approximately 180,000 people with dementia being prescribed
antipsychotic drugs across the country per year, associated with an additional 1,800 deaths
per year and 1600 vascular events, half of them serious.
As you will be aware, the government has recently committed to achieving an overall twothirds reduction in the use of antipsychotic medication by November 2011. The Department
of Health has commissioned a national audit to measure progress at a national level, which
is being undertaken by the NHS Information Centre. The audit will deliver its first results in
Spring 2011.
It is important that the over-prescribing of antipsychotic medication is tackled as part of
whole-system change to deliver quality outcomes for people with dementia and their carers
and that the issue is not seen in isolation. It is crucial that work on improving prescribing
progresses in conjunction with improving the design of services for people with dementia
and their carers, especially early diagnosis and intervention, and support in managing
challenging behaviours.
The NHS in the South West (under the leadership Sir Ian Carruthers OBE as the National
Dementia Champion for the NHS) and the Alzheimer’s Society have agreed to take forward
work to help accelerate work across the country on improving prescribing practice. We
know that many localities have started work on responding to the report, with local audits on
prescribing using the NICE/SCIE clinical guideline (Number 42), often building this into their
QIPP programmes. However, some parts of the country are still at an early stage.
1 The use of antipsychotic medication for people with dementia: Time for action - A report for the Minister of State for Care Services by
Professor Sube Banerjee,12 November 2009
Chair: Charles Howeson
Chief Executive: Sir Ian Carruthers OBE
Our initial thoughts are that the key elements of the programme of work will include:
a) Sharing national, regional and local comparative data on antipsychotic prescribing to
help inform local work on patient-level audits of current practice using the NICE
guidelines;
b) A “model process” to help Strategic Health Authorities, Primary Care Trusts, mental
health service providers and emerging GP commissioners and partners providing
social care services develop a local timeline for making progress in reducing
antipsychotic prescribing;
c) Establishing “prescribing champions” in each Strategic Health Authority to advise
local work on improving prescribing;
d) Advice on undertaking a regional audit of prescribing in secondary care;
e) Advice on how to involve people with dementia and their carers in the work to identify
effective alternatives to the use of anti-psychotic medication.
We are seeking views from around the country to these suggestions and propose to share
further details in a few weeks.
We very much hope you are able to participate in this work and look forward to hearing from
you.
With best wishes
Yours sincerely
Sir Ian Carruthers OBE
Chief Executive
South West Strategic Health Authority
Jeremy Hughes
Chief Executive
Alzheimer’s Society