Dementia Services Review Design and modelling stage Update on progress April 2018 Di Bardwell
Dorset vision Every person with dementia, and their families and carers, receive high quality, compassionate care from diagnosis to end of life care. This applies to all care settings, whether home, hospital or care home.
Outcomes • I have personal choice and control over the decisions that affect me • I know that services are designed around me, my needs and my carer’s needs • I have support that helps me live my life • I have the knowledge to get what I need • I live in an enabling and supportive environment where I feel valued and understood • I have a sense of belonging and of being a valued part of family, community and civic life • I am confident my end of life wishes will be respected. I can expect a good death
Objectives Through a co-production approach and within the current resources and finances available through health and social care : • Design and deliver consistent and high quality, compassionate care and support to meet the needs of people living with dementia and their carers from diagnosis to end of life. • Ensure equity of outcomes for people living with dementia and their carers across Dorset localities. • Achieve and maintain a diagnosis rate of two thirds of prevalent population. • Increase the number of people being diagnosed with dementia, and starting treatment, within six weeks from referral. • Improve quality of post-diagnosis treatment and support for people with dementia and their carers.
Services included in the review Dorset Healthcare NHS Services Foundation Trust 48 commissioned inpatient bed - Alderney Hospital 16 commissioned In-patient beds - Chalbury Unit (currently closed) 12 commissioned In-patient beds - Betty Highwood (currently closed) In-reach service Psychiatric Liaison Services Intermediate Care Service for Dementia (ICSD) East – an intensive support service Older Persons Community Mental Health Teams Haymoor Day Hospital, Alderney Melcombe Day Unit, Weymouth Memory Assessment Service (MAS) Alzheimer’s Society Memory Support and Advisory Service (MSAS) Poole Borough Care UK: Specialist dementia care at home (domiciliary) Respite provision Bournemouth Borough Early Help and Prevention services commissioned by BBC to support people living with Council dementia in the community Dorset County Council Care Homes and Respite provision for people with dementia Acute/Com Hospitals Hospital links to Community Various Information provision Out of Hours crisis services Care home providers providing dementia care Dementia workforce – recruitment, retention and training
Review process Going on the journey together to find solutions Model View NHS Options Consultation Implementation Assurance Seeking Development Benchmarking, Data, Information and Insight Analysis
Critical Success Factors Factors to be considered Can the option really be implemented? Does this deliver services which are safe and sustainable? Will option be affordable? Will this option deliver services that will be acceptable to people? Is the option based on evidence of best practice? Will this option result in a better experience for those who use the service?
NHS England national dementia diagnosis target (Dec 2017) • Estimated prevalence of 65+ years = 13,164 patients • Total aged 65+ on dementia registers = 8,164 • Diagnosis rate December 2017 = 62% • Gap to meet national target of 66.7% = 616 patients East Dorset North 844 (60%) Dorset 857 Bmth C/church (57%) Poole North 790 (72%) North 449 West 507 Central (62%) Dorset (64%) Mid Dorset Bmth Poole 389 (45%) 437 (57%) 461 Central (74%) 660 (75%) East Weymouth & Poole Bmth Numbers of people diagnosed with Portland Bay 898 Purbeck 410 714 dementia across Dorset 65+ ages 748 (62%) (81%) (62%) (Dec 2017) (83%) In brackets % of population Exceeded diagnosed against the estimated national prevalence. target 8 Source GP Practice Registers and NHS England and NHS Digital
Summaries across stages Summaries across stages ENGAGEMENT & VIEW SEEKING ANALYSIS DATA AND NEEDS ANALYSIS DESIGN THEMES Prevalence of dementia in Smoother and quicker Support groups, charities Dorset estimated 13,089 diagnostic pathway and volunteers identified as working well Numbers of people Joined up services across diagnosed appears to have health and social care Failures in care pathway plateaued Support, advice and guidance Fragmented services Ageing population is along whole pathway – No continuity of staff increasing Dementia Co- Lack of support particularly ordinator/Navigator role Different demand shown post-diagnosis across Dorset localities and Information and crisis Carers want more rural/urban helpline involvement in care 61% of people with dementia Improved support for carers planning have other health conditions Education and training Awareness raising in Currently 189 people have Tackle delayed discharges general public needed early onset dementia Improved care in the home Services understaffed Bournemouth localities and Wider options for carer Need for better respite the Purbecks have the breaks and respite options and carer breaks highest % of people within care homes Meet crisis needs and higher levels of support
Dementia ia care pathway Population requiring Dementia – High inpatient care need (Inpatient) Each person will have Population experiencing a different profile of Dementia – Crisis an episode of crisis need over time, some with multiple periods of high need Population with in Dementia – Moderate need Mental health care (Secondary mental health services) clusters 19-21 Population with Dementia – Low need (Primary Care) dementia diagnosis Population with dementia Well Population @ Risk of developing dementia risk factors – age, vascular health etc Population of Dorset Well Population
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SUPPORTING WELL SUPPORTING WELL LIVING WELL – DIAGNOSING PREVENTING – HIGH LEVEL LOW LEVEL – CRISIS SUPPORT WELL WELL SUPPORT SUPPORT Intensive support team Dementia Telephone Secondary Dementia (ICSD) commissioned Nurses/Team helpline based diagnosis coordinators formally West and (OP CMHT) service options continue East All settings or or Admiral Nurses Information supporting family In-reach service into care & carers homes across whole of Primary Care Dementia signposting Dorset triage service coordinators. with 2 referral Day hospital In-reach into care routes provision as current Specialist Dementia homes only Dementia Inpatient Unit based or Healthchecks Alderney Hospital only Dementia Day hospital provision coordinators closed to release Specialist Dementia resources into NHS Primary Care for Early onset Inpatient Unit based Dementia Dementia services. based nurse led Alderney Friendly clinic Communities, Utilise social care day Living well with plus ‘Step up’ and ‘Step businesses & GP services for patients Dementia down’ care home beds practices where appropriate educational session for all Crisis Helpline Neuropsychology newly diagnosed Align both Day Out of Hours Hospitals with Intensive Support Carer’s emotional (ICSD) as day provision support training Cognitive Stimulation Therapy 12
In your groups: • Facilitator’s will move around groups with note takers each covering one theme. • You will have 25mins for each theme and to consider the options. • In your packs to refer to: Emerging options and background info Model option summary and scoring Case study vignettes Data handbook on your table
In your groups: 1. Introduce yourselves 2. Read through case study (not for prevention) and critical success factors 3. In your group complete brief SWOT analysis for each option 4. You will cover all 5 themes 5. In the final session we would like you individually to complete the model option scoring document
Next steps Deliverables Completion date Stage 1: Preparation documents September 2016 Stage 2: Stakeholder engagement and data analysis March 2017 Needs and Data Analysis report Engagement and View Seeking Stage 3: Design and Modelling June 2018 Benchmarking Visits and learning from other services Co-produced design ideas and models Shortlisted and costed model options Strategic Outline Case with model options Stage 4: Approvals and Consultation December 2018 Stage 5: Evaluation of consultation and fully costed March 2019 Business Case Stage 6: Procurement and secure service provision September 2019 Stage 7: Mobilisation and contract management To follow
We may have all come on different ships but we’re in the same boat now Martin Luther King Jr Thank you !!
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