Dementia Clinical Leadership Group Meeting Date May 2017 Dr Daniel Harwood Clinical Director Dementia Clinical Network
National Update • Achieving Better Access Implementation Guide for memory services – awaiting publication date • New dementia indicators in IAF • Change diagnosis rate methodology: Estimated prevalence now taken from GP register April diagnosis rates – published 12/05 2
CCG work- Dementia Diagnosis Rate • Continuing rolling programme of meeting CCG’s to offer individual tailored advice • Since January - meetings with 4 CCGs Key themes – areas of potential missed diagnosis: • Lack of MCI pathway • Care homes • Missed physical health populations • Working with quality assurance team at NHSE to take action plans forward 3
Improvements in Diagnosis Rates August 2014 March 2016 4
Current diagnosis rates – March 2017 100% 96.8% 80% 60.9% 60% 40% 20% 0% 5
Effective Diagnosis Feedback for the CLG May 2017 Date Dr Jeremy Isaacs May 2017
Aims and Objectives Share best practice, offer bespoke education and work to decrease variation in Memory Services • Network meetings • Audit • Pathway Mapping Project Support engagement of Join Dementia Research and collaboration of Clinical Research Network Leads with memory services 7
Project Action Plan Achievements (since last 17/18 Planned activity CLG) Audit Audit completed Work with service leads of Preliminary results key areas of variation to presented gain consensus Meeting with 7 memory Create tool kit Pathway services (17 in total) Service user views Mapping 1:1 pathway advice for services Network Meeting in March 17 – Meeting June 17 – police, meetings prisons, audit research project, taking alcohol history Research Engagement with Join Research engagement Dementia Research support tool programme manager in working group 8
Audit – Key messages 500 patients across 10 services Data Variation between services Average wait referral to diagnosis 5 – 23 weeks Patients deemed not to require imaging 6 - 43% CT scan performed within 30 days 0 – 95% MRI scan performed within 30 days 8 – 75% Proportion of patients diagnosed with MCI 3 – 28% Of patients diagnosed with dementia- subtype Alzheimer's: 25 – proportion 77% Vascular: 3% - 22% Unspecified: 0 – 22% Proportion of appropriate patients prescribed 43 – 100% an anti dementia medication 9
Audit – Key messages Also marked variation in: • Referral rejection rates • Location of initial assessment • Choice of imaging modality • Use of neuropsychology • Identification of treatable psychiatric illness • Provision of information about research • Access to Cognitive Stimulation Therapy 10
Pathway Project – Key Findings Workforce • Optimal use of staff skill set Triage • Which staff can diagnose • Think ‘lean’ autonomously? • Staff supervision • OT community assessment Scanning • Contracts • DNA avoidance Digital • Online diaries with slots Under 65 • Access to scans and reports • Bespoke pathway required 11
Service User Involvement • Meeting with memory service user groups to explore their views on aspects of the memory service pathways • Fed into toolkit and advice to services Advice and Support from SCLG • Bringing clinical experts together to reach consensus • Any expertise in change management 12
Reducing Inequalities Feedback for the CLG May 2017 Date Tim McLachlan Dr Sujoy Mukherjee May 2017
Aims and Objectives Aim of the working group • Improve awareness and access to dementia services for people of Black, Asian and minority ethnic origin Objectives • Review referrals to memory services from BAME communities • Develop a resource pack bringing together the work across London on BAME populations 14
Project Action Plan Achievements since last CLG (January 2017) • Collected resources -service initiatives, leaflets, videos, educational, cognitive tests. • Mapped resources to language and religion Planned activity 17/18 • Create webpages on Alzheimer's website • Dissemination 15
Service User Involvement • Webpages being testing by service user group at Alzheimer's society Advice and Support from CLG • Any knowledge on BAME resources or contacts? • Webpage testing 16
Acute Hospitals Feedback for the CLG May 2017 Date Professor Siobhan Gregory May 2017
Aims and Objectives Aim of the working group • Set up a process to support the improvement of quality of care in hospital for people with dementia across London. • We have proposed this is done through a peer review process • The working group have decided to initially focus on nutrition and carer involvement in the first 48hours of admission 18
Project Action Plan Achievements since last SCLG (Jan 17) • Completed guidance on nutrition and carer involvement in first 48 hours of care • Created peer review pack • Peer review completed in 2 hospitals Planned activity 17/18 • Meeting next week for feedback on further reviews • Plan complete 6-8 reviews and disseminate learning • Decided on next topic to focus on 19
Service User Involvement • Best practice guidance reviewed by hospital service user group and Age UK and feedback incorporated. Advice and Support from CLG • Would your hospital like to get involved • How to gain continued engagement form nursing leads • Topic ideas to focus on after nutrition and carer involvement 20
Primary Care Leadership Feedback for the CLG May 2017 Date Dr Nerida Burnie May 2017
Aims and Objectives Support GP leads across London to develop effective leadership roles in their CCGs: -share best practice - disseminate guidance - local advice/support • Focus: - care planning - diagnosis rates 22
Project Action Plan Achievements since last SCLG (Jan 17) • Telephone interviews with 11 GP Leads. • First meeting April – care planning • Set up Yammer – online forum Planned activity 17/18 • Expand to primary care leadership • Care plan audit • Learning event 23
GP telephone interviews Key learning Struggles Initiatives Educational needs Care Plans Coding clean up Care Planning Diagnosis Rates Dementia nurse Post diagnostic link worker support Memory service Memory service Behavioural and waits referral audit psychological symptoms Medicine management 24
Service User Involvement • None currently – any suggestions? Advice and Support from SCLG • Primary care leaders (other then GPs) • Information to disseminate on Yammer 25
Care Home Training Feedback for the Dementia Clinical Network Leadership Group - May 2017 Date Sian Jones – UCL Partners Rebecca Jarvis – Health Innovation Network May 2017
Aims and Objectives • Funded by NHS London Clinical Network, in collaboration with UCL Partners (UCLP) and the Health Innovation Network (HIN), dementia awareness training to care home staff will be undertaken by UCLP across North Central and East London and by the HIN across South London. • Raise awareness and understanding of dementia amongst care home staff working in residential and nursing homes, thereby facilitating better support for individuals with dementia, and their families. This will be achieved through the delivery of a sustainable dementia training package which can be cascaded to care homes using a ‘train - the trainer’ approach. 27
Project Action Plan Achievements since last meeting (Jan 17) UCLP (NCEL region, target of 24 care homes): 40 people across 24 care homes trained using TTT • 18 support sessions have taken place with evaluation data collected • Approximately 105+ care home colleagues trained • HIN (South London region, target of 12 care homes): 14 homes involved in initial TTT • 5 Observations have taken place, with others due to take place • Planned activity Continue support sessions with those care homes who have not • currently held first training session Interviews are currently being conducted across NCEL • Share programme and lessons learned across network through • presenting at conferences and joint reporting 28
Initial Data Collection UCLP: Totally Confident (Pre) Totally Confident (Post) How confident do you feel in recognising that a person may have dementia? 18% 58% How confident do you feel in communicating with a person who has dementia? 27% 69% How confident do you feel supporting an individual with dementia using person-centred values? 48% 80% How confident are you in encouraging a person with dementia to get involved in research? 14% 53% How confident do you feel referring a person you think has dementia to a GP? 26% 65% Care Home Manager Quote: “The training has been a real plus to all staff who have undertaken it. We have even received good feedback from families who are happy with levels of staff awareness in caring for their family member. I see the training being a real benefit to the care home, now and in the future.” 29
Service User Involvement • Bromley and Lewisham Mind have attended two family meetings to speak about JDR, and have asked the care home manager at the other homes to do this • Delivered a dementia friends session at two of the homes for families and friends • Homes requested to order their own JDR leaflets and posters to promote with families and friends 30
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