Dementia Services Review - Design and modelling stage Update on progress April 2018 Di Bardwell - NHS Dorset CCG
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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 careReview process
Going on the journey together to find solutions
View Model
NHS
Options Consultation Implementation
Seeking Development Assurance
Benchmarking, Data, Information and Insight AnalysisCritical 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
(57%) Bmth C/church
Poole
North 790 (72%)
North
West 449
507 Central
Dorset (62%)
Mid Dorset Poole (64%) Bmth
389 (45%) 437 (57%) 461
Central
660 (74%)
(75%)
East
Numbers of people diagnosed with Weymouth & Poole Bmth
dementia across Dorset 65+ ages Portland Purbeck 410 Bay 898 714
(Dec 2017) 748 (62%) (62%) (81%) (83%)
In brackets % of population
diagnosed against the estimated Exceeded
prevalence. national
target
8
Source GP Practice Registers and NHSSummaries across stages
Summaries across stages
ENGAGEMENT & VIEW
DATA AND NEEDS ANALYSIS SEEKING ANALYSIS DESIGN THEMES
Prevalence of dementia in Support groups, charities Smoother and quicker
Dorset estimated 13,089 and volunteers identified as diagnostic pathway
Numbers of people working well Joined up services across
diagnosed appears to have Failures in care pathway health and social care
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
rural/urban Carers want more 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
Services understaffed Improved care in the home
Bournemouth localities and
the Purbecks have the Need for better respite Wider options for carer
highest % of people within options and carer breaks breaks and respite
care homes Meet crisis needs and higher
levels of supportDementia 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
clusters 19-21 health services)
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 Population11
LIVING WELL – SUPPORTING WELL SUPPORTING WELL
PREVENTING DIAGNOSING – HIGH LEVEL
WELL WELL LOW LEVEL – CRISIS SUPPORT
SUPPORT SUPPORT
Dementia Intensive support team
Telephone Secondary Dementia Nurses/Team (ICSD) commissioned
helpline based diagnosis coordinators formally West and
options service (OP CMHT) continue East
All settings
or
or Admiral Nurses
Information
supporting family In-reach service into care
&
Primary Care Dementia carers homes across whole of
signposting
triage service coordinators. Dorset
with 2 referral Day hospital
In-reach into care
routes homes only provision as current Specialist Dementia
Dementia
Healthchecks or Inpatient Unit based
Alderney Hospital only
Dementia Day hospital provision
coordinators closed to release Specialist Dementia
Dementia Primary Care for Early onset resources into NHS Inpatient Unit based
Friendly based nurse led Dementia services. Alderney
Communities, clinic Utilise social care day
Living well with plus ‘Step up’ and ‘Step
businesses & GP Dementia services for patients down’ care home beds
practices educational where appropriate
session for all
Neuropsychology newly diagnosed Crisis Helpline
Align both Day
Out of Hours
Hospitals with
Carer’s emotional Intensive Support
support training (ICSD) as day provision
Cognitive
Stimulation Therapy
12In 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 followWe may have all come on different
ships but we’re in the same boat now
Martin Luther King Jr
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