Dementia Services Review Innovation Event Workshop 16 May 2017
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.
Current diagnostic pathway Signposted to other organisations Worried about memory GP bloods, history, physical checks Memory Support and Advisory Service screening, provide support, advice, info, signposting Scans Memory Assessment Service nursing assessment, consultant appointment, care and treatment plan Memory Support and Advisory Service post diagnostic support and info Older People s CMHT GP yearly medication reviews
Current overview of post diagnostic pathway (varied across Dorset) Respite Community groups, Memory Café s, Carer Groups etc Care at home Day Hospitals and Social care provision Older Person CMHT s MH Liaison Specialist Dementia Inpatient - Alderney Hospital Poole Intermediate Care Service Dementia on East Primary Care including Memory Support and Advisory Service Acute Hospitals In-reach service Care Homes
Highlights from Innovation Event
Data from Memory Services 16/17 MSAS pre diag refs MAS refs Dem diagn MCI diagn MAS 1:1 FU appts Apr Ma Jun July Aug Sept Oct Nov Dec Jan Feb Ma total 236 281 309 285 264 306 269 303 285 263 266 242 3309 178 163 189 192 202 175 169 195 177 188 169 2178 est 117 119 120 125 96 112 121 109 97 109 91 1327 est 25 26 28 30 21 23 17 34 17 14 24 283 est 339 292 368 301 252 259 245 274 253 300 274 3444 est
MSAS post diagnosis activity 16/17 MSAS post diagno sis Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Total 192 166 205 197 135 200 163 195 182 156 162 157 2110 Carers 67 79 94 89 102 80 76 82 44 96 61 60 930 Group s Group attend ance 57 57 62 64 56 59 59 60 40 62 61 68 705 878 824 906 806 709 680 709 686 499 685 657 848 8887
Overall estimated workforce Memory and CMHT workforce Memory Support and Advisory Service Admin 1.0 WTE Memory Advisor (+ triage) 15.28 Support Managers 2.0 Service Manager 0.7 Memory Assessment Service Admin (all grades) 6.59 Nurse Band 5 & 6 12.49 Band 8a 1.0 Consultant + Ass Specialist 0.9 Community linked CMHT OP Admin (all grades) 11.4 est dementia (21.2 total) Nursing (all grades) CMHT OP Medical (all grades) CMHT OP 33 est dementia (64 total) 10 est dementia (17.8 total)
Functions Improving knowledge and skills of the workforce Outcomes Dementia Pathway for people with dementia and their carers I know services are designed around me, my needs and my carers needs I have the knowledge to get what I need I have a sense of belonging and being a valued part of family, community and civic life I know there is research going on which will deliver a better life for people with dementia and I know how I can contribute to it I have personal choice and control over the decisions that affect me I have support that helps me live my life I live in an enabling and supportive environment where I feel valued and understood I am confident that my end of life wishes will be respected. I can expect a good death Dementia Care Pathway Raising awareness and prevention Improving diagnosis Support after diagnosis Supporting carers Care at home Care in hospitals and care homes End of life care Improved public awareness, Dementia Friendly Communities, healthy life style messages, NHS Health checks Identification/referral by GPs, health and social care professionals and in hospitals Diagnosis and treatment, health checks Support, advice, information and signposting, community support and groups Local support, respite and services available to carers Care at home (Integrated care teams), domiciliary care, crisis support, hospitals and care homes Advance care planning High quality palliative care
Pathway developments 1. Consider the needs and solutions from innovation Day. 2. Draw your ideal new pathway focusing in particular on pre diagnosis, diagnosis and living well with dementia at home. 3. Refer to the various reports and consider how these services could be provided to better meet people s needs. Consider who, where, what, how etc. 4. Use Six Thinking hats to check against your key elements to the new pathway.
Six Thinking Hats NEW IDEAS BENEFITS RISKS FACTS / DATA SUMMARISE Go Forward?
What next? Moving along the pathway
Next steps Innovation event Modelling Groups Poole 23 May Kinson 24 May Dorchester 25 May Modelling Groups Poole 18 July Kinson 19 July Dorchester 20 July Options Day 13 Sept Shortlisting Modelling Groups Options to take to consultation Poole 20 June Kinson 21 June Dorchester 22 June Cross check day Approval process to go to consultation Assurance CONSULTATION
Critical Success Factors Factor 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?
Amanda and Keith's story Innovation Day 16 May 2017
Setting the scene About us, 3 or 4 years ago Married couple Keith and Amanda One daughter taking A levels One dog Living in a chalet bungalow In a Dorset village Mother in law living in the village who has vascular dementia Me - ex local government manager Now working as an independent consulting engineer Amanda, showing signs of eccentricity We - contemplating our retirement
Explaining the dementia development About Amanda (then and now) - You are allowed to smile! Always had a sensitive and unusual character (OCD) Even so, strange behaviour patterns were developing At concerts wow! Did you come with your father - he's a bit old then! Rings - oh are you not married, never mind She's fat! she's wrinkly! Hoarding paper cuttings. Craving sweets Driving patterns
Explaining the dementia development Memory confusion episodes/incidents Cooking, shopping item placements Diagnosed in early June 2015 with early onset dementia With frontotemporal complications Please stop her driving immediately!
The desperate search for knowledge Denial, Blame and Bereavement Initially - immediate search of the internet (but solo) Then - devouring of Alzheimer's Society literature Personal visits from charity representatives Attendance at dementia organised events Advice and understanding from GP and local nurses Advice and understanding from professionals at Community Mental Health teams
The desperate search for knowledge Advice and understanding from Dorset County Council Social Services Assistance from Citizens Advice Bureau But really need a structured approach to proceed
Explaining the speed of Amanda s early onset Alzheimer's From June 2015 to now - quite a devastating regression Cannot drive or go anywhere unaided Cannot communicate but can smile and giggle Cannot walk alone (no traffic sense) Cannot speak Cannot dress or undress herself Cannot feed herself Cannot differentiate hot and cold or dangers
Explaining the speed of Amanda s early onset Alzheimer's Will eat any item she can get in her mouth Cannot wash or bathe herself Cannot signal her right sided limbs-initially Consequently cannot get out of bed, chair, unaided Cannot initiate when needs to go to the toilet Consequently is now double incontinent Physical as well as mental health needs now increasingly required (constipation, heel ulcers etc.)
Defining and sharing the problem So - there was a burning desire to understand: WHAT? (is going on?) WHY? (has it happened) WHO? (Can provide help) HOW? (Will it develop and how will I cope) WHEN? (Will matters slow down or plateau so I can get some sleep!!) A structured approach as mentioned earlier in the presentation Enter Dementia first aid course for carers Dorchester Course presenter Rosemary Dewhurst NHS CMHT
So where are we now? Amanda has now reached a plateau (very low) I am up to speed on knowledge of dementia I am up to speed on what financial assistance is available to Amanda (for example PIP) We have assistance aids supplied by DCC Social Services We attend Alzheimer's society Singing for the Brain I attend a DCC led monthly carers coffee morning We are back to the GP surgery as main reference point
How the Dementia Services Review could help Finally I am hopeful that the Dementia Services Review will: Enable regular contact with the helpful CMHT team to be maintained once established Enable the Dementia First Aid course to thrive and develop Enable facilitators to be provided to be establish regular carer group meetings
Thank you
Dementia Services Review Innovation Event Workshop NEXT STEPS
Dementia Services Review Discover Dream Design Deliver
Next steps Innovation event Modelling Groups Poole 23 May Kinson 24 May Dorchester 25 May Modelling Groups Poole 18 July Kinson 19 July Dorchester 20 July Options Day 13 Sept Shortlisting Modelling Groups Poole 20 June Kinson 21 June Dorchester 22 June Cross check day Options to take to consultation Approval process to go to consultation Assurance CONSULTATION
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