http://youtu.be/hedb6_tkuus

Admiral Nurses Admiral Joe Service set up 20 years ago by the Levy family due to the lack of support they experienced when caring for Admiral Joe Currently approximately 140 Admiral Nurses nationally

What are Admiral Nurses? Registered mental health nurses, specialising in dementia nursing. Support family carers and people living with dementia, particularly during complex periods of transition Provide education, leadership, development and support to other colleagues and service providers

How do we work The Competency Framework Therapeutic Interventions Balancing Needs Sharing Information Health Promotion Ethical and Person Centred Care Advanced Assessment Prioritisation of Work Promoting Best Practice.

Dementia in Context Some Facts There are currently over 8,600 people living with dementia in Worcestershire and it is estimated that this number will rise to 10,443 by 2020. https://ylyc.worcestershire.gov.uk/information-and-advice/health-and-wellbeing/dementia/ Approx. 430 families are thought to be living with young onset dementia.

Dementia in context 2/3 of people with dementia are cared for at home. Unpaid carers are estimated to save the UK economy 7 billion per year Despite this, avoidable admissions to hospitals and early entry to care homes still regularly occur, which are very costly. World Alzheimer s Report 2013

ADMIRAL NURSING IN WORCESTERSHIRE In 2013, when every Worcestershire family could access an Admiral Nurse we received 728 referrals. 39.5% are self referrals. The underlying trend is that referrals are increasing.

A typical month: Between 150 and 180 clinical contacts excluding group contacts Typically 40-80 liaison contacts

Lets dispel a few myths Admiral Nurses are expensive Admiral Nurses only work with carers Admiral Nurses and Dementia Advisors provide the same support

Are Admiral Nurses cost effective? Telford and Wrekin (Primary Care) estimate saving approximately 11,000 per month Acute Hospital costs in Southampton reduced by 322,000 in 18 month period Reducing specialling costs Improved carer satisfaction Improved recognition and staff understanding

Are Admiral Nurses cost effective? 400,000 + saved in Norfolk over 10 month period Decreased unnecessary admissions to hospital Reduction or delay in admissions to residential or nursing homes Increased diagnosis rates Increased well-being reported by people living with dementia Families felt supported anxiety and stress reduced

All of these savings were achieved by working smarter.

http://youtu.be/kndzuxldfd4

Vanessa Godfrey

https://youtu.be/_xoo-ph90iu

New ways of working

Making a Difference in Dementia: Nursing Vision and Strategy https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147956/making_ a_difference_in_dementia_nursing_vision_and_strategy.pdf

How we work currently AN s in 4 areas of the county Each locality mirrors CMHT boundaries Most referral receive a first contact within 3 working days Areas close to referrals when posts become vacant or in situations of ill-health.

Tier 3 interventions All referrals to central point All referrals to receive a first response within 24 hours All clients will get a triage contact lasting upto 30 mins. Decision support tool developed to identify appropriateness of need Online contact and referral system http://

3 tier Dementia Pathway Complex intensive case management / psychological support In depth support /advocacy Need for information Tier 3 Tier 2 Tier 1 Admiral Nurses Dementia skilled professionals/ Support workers Dementia Advisor

3 tier interventions Working with complex behaviours Understanding rare & unusual diagnoses Significantly altered relationships and family dynamics. Loss, Adjustment & Bereavement Carers mental health assessment Physical health assessment Risk (working with risk) Joe s Club End of Life Care

The decision support tool Domain PWD health and well-being Current situation Carer health and well-being Risk Information required What services are currently involved? Diagnosis and symptoms. What has changed? Why is person contacting us now? Stress, burden, mood impact on relationships What are current risk to PWD, carer and/or their relationship? Evidence base: Neuro-psychiatric Inventory (NPI), Carers assessment of difficulties index (CADI) and Admiral Nurse Risk Assessment

Admiral Nursing referral pathway Referral Received TRIAGE PHONE ASSESSMENT using decision support tool OUTCOME Need for on-going work identified as defined in Tier 3 Needs identified for Tier 1 or Tier 2 interventions No follow up needs identified Case referred to appropriate AN and clinic appointment offered (unless otherwise indicated) for further assessment Onward referral CASE OPEN CASE CLOSED

New ways of working Benefits to the public Single point of access More responsive service Multi media contact Potential to be responsive to new technology Benefits to the organisation More targetted intervention Sustained countywide service Reduced travel costs

Worcestershire Admiral Nurses 0300 123 1734 E: Admiralnurses@hacw.nhs.uk W: