Report to the Clinical Commissioning Groups on the Proposed Monitoring of the Implementation of the NDS Strategy Date: 21st November 20 Author: Malusky Purpose of the Report: To provide the Clinical Commissioning Groups with a template and project outline on how the measures set out within the document: Living Well with Dementia, Hertfordshire s Joint response to the National Dementia Strategy http://www.hertsdirect.org/docs/pdf/d/dementia.pdf will be monitored and evaluated and reported to the Clinical Commissioning Groups, and other key partners and stakeholders. Introduction The Joint Commissioning Team, through leading the Hertfordshire National Dementia Strategy Implementation Strategy Steering Group published the above document as set out in the NHS Operating Framework guidelines at the end of September 20. Since then work has progressed on pulling together further details on how the methodology for collating data on the agreed measures set out in the document will be formally reported to the Clinical Commissioning Groups and key partners. This document will be set out as the Monitoring Framework. The Monitoring Framework document contains a total of 50 measures set out against the 14 s contained within the National Dementia Strategy. Some of the measures are spread across a number of objectives, eg: a reduced number of admissions into residential care placements will impact on delivering objectives 8, 9 and 10. As the document is a Joint response from a numerous organisations across the county, these include Hertfordshire County Council, NHS Hertfordshire, soon to be the 2 Clinical Commissioning Groups, the local acute trusts, Hertfordshire Partnership Mental Health Trust, Carers in Hertfordshire, the, and Age UK to name to main key partners, the measures and monitoring process is a complex piece of work which will involve a number of methodologies and differing information sources and systems. Appendix 1 sets out the measures, the descriptions, the evidence and data sources, a named countywide lead and quarterly timetable for reporting back the information. It is proposed that this template is monitored quarterly by the Herts National Dementia Strategy Implementation Steering Group and reported annually to the Clinical Commissioning Groups and key partners. Should significant risks be Page 1 of 8
identified by the NDS Steering Group then the Group will escalate the matter to the CCG s. Compiling the Monitoring Framework. Some of the measures will include the work being undertaken at a national level such as the national dementia awareness campaign. On the back of this campaign last year, local billboards and advertising units were placed in parts of the county including Watford and nage football grounds to increase awareness. Viewing figures suggest the reach in order of 250,000 people. During the year there has been a lot of local work which is already mentioned in the document. Information packs and top tips carer packs have been produced over the year alongside mugs distributed to GP practices to promote the local Early Memory Diagnosis and Support Service. Training for carers to help them become better carers and to become expert carers of people with dementia. The Annual Dementia Conference for health and social care professionals is now in its 3 rd year and continually is oversubscribed. The implementation of dementia champions within acute trusts has been welcomed alongside the national CQUIN (Commissioning for Quality and Innovation Targets) which has begun to turn around the lack of understanding within general hospitals of identifying and effectively dealing with people with dementia. The publication of the local joint response to the NDS has highlighted the need to develop a more robust framework to ensure that improvements to the lives and well being of people with dementia can be evidenced and that partners resources are being targeted effectively across the health and social care community. The Monitoring Framework has been put together to provide this robust mechanism. The Joint Commissioning Team will lead on compiling the Framework with the help from partner agencies responsible for their part. Due to the complexity of collating the data from differing agencies the JCT will need to work with partners to establish the baseline and to collate all the data in one place. Whilst this data does exist, it is reported in different forums and has never been brought together and compiled within a single document and reported centrally which is what this framework will achieve. It is intended to complete the baseline figures by the end of the year with data being published in time for the March NDS Steering Group. The final data will be available for publication in June 20 when the completed data set for 20/20 can be presented to the Clinical Commissioning Groups. The JCT are also currently considering CQUIN targets for next year and will be making future recommendations based on achieving the outcomes set out in the NDS Strategy in conjunction with the guidance set out in the NHS Operating Framework for 20/14 the Health and Well Being Board Priorities and the Prime Ministers Challenge on Dementia. Recommendations and Next Steps 1. The JCT recommends that the Clinical Commissioning Groups support the development, implementation and reporting of the Monitoring Framework for Page 2 of 8
the Joint Hertfordshire Response to the National Dementia Strategy; Living Well with Dementia. 2. The JCT recommends that the Clinical Commissioning Groups support the proposal the Monitoring Framework will be regularly reviewed by the NDS Steering Group. 3. The baseline for the monitoring framework will be completed by January 20, with data compiled up to available for publication in March 20. Page 3 of 8
National Dementia Strategy Monitoring Framework Covered Description Evidence Owner 1 1 2 1 3 1 4 2 5 2 Feedback forms from public briefings, participation events and Dementia Carers Forum Increase in number of people with an awareness of dementia Questionnaires and surveys to be delivered through statutory organisations and Carers Organisations Greater uptake of information and resource packs Increase in number of people being recorded with dementia within Hertfordshire Practice Registers Quality Outcomes Framework (QOF) Quarterly Report Billboard reach, advertising spend, Conferences, DVD's for Carers survey. HertsHelp surveys. Carers in Herts report Printing and distribution costs. Increase in QOF number. Malusky, PohWer, Carers in Herts Johannah Stephen 3K Adverti sing. 41.8% 1,000 already printed, 1,000 more being ordered. Develop online download facility and measure hits. Due Octob er 20 6 2 7 2 Increase in the numbers of people accessing social care services. Increase in the numbers of people accessing voluntary services. Local Authority Data HCS Age UK. British Red Cross. Alzheimer s Society. Crossroads etc 8 2 Increase in Carer's assessments HCS Increase in the uptake of Early Memory 9 2 Diagnosis and Support Service s referred 10 3 People will tell us they are confident in making choices regarding their care of their loved ones Eaglesham Eaglesham
11 3,4 Covered Description Evidence Owner survey. People will tell us they know what services are available to them 3,4 People will tell us where to go for information We will see an increase in hits on local 3,4 information websites (Hertshelp) We will see local networks develop outside the formal structures developed by statutory and non 14 3 statutory services We will see more people take up and use 15 3,4 advance statements 16 4 17 4 18 5 People will tell us they access services they have chosen that are suitable for them People will tell us they are confident in making choices regarding their care of their loved ones of attendances at the Carer support groups 19 5 of attendances at the Dementia Cafes 20 5 of attendances at the Dementia Forums of attendances at the Young Onset 21 5 groups survey. SPA. survey. SPA. Website data HPFT CQUIN survey. survey. SPA. Cares in Herts reports. Quarterly Report Quarterly Report Quarterly Report, PohWer, PohWer Pohwer (HertsHelp) Page 5 of 8
22 5 23 5 Covered Description Evidence Owner Reduced reliance on statutory health and social care services, less potential spend per head on social care and reduced outpatient attendances and GP visits Satisfaction surveys undertake by Alzheimer s Society and Carers in Herts 24 6 Delay in admission to long term residential units Increase in the uptake of community equipment 25 6 services 26 6,7 Reduction in access to crisis services 27 6,7 Reduction in acute admissions 28 7 Greater uptake of services and direct payments Increased number of carers receiving an assessment via Hertfordshire Community 29 7 Services Dementia toolkit Quarterly Report / Carers in Herts Feedback Reduction in social care spend Spend and numbers. Reduction in inpatient admissions to HPFT services, CATT team referrals, IOT referrals for over 65s Acute trust reports, HPFT reports, RAID of people accessing social care and receiving a direct payment/personal budget. of carers assessments Maddex Barry Fearon Acute contract manager, Updat e Decem ber 20 Eaglesham Eaglesham Page 6 of 8
Covered Description Evidence Owner Maddex / Spend and 30 8,9,10 Reduced admissions into residential care setting numbers. Eaglesham Acute contract 31 8,9,10 Reduced length of stay in acute hospital Acute trust reports manager Acute 32 8,9,10 Reduction in re-admissions into acute care Acute trust reports, for 65+ contract manager 33 9 Increase peoples independence, uptake of more community based services Spend and numbers. Barry Fearon 34 10 Increase in time people spend in the community before accessing residential care Reduced spend in residential social care Maddex 35 10 Involvement in community activities Spend on voluntary sector and numbers accessing. 36 10 Uptake in community alarms and equipment services s and spend Barry Fearon 37 11 Care Quality Commission inspection reports and ratings CQC Website www.cqc.org.uk 38 11 HCS Contract monitoring of care homes and accreditation Maddex 39 11 Reduction in admission rates to local acute hospitals from care for example relating to trips and falls Falls Liaison Barry Fearon 40 11 Reduction in the use of anti-psychotics Audits NDS 41 11 Staff training programmes All Trusts Steering Page 7 of 8
Covered Description Evidence Owner Group The number of people choosing to complete 42 advance care plans HPFT CQUIN The number of people who die in accordance of 43 the wishes of the advance care plan CQUIN 44 45 46 14 47 14 48 14 49 14 50 14 Feedback from service users and carers feel they were appropriately supported by staff that understood the condition of dementia The numbers of people attended the differing levels of training provided across the county To ensure staff working in local units are sufficiently trained to deal with people with dementia and can implement appropriate care strategically to maintain calm and well being To reduce the number of people with dementia prescribed anti-psychotics by GPs in Acute Hospitals To reduce the number of people with dementia prescribed anti-psychotics by GPs in Care Homes To reduce the number of people with dementia prescribed anti-psychotics by GPs in HPFT inpatient units To reduce the number of people with dementia prescribed anti-psychotics by GPs in Primary Care Quarterly Report / Carers in Herts Feedback All Trusts HCS contract monitoring reports. Audits Audits Audits Audits NDS Steering Group Maddex 5% 11% 16.1% (ENCC G) Page 8 of 8