Where are we now?
National and local policy, legislation and guidance and key drivers
There are a number of national strategic drivers that have helped to shape the strategy. These include:
- The National Dementia Strategy, ‘Living Well with Dementia’ 2009 (Department of Health, 2009)
- Quality Outcomes for People with Dementia: Building on the Work of the National Dementia Strategy 2011 (Department of Health 2010)
- The Prime Minister’s Challenge on Dementia 2020 – Delivering Major Improvements in Dementia Care and Research by 2015 (Department of Health, 2012)
More operationally, the 2016/17 NHS planning guidance expects services to achieve measurable improvement in all areas of the Prime Minister’s challenge on dementia 2020, including:
- achieve and maintain a diagnosis rate of at least two thirds (67%)
- increase the numbers of people receiving a dementia diagnosis within six weeks of a GP referral
- improve quality of post-diagnosis treatment and support for people with dementia and their carers
Care Act, 2014
The Act has most relevance for people with dementia and their carers in these areas:
- general responsibilities of local authorities
- determining who is entitled to care and support
- charging for care and financial assessment – personal budgets
- integration and partnership working between health, social care and housing
- information, advice and advocacy
- adult safeguarding
Five Year Forward View 2015
This plan for the NHS is far ranging and gives priority to:
- helping people to lead healthier lives
- giving people more control of their own care
- more integrated treatment and care, across health and social care, primary and secondary care and physical and mental health (‘Parity of Esteem’)
- care provided in a uninstitutional setting as possible
- stronger partnership between NHS, councils and local communities
Expanding the Options Service Review 2015
South Gloucestershire Clinical Commissioning Group commissioned a dementia services review (Expanding options for people living with dementia, by Trevor Eardley of Organi Consulting, 2015) which found that service users and their carers feel that there is a lack of coordination of support across agencies. This is a particular problem for those with complex needs. Another problem identified is that the majority of support is only accessible between normal office hours and the availability of emergency respite is limited and difficult to access.
Most of the recommendations in the ‘Expanding options for people living with dementia’ report relate directly to services, but the three below are about how we plan these services and support:
- The dementia strategy should be fully costed and be underpinned by a detailed implementation plan, the delivery of which should be regularly monitored and reported on (recommendation no 1)
- There is a detailed mapping exercise which plots high levels of dementia in the population, ward by ward, against the location of current services (recommendation no 2)
- A project management discipline should be adopted for the delivery of projects and initiatives within an overall programme dictated by the dementia strategy (recommendation no 3)
Asset Based Community Development (ABCD)
Building on existing resources, recognising the unique contribution of:
- people with dementia themselves and their potential to live well
- families and friends capacity to support them to live well
- neighbours and local communities welcoming people living with dementia
- voluntary sector capacity building, community development and advocacy
- public sector funding person centred services, infrastructure and support
- private sector welcoming people living with dementia as customers
- partnerships to combine above strengths to help people with dementia live well
Safeguarding is everyone’s business
It is important to recognise that people with dementia and their carers may be vulnerable and at risk of abuse and neglect. The largest proportion of abuse happens in people’s homes, but can happen wherever they live. Unintentional abuse can occur at any time. Abuse and neglect can take many different forms including physical, medical or emotional neglect, physical or psychological abuse, financial or sexual abuse. There is evidence to show that abuse is higher than average among people with dementia and that people with dementia can be particularly vulnerable to abuse.
Current service provision in South Gloucestershire
Improving care and support for people with dementia is a priority and features in a number of work streams including the Better Care Fund programme and Urgent Care and includes:
- Dementia Action Alliance and Dementia Friendly initiatives
- Dementia advisors
- improving diagnostic pathways
- preventing unplanned hospital admissions
- improving hospital care
- reducing delayed transfers of care
- support for care homes and end of life care planning
More strategically the Dementia Health Improvement Team (HIT) work together and have developed action plans for five work streams:
- transforming care
- dementia friendly
- patient and public involvement
A key theme of all this work is a change in focus toward risk reduction, early intervention and community based support, thereby delaying the point where a person’s care needs become more serious. Since 2015 South Gloucestershire Council, South Gloucestershire Clinical Commissioning Group, Avon and Wiltshire Partnership and other partners have been increasingly working together in clusters of GP practices through their multi-disciplinary team meetings.
The largest asset in dementia care is unpaid carers, families, friends and informal community support mechanisms around the person with dementia. We need to continue to raise awareness about dementia across our communities enabling carers and communities to support individuals as the disease progresses.
There are a range of services and sources of support available to people with dementia and their carers in South Gloucestershire. The diagram below describes the assets and services available. It illustrates the potential ‘circle of support’ around people with dementia and their families and other carers in South Gloucestershire.
GPs in South Gloucestershire have been instrumental in raising the proportion of people with dementia who have a diagnosis. Since 2012 the proportion of people estimated to have a confirmed diagnosis has increased from 37% to 60%. Our challenge now is to achieve the 67% national aspiration. It is estimated that over 40% of all medical admissions, aged 70 years or over, have dementia but only half have a confirmed diagnosis (NICE, 2006).
ExtraCare Housing enables individuals to live in self-contained flats or chalets within an environment that promotes privacy, comfort, support and companionship. It is an important component of housing designed to meet the needs of an ageing population where care and support needs can be focussed into individual housing developments as required. We have an aspiration to develop an Extracare facility which will be a life time home for someone with dementia. Enabling people with dementia to become resident during the early phase of the disease through to supporting them as the disease progresses and an advanced stage with the appropriate levels of care and support.
There is a range of both statutory and non-statutory community based services available, however, an increasing number of people may require a stay in hospital or respite, reablement or permanent care in residential and nursing accommodation.
We work with our health partners on effective patient flows, including supported discharges from acute hospital trusts but the demand for home care and care home beds, particularly affordable care home beds, continues to outstrip demand across South Gloucestershire, its neighbouring areas and across the country itself. Care home bed placements with higher demand and increased costs for providers, indicate that costs to local authorities and health partners are set to continue to rise.