1. NUH Clinical Strategy 2010 Dementia

2. 1 The story In February 2009 the National Dementia Strategy was launched. It is a five year plan to transform the lives of people with dementia and their carers. This builds on previous policy documents including: Who Cares Wins, Royal College of Psychiatrists 2005; Everybody’s Business, DH 2006; NICE guideline No 42 – Dementia 2006. The key aims are: improved awareness, earlier diagnosis and intervention and a higher quality of care. NUH recognises the importance and magnitude of the dementia challenge and is committed to prioritising the improvement of dementia care and fulfilling the requirements of the Strategy in order to secure change Objectives for change identify some of the biggest opportunities to deliver on dementia in hospitals and create a more cost-effective system that delivers high quality care to people with dementia and carers Alzheimers Society ‘Counting the Cost’ suggests that 25% of acute beds are occupied by people over 65 with dementia. People with dementia stay in hospital longer than other people who go in with the same condition or for the same procedure. As well as cost to the person with dementia, increased length of stay is placing financial pressure on the NHS Staff are ill equipped to provide the specialist dementia care required 77% of careers express dissatisfaction with the level of care provided. Introduction National Policy

3. 2 The story The key drivers for future change are the National Dementia Strategy, and requirements of commissioning PCTs and NHS regulators Responsibility for services for people with dementia is divided amongst many agencies, including primary care, NHCT, intermediate care, adult social care, and care homes. PCTs and adult social care commission these services. PbR tariffs make it difficult to account for liaison and cross-agency services. Many national policies and guidelines have been written from the perspective of mental health, and take poor account of the particular dependencies and needs of this patient group in acute hospitals, nor the competing demands, constraints and targets of acute hospitals. Current position External Environment Patients with dementia are treated by almost all adult care services in the Trust. Patients are usually admitted with another condition, with dementia being a co-morbidity. Local data suggest 30% of Acute Medical Directorate patients have cognitive impairment (dementia and /or delirium) NUH is a large trauma orthopaedic centre, treating 780 hip fracture patients a year. 40% will have dementia. NUH will treat more people with mental health diagnoses in a year than the Nottinghamshire Healthcare (mental health) Trust Many cases of dementia are first recognised during an acute hospital admission There is currently little recognition nor specific provision for their needs by NUH, although many generic policies and procedures apply to their care Patients with dementia, have longer length of hospital stay and poorer outcomes than those without, both because of their underlying illnesses, and because of their management in hospital (and the rest of the health and social care system), and family and societal expectations. Local data suggest a mean length of stay around 15 days, but with substantial variation between cases. Absolute numbers of patients, and the proportion of the trusts patients with dementia will increase over coming years, both because of demographic changes in the local population and because in many instances it can be difficult to provide non-hospital alternatives for this group Locally and nationally there is dissatisfaction with the management of patients with dementia from families, carers, their advocates and regulators NUH is currently taking part in the National Dementia Audit, which will enable us to benchmark our current position

4. 3 The story contd. Strategic Ambition Enhance the quality of life for patients and carers by ensuring prompt access to expert services which recognise the individual needs of patients and carers Deliver a service which aims to:-  Reduce length of stay, readmissions and care home placements.  Perform in the top quartile of National Dementia Audit measures  Be recognised as a leading venue for teaching and training  Support and develop a portfolio of innovation and research Action plan Development of Dementia Pathway to guide management of patients with dementia throughout the Trust Review of current policies and structures to drive Trust wide improvements in care Ensure new policies, pathways and structures are ‘dementia aware’ and ‘dementia friendly’ Development of Education and Training strategy Work with PCTs and Nottinghamshire Healthcare Trust to specify, commission and accommodate an Older Persons liaison service Ensure success of NIHR Medical Crises in Older People research programme and other externally funded research Use emerging results from NIHR MCOP and SDO BMH research programmes to inform service development Use CLARHC structures to drive change