DRAFT
Project Initiation
Document 05
Dementia Diagnosis
and Post Diagnostic
Support –
Enablement and
Tools for System
Quality
Improvement
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
Amendment History:
Version
Date
Amendment History
0.1
14/02/2014
First draft for comment
0.2
24/02/2014
Revision
0.3
05/03/2014
Revision
0.4
25/03/2014
Revision
1.0
15/04/2014
Final
2.0
06/06/2014
Major Amendment
Reviewers:
This document must be reviewed by the following:
Name
Signature
Title / Responsibility
M Emurla
SCN Manager
C Dollery
SCN Clinical Director
Date
Version
Date
Version
Approvals:
This document must be approved by the following:
Name
Signature
C Dollery,
signatory on
behalf of
Strategic
Dementia
Advisory
Group
Title / Responsibility
SCN Clinical Director
Geographic
Oversight
Group (GOG)
The controlled copy of this document is held by the work area it covers. Any copies of
this document held outside of that area, in whatever format (e.g. paper, email
attachment), are considered to have passed out of control and should be checked for
currency and validity.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 2 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
Contents
1
2
Background .........................................................................................................5
1.1
Introduction....................................................................................................5
1.2
Overview .......................................................................................................5
Project Definition .................................................................................................7
2.1
Project Objectives..........................................................................................7
2.2
Project Scope ................................................................................................7
2.2.1
3
Exclusions from Scope ...............................................................................7
2.3
Deliverables and/or Desired Outcomes .........................................................7
2.4
Dependencies ...............................................................................................8
2.5
Constraints ....................................................................................................9
2.6
Exclusions .....................................................................................................9
2.7
Interfaces.......................................................................................................9
2.8
Assumptions ..................................................................................................9
2.9
Approach .......................................................................................................9
2.9.1
Overview ....................................................................................................9
2.9.2
Guiding Principles ....................................................................................10
2.9.3
Project Lifecycle .......................................................................................11
2.10
Procurement Strategy ..............................................................................11
Business Case ..................................................................................................12
3.1
Benefits .......................................................................................................13
3.1.1
Patient Benefits ........................................................................................13
3.1.2
User Benefits............................................................................................13
3.1.3
Programme Benefits ................................................................................13
3.1.4
4
14
Project Organisation ..........................................................................................15
4.1
Project Structure ..........................................................................................15
4.2
Project Governance .....................................................................................15
4.3
Key Stakeholder Groups .............................................................................15
4.4
Project Resources and Responsibilities ......................................................16
4.4.1
4.4.2
5
Predicted Specific Benefits from Enablement Toolkit
Project Manager
16
Project Board (SDAG/SCN) Responsible Officers ...................................16
Project Management Controls ...........................................................................16
5.1
Project Management ...................................................................................16
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 3 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
5.2
Project Controls ...........................................................................................17
5.3
Change Control ...........................................................................................17
5.4
Risks and Issues Management ...................................................................17
5.5
Project Risks & Issues .................................................................................17
5.6
Previous Projects Lessons Learned ............................................................18
6
Project Plan .......................................................................................................18
7
Quality Plan .......................................................................................................18
8
Communications Plan........................................................................................19
9
Resource Plan ...................................................................................................19
10 Project Costs .....................................................................................................19
10.1
Capital Expenditure ..................................................................................19
11 Appendix 1 ........................................................................................................21
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 4 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
1 Background
1.1 Introduction
There are 800,000 people in the UK diagnosed with dementia, with 665,000 of this
number in England (Alzheimers Society 2013). This figure is estimated to increase,
although positively, recent research has indicated a lower rate of increase then
initially understood. Nevertheless, the condition currently places immense burdens
on patients, carers and health and social care resources, and this will become more
acute over the long-term.
One of the critical issues with dementia is that on average, less than half of patients
with the condition have a diagnosis (DoH 2013; Alzheimers Society 2013) - resulting
in a diagnosis “gap” between actual prevalence and diagnosis rates. The
consequences of this are:



individuals are not accessing early intervention services and appropriate
support,
that health and social care systems, models and planning are predicated
on a substantially smaller dementia population than the actuality – raising
strategic resource and capacity concerns.
that there is insufficient provision of equitable, appropriate, effective and
systematic post-diagnostic support.
The issue of improving diagnosis rates in dementia is inextricably linked to the need
for high quality post diagnostic support, and also recognises the need for strong
integration between health and social care commissioning, and primary and
secondary care service delivery.
Addressing low and variable dementia diagnosis rates, and the availability and
utilisation of post-diagnostic support, forms a central plank of government, health and
social care priorities.
This project aims to enable commissioners in the East of England to address
diagnosis rates for dementia, and provide an opportunity for piloting a transformative
post-diagnosis support project, through an integrated approach, to improve quality of
services, identifying benefits and outcomes, utilising best practice, evidence and
information, and facilitation of expert collaboration.
This will be achieved through proactive enablement of the implementation of
improved diagnosis rates against the national ambition, and support for pilot
commissioner-led transformative post diagnostic support project. (See Appendix 1
for enablement toolkit, and Sections 1.2 and 3.1 for benefits).
1.2 Overview

Improving dementia diagnosis and post-diagnosis support have been
identified as a high priority by the integrated Strategic Dementia Advisory
Group (SDAG) for the East of England, a collaborative forum facilitated by the
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 5 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
Strategic Clinical Network. The project areas covered by this document will be
commenced in April 2014, with a projected timeline of two years.

Initial agreement of a proposed suite of offers was sought from the SDAG, and
commissioner engagement processes have been initiated. Scoping and
development of a transformative quality improvement project will be
undertaken, with the offer of support, resources and evaluation for
commissioner-led approaches, facilitated through a tendering process.

A review of resources has culminated in further focusing and development of
thinking from v1.0 of this Project Initiation Document, resulting in a targeted
approach, with the specific aim of enablement of implementation and delivery

All involved organisations must undertake to share all data, outcomes, lessons
learned, risks and benefits with the wider health and social care community;
such sharing to be facilitated by the SCN. This will ensure that whole system
benefits across organisational boundaries are realised.

The project will be co-produced at all stages.

The expected benefits of the project (with patient benefits highlighted in bold)
include:
o Quality and service improvements for people with dementia and
their carers in the east of England and beyond.
o Improved dementia diagnosis rates in the east of England, with
improved equity of service provision and reduction in variation in
both diagnosis rates and post diagnostic support.
o Improved access to services, treatment and support through timely
diagnosis and early intervention, resulting in cost and personal benefits
and benefits realisation from:
 Improved support to maintain people with dementia in their own
homes and communities, and delayed entry to care and nursing
home facilities
 Avoidance of un-necessary hospital admission and crisis
intervention
 Improvements in quality of life from the above.
o Targeted support for carers and evidence-based understanding of
post-diagnostic support needs.
o Integrated and regional approach to commissioning guidance, support,
tools and resources, providing consistent high standards and evidence
based approaches for all commissioners.
o Opportunity to share and disseminate good practices and outcomes
arising from the project inter- and extra-regionally
o Embedding of a culture of co-production into all SCN facilitated/enabled
projects.
o Compliance with intentions and ambitions of the National Dementia
Strategy, PM’s Dementia Challenge, NHS England Mandate and
Outcomes Framework, and NICE Guidance, pathways and standards
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 6 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
o Contribution to CCG QIPP and quality premium programmes.
2 Project Definition
2.1
Project Objectives
The Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for
System Quality Improvement Project, is intended to enable implementation and
support delivery of the national ambitions and PM challenges in dementia care, via
commissioner-led projects and programmes of work.
The specific objectives of the project are to:

To enable commissioners to improve low and variable dementia diagnosis ,
provide timely and high quality memory assessment and diagnostic services,
and transform quality improvements in post-diagnostic care in the east of
England

To ensure proactive and effective co-production of the project, in collaboration
with service users, carers and their representatives.
2.2
Project Scope


Improvement in dementia diagnosis rates in the east of England
Improvements in post-diagnostic care, facilitated through piloting and
evaluation for benefits and outcomes
Projects to be commissioner-led, SCN enabled and supported through SDAG.
References to “commissioners” encompass both health and social care
commissioners.
Geographical remit to be east of England, but with ability for further
dissemination on an extra regional and national basis.



2.2.1 Exclusions from Scope
The following products and activities will be deemed out of scope for the Dementia
Diagnosis and Post Diagnostic Support – Enablement and Tools for System Quality
Improvement Project:

Areas in dementia care outwith dementia diagnosis and post diagnostic
support
Commissioning bodies outside east of England region.

2.3
Deliverables and/or Desired Outcomes
Product / Deliverable
Owner
Definition
Enablement toolkit and
offers scoped and
identified (Appendix 1).
SDAG
SCN
Agreed set of tools assessed for
benefits to system, and
communicated and supported in
roll out to commissioners.
Project brief on quality
improvement project in
SCN
Scoped, evidence-based, and
developed brief, for consideration
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 7 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
Product / Deliverable
Owner
Definition
post diagnostic care, with
transformational potential.
Commissioners
of commissioners, and as
platform for tendering process for
pilot.
Toolkit for commissionerled programmes on
improved diagnosis rates
and post-diagnostic
support
Commissioner
SDAG
Diagnostic tools, packaged for
easy accessibility and utilisation
and engagement by
commissioners and GP’s/primary
care.
SCN
Provision of project brief on post
diagnostic care approaches.
Interim reports on
progress of
Commissioner-led
projects
SDAG
Structured support on
resources, standards,
tools and evidence-base.
SDAG
SCN
Completed documentation and
report
SCN
CLARHC
Accessible toolkits, signposting
and resource repository.
AHSN’s
Evaluation report on
outcomes /progress to
date
SDAG
SCN
Commissioner
Dissemination of good
practice identified during
projects and arising from
suite of offers
SDAG
Confirmation of successful
co-production of project
SDAG
SCN
Commissioner
SCN
Commissioner
Learn and Share event
SDAG
SCN
Commissioner
2.4
Completed documentation and
report
Established platform for
communication; utilisation of
stakeholder database, discussion
boards and website.
Full and effective co-production;
evaluation of co-production and
agreement of lessons learned,
areas for any improvement and
areas of good practice.
Event with stakeholders to
disseminate outcomes from
projects and support on-going
enablement of quality and
service improvements.
Dependencies
The Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for
System Quality Improvement Project, is dependent on the following:
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 8 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document

2.5
Successful engagement with Commissioners to enable the establishment of
Commissioner-led programmes of work, based upon the toolkit and postdiagnostic project brief.
Constraints
The Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for
System Quality Improvement Project, has the following constraints:

Budget

Individual and organisational engagement

Commissioner resources to engage with, and implement programmes based
on the toolkit and post diagnostic project brief.

SCN resources
2.6
Exclusions
None identified at present – please see Section 2.2 Scope.
2.7
Interfaces

Other local, national, individual and organisational projects, resources and
information regarding dementia diagnosis and post diagnostic support.
Commissioners of dementia services across the east of England.

2.8
Assumptions
The following assumptions have been made with regards to Dementia Diagnosis and
Post Diagnostic Support – Enablement and Toolkit for System Quality Improvement
Project as a whole:


Support of the SDAG regarding the reviewed toolkit and project brief.
Engagement with Commissioners in relation to their undertaking programmes
of work related to the toolkit, and proposed post-diagnostic care project
referenced within this initiation document.
The SCN will provide enablement and support with project oversight resource
and funding elements project during 2014/15 and 2015/16.

2.9
Approach
2.9.1 Overview
The project will be commenced in April 2014, with a projected timeline of two years.
Project management approaches will be utilised in order to achieve deliverables (see
Section 2.3).
Support will be sought from the SDAG, with SCN enabling commissioner
engagement with the assembled toolkit, through robust and proactive communication
and personal meeting schedules to support take-up and delivery.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 9 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
SDAG, Commissioner and Service user input will be sought in defining the postdiagnostic care project brief, after which formalisation, an offer/needs/tendering
facilitated process will be undertaken to identify commissioner bids and approaches
to the brief and identify leads for the pilot phase.
Robust project management will be expected from lead organisations, with support
from the SCN project lead for Dementia.
All lead organisations must undertake to share all data, outcomes, lessons learned,
risks and benefits with the wider health and social care community; such sharing to
be facilitated by the SCN. This will ensure that whole system benefits across
organisational boundaries are realised.
Evaluation must be undertaken and shared for all work enabled within this document
to provide credibility and validity to programmes of work. It should be noted that
formal evaluation support is encompassed within funded support for post-diagnostic
care pilots.
The project will be co-produced at all stages.
2.9.2 Guiding Principles
The project is guided by the following principles:











NHS Mandate (Objectives 8 and 13)
National Dementia Strategy 2009-14
Prime Minister’s Dementia Challenge 2012-15
National Dementia Audit 2012/13
Dementia – A State of the Nation Report 2013
NICE Guidelines, Pathways, Quality Outcomes Framework and Quality
Standards
Dementia Prevalence Calculator
NHS and Social Care Outcomes Frameworks
NHS England Objectives for Dementia
Dementia CQUIN
NHS England Business Plan (Priority 4/NHSOF Domain 2 - enhancing quality
of life for those with long term conditions; Priority 6/Domain 4 - ensuring a
positive experience of care; Priority 8 – promoting equality and reducing
inequalities in health outcomes).
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 10 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
2.9.3 Project Lifecycle
Stage/Task
AprilJune
14
JuneSept
14
SeptDec
14
JanMarch
15
MarchJune
15
JuneSept
15
Sept
15 –
March
16
Assembled toolkit
finalised, and post
diagnostic project brief
scoping commenced.
Commencement of
engagement and
meeting schedule with
commissioners
Finalisation of postdiagnostic care project
brief
Commencement of
programmes of work at
Commissioner localities
Programmes of work
undertaken
Evaluation of initial
outcomes and interim
milestones
Final evaluation and
reporting to support roll
out/dissemination
Onward development
of project and roll
out/dissemination of
outcomes /good
practice
Stakeholder learn and
share event to
disseminate outcomes
from project and
support on-going
enablement of quality
and service
improvements
Co-production of
project at all stages
2.10 Procurement Strategy
None required.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 11 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
3 Business Case
Since the publication of the 2009 national Dementia Strategy, concerted efforts to
address low diagnosis rates for dementia have resulted in some marginal
improvements towards the national ambition of 67% (67% of those estimated to have
dementia, to receive a diagnosis).
There is still a significant gap in most CCG areas within the east of England region
between individual diagnosis rates and the national ambition, and equally there is
substantial variation within the region at CCG level, ranging from 34.97% to 51.09%
(Dementia Prevalence Calculator v3). Further, at GP practice level within CCG’s,
some practices demonstrate far higher diagnosis rates than others.
Strategic work is required to understand the current rates of diagnosis and consider
the reasons behind variation and different levels of diagnosis. Such work would also
provide the opportunity to consider the benefits and lessons from increased
awareness and increased numbers of people becoming known to services to inform
commissioning locally regionally and nationally. In this manner appropriate data may
be utilised in planning processes along with supportive actions and tools, to enable
service and quality improvements.
Lessons learned at practice and CCG levels can respectively be scaled up to apply
at CCG and regional levels, disseminating improvements.
Diagnosis is inextricably linked to post-diagnostic support for service users – both
patients and carers. This is recognised in the Prime Minister’s Dementia Challenge,
and forms the basis for a complete pathway approach to dementia care. However
service users and representative groups consistently confirm that post diagnostic
support remains the biggest gap in service provision, and therefore the biggest
opportunity for improvement.
Post-diagnostic support also represents the interface between health and social care,
and the transition from medical model diagnostics to holistic care packages and
support.
Integrated and joint commissioning approaches are a necessity in the continuing
economic climate, and the demographic inevitabilities of dementia.
Equally importantly, dementia cannot be seen in isolation from other areas of health
and social care. It is the pre-eminent long term condition and chronic disease in
terms of individuals affected and the economic (and personal) burden on society.
Improvements in dementia services will have a far reaching and deeply felt effect on
many other areas of health and social care commissioning.
Improving dementia services is a positive commissioning story, but further work is
required on the tools, approaches, and support that are necessary to fulfil the
potential within dementia commissioning, and provide service users with the
confidence that they will be able to live well with dementia.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 12 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
3.1
Benefits
Please refer to Section 1.2. For clarity, benefits are broken down as follows:
3.1.1 Patient Benefits
o Quality and service improvements for people with dementia and their
carers in the east of England and beyond.
o Improved dementia diagnosis rates in the east of England, with
improved equity of service provision and reduction in variation in both
diagnosis rates and post diagnostic support.
o Improved access to services, treatment and support through timely
diagnosis and early intervention, resulting in cost and personal benefits
and benefits realisation from:
 Improved support to maintain people with dementia in their own
homes and communities, and delayed entry to care and nursing
home facilities
 Avoidance of un-necessary hospital admission and crisis
intervention
 Improvements in quality of life from the above.
o Targeted support for carers and evidence-based understanding of postdiagnostic support needs.
o Proactive implementation of the Equalities Act in addressing health
inequalities, and equity of access.
3.1.2 User Benefits
o Integrated and regional approach to commissioning guidance, support,
tools and resources, providing consistent high standards and evidence
based approaches for all commissioners.
o Improvement against national ambition for dementia diagnosis of 67%.
o Reduction in hospital admissions, crisis intervention and care home
costs.
o Opportunity to share and disseminate good practices and outcomes
arising from the project inter- and extra-regionally
o Contribution to CCG QIPP and quality premium programmes.
o Proactive implementation of the Equalities Act in addressing health
inequalities, and equity of access.
3.1.3 Programme Benefits
o Delivery of SCN Improvement Plan for Mental Health, Dementia,
Neurological Conditions, Learning Disability and Autism for 2014-16 in
relation to cross cutting themes, System Objectives One-Five and
Domains 1-5.
o Embedding of a culture of co-production into all SCN facilitated/enabled
projects.
o Compliance with intentions and ambitions of the National Dementia
Strategy, PM’s Dementia Challenge, NHS England Mandate and
Outcomes Framework, and NHS Business Plan.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 13 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
o Proactive implementation of the Equalities Act in addressing health
inequalities, and equity of access.
3.1.4 Predicted Specific Benefits from Enablement Toolkit
(See Appendix 1)
o GP Coding Tool: 4.7 hours’ time commitment per practice, resulting in
average 8.8% increase in dementia diagnosis rates per practice (Russell
et.al (2013) Improving the identification of people with dementia in primary
care: evaluation of the impact of primary care dementia coding guidance
on identified prevalence; BMJ Open).
o Dementia Prevalence Calculator v3 (2014): 2012/13 QOF analysis, data
reporting, indicative gap analysis, service projections, capacity planning
tool; most accurate, timely resource for commissioning to date.
o Health Fabric: Used in conjunction with the Gnosall Dementia Care
pathway, results included fewer bed days, reduced admission to care
homes, and reduction in use of anti- psychotic drugs. The patient health
and social care record is provided on the tablet based solution which
enabling multiple care professionals to collaborate more effectively, based
upon the integrated care planning requirements of the patient (Health
Fabric, http://www.healthfabric.co.uk/casestudy.html; accessed 5/3/2014).
o Facilitated support in collaborative work with PrescQIPP or local medicines
optimisation teams: similar exercises in NHS Somerset resulted in 300
additional patients added to dementia registers.
o Package of support and evaluation to provide evidence base on
transformative potentiality of targeted post-diagnostic care pilots.
o Substantial systemic benefits realisation from: sharing good practice;
readily accessible resource repository for planning, commissioning and
business case development, and standards to improve quality and
consistency.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 14 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
4 Project Organisation
4.1
Project Structure
This section of the document outlines the overall project organisation necessary to
implement the Dementia Diagnosis and Post Diagnostic Support – Enablement and
Toolkit for System Quality Improvement Project.
Geographic Oversight Board
MHDNLDA Steering Group
Project Manager
Strategic
Dementia
Advisory Group
4.2
Coproduction
Task and Finish
Group
Project Governance
Please refer to project structure above, which mirrors governance arrangements.
In addition to this, individual Commissioner governance structures will be utilised for
each commissioner engaged in a project under this umbrella document.
Please refer to the SDAG, Mental Health, Dementia, Neurological Conditions,
Learning Disability and Autism (MHDNLDA) Steering Group and Geographic
Oversight Group (GOG) Terms of Reference, and SDAG Sub Group Statement of
Purpose, for responsibilities and accountabilities of each body.
The governance bodies meet as follows:

SDAG - bi annually, with virtual group communication/additional meetings
more frequently as required.
SDAG Sub Group – quarterly.
MHDNLDA Steering Group – quarterly.
GOG – quarterly.



Please also refer to Section 5.2 Project Controls.
4.3
Key Stakeholder Groups
The primary stakeholders to the Dementia Diagnosis and Post Diagnostic Support –
Enablement and Toolkit for System Quality Improvement Project are the SDAG, the
SCN and Commissioners of dementia services in the east of England.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 15 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
4.4
Project Resources and Responsibilities
Resource
Time
Role
Core Project Management
Senior Responsible
Owner – Mary Emurla
and Caroline Dollery
Project Manager – Sally
Donaghey
SCN Manager and Clinical Director
2 days p.w.
0.4 FTE
Programme roles
As required
Quality Improvement Lead – leading on dementia
elements of SCN work programme and ensuring
effective project management support for the
provision of offers from the SDAG, facilitation by the
SCN, and to CCG’s for projects arising from this
brief.
Within commissioner organisations.
Please refer to full job descriptions for further details.
4.4.1 Project Manager
The Project Manager is Sally Donaghey.
The Project Manager will report to the Project Board (SCN) Responsible Officers on a
monthly basis as per Section 5.2, and more frequently if/as required. Formal
reporting to the SDAG will take place on a bi-annual basis and more frequently as
required.
4.4.2 Project Board (SDAG/SCN) Responsible Officers
Interim Chair
Caroline Dollery
SCN Manager
Mary Emurla
Project Manager
Sally Donaghey
Administrative Support
Gemma Emsden
Commissioner Lead(s) for Offers
To be advised
5 Project Management Controls
5.1 Project Management
The approach to project management for the project shall be consistent with the
PRINCE 2 methodology.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 16 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
5.2 Project Controls
The following items are submitted monthly to the SCN Responsible Officers:

QA/Status Report – to provide the Project Board with the QA and status of a
project, and the committed project spend to date;
Risk Register/Issues Log – an updated risk/issues register for the project;
Lessons Learned Log – an updated lessons learned log for the project.


The following items will be required in cases where the project exceeds agreed
tolerances:

5.3
Exception Report / Plan – The mechanisms used by the Project Manager
when the project exceeds agreed tolerances.
Change Control
Major changes to the content of this PID following approval can only be authorised by
the Geographic Oversight Group. Minor changes/amendments may be authorised by
the Mental Health/Dementia/Neurological Conditions/Learning Disability/Autism
Steering Group and/or SDAG Sub Group.
5.4
Risks and Issues Management
Risks and issues will be tracked and managed in accordance with the PRINCE 2
principles, the NHS England Project Risk/Issue Template, Risk Register Report,
Issues Log, and Exception reporting as required.
5.5
Project Risks & Issues
Issue/Risk
Description
Type
Impact
Controllability
RAG
Mitigating Actions
Engagement with
stakeholders to the
project – both internally
within NHS England
and externally
Risk
Utilising network
approaches to enable
facilitation, and
demonstrate tangible
benefits to quality
improvements, patient
outcomes and wider
stakeholders.
Commissioner buy-in
and ownership of
projects arising from
toolkit/project brief.
Risk
Undertaking facilitated
engagement processes
with commissioners.
SCN budget
constraints and
financial sufficiency for
project scope.
Document Number: PID05
Status: Draft
Support of SCN GOG
and availability of
programme monies
Issue
Commissioner and
organisational
engagement and
promoting influence of
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 17 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
Issue/Risk
Description
Type
Impact
Controllability
RAG
Mitigating Actions
national drivers
Inability of
commissioners to
provide resources and
budget to undertake
programmes of work–
resulting in more
limited implementation
of project potential.
Identification and
provision of necessary
data and informatics –
resulting in reduced
credibility and validity,
and barrier to
successful evaluation
Risk
See above
Liaison with NHS
England Area Team and
Regional teams, and
commissioner generated
databases and sources
of information within
appropriate information
governance
requirements.
Issue
Utilising sharing good
practice and information
sharing protocols.
Communication
effectiveness and
management between
and within numerous
potential stakeholders
to project.
Exploring and utilising
different forms of
communications including focus groups,
web site, virtual, email,
face-to-face.
Risk
Robust and effective
Advisory Group
management.
Utilisation of NHS
England/SCN
Communications
Strategy.
5.6
Previous Projects Lessons Learned
None at present.
6 Project Plan
Please refer to Section 2.9.3 Project Life Cycle for high level baseline plan.
7 Quality Plan
PRINCE 2 quality standards and expectations will be adhered to for the project.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 18 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
8 Communications Plan
Please refer to NHS England SCN Communications Strategy for overarching
document.
The Project Manager will undertake robust communications with all stakeholders and
commissioners leading on projects arising from the enablement toolkit within this
Project Document (See Appendix 1).
All appropriate forms of communication will be utilised to ensure effective, regular
liaison.
Formal reporting will be undertaken as per Section 4.4.2 and 5.2.
9 Resource Plan
Please refer to Section 4.4.
Further and better details of resources external to the SCN arising from
Commissioner-led work, will be detailed here in revisions to this document as the
project goes through approval.
10 Project Costs
10.1 Capital Expenditure
*Capital Expenditure
Preparation and
Lead
Implementation
(Stage 2,3)
NHS CFH Wide
Enablement
(Stage 4)
Total
Estimated project costs for programmes of work to March 2016
Health Fabric application – patient held,
cloud-based record of care:


SCN support in introducing app
and contacts to SDAG and
commissioners. SDAG/ SCN
support for commissioners who
opt to undertake projects in
localities to trial Health Fabric.
Enablement,
implementation
and evaluation of
App.
5
Further support in evaluation of
CCG projects in this area.
Facilitated support in collaborative work
with PrescQIPP (NHS England
medicines Management team in the
EoE)/local medicines optimisation
teams, to audit usage of
anticholinesterase inhibitors medication,
against dementia diagnosis, to inform
gap analysis and identify potential
improvements in diagnosis rates for this
Document Number: PID05
Status: Draft
5
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 19 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
population.
SCN facilitation for commissioner-led,
transformational post-diagnostic care
project.
50
Patient representative expenses SDAG
1
Regional learn and share event for
project close, reporting, celebration of
successes/lessons learned and roll-out
2
Total
63
*Capital Expenditure – All values given in (£000s) and totals have been rounded up
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 20 of 21
Dementia Diagnosis and Post Diagnostic Support – Enablement and Toolkit for System
Quality Improvement Project Initiation Document
11 Appendix 1
Enablement Toolkit for System Quality Improvement
1. Coding Tool for use in GP Practices.


Evidence base, guidance, tool supplied.
SCN support in identifying practices to undertake projects in localities.
2. Dementia Prevalence Calculator v3


SCN support in undertaking analysis at practice level to identify strategic approaches
and service improvements.
SCN support for undertaking analysis at CCG level to identify variations and enable
collaborative working between commissioners to share good practice and lessons
learned.
3. Health Fabric Application – for patient held, cloud based full record of care for utilisation
by all providers of care.


SCN support in introducing app and contacts to SDAG and commissioners. SDAG/
SCN support for commissioners who opt to undertake projects in localities to trial
Health Fabric.
Further support in evaluation of CCG projects in this area.
5. Facilitated support in collaborative work with PrescQIPP (NHS England medicines
management team in the East of England),or local medicines optimisation teams, to audit
usage of anticholinesterase medication against dementia diagnosis, to inform gap analysis and
identify potential improvements in diagnosis rates for this population.
6. Identify repository of recommended and supported guidance and tools for utilisation by
commissioners in business case enablement.
 SCN support to facilitate “ready reckoner” of resources for ease of access and use.
 SDAG advice and guidance to confirm and recommend resources identified, as gold
standard for local use, improving equity and cross-organisation collaboration.
7. SCN enablement and facilitation for post-diagnostic care project, with transformational quality
improvement potentiality, including resources, post-project reporting, evaluation, dissemination
and roll-out as appropriate.
8. Sharing Good Practice
 Web-site space development by SCN to enable sharing of good practice, lessons
learned, appropriate data and informatics and peer support for stakeholders and
partners in dementia care in the east of England region and beyond.
 Promotion of accessibility of resources.
 Continuation and further development of Dementia Bulletin, facilitated by SCN, and
supported by input from SDAG.
Document Number: PID05
Status: Draft
Issue/Approval Date:
Next Review Date:
Version Number: 2.0
Page 21 of 21