Intelligent Targets:
Dementia
(NHS Wales)
Professor Bob Woods
Bangor University
National Dementia Plan for Wales
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October 2008: Health Minister, Edwina Hart,
commissioned a ‘new group of health
professionals and experts’ to produce a Plan
To ‘provide us with the opportunity to address
current dementia services and look at how we
can effectively deal with the projected growth in
the number of people suffering with dementia
over the next 20 years.’
National Dementia Plan for Wales
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Starting point: conclusions from Charles
Twining’s scoping review
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Wales has enough strategies (e.g. NSF, 2006)
What is needed is an Action Plan
Group worked from December 2008 –
April 2009
Chaired by Ian Thomas (Alzheimer’s
Society)
Draft National Dementia Action
Plan
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Issued for consultation summer 2009
‘Dementia supportive communities’
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Strengthening individuals
Strengthening communities
Improving infrastructure and access to
services for all
Making structural changes to economic,
cultural and environmental conditions
Draft National Dementia Action
Plan - Consultation
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Consultation included several workshops with
professionals and sessions with people with dementia
and carers
Consultation closed September 2009
Consultation responses published on WAG web-site –
400 pages
Draft plan broadly welcomed, but seen by many as
‘aspirational’ or a ‘wish-list’
Major gaps:
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Rural diversity
Younger people with dementia
Language preferences (including Welsh)
National Dementia Action Plan –
phase 2
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January 18th 2010: Edwina Hart reconvened
the task and finish group
Presented with short-list of key priorities
Workshop with wider group of stakeholders –
Port Talbot, February 19th 2010
Instructed to come up with a SMART action
plan by end of March 2010
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(Specific, Measurable, Achievable, Realistic, Timebound)
Priority areas for action
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Improved service provision through better joint
working across health, social care, the third sector
and other agencies, including:
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Older people CMHTs to be fully integrated across
health and social care
Improve quality of general hospital care
Reduce inappropriate use of anti-psychotics
Improved early diagnosis and timely interventions
Improved access to better information and
support for people with the illness and their carers
Improved training for those delivering care &
greater awareness of need for advocacy
Ministerial statement – May 11th
2010
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Focus must now be ‘on operational delivery and genuine
meaningful service improvements’
‘Action plans’ from the 4 sub-groups published on the WAG
web-site – unedited, unformatted, uncosted
Implementation entrusted to the Mental Health Programme
Board
Intelligent targets seen as a core component of the plan
Bitter disappointment that no Action Plan as such would be
published (yet)
Programme Board has established Dementia Group, chaired
by Rob Pickford (Director Social Services Wales), including
chairs of the 4 sub-groups, to take forward implementation
Additional funds for dementia
care – 13th July 2010
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£1.5 million per annum
Develop services for younger people with
dementia
‘An additional dedicated dementia clinical post in
every older person's community mental health
team across Wales, to provide advice and support
to those diagnosed with dementia and also
provide direct support to memory clinics, dementia
training and awareness-raising for staff’
Plans to be submitted by end of October
Advisory workshop 6th October 2010
The Dementia Plan and Intelligent
Targets for the NHS in Wales
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Early in 2009 a number of areas were identified where a
focus on improvement in the NHS was thought
important.
Mental health domain led by Mary Burrows included
depression, eating disorders, first episode psychosis as
well as dementia
Dementia Plan Task & Finish Group collaborated with
this process to ensure consistency
How can we best improve NHS services for people with
dementia in Wales with targets that will make a real
difference??
Intelligent targets are highly congruent with the 4
priority action plans – main additional area in plans is
integration of health and social care
Developing the dementia targets
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Possible domains and care bundles identified
from NICE-SCIE guidelines and other relevant
documents
Evidence-based
Consultation with people with dementia and
carers:
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Agreed domains
Prioritised actions from the ‘care bundle’ for each
domain
Consultation with practitioners & managers
What are the key areas for (NHS) improvement?
Draft measures for each domain
Selected domains
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1) making and sharing the diagnosis - empowerment
2) dementia in the general hospital
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3) use of anti-psychotics
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Counting the cost – Alzheimer’s Society Nov 2009 – dementia
increases length of stay
POTENTIAL FOR COST SAVING AND BETTER QUALITY
Department of Health report Dec 2009 1800 deaths, 1620 CVAs
per annum
Reduce use by a third in England
POTENTIAL FOR COST SAVING AND BETTER QUALITY
4) support for care-givers – high levels of distress,
increased mortality
5) improving quality of care in NHS in-patient care (and
in care homes) – evident risk of harm
Training as an over-arching theme
Targets and measures to be
reported to Health Boards - 1
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Target One: Memory Assessment Services - First
point of contact – reduce time between onset of
symptoms & diagnosis being communicated
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Median time from referral by GP, social worker or
other primary care worker to feedback interview.
Target Two: General Hospitals - Improved quality
of general hospital care for people with dementia
and reduced length of stay
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Number of patients following agreed dementia care
pathway (as percentage of at risk group i.e. over 65s)
Relatives’ satisfaction with care survey
‘Care bundles’
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In the dementia context these were not
intended to be prescriptive or comprehensive
They indicate the range of interventions that a
person with dementia and his/her carer could
expect to have considered with them and which
would typically be documented
They indicate the range of interventions needed
to produce the desired process improvements,
leading ultimately to improved outcomes
Targets and measures to be
reported to Health Boards - 2
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Target Three: Community mental health services
for people with dementia (including those in care
homes) - Reduced inappropriate use of antipsychotic medications in accordance with
NICE/SCIE guidelines.
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Number of people with dementia prescribed antipsychotic medication
Proportion of people with dementia who are on antipsychotic medication where review within 3 months
Proportion of people with dementia who have been
on anti-psychotic medication for >9 months
Targets and measures to be
reported to Health Boards - 3
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Target Four: Community mental health services for people
with dementia (including those in care homes) - Improved
support for care givers
 Number of carers participating in multi-component carer support
programmes
 Proportion of care-plans for people with dementia supported at
home by family carers which include detailed and specific
arrangements for emergency and crisis support
 Number of carers receiving individual psychological therapy for
depression and anxiety related to care-giving.
Target Five: NHS dementia inpatient units – Improved quality
of care
 Results from observational audit
 Relatives’ satisfaction with care survey
What will happen?
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A ‘How to’ guide will be published later this year,
detailing the targets, and with suggestions for
assisting implementation
Will include two brief survey forms for relatives of
people with dementia which have been piloted with
good response rates
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General hospital wards
NHS mental health units
Aim is to help staff understand and respond to the
perspectives of the relative and the person with
dementia
Leads from each health board will meet regularly to
coordinate learning and actions
The intelligent use of targets
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Use developmentally, to drive forward
service improvement
Don’t look for prescriptive targets or
national solutions
Ownership
Joint working
A tool – not the solution – aim for
systemic change