Developing Dementia Services for Older People in East Dorset

APPENDIX 4

Developing dementia services for older people in east Dorset

Final proposals June 2012 - draft

Introduction There are approximately 750,000 people living with dementia in the UK and this number is expected to almost double within 30 years, with the estimated cost of care rising to £35 billion by 2026.

The effects of this are likely to be very significant in Bournemouth, Dorset and Poole because in our local population we have a high proportion of elderly people, which is going to increase substantially over the next decade.

In developing services for people with dementia the following key issues have been considered

1. Dementia is not an inevitable consequence of growing old, but it is one of the most common forms of mental illness in older people and many people who begin to experience memory loss may not realise that they are ill and can get help. 2. Earlier treatment and support can improve the quality of life for people with dementia and be more cost effective, so there is the opportunity to reshape services to provide care in community-based settings, offering more choice to patients and their carers. 3. It is important that providers of health and care services have specialist advice, training and support to raise their awareness of the needs of people with dementia and their carers.

To ensure local health services can meet the needs of people with dementia and their carers in the future, it is necessary to change existing services to

 ensure earlier diagnosis and support  develop an intensive dementia community support service for carers and people with dementia when they need it  have age-appropriate inpatient care at a single site to develop a centre of excellence  provide specialist support to GPs, community care teams and care homes

The development of these services will  Ensure an earlier diagnosis of dementia or other organic mental illness so that people with diagnosed illness and their carers can be offered information, advice, support and treatment at the earliest opportunity so they can make choices about their future and continue to live independently for longer and enjoy a better quality of life

1  Deliver prompt and effective care for people requiring a high degree of support where they live rather than requiring them to be admitted to hospital

 Develop hospital care for those who need it in a purpose-designed dementia-friendly environment from expert staff who will also work to help them return back to community living at the earliest opportunity

 Ensure that more people who develop dementia as well as physical illness are able to continue receiving care from their existing community services but with additional input and support from staff experienced in the management of dementia

Since February 2012, the Dorset Clinical Commissioning Group has been engaging with service users and carers of people with dementia to explore these four service areas to ensure they are focused on the needs of the user and the carer and are developed appropriately.

This document outlines the proposals for future services and welcomes comments and views on them.

Proposals for future services

Early diagnosis and support The Primary Care Trust has commissioned a dedicated Memory Assessment and Early Diagnosis service to operate county-wide. It has also established a support programme for general practices to raise awareness about dementia, the importance of early diagnosis and the availability of services for people with dementia and their carers. GP localities have been asked to identify dementia champions to maintain the profile of dementia within practices and provide a reference point for information and advice. In addition the Primary Care Trust and Local Authorities have commissioned a range of community support services for people with dementia and their carers, including a network of Memory Advisers, extended day services and access to information/advice.

To develop an intensive dementia community support service for carers and people with dementia when they need it

There will be an increase in the range and scope of community services for people with dementia and their carers to provide urgent support when it is needed. This will help more people to be cared for in the setting most appropriate for them. This service will also offer more support for carers as it will be able to provide enhanced social care if required. Whilst the aim of this service is to reduce the reliance on hospital care, it will be able to support access to inpatient care if necessary and also support discharge from hospital to ensure that both the patient and the carer are supported at this time. This service will offer a rapid (same day) and intensive response to help maintain care in the home for up to twelve service users at any one time for up to six weeks. The service will operate from 7.30am to 7.30pm every day and

2 because it will be designated as an intermediate care service it will be able to provide access to social care support as well as health care if this would enable the service user to continue to be cared for at home. For referrals outside these hours the existing crisis response and home treatment service will continue to provide an urgent response service.

Dorset HealthCare has been piloting an in-reach service to care homes. This is valued by the care homes where it has been available and the new intermediate care service for dementia will incorporate an extended care homes in-reach element as a core part of the service. Many people likely to benefit from the service rather than a hospital admission will be living in care homes, so this will enable them to continue to be cared for in their normal surroundings with additional care from the service.

To have age-appropriate inpatient care at a single site to develop a centre of excellence

It is proposed to have a single specialist inpatient ‘centre of excellence’ at Alderney Hospital. These proposed changes to specialist inpatient services means that inpatient beds will be removed from Kings Park Hospital, which is a specialist older people’s mental health hospital, with some being re-provided at Alderney Hospital. There are a number of other patient services which will remain at Kings Park including day care services, drugs and alcohol services and outpatient services. The hospital also provides a base for a number of community teams serving Bournemouth and East Dorset. It is likely that over a period of time these services may relocate in line with Dorset Healthcare’s estates strategy.

Engagement with carers in particular suggested that any new inpatient service should be able to provide advice and information to carers about dementia and be a source of guidance on challenges resulting from progression of the condition. Some people suggested it would be a good opportunity and important to create a new image of specialist dementia care, far removed from an old fashioned hospital environment. The facilities at Alderney will be considerably upgraded and remodelled using the latest guidance and research to establish a “dementia friendly” environment, with the appropriate use of colour, light and themed areas which is known to be important in the therapeutic process. Access to information and advice will be a more prominent feature of the service and the new Dorset HealthCare website already has a specific information page for carers with details of available support. The new Recovery Education Centre will be developing courses for carers, developed by carers and piloted by them.

Community mental health teams Because there will be more older people living in Bournemouth, Poole and Dorset in the coming years there will be more people living with dementia. They are also likely to be receiving care for other illnesses so it is important that their care is managed in a holistic way. The role of the community mental health teams for older people will be reviewed so that comprehensive community-based care can be provided seamlessly at the appropriate level.

3 More emphasis will be placed on providing education, advice and enhanced input to other services managing the care of people with dementia. This will enable the service to better meet the anticipated increase in demand for dementia care, support better diagnosis of the condition and provide more support for carers.

Conclusion The priority for the Dorset Clinical Commissioning Group is to have user centred services, and to ensure that both users and their carers have the opportunity to shape future service provision.

The work undertaken to date has ensured that the views of older people, carers and service users have been heard and have been fundamental to shaping the services outlined in this document.

Your comments Now wider feedback is welcomed on these proposals for the future of dementia services for older people. Comments can be made in writing to

Older People’s Mental Health Service feedback Dorset Clinical Commissioning Group Canford House Discovery Court Business Park 551-553 Wallisdown Road Poole Dorset BH12 5AG

Or via email to [email protected]

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