Transcript Document

Cornwall and Isles of Scilly
Memory Assessment Service
Julie Green, Commissioning Manager, Older People and
People with Long Term Conditions
Angie Turner Project Lead Cornwall Partnership Trust
17th November 2009
Commissioning Dementia
Assessment and Diagnosis
Services
Local Context
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Dementia a PCT/Council commissioning priority as determined by local needs
analysis and epidemiological challenges before the National Dementia
Strategy!
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Epidemiological Analysis: 8,213 vs Aug 08 Dementia Registers: 2,645
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Tools available to Commissioners:
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NICE Guidelines - Evidence-Based Instruction Manual
(Implementation Guidance very helpful)
World Class Commissioning –
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Increasing numbers of people receiving a diagnosis set as World Class
Commissioning Outcome
Focus on ‘market segmentation’ and market management, with expert advice
from SHA Commissioned consultancy AT Kearney
Emphasis on involving patients and carers
Beyond ‘Older People’s
Mental Health’ and towards
integrated pathways for
‘PEOPLE with dementia’
Commissioning integrated pathways
rather than organisations
Prevention
Awareness
Recognition
Assessment
Diagnosis
Case Mgmt
Tiered Menu of Interventions
Unscheduled
Tiered Menu of Interventions
End of Life
Simple pathways and overlapping services
Good quality care
tailored to dementia
Drivers for Change (Old Provision)
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No service specification
Bundled in with wide range of ‘Older People’s Mental Health
Services’ – i.e. the mix of functional and organic
Unclear provision for younger people
Established provision for people with learning disabilities, but not
integrated
Wide variation across county (access, waits and quality)
Some Memory Clinics
Little carer or service user involvement in design, delivery and
review of services
Lack of integration with ‘primary care’ and no flows of
communication back to Dementia Registers – absolutely essential
Developing a Service Specification
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Decision made to develop a service specification and ask existing specialist provider, Cornwall
Partnership NHS Trust to reconfigure to meet standards and expectations set
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To be achieved within existing resources – a reframing and standardisation of existing service
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Would initially remain as a ‘block contract’, but with a view to developing an activity based tariff
(most straightforward part of pathway to do this)
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Available to everyone with suspected dementia, irrespective of age, ethnic origin or social
status, including people with Learning Disabilities
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The service would offer a choice of venues for assessment, including ‘Memory Clinics’, home
assessments and assessments in care homes.
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Key principle – organise around GP practices as early on identified anticipated prevalence and
numbers of people on register
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Would be required to work closely with GPs and upskill primary care to increase the amount of
screening, assessment diagnosis that could eg take place here
Calculating Referral Demand
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For service planning, need to know how many referrals to expect a year
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Limited historical information – new referrals for dementia not previously
recorded (remember just OPMH activity and included eg crisis referrals for
‘functionals’)
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Advice from local service was approximately 2000 assessments a year
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Non-learning disability referrals set as 23% of prevalence (i.e. 1864)
assessments a year
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Learning Disability referrals set as 2% of prevalence (164 assessments a
year)
Calculating Demand for Memory Clinics
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Clinics vs Home Assessments
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Need to balance the need for increasing throughput with realities
of being a rural area with limited transport infrastructure
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Some concerns that clinic assessment lower quality than home
assessment – but difficult to evidence.
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Decided to set expectation that 40% of total referrals could be
seen in Memory Clinic, collect evidence for first year and then
adjust if necessary
Determining Location of Memory Clinics
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Shift from being organised around the convenience of organisational
bases and professionals to the convenience of patients and carers!
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Major Towns (Truro, Falmouth, Liskeard, Saltash, St.Austell, Newquay,
Wadebridge, Bude, Bodmin, Camborne, Helston, Penzance, Redruth,
Hayle, St.Ives, Looe, Callington)
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Easily accessible venues – close to public transport
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Non-stigmatising – preferably not associated with ‘Mental Health’
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Quality Check – would be vetted and signed off by panel of service users
and carers
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Specifying locations very popular with patients, carers, the public, council
and GPs and the media
Determining Frequency of Memory
Clinics
•Less then 10 potential annual assessments in Memory Clinic = No Memory Clinic
•11 - 50 potential annual assessments in Memory Clinic = 0.5 Day Memory Clinic every two
weeks
•51 - 94 potential annual assessments in Memory Clinic = 0.5 Day Memory Clinic every
week
•95 - 149 potential annual assessments in Memory Clinic = 1 day Memory Clinic a week
•150 potential annual assessments in Memory Clinic = 1.5 day Memory Clinic a week
Other Quality Standards
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Enable self-referral for those who do not want to access GP first
Referral to appointment target wait of 20 days
Appointment to Diagnosis target wait 30 days
Pre-counselling (compare genetic counselling) – to evidence ‘informed
choice;
Post diagnosis counselling – working through and beyond the diagnosis.
Emphasis that there is rewarding and meaningful life after diagnosis, this is
not a death sentence.
Standard information pack (approved by panel of patients and carers)
Everyone assigned a key-worker (Case Manager), linked to GP practice to
support patient from diagnosis until end of life (Newquay model)
Patient / Carer Satisfaction results collated and published on service website
Requirement on new provider to deliver education, training and support to
primary care
Public Engagement
- Draft service specification sent out to wide range of
stakeholders for feedback
- Summarised version sent to every member of Alzheimer’s
Society in Cornwall for feedback – received some very
encouraging hand-written letters of support and telephone
calls.
Implementation and Monitoring
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Action plan for delivery set out in service specification
• 25% of Memory Clinics are established by July 09
• 75% of Memory Clinics are established by Dec 09
• 100% of Memory Clinics are established by Apr 10
• Additional Monthly Commissioner/Provider performance meetings
established to monitor progress and delivery
• Information reports agreed (Section 20 of Spec)
Next steps for Commissioners
• Ensuring implementation
• Agreeing quality standards when patients diagnosed
e.g. in Acute hospital (different provider)
• Unlocking the finances – once established, should
have sufficient data to determine cost of average
diagnosis, opening up possibilities of moving to a cost
per case activity contract
• Developing a service specification for Case
Management (i.e. post diagnosis)
The Providers Journey
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Where we started
The journey and who we met along the way
Some of Road Blocks
Where we have got to
Where we go next
Context
• Draft Commissioning strategy January 2009 based NICE
guidelines
• Debate/Discussion. Pressure on Commissioner - Provider
relationship
• March 09 Project Lead role
• Inclusive style to facilitate service change and delivery
Where we started
• Each team offering memory assessment and diagnosis
service
• Service delivered in different ways across the county
• Different resource allocation
• No standardisation of assessment
• Specific details not captured on data system
The Journey
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Engagement with key individuals
Working on strengths and what could be achieved
Project Management Group
Broadening out involvement- Task groups
Standardise services
Task groups
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Right people Right Place
Venues
Assessment and Diagnosis Pathway
Referral Protocol
Scans
Drop in/Self Referral
Performance data
Booking system
Service Information
Post Diagnosis Counselling
Training Plan
Outcomes/Learning from task
groups
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Care Pathway
Enhancing the Commissioning Specification
Venues and Partnership
Partnership
Supporting workforce change and development
Data collection
Where have we got to
• 18 out 20 clinics up and running rest scheduled within
next 6 weeks
• Standardised practice across the services
• Information on service on web site, service leaflets.
information packs
• Process for feedback from individuals and carers
• Raised Profile of Early Detection and Diagnosis
• Increased reported morale of staff with focus on specialist
skills development
• Increase in positive attitudes around Partnership working
Road Ahead
•The future-Case
management
•Capacity planning
•Audit and research
•Robust data collection and
reporting
Getting it Right For People
Good End of Life
Care
Good early
Diagnosis, memory
clinics and support
Good Quality of
Care in Care Homes
Information and
Advice to stay
Independent
Support at home
Housing & Support
and Telecare
Intermediate
Care/Rapid
response/reenablement etc
Support for Carers
Good Acute Care
Contact Details
Angie Turner
Project Lead
Cornwall Partnership Trust
Tel: 01209 881803/1876
Email: [email protected]
Julie Green Julie Green, Commissioning Manager, Older People and
People with Long Term Conditions
Tel: 01209 886585
Email: [email protected]
www.dhcarenetworks.org.uk/dementia/topics/browse/commissioning/