nhs england powerpoint template 16 - royal college of ... england - dementia programme.pdf · 1....
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www.england.nhs.uk
Dementia Programme
Kevin Mullins
Head of Mental Health Services
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NHS Mandate 2016/17
2
Overall 2020 goals
Measurable improvement on all areas of Prime Minister’s challenge on dementia 2020, including:
• Maintain a diagnosis rate of at least two thirds
• Increase the numbers of people receiving a dementia diagnosis within six weeks of a GP referral
• Improve quality of post-diagnosis treatment and support for people with dementia and their carers
2016/17 deliverables:
• Maintain a minimum of two thirds diagnosis rates for people with dementia
• Agree an affordable implementation plan for the Prime Minister’s challenge on dementia 2020, including to improve the quality of post-diagnosis treatment and support.
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Aggregating the indicators
The table to the right shows how the assessments
against the two indicators are aggregated. For
example, a CCG rated as having the greatest need for
improvement against both indicators will receive an
overall rating of Greatest need for improvement.
Diagnosis rate
Top performing Performing
well Needs
improvement Greatest need
for improvement
Care plan
review
Top performing
Top performing
Top performing
Performing well
Needs improvement
Performing well
Top performing
Performing well
Needs improvement
Needs improvement
Needs improvement Performing well Needs
improvement Needs
improvement Greatest need for
improvement
Greatest need for improvement
Needs improvement
Needs improvement
Greatest need for
improvement
Greatest need for improvement
CCGIAF: Dementia Indicators
Rating Proportion of
CCGs with
rating
Description
Top performing 19% At, or above national target
Performing well 36%
Needs improvement 41% No more than 10
percentage points below
target
Greatest need for
improvement
4% More than 10 percentage
points below target
1. Estimated dementia diagnosis rate (65+)
March 2016 data: CCGs assessed against static thresholds for
each rating
2. % of people having a care plan review in preceding
12 months (14/15 data): CCGs put in ranked order of
performance and assessed relative to each other
Rating Proportion of
CCGs with rating
Description
Top performing 25% This half of the
CCGs are doing
ok for this
indicator
Performing well 25%
Needs improvement 25% This half are not
doing ok for this
indicator Greatest need for
improvement
25%
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Overview of performance National Dementia Outliers Mar-16 Apr-16 May-16
Total no. of CCGs below ambition 93 109 111
Adrift by 5% or more 34 48 49
Adrift by 10% or more 8 11 10
North Dementia Outliers Mar-16 Apr-16 May-16
Total no. of CCGs below ambition 13 19 19
Adrift by 5% or more 6 8 9
Adrift by 10% or more 2 2 2
Midlands & East Dementia Outliers Mar-16 Apr-16 May-16
Total no. of CCGs below ambition 39 41 40
Adrift by 5% or more 16 20 21
Adrift by 10% or more 6 7 7
London Dementia Outliers Mar-16 Apr-16 May-16
Total no. of CCGs below ambition 8 9 11
Adrift by 5% or more 1 1 1
Adrift by 10% or more 0 0 0
South Dementia Outliers Mar-16 Apr-16 May-16
Total no. of CCGs below ambition 33 40 41
Adrift by 5% or more 11 19 18
Adrift by 10% or more 0 2 1
The key themes explaining underperformance in these CCGs include:
• Pathway issues which have led to long waits from referral to assessment in
memory clinics;
• Inappropriate referrals which further compounded pathway issues and long
waits;
• Coding issues where practice registers have not been up to date with the
cleansing of their registers to identify cases both within primary and across
secondary care;
• Data reporting issues via the CQRS;
• Undiagnosed cases in care homes.
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Improvement offer
Level 1
Level 2
Level 1 – general advice available to all CCGs
Continuation of the support already available to CCGs e.g.
• Publication of monthly diagnosis rates and letter to CCGs from NCD
• Publication of supporting dementia metrics on PHE Fingertips tool
Additionally:
• Repository of best practice examples
• Letter to CCGs from panel chair (also used to communicate support offer)
• Face to face meeting with senior policy advisor from Alzheimer’s Society
Level 2 – targeted support available to those CCGs that need to make an improvement
In addition to level 1:
• Continued support from NCD to discuss individual CCG concerns about dementia leadership, disseminate
best practice and provide advice
• Peer support - buddying system to pair CCGs needing to improve with high performing CCGs. This will
facilitate sharing best practice and collaborative learning.
Level 3 - bespoke support available to those CCGs with the greatest need to improve
In addition to levels 1 & 2:
• Intensive support - NHS England will work closely with NHS Improvement to provide intensive support to the
CCGs that need to make the greatest improvement
• Resources will be available to support at least one new CCG per month for the remainder of 2016/17, with
2017/18 subject to programme budgets
• Comprises pre-visit discussions, a visit to carry out a diagnostic review to ascertain whether there are any
system/process issues, and subsequent discussions with the CCG to develop recovery strategies with
ongoing support
Level 3
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• Develop commissioning guidance based on NICE guidelines, standards and evidence-based best-practice.
• Agree minimum standard service specifications, set business plans, mandate and resources.
• Work with ADASS, PHE & other ALBs on co-commissioning strategies to provide an integrated service.
COMMISSIONING GUIDANCE:
• Develop Quality, Access and Prevention metrics to form the basis of the CCG assessment framework.
• Identify data sources and agree with HSCIC, et al on the extraction processes.
• Set ‘profiled’ ambitions for each metric, to form the basis of the transformation plan.
MEASUREMENT:
• Transformation: using CCG scorecard to set & achieve a national standard for Dementia services.
• Intervention: Intensive Support Team to provide ‘deep-dive’ support and assistance for CCGs that fall short.
• Innovation: Intel from Research, Patient involvement, best-practice and technology to influence change.
TRANSFORMATION, RESEARCH, INNOVATION, TECHNOLOGY, PATIENT ENGAGEMENT AND BEST-PRACTICE:
Prevention(1)
Risk Reduction(5)
STANDARDS:
NHS ENGLAND TRANSFORMATION FRAMEWORK – THE WELL PATHWAY FOR DEMENTIA PREVENTING WELL DIAGNOSING WELL SUPPORTING WELL DYING WELL
Risk of people
developing
dementia is
minimised
Timely diagnosis,
integrated care
plan, and review
within first year “I was given information
about reducing my
personal risk of getting
dementia”
“I was diagnosed in a
timely way”
“I am able to make
decisions and know what to
do to help myself and who
else can help”
People living with
dementia die with
dignity in the place
of their choosing “I am treated with dignity &
respect”
“I get treatment and
support, which are best for
my dementia and my life”
“I am confident my end of
life wishes will be
respected”
“I can expect a good death”
Access to safe high
quality health & social
care for people with
dementia and carers
Diagnosis(1)(5)
Memory Assessment(1)(2)
Concerns Discussed(3)
Investigation (4)
Provide Information(4)
Care Plan(2)
Choice(2)(3)(4)
BPSD(6)(2)
Liaison(2)
Advocates(3)
Housing (3)
Hospital Treatments(4)
Technology(5)
Health & Social Services (5)
Palliative care and pain(1)(2)
End of Life(4)
Preferred Place of Death(5)
References: (1) NICE Guideline. (2) NICE Quality Standard 2010. (3) NICE Quality Standard 2013. (4) NICE Pathway. (5) Organisation for Economic Co-operation and Development (OECD)
Dementia Pathway. (6) BPSD – Behavioural and Psychological Symptoms of dementia.
STANDARDS: STANDARDS: STANDARDS:
LIVING WELL
“Those around me and
looking after me are
supported”
“I feel included as part of
society”
People with dementia
can live normally in
safe and accepting
communities
Integrated Services(1)(3)(5)
Supporting Carers(2)(4)(5)
Carers Respite(2)
Co-ordinated Care(1)(5)
Promote independence(1)(4)
Relationships(3)
Leisure(3)
Safe Communities(3)(5)
STANDARDS:
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Getting there……
7
Programme Aim: Establish an evidence-based treatment pathway for
dementia, to be implemented by 2020
• National Collaborating Centre for Mental Health commissioned to
design pathways for a range of mental health areas and dementia
• Expert Reference Group convened to advise and guide this
process
• Publication expected Autumn 2016
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Dementia pathway
9
• Evidence-based treatment pathway for dementia
• Timeliness of diagnosis
• Care plan, agreement, initiation & review
• Care across the domains of the well-pathway
• Rationale for implementing a standard
• Implementation guide due to be published autumn – winter 16/17
• Incorporating:
• Technical guidance eg on clock starts/stops for assessment/treatment
• Quality standards & self assessment
• Workforce requirements
• Metrics
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Implementing the pathway
10
• On-line self-assessment tool to be deployed Autumn-Winter 2016
• Annual assessment required from all providers?
• MSNAP Alignment
• CQC Alignment
• CCGIAF Alignment
• Potential baseline data collected via a survey in May 2016
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Costed implementation plan
11
• Builds on implementation guide for pathway
• Where are we now?
• Where do we need to be?
• Identify/quantify the gap
• What do we need to do to fill the gap
• What are the costs/benefits?
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Next steps…
12
• Secure clearance & publish the guidance
• Undertake audit of service standards via CCQI
• Develop a more coherent view on most effective service models
• Establish formal governance & engagement processes
• Continue to scan horizon and look for opportunity to drive implementation
