national perspective dr nick cartmell n somerset conference 3.11.14
TRANSCRIPT
National perspectiveDr Nick Cartmell
N Somerset Conference 3.11.14
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Diagnosis ratesReaching the national aspiration
Section 1
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National focus for 2015
• A huge priority for DoH and NHSE
• Two thirds diagnosed (66%) by April 2015
• Need much greater annual growth now
• New Intensive Support Team for Dementia…
• …that’s me!
Where we had got to, August 2014
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What are the challenges?
Diagnosis rates are limited because:
• Estimated prevalence is only an estimate
• No allowance for local variation
• No allowance for deprivation
• They depend on the accuracy of GP QOF registers
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What can we do?• Data accuracy: GP QOF registersPatients receiving AChIsPatients diagnosed by MASPatients with related Read CodesThose at risk and eligible for the Dementia DESThose in the new 2% Unplanned Admission DES
• Care home residents
• Consider greater primary care role in diagnosis
There is still time and there is extra money!
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Dementia preventionReducing your risk
Section 2
Evidence for preventionBig European RCTs, linked through the European Dementia Prevention Initiative (www.edpi.org):
• MAPT 2009
• PreDIVA 2011
• FINGER 2014
• HATICE ongoing
Supportive evidence from lack of expected prevalence growth in the UK:
• CFAS II (2013)
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A new hope for dementia“Prevention is better than (no) cure”
• Wide overlap with other disease prevention strategies:
• Cardiovascular (smoking, BP, cholesterol)
• Diabetes (obesity, exercise levels)
Also:
• Better education (hard wire your brain)
• Avoid or tackle depression and social isolation
And the best bits:
Never too young to start yet works even if diagnosed!
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Getting the message out thereDementia is now the most feared condition in over-50yr olds but few know it’s preventable.
• National publicity (PHE)
• Local joint strategy (H&WBB, CCG, DsPH)
• Local publicity (BBC SW, local papers, posters)
• Publicise at GP HealthCheck
• Publicise at other local health initiatives
• Emphasise at time of MCI diagnosis
• Tell everyone you know!
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Secondary care resourcesMaking best use
Section 3
Tighter budgets, growing demandCCGs and LAs are facing big challenges:
• Static or shrinking budgets
• Growing, and ageing, populations
• Need to improve services for dementia
• Money tied up in acute hospitals
Clever and innovative commissioning is essential!
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Possibilities?1. Shift demand into Primary Care to free up CMHTs for more
challenging work
• Primary care diagnosis with specialist out-reach support
• Streamline prescribing guidelines (AChIs)
2. Link dementia with other frail elderly commissioning
• Unplanned admissions work
• Better advance care planning
• Reinvest admissions savings into community/Primary care
• Include mental health in Virtual Hubs
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Questions and Suggestions?Thank you!
Please share your ideas or examples of better ways of working:
http://dementiapartnerships.com
“In a gentle way you can shake the world” - M Gandhi
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