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Current services in relation to need

Adults :: Dementia :: Current services in relation to need

Primary care

The number estimated for the registered population for Medway CCG is 2,783. Data from the Quality and Outcomes Framework primary care dementia registers in 2012/13 have only identified 1,332 patients in Medway as having dementia. The estimated diagnosis rate for Medway CCG population is 47.87%, which is higher than the Kent and Medway average of 42.94% and the South of England average of 45.65%. The diagnosis rate has fewer than half of the population who are estimated to have dementia receiving a diagnosis. This could be due to a number of factors including late presentation and underdiagnoses. Nationally late diagnosis has been recognised as a problem and earlier diagnosis could be more cost effective in that it could slow progression of the disease and reduce costs. There are a number of actions being undertaken to improve the diagnosis rate. These include;


• Medication analysis — using Audit Plus to identify patients who have been prescribed dementia medication but who do not have a recorded diagnosis
• Coding cleansing — based on work undertaken at Waltham Forest CCG to support GPs to identify problems in coding, which are contributing to low rates of dementia diagnosis on practice registers.

• Care Home Population analysis — Liaison with care homes to identify residents who clearly have dementia and liaise with practices to check that formal diagnoses have been made

The central role of GPs is recognised in the Dementia Strategy and initiatives are being developed to develop a greater understanding and awareness of the importance of early diagnosis, treatment and providing patients and carers with meaningful information about care and support services that are available through the NHS, Adult Social Care and the independent sector.

An overriding approach adopted by the Dementia Strategy will see integration with the CCG's key clinical strategies and the Partnership Commissioning themes within the Better Care Fund. Knitting together the various strands that make up the communities complex needs is vital to ensuring those needs are met.

Statutory services are trying hard to work together to ensure that the services they provide offer people a coherent pathway as their dementia illness develops and needs become more complex. Most people will approach their GP when they feel that something is not right and support is being provided to local Practices to help Doctors and other professionals gain a better understanding of dementia and the importance of obtaining an early diagnosis.

Secondary care

Medway Foundation Trust have made dementia the focus of much work in the last year and opened the dedicated Bernard unit to support people with dementia whilst they receive treatment. The Trust has also adopted the Butterfly scheme which allows people with memory impairments to request a particular person centred approach to their care – this operates throughout the hospital. In addition to these initiatives dementia awareness training for staff working in the hospital has also been given a priority.

Kent and Medway NHS and Social Care Partnership Trust (KMPT) take referrals from GPs where there is an indication of a dementia disease and support people through an assessment process with both pre and post diagnostic counselling as part of their memory assessment service. This support is provided through a multi-disciplinary team which includes Admiral Nurses, who are mental health nurses that specialise in dementia. KMPT provide on-going support and guidance with the aim of working in a shared care approach with a person's GP.

Community care

Current services to support people living with dementia are wide and varied but are not always known about and those that operate in one area may not be present in another. There are dementia cafes run by voluntary sector organisations that provide an opportunity for those people with dementia and their carers to come together in an informal setting for mutual support and guidance. Organisations such as the Alzheimer's Society, Age Concern and the Sunlight Trust provide valuable support by telephone and face to face to help people deal with daily lives that are affected by dementia.

Medway Community Healthcare (MCH) provide community based services and are registered to run Darland House a specialist residential facility providing nursing care to older people with mental health needs which are predominantly associated with dementia. Darland House offers people with complex needs an opportunity for careful assessment and for care plans to be developed that will help people live with needs that are often felt as very challenging to less specialist facilities.

Medway Community Healthcare (MCH) provide a Dementia Support Service with a multidisciplinary team lead by an Admiral Nurse which responds to and works to prevent crises that might occur in people's homes where the main support for a person with dementia is being provided by a carer. It is the aim of the service to avoid, where possible and appropriate, an admission to hospital or care home. A move away from a familiar setting can be a highly traumatic experience which may exacerbate a decline in the person's wellbeing. Where a person is admitted to hospital it is important that where possible and appropriate that a return to home is arranged as early as possible and the hospital's new Integrated Discharge Team will work with the Dementia Support Service and Adult Social Care to ensure this is achieved.

MCH are also overseeing a scheme that employs two Carer Support Coordinators from Carers First, with one being based with the Dementia Support Service in the community and the other based with the Integrated Discharge Team at Medway Maritime Hospital. This scheme provides support to carers to reduce the risk of crisis leading to avoidable hospital admissions or to support an earliest possible discharge.

Medway's Council for Voluntary Service has been commissioned by Medway Council to achieve the following outcomes in the local area: Capacity Building; Co-ordination, Networking and Engagement; Encouragement and Development of Volunteering; Representation; Information, Support and Training

A crisis support team has provides 24/7 support for people in dementia and their carers in the home when this support is needed.

Residential care

Medway Community Healthcare (MCH) provide community based services and are registered to run Darland House a specialist residential facility providing nursing care to older people with mental health needs which are predominantly associated with dementia. Darland House offers people with complex needs an opportunity for careful assessment and for care plans to be developed that will help people live with needs that are often felt as very challenging to less specialist facilities.

In Medway, there are twelve independent sector nursing homes registered with the Care Quality Commission and most of these will support older people many of whom are likely to have varying degrees of dementia. However there are few dedicated nursing homes providing care to people with complex and often challenging needs arising from their dementia. A pilot scheme will provide these homes with additional support through a multi-disciplinary team in the form of the Integrated Care Home Model. The aim of this scheme is to support homes to achieve an equal and improved standard of care and reduction on secondary care services.

Acute inpatient care at Medway Foundation Trust

A psychiatric liaison team is in place at Medway Maritime Hospital who are also able to support appropriate management of Emergency Department attenders and inpatients with dementia. MFT and KMPT are currently developing a dementia pathway within Enhancing Quality Programme. This will include appropriate screening on entry during any stay and onward referral into dementia services and/or primary care or a return home with additional support services.