iSPACE – dementia friendly GP surgeries

iSPACE is helping surgeries improve support for patients with dementia and their carers | AHSN

iSPACE is a quality improvement and innovation programme delivered in GP surgeries in all parts of Hampshire, Dorset, Isle of Wight and south Wiltshire. The aim of iSPACE is to improve the pathway of patients with dementia and their carers through primary care.

The key to the spread of iSPACE is the engagement of staff teams and a recognition that people with dementia need a more personalised care plan and access to resources to help them and their carers to better manage the pathway.

Wessex Academic Health Science Network (AHSN) worked with Alzheimers charities, clinical commissioning groups (CCGs), Public Health England (PHE), Health Education England (HEE) and companies providing dementia services both within and outside the NHS to deliver this project. The AHSN delivered the project into 153 GP surgeries providing training, access to resources, meetings to encourage progress and physical resources such as funding for environmental changes and literature.

Patients reported feeling more supported by their surgery; carers reported a greater understanding of dementia from the surgery team and seeing the same clinician at each appointment. Dementia diagnosis rates increased (15.9% for people aged over 65), care planning increased by 26% for face to face reviews and 80% of surgeries now have a dementia noticeboard.

Full detail at The AHSN Network

Improving clinical services in the areas of musculoskeletal (MSK), falls, fractures and frailty.

A new guide compiled by the Oxford Academic Health Science Network showcases the extensive range of programmes being delivered by AHSNs to improve clinical services in the areas of musculoskeletal (MSK), falls, fractures and frailty – all key priorities for the NHS 

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Image source: http://www.oxfordahsn.org/

Across England’s 15 AHSNs there is a wealth of experience and practical skills in working with NHS organisations to improve services in these clinical pathways. Evaluations have shown that they have led to improved patient outcomes and better use of resources.

The new guide, compiled by Alison Gowdy, Clinical Innovation Adoption Manager at Oxford AHSN, with input from all AHSNs, provides a valuable overview of these projects.

It is hoped the guide will help shape discussions with Sustainability and Transformation Partnerships (STPs), commissioners and providers regarding future work to improve services and patient outcomes in these areas, while enabling others to share in learning to help implement and/or build on an existing, proven concept.

Download the guide here

Music and dementia

In this blog, NHS England’s National Clinical Director for Dementia and the Deputy Chief Allied Health Professions Officer look at how music can trigger golden memories and benefit people with dementia | NHS England

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This blog explores the many benefits music can have in the setting of dementia. Music, the authors state, can help reduce anxiety and depression, help maintain speech and language, is helpful at the end of life, enhances quality of life and has a positive impact on carers. The article quotes specific benefits including:

  • music provides a ready resource for enjoyment and entertainment, especially when shared with families and loved ones in a shared experience
  • bespoke playlists for carers and loved ones for people with dementia can facilitate sharing and very positive interactions

Full blog: Music and dementia: a powerful connector

See also: Commission into Music and Dementia | The International Longevity Centre

Improving the care of people living with dementia admitted to hospitals

This review seeks to identify primary research and use its findings to develop explanations of what characteristics of dementia-friendly initiatives in hospitals make them work, in what circumstances, and why | BMJ 

Abstract

Objectives To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.

Design A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.

Data sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.

Eligibility criteria Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.

Results Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.

Conclusions This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.

Full reference: Handley M, Bunn F, Goodman C. | Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review | BMJ Open 2017; 7:e015257

See also: Dementia care in hospital: training, leadership and culture change needed | The Mental Elf

Specialist geriatric medicine ward for older patients with dementia

The objective of this study is to clarify if admission to a specialist geriatric medicine ward leads to improvements in aspects of acute medical care for patients with dementia.

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We analysed combined data involving 900 patients from the Irish and Northern Irish audits of dementia care. Data on baseline demographics, admission outcomes, clinical aspects of care, multidisciplinary assessment and discharge planning processes were collected.

Relatively low numbers of patients with dementia received care on a specialist geriatric medicine ward. There appears to be a more streamlined discharge planning process in place on these wards, but they did not perform as well as one would expect in certain areas, such as compliance with multidisciplinary assessment and antipsychotic prescribing

Full reference: Briggs, R. et al. (2017) Does admission to a specialist geriatric medicine ward lead to improvements in aspects of acute medical care for older patients with dementia? International Journal of Geriatric Psychiatry. 32(6) pp. 624–632

 

Producing a joint strategic needs assessment for mental health or Dementia

The Centre for Mental Health has published Meeting the need: what makes a ‘good’ joint strategic needs assessment (JSNA) for mental health or dementia?

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Image source: http://www.centreformentalhealth.org.uk

This report explores how five local councils across England went about understanding the mental health needs of their communities, and taking action to meet them more effectively.

The report finds that JSNAs for mental health and dementia can help to direct investment, improve services and help local agencies work together more effectively. To have the biggest impact, they need a clear purpose, effective leadership and advocacy, and partnerships that continue after the JSNA is completed to ensure that they lead to action.

Report author Andy Bell highlights eight key success factors behind the creation of an effective and impactful needs assessment:

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Image source: http://www.centreformentalhealth.org.uk

NHS England offering support to CCGs to improve dementia care

Following publication of the CCG improvement and assessment framework 2016/17, NHS England is offering support to CCGs to improve dementia care | NHS England

NHS England introduced a new CCG improvement and assessment framework in 2016/17, fully aligned to the Five Year Forward View and NHS planning guidance. This brings together a range of key indicators, enabling NHS England and CCGs to work together, using the indicators to drive improvement for patients.

There are national ambitions for transformation in a number of vital clinical priorities, including Dementia.  Each priority area has a number of indicators in the framework and the areas are assessed by independent panels, with a separate, clear rating.  These ratings are published on MyNHS.   Each area has its own support programme for CCGs, which may already be in place or is being introduced in stages.

The dementia support offer recognises that CCGs will have varying levels of need for support and provides three levels, which can run concurrently.  The more bespoke levels of support will be focused on a smaller number of CCGs with the greatest identified need.

Read the full outline here