This resource aims to enable Clinical Commissioning Groups to achieve and maintain dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia, and improve the quality of and access to post diagnostic care for people living with dementia and their carers.

Download the Dementia Commissioning know how guide

The know how guide contains usefull information and links to documents, case studies and tools to help to achieve commissioning ambitions.

The know how guide covers the dementia care pathway and advocates a systematic, standardised approach to investigating and enhancing the attributes and processes that positively impact effective commissioning of dementia care services.

After working through the document, commissioners should be able to identify and develop, or enhance, the abilities and processes that need to be in place in order to successfully deliver commissioning of high quality dementia care services including:

• Strategic and leadership qualities and abilities
• Awareness of current performance
• Collaborative working with service providers
• Use of appropriate levers and incentives
• Accuracy and use of data in monitoring and reporting
• Resources to address any gaps or improvements required
• Futureproofing knowhow

This tool to support commissioning dementia services will help CCGs and STPs to:

• Improve the Dementia Diagnosis Rate as a continuous process.
• Assist with the refinement of local diagnosis processes and the dementia care path- way to deliver in line with the Implementation guide and resource pack for dementia care and improve outcomes for patients and carers.
• Realise the national ambition to provide consistently good quality, evidence-based dementia care and support for patients and carers.

The World Alzheimer Report 2015, ‘The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends’ makes key recommendations to provide a global framework for action on dementia.

The report also includes a systematic review of the evidence for and against recent trends in the prevalence and incidence of dementia over time, as well as an analysis of the broader societal impact of dementia.

Download:

• World Alzheimer Report 2015
• World Alzheimer Report 2015 – Summary Sheet

Additional materials:

• Online appendix with list of studies reviewed
• Infographic (as shown below)
• News release
• Microsite with additional content

This tool, developed in Miscrosoft Excel, aims to support commissioners to estimate how a local care economy spends its money by age group, patient group and care settings.

By filling in some basic variables, commissioners can create a quick, indicative patient segmentation for their locality.

Monitor have published an accompanying user-guide to help commissioners.

Download

• Care spend estimating tool
• Care spend estimating tool: user guide

Before using the ‘Care Spend Estimating Tool’, commissioners should assemble the data they need. You can then create an indicative population segmentation for your CCG based on one of the four archetypes.

To use the tool, a minimum of four inputs are required:

1. the total population of the CCG
2. demographic growth assumptions for years 0-4 (by age group)
3. non-demographic growth assumptions (ie increase in activity per capita) by setting of care (eg whether the average number of A&E attendances per capita is likely to increase), for years 0–4
4. commissioner spend growth assumptions for each setting of care for years 0–4

Commissioners can customise other elements of the model to obtain more accurate insights, by overriding the default settings with data for a specific CCG. Inputs that can
be tailored are:

1. population profile by age and patient group (eg 6% of the population is known to be 16−69 with one long term condition (LTC) rather than the default 9%)
2. total spend by setting of care for year 0-10
3. demographic growth assumptions for years 0-4 by patient group, as well as age group
4. non-demographic growth assumptions for increase in activity per capita by age and patient group, as well as care setting, for years 0−4
5. commissioner spend growth assumptions per patient group as well as each settingofcare for years 0−4

This report published by the Northern Rock Foundation, outlines the state of dementia care in the North East of England. It provides a summary of demographic trends and the work that is being undertaken to support people with dementia and their carers by statutory, voluntary and academic sectors.

The report highlights progress made and gaps in service development and provision; setting this work against the English policy context and the views and experiences of people with dementia and their carers.

The authors have also produced a shorter summary of the report, an infographic which represents the report visually, a ‘Think piece’ which aims to stimulate debate and a case studies report which highlights examples of good practice from the region.

• Download Dementia 2014: A NE Perspective
• Download Dementia 2014: A NE Perspective summary of report
• Download Info graphic of report
• Download ‘Think piece’
• Download Case Studies

The Dementia Prevalence Calculator has been revised and updated for 2014-15 and presents an opportunity for all health communities to gain a better understanding of their local estimated prevalence of dementia in the community, and among people living in local care homes.

The tool enables General Practices and commissioners to establish a baseline by which to set and work toward local quantified ambitions for improvement in diagnosis rates, as set out in NHS Mandate, and inform local joint strategic planning, commissioning, and service redesign and improvement.

Access the Calculator

The dementia prevalence calculator is accessible to registered users including GP practice staff, Clinical Commissioning Groups, Area and Regional Teams and other approved stakeholder organisations at https://www.primarycare.nhs.uk/.

Register to access the Calculator

To register visit https://www.primarycare.nhs.uk/register.aspx and complete the registration form. A member of the Primary Care Web Tool team will get in touch. If you have any questions contact the Primary Care Web Tool Team primarycareweb@nhs.net.

About version 3

Version 3 of the calculator has been designed with the same look, feel and functionality of the other Primary Care modules, to facilitate ease of use and navigation. From within the DPC module, users can access in-line help, help menus and supporting documentation in the resources section.

Supporting resources

• Introduction to the Dementia Prevalence Calculator
• 10 key steps to improving timely diagnosis: A resource pack for Commissioners and General Practices

This resource supports commissioners, clinicians and managers to commission high-quality evidence-based care for people with dementia and their carers.

Support for commissioning dementia care summarises the key commissioning issues and the resource impact that will arise from implementing the recommendations in NICE guidance and other NICE accredited guidance, to support improvements in the quality of care for people with dementia, in line with the statements and measures that comprise the NICE quality standards for dementia.

Increased investment in the identification of people with dementia has meant that greater numbers of people are being diagnosed with dementia, often at an early stage. This is creating greater demand for services that support people to live well with dementia. There is evidence that investing in this care and support can help prevent crises, avoid unnecessary hospital admissions and reduce the avoidable use of residential care.

The Commissioning tool that accompanies this guide enables commissioners to show how well they are performing against a range of outcome measures that together demonstrate how well the whole system is working. Where data is available, the tool also demonstrates where improvements against outcome measures have prevented or reduced avoidable expenditure in the health and social care system.

• Support for commissioning dementia care
• Commissioning tool: dementia care

This guide updates and replaces the previous NICE commissioning guides on memory assessment services (2007) and end of life care for people with dementia (2010).

Other information

This support for commissioning should be used in conjunction with the following NICE guidance and quality standards:

• NICE quality standard 1: Dementia
• NICE quality standard 30: Supporting people to live well with dementia
• NICE quality standard 13: End of life care for adults
• NICE clinical guideline 42: Dementia – supporting people with dementia and their carers in health and social care (NICE-SCIE guidance on dementia)
• NICE technology appraisal guidance 217: Alzheimer’s disease – donepezil, galantamine, rivastigmine and memantine

A series of learning resources have been launched to support the establishment of well-functioning health and wellbeing boards.

The learning resources, which launched at the National Learning Network’s national summit, cover themes including integration, criminal justice, improving population health and patient and public engagement.

Integration

• Operating principles for Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies
  This co-produced report complements the Department of Health’s guidance and is designed to support areas to develop successful Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. It provides operating principles to guide key processes and practical examples of how these have been put into practice.
• Encouraging integrated working for adults and older people: a practical guide for health and wellbeing boards
  Provides some practical approaches to consider and use in promoting closer joint working.
• Poster: Health and wellbeing boards: developing a local outcomes framework for adults and older people
  Provides a visual map of each of the national outcomes frameworks for adult social care, the NHS and public health. It aims to help HWBs to develop local outcomes frameworks linked to priorities set out in Joint Health and Wellbeing Strategies.

Criminal justice

• Criminal justice system agencies: building effective engagement
  This briefing details practical information and learning on building effective engagement between health and wellbeing boards and local criminal justice system agencies.

Patient and public engagement

• Review of key policy documents
• Patient and public engagement: a practical guide
  Designed to help people think through, plan and deliver their responsibilities in relation to patient and public engagement. It provides practical learning on ‘how’ and ‘when’ to engage, and ways this can work alongside the responsibilities of partner organisations, in particular local Healthwatch.

Improving population health

• Health impact assessment: tool for health and wellbeing boards
• Improving population health: action learning for health and wellbeing boards
  Demonstrates valuable learning of how others have addressed some of the difficult strategic and policy issues involved.

Support and resources

• Support and resources for health and wellbeing boards
  Provides information on organisations that deliver support and produce resources to enable health and wellbeing boards develop and operate effectively. It aims to spread networking and learning opportunities for health and wellbeing board members.

Children and young people

• Poster of key success factors and issues for boards to consider
• Review of key policy documents
• Putting policies into practice – real examples

Leadership

• A guide to governance for health and wellbeing boards
• Working with local government: a guide for GP commissioners
• Working with GP commissioners: a guide for local councillors and officers

Collective resources

• Summary guide on the best use of collective resources
• Examples in practice

Key points

• Councils and councillors work very differently to GPs and the NHS, but their work is integral to health and health services.
• Differences in the purpose, backgrounds, culture and structure of local government can present barriers or benefits to joint working, depending on how they are approached.
• Understanding and awareness are the most important first steps for GP commissioners wanting to foster strong, productive relationships with local government.

Download: Working with local government: a guide for GP commissioners

PbR aims to promote efficiency, patient choice and incentivise best practice models of care.

PbR involves:

1. Capturing the number of service users treated.
2. Allocating each patient to a classification system.
3. Agreeing what should be provided for people in each cluster.
4. Agreeing a price for each group/cluster in the classification system that means providers can afford to deliver the agreed care.

Download:

• Mental health clustering booklet 2012-13
• Information on plans for PbR in 2013-14
• PbR Guidance 2012-13
• PbR Code of Conduct 2012-13
• PbR tariff information 2012-13
• Step-by-Step guide: calculating the 2012-13 tariff
• PbR and the Market Forces Factor in 2012-13

The research, published in the Journal of Alzheimer’s Disease, states that the cost of health and social care alone for each patient in Britain is £13,000 per year. The figure doesn’t include the factor of informal care by families and friends, such as help with household tasks, shopping, transport and supervision which Oxford University claim accounts for £21bn each year.

The researchers also found that the UK is investing more heavily in dementia research than elsewhere, accounting for 40 percent of all dementia research funding in the 15 countries studied but 25 percent of the total cost burden.

The economic burden of dementia was estimated using patient-level studies and aggregate data on morbidity, mortality, and health and social care use. Healthcare and social care costs were estimated from expenditure on nursing and residential home care; and primary, outpatient, emergency and inpatient care, as well as drug treatment. Costs of unpaid care and lost earnings due to morbidity and premature death were also included in the study.

Reference
Ramon Luengo-Fernandez, R. Leal, J. and Gray, A. M. (2011) Cost of Dementia in the Pre-Enlargement Countries of the European Union. Journal of Alzheimer’s Disease 27 (2011) 1–11. IOS Press. Download the article.