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.

Race Against Dementia is an alliance of groups currently providing information and support to people from Black, Asian and minority ethnic communities in the UK.

Race Against Dementia promotes improved understanding of dementia in Black, Asian and minority ethnic communities and improved services and support for all those living with dementia and their carers and families. The alliance wants to invite the support of any and all of those who want to help with its aims.

The All Party Parliamentary Group report ‘Dementia does not discriminate’ in July 2013 indicated that the numbers of people from black, Asian and minority communities in the UK living with dementia will increase sevenfold by 2051 to reach 172,000. This will mainly impact on those settled migrant communities with the oldest age demographic; those arriving in the UK during the 1960s and 1970s. Chief amongst these are the Irish, Indian and African-Caribbean populations, but other smaller more dispersed long-standing communities such as the Chinese will be significantly affected.

Local community and faith groups throughout the UK have a potentially powerful role to play in both educating communities, working with commissioners and delivering support and guidance but this role is currently barely tapped into. Race Against Dementia is calling for increased investment in capacity building in grass roots organisations to provide competent support and information to those in black, Asian and minority ethnic communities living with dementia and their relatives and carers.

As a result of this increased capacity the alliance aims to acheive improvements in practice, knowledge and awareness of dementia, inclusive policy making and research.

Keep in touch with Race Against Dementia:

• Facebook
• Twitter
• LinkedIn

This literature review published by Public Health England examines evidence on how the prevalence of dementia varies with different characteristics, such as ethnicity, gender and religion.

Download Prevalence of dementia in population groups by protected characteristics: a systematic review of the literature

The review builds on previous work by the Department of Health and considers scientific papers and those published by voluntary sector organisations.

The review examines evidence on how the prevalence of dementia varies with the following characteristics:

• socio-economic position
• race or ethnic group
• religion or belief
• gender
• sexual orientation
• disability

Key findings include:

• Dementia was more common in people from African-American, black-Caribbean or Hispanic background. There was no information published on people from south-east Asian backgrounds.
• Dementia is more common in women. There was no information to help understand if religion or sexual orientation changed the prevalence of dementia. Learning disability and lower socio-economic position both increased the prevalence.
• Risk factors known to increase dementia (diabetes, stroke and depression) also increase dementia in groups with increased prevalence, and education remains protective against dementia.

Key recommendations for future research include:

• In some groups people do not always appear to be diagnosed with dementia when they have it. Research should focus on the causes of this and how to increase the diagnosis of dementia.
• Specific research is needed to understand how common dementia is in people from a south-east Asian background in the UK. Research is needed to investigate the exact impact of the known risk factors (depression, diabetes and stroke) across the protected characteristics, as this will help organise and target services.

Pathways 4 Life dementia support worker service for hard to reach groups is a partnership initiative between the Accord Group and Age UK Walsall offering dementia support and advice to Black and Minority Ethnic groups (BME) in Walsall.

The service which has been running since 2012 is commissioned by the joint commissioning unit for NHS Walsall Clinical Commissioning Group and Walsall Council.

The service has two parts to it:

1. Raising awareness of dementia and supporting people to go to their GP – this might mean carrying out a Six Item Cognitive Impairment (6-CIT) test , and
2. Healthy lifestyles to reduce risk and promote independence.

The video below showcases the range of services – all helping to raise awareness and improve access to services in hard-to-reach communities. It was produced for Community Care Live in Birmingham recently where both the commissioner and provider co-presented the dementia services aimed at hard to reach groups in our area.

To find out further information about Pathways 4 Life in Walsall please contact Michael Hurt, Commissioning Manager, Older People’s Mental Health and Dementia, NHS Walsall CCG, using the contact details at the top of the page.

This report published by Alzheimer’s Research UK reveals that dementia has become the leading cause of death among British women and that women are far more likely to end up as carers of those with dementia than men, suffering physical and emotional stress and job losses in the process.

The report highlights the unique impact of dementia on women, including the stress and demands of living with dementia or caring for someone with the condition.

Download Women and dementia: A marginalised majority and the supporting infographic shown below which highlights some of the reports key findings

This document, published by Public Health England, summarises some of the main themes emerging from discussions at a workshop to consider equality and health inequality issues in dementia.

Download PHE Dementia Equity Event – Summary

The workshop held on 7 May 2014 was attended by forty participants, including leading figures from the voluntary, community, and statutory sectors, alongside people living with dementia.

The workshop began with 3 presentations intended to bring everyone to a common level of understanding and provoke discussion on how to improve.

1. Overview of equality and health inequality issues and dementia. Jo Moriarty, Social Care Workforce Research Unit, King’s College London
2. A workforce and provider perspective – ethnic identity and cultural diversity in dementia care: a person-centred approach. Karan Jutlla, The Association for Dementia Studies, University of Worcester
3. A commissioner’s perspective – focus on Enfield. Paul Allen, Older People’s Commissioning Manager, Enfield Council

Download PHE Dementia Equity Event – Presentations

Attendees described a very complex picture, where an individual’s experience of dementia can be significantly determined by factors such as ethnicity, disability, or sexual orientation. They described low levels of commissioner understanding of these issues, and that good practice is not yet widely shared.

Partners will be seeking to turn these reflections into action over the coming months. In particular, several partners are coming together to create an evidence review on equality and health inequality issues in dementia for local commissioners. The aim will be to bring together disparate sources of information and analysis into a single document that can help commissioners understand the issues, and learn from case studies of good practice around the country.

Public Health England plans to hold a further event towards the end of 2014 for partners to review progress and consider next steps. To get involved or for any more information, please email dementiaequalities@phe.gov.uk.

Less than half of the estimated number of people with dementia have a formal diagnosis denying them, and their carers, the emotional, practical and financial support that can follow. The increasing profile of dementia and the current Enhanced Service for Dementia in Primary Care has underscored the opportunities for the identification and detection of people with dementia.

Primary Care is under increasing pressure and with more people with dementia to see and diagnose, innovative ways of linking memory services with primary care are needed. We describe here an innovation in one practice in South Manchester, inspired by the Gnosall model (https://www.ncbi.nlm.nih.gov/pubmed/19480115, now “Memory First”), which may be helpful if colleagues are thinking of developing something similar.

As with many things, it started with a conversation between individuals who get on and who feel that things could be better for a group of patients and their carers. Two things emerged from it: First, an opportunity to pilot a primary care memory clinic with dementia in the Practice and, second, the chance to improve the coding and recording of dementia.

So what actually happens in the primary care memory clinic?

The secret of the clinicis that it is relatively light touch and dominated by governance and bureaucracy. It is owned by the practice. For one session a month, a memory clinic specialist does a clinic in primary care. The assessment is usually scheduled for half an hour with information readily available (a history, GP Cog, blood tests) at the touch of a button.

A brief note is dictated at the practice and appears as an entry on the system under AB’s name (a challenge was dictating a succinct note after 30 years of writing clinic letters – for example an entry does not need to start ….”I saw Mr and Mrs Smith at…..”!.

Patients can be referred to the Memory Clinic and the referral is helped by having an initial assessment (for example a scan can be ordered immediately). A diagnosis can be made there and then and appropriate post diagnostic support provided. Some treatment for symptoms such as depression can be implemented and a review organised at the next practice visit. Home visits are often carried out.

The experience has been universally positive in that people are much more willing to be seen in the practice without recourse to the hospital based clinic and has been welcomed by the local health economy. Earlier and more timely identification of dementia has been facilitated (see the case study). Referrals to the memory clinic have not been changed but more people are seen in primary care and the system has been significantly speeded up.

Colleagues in primary care can extend their skills to support and give them the confidence to make a diagnosis of dementia and a review of some of the patients who have been diagnosed as having dementia showed that many could quite easily and competently been diagnosed in primary care. Memory specialists can gain from seeing a group of patients who have been relatively unfiltered.

Improving coding

Improving the coding can help with the identification of people with dementia which is important on a number of levels. In primary care, the numbers of people on the QOF “register” (in practice, a list generated in the practice as a result of an inquiry for a particular set of codes) determines the annual return in QOF which in turn allows the diagnosis rate to be calculated for each CCG, region and nationally. The benefits include the correct identification of people who have a diagnosis of dementia, facilitating clinical reviews, making sure payments are correct in primary care, informs CCG planning, identifies carers, raising the quality of care provided and allowing local and national planning to take place.

As part of this, a focus was placed on the coding of people with dementia in the practice. There are several other examples of this around the country and we present here our own experience. DJ was made aware of the work by Paul Russell and Sube Banerjee on coding of dementia. Searches of registered patients were compared them our existing dementia register. The reviews involved no clinical contact only assessing information recorded in the patient record.

Prior to carrying out the exercise our dementia register had fifty patients and the exercise resulted in an increase of twenty four patients increasing the register to seventy-four. Without further study it is not possible to be sure if this problem is unique to Dementia but a search for Diabetic drugs did not reveal the same problems with patients not being on the Diabetic register. (For a detailed analysis of the project to improve the dementia register see Improving accuracy of the GP practice Dementia Register in South Manchester)

There are different models where primary care and memory clinic colleagues can work more closely together to achieve better outcomes for patients. This is just one example.

Case study

Mrs L, an eighty six year old lady, had a one year history of memory problems which were not causing her any particular concern but her husband and family were very worried as she was not keeping herself as clean as she usually did. She had forgotten the grand children’s birthdays for the first time DJ had spoken to her but she was adamant that she did not have any problems and certainly did not want to go to a Memory Clinic let alone see an old age psychiatrist.

She did, however, agree to see a doctor in the surgery with a special interest in memory problems. She was seen at the surgery by AB within a month of presenting to the surgery. All the blood results were available at the touch of a button in the surgery and a GP Cog had been done.

The history was strongly suggestive of a dementia of the Alzheimer type. After chatting for a few minutes she readily agreed to be seen at the clinic for a CT scan (she had had a bad fall a few months before). She was seen there and the diagnosis was shared with her and her family. She was put in touch with one of the clinic’s dementia advisors and started on donepezil.

It is easy to imagine the scenario that she may have come back, three, six or nine months later still not wanting to see anyone then could have presented in a crisis if she, say, developed a urinary tract or chest infection.

Authors

• Doug Jeffrey, Managing Partner, Barlow Medical Practice, Didsbury, Manchester.
• Alistair Burns, National Clinical Director, NHS England. Honorary Consultant Old Age Psychiatrist, Manchester Mental Health and Social Care Trust.

This guidance provides a high-level framework through which commissioners can plan, develop and implement major service changes.

Download Planning and delivering service changes for patients

The guidance sets out processes and principles for the planning and delivery of major service change.

Commissioners that are considering major service changes are recommended to use this document and to discuss locally with partners – including providers of NHS services, local authorities and groups representing patients – how the guidance will shape proposals and planning arrangements.

The guidance stresses that major service changes and reconfigurations must put patients and the public first, by leading to higher quality and more sustainable services. The focus of reconfiguration should be on proposals that lead to improved outcomes, reduced health inequalities and more efficient models of care.

The NHS Outcomes Framework 2014 to 2015 sets out the outcomes and corresponding indicators that will be used to hold NHS England to account for improvements in health outcomes, as part of the government’s Mandate to NHS England.

This version builds on the previous versions and contains measures to help the health and care system focus on measuring outcomes. It provides an update on the progress that has been made to develop existing indicators and describes how the NHS Outcomes Framework works in the wider health and care system.

The high level outcomes are:

1. Preventing people from dying prematurely
2. Enhancing quality of life for people with long-term conditions
3. Helping people to recover from episodes of ill health or following injury
4. Ensuring that people have a positive experience of care, and
5. Treating and caring for people in a safe environment and protecting them from avoidable harm.

Download:

• The NHS Outcomes Framework 2014/15
• At a glance
• Equalities Analysis
• Technical Appendix

The diagram below provides an at a glance overview of the outcomes and corresponding indicators for each of the five domains in the framework.

The technical detail for the live indicators in the NHS Outcomes Framework for 2014 to 2015 are available on the Health and Social Care Information Centre website.

See also:

• NHS Mandate
• Adult Social Care Outcomes Framework 2013-14
• Adult Social Care Outcomes Framework website
• Public Health Outcomes Framework  2013-16
• The role of the outcomes frameworks
• CCG Outcomes Tools
• NHS Outcomes Framework 2013-14