Gary Blatch, Dementia Strategy Manager, South Essex Partnership University NHS Foundation Trust
Background
PCT data showed that between April 2010 and March 2011 a six figure sum was spent within the Basildon and Thurrock University Hospital on people with dementia who did not require any procedures.
It was felt that actions needed to be taken to prevent inappropriate admissions for people with dementia and shorten the length of stay if admitted.
Aim
• Reduction in acute budget.
• Reduction in ambulance attendances to Basildon and Thurrock University Hospital.
• Reduction in care/residential home placements.
• Reduction in length of stay if admitted.
• Reduction in readmissions for people with dementia (PWD).
• Increase the number of PWD receiving telecare.
• Increase carer support and assessments.
• Reduction in falls within the acute hospital.
• Raise awareness of the needs for PWD.
• Access to specialist support.
• Improved outcomes for PWD and their carers.
• Improve quality of care.
• Releasing time to care.
What did you do?
NHS South West Essex looked at the results from a pilot that took place in West Suffolk and put together a similar multi-agency team within Basildon and Thurrock University Hospital – the ‘Dementia Intensive Support Team’ (DIST) consisting of two social workers, one from Essex County Council and one from Thurrock Council, two general nurses from NHS South West Essex Community Care Services, two mental health nurses from South Essex Partnership University NHS Foundation Trust and two support workers (with 0.5 wte admin support).
DIST works alongside the existing Admission Avoidance Team, facilitating existing resources and providing support to prevent people with dementia being admitted to a ward if possible (for those where the presenting condition would not have resulted in admission were there not dementia related factors also in place – lack of specialist input, carer breakdown, the person living alone and has an acute condition which has left them temporarily unable to look after themselves – such as the complications from a urinary tract infection, constipation etc).
They do this by utilizing their local knowledge of services to arrange dementia friendly care packages and support systems so that the person with dementia can return home safely.
DIST dovetails into Basildon and Thurrock University Hospital’s Dementia Action Plan, drawn up by clinicians and part of their new Dementia Pathway.
DIST have been working closely with East of England Ambulance Service and take referrals direct from crews. Their Regional Dementia Leads, Suzanne Lillington and Chris Harris, met with as many crews as possible in the area to promote the scheme and discuss the criteria for referrals.
When the team had been up and running a couple of weeks, GPs were contacted about the service and encouraged to call the team direct if they had a patient who met the same criteria. It is hoped this will reduce calls to the Ambulance Service.
The teams now link closely with the area’s Dementia Care Home Liaison service so that where DIST are notified that there is a resident from a care home on the wards, they will work with the care home and the liaison nurses to ensure a speedy return.
They also support people with dementia on the wards, assisting ward staff to ensure that dementia related issues do not lengthen the length of stay, providing specialist input to care planning and arranging or carrying out specialist assessments, liaising with the Complex Case team. Where the problems of the person with Dementia on the wards need more intensive input, the team are able to call on the services of the Clinical Nurse Specialist in dementia who can offer advice and refer to mental health services if necessary.
DIST staff follow the patient up in the community after admission avoidance or earlier discharge, giving support until handing over to other services. It is hoped that this will reduce repeat admissions, but this will only be known at a later date.
What changed?
DIST has been in place since August and PCT data shows that DIST has contributed to preventing admissions to hospital and to reducing the lengths of stay for people with dementia.
We have a dementia awareness week planned where we are combining a roll out of the RCN Commitment while distributing the new DH dementia awareness literature and posters as well as explaining to ward staff the purpose and role of DIST. The Alzheimers Society are attending to meet people with dementia and their carers on the wards and to introduce their services.
Advice for others
Despite feeling that we had communicated the aims and role of DIST widely, we found at every turn that we were meeting people who had no knowledge of its existence. We would advise anyone introducing a similar team to have one person dedicated to raising awareness within the various units and organisations as face to face was found to be the most successful method of doing so, however time consuming this is.
We also found that where there is more than one organisation offering similar services in an area (e.g. neighbouring councils) then documentation and record keeping becomes complex and cumbersome. We would advise that this issue is agreed to everyone’s satisfaction at a very early stage of planning.
We found that the close working between organisations on this project had knock on effects for all in the new networking that occurred. We are communicating more on unrelated but dementia focussed issues and benefiting from each other’s experience.
For further information please contact Gary Blatch at Gary.Blatch@sept.nhs.uk
See other examples at Dementia - best practice examples.