Template action plan to improve care for people with dementia in the community

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Commissioning Packs are tools to help commissioners improve the quality of services and minimise unwarranted variation in service delivery. Each Pack provides a tailored set of guidance, templates, tools and information to assist commissioners in commissioning services from existing providers or for use in new procurements.

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21 Jul 2011PCT CEs, SHA CEs, Local Authority CEs, Directors of Adult SSs, GPs

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Best Practice Guidance

For Recipient's Use

Dementia Commissioning Pack

LS2 7UE0113 25 46359

Gill AylingQuarry HouseLeeds

The Dementia Commissioning Pack

Handbook

Procurement templates and guidance

1. Early diagnosis 2. Care at home / care home 3. Care in hospital Commissioning Framework & Assessment Tool Commissioning Framework & Assessment Tool

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Contents

A. Introduction 2 A.1 Template action plan 2 B. The case for change 3 B.1 The national and local context 3 B.2 Commissioning context 4 C. Response template 5 C.1 Response details 5 C.2 Leadership, governance and project resources 6 C.3 Action plan 11 C.4 Outcomes 13 C.5 Training needs analysis 18 C.6 Training delivery 19 C.7 Training numbers and activity 20 C.8 Awareness raising and communications strategy 21 C.9 Sustainability 22 C.10 Reporting requirements 23

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A. Introduction A.1 Template action plan

This is a template action plan for use by local authorities and commissioning consortia working together under the auspices of Health and Well-being Boards to improve care for those people with dementia who live in their own homes or in some other residential setting. Completion of the action plan will help to inform the development of the local Joint Strategic Needs Assessment, will influence the priorities of the proposed Joint Health and Well-being Strategy, and will identify appropriate resources for the implementation of change.

Improving the delivery of services for people with dementia and their carers requires a commitment to better ways of working within and between organisations. The action plan therefore includes:

1. a commitment to providing leadership and resources at Board level in all participating organisations

2. a review of current service offerings to identify services that could be made more dementia friendly1

3. identification of four priorities for improved service provision for people with dementia and their carers

4. analysis and development of an approach to delivering training and support for people who care for people with dementia (carers, domiciliary care workers, care-home staff, etc).

Implementation of the action plan should help develop ‘dementia-friendly’ communities, in which good dementia care is part of mainstream services rather than an adjunct to them, in which cost-effective preventative interventions are available, and in which individuals and third sector organisations are actively involved in supporting and delivering good-quality dementia care.

1 An analysis tool is provided on page 11 of this document in order to help identify gaps in provision.

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B. The case for change

B.1 The national and local context

Over the next 40 years, the number of people in the UK with dementia will more than double – to 1.7 million.2 From 2000 to 2031 the number of older people in the UK (aged 65 and over) will rise by 59%.3 Both of these figures represent challenges for the way in which public services should be delivered, particularly as there is widespread acknowledgement that existing health and social care models do not meet the requirements of support for independent living and well-being, and over time will become increasingly unaffordable.

This view is supported by a National Audit Office report, which notes that much of the £7.4 billion that goes on the direct health and social care costs of dementia is spent at a later stage, when services are necessarily more expensive; meanwhile earlier interventions that are known to be cost effective and that improve quality of life are not widely available.4

All this must also be set against rising expectations of quality and choice. People want care closer to home that is responsive to their needs and delivered at the right time by a well trained workforce, regardless of whether the service is ‘dementia specific’ or mainstream.

For commissioners, the challenge is to meet individuals’ preferences and needs, while at the same time having regard for the body of evidence about the effectiveness of service interventions and value for money.

Implementing appropriate, community-based interventions can help to prevent admissions to hospital or to delay admissions to care homes, and should result in better-quality and more cost-effective care for people with dementia.

2 Luengo-Fernandez R, Leal J and Gray A (2010), Dementia 2010: The economic burden of dementia and associated research funding in the UK. Report by the Health Economics Research Centre, University of Oxford for the Alzheimer’s Research Trust. Cambridge: Alzheimer’s Research Trust. 3 Government Actuary’s Department (2002), National Population Projections 2000-based. London: TSO. 4 National Audit Office (2007), Improving Services and Support for People with Dementia. London: TSO.

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B.2 Commissioning context

Delivering more for less is a challenge facing all public services. In the context of health and social care, this challenge is set against a backdrop of rising costs, rising demand and rising expectations. Tackling inefficiency, providing better ways of working within and between organisations and focusing on quality and on interventions that prevent admissions to hospital or delay admissions to care homes should help to deliver services that are more responsive to the needs of people with dementia and their carers, and should result in more people having a positive experience of health and social care.

As an example, the evidence indicates that caregiver intervention programmes can be effective in reducing institutionalisation and are of greatest benefit to those with advanced dementia. One study found that 65% of an intervention group were living at home after 30 months, compared to 26% in the control group,5 while another study (this time from Finland) showed that the median time of residing in the community following a period of comprehensive support was 647 days in the intervention group and 396 days in the control group.6

5 Brodaty H, Gresham M and Luscombe G, The Prince Henry Hospital dementia caregiver’s training programme. International Journal of Geriatric Psychiatry, 1997; 12(2): 183–92. 6 Eloniemi-Sulkava U, Notkola IL, Hentinen M, et al., Effects of supporting community-living demented patients and their caregivers: a randomized trial. Journal of the American Geriatrics Society, 2001; 49(10): 1282–87.

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C. Response template C.1 Response details

Please fill in the details of the health and social care organisations that are completing the action plan, as well as the name of the person who is responsible for leading implementation of the plan.

Name of organisation(s)

Name of lead contact

Job title

Address

Telephone

Email address

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C.2 Leadership, governance and project resources

Effective leadership, commitment and resources are required to implement and sustain organisational changes aimed at improving dementia care. As part of the action plan, please provide details of the people who will be responsible for delivery of the project.

Local authority

Executive Board member7

Name

Job title

Weekly time commitment [x] days

Description of responsibility To provide leadership on the implementation of organisational changes to improve care for people with dementia

Deliverables Agreed action plan priorities

Quarterly report to the Board on progress against action plan

7 There should be a named Executive Board member for all participating local authorities, or consideration should be given to having an elected member of the council as a responsible officer for the delivery of the action plan.

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Commissioning consortia Executive Board member8

Name

Job title

Weekly time commitment [x] days

Description of responsibility To provide leadership on the implementation of organisational changes to improve care for people with dementia

To link with the Health and Well-being Board

Deliverables Agreed action plan priorities

Quarterly report to the Board on progress against action plan

Report to Health and Well-being Board on progress against action plan

8 There should be a named Executive Board member for all participating commissioning consortia.

Page 8

Social Care Lead9

Name

Job title

Weekly time commitment [x] days

Description of responsibility To lead on the delivery of the action plan from a social care perspective

Social care input into the design and implementation of the action plan

Management of the Delivery Lead

Deliverables Monthly report to Executive Board member on progress

Quarterly progress report to commissioning authority

9 This may be a director of adult social services.

Page 9

Health Care Lead10

Name

Job title

Weekly time commitment [x] days

Description of responsibility To lead on the delivery of the action plan from a health care perspective

Health care input into the design and implementation of the action plan

Management of the Delivery Lead

Deliverables Monthly report to Executive Board member on progress

Quarterly progress report to commissioning authority

10 This may be a clinician with a special interest in dementia.

Page 10

Delivery Lead

Name

Job title

Weekly time commitment [x] days

Description of responsibility To ensure that the action plan is implemented on time and within budget

Liaison and management of other resources involved in the delivery of the action plan

Deliverables Monthly progress report against implementation and benefits

realisation plan

Page 11

C.3 Action plan

Please provide details of the four priority areas that your organisations will be focusing on to provide better care for people with dementia and their carers. An assessment tool is provided to assist in the identification of priority areas for development in terms of provision and service quality. One of the priorities should be capacity building for carers, care-home workers and domiciliary care workers. Please complete and save results from the assessment tool in the document attached:

Assessment Tool

Examples of some of the priorities respondents may wish to consider are: • early diagnosis and interventions • a specialist mental health service to support primary care • carer support; carers’ assessment • peer support • personalisation – personal budget • assessment, information and advice • active ageing programme • home care • housing adaptations • assistive technology • day services • respite care and short breaks

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• extra care housing • community nursing • workforce planning and development • other primary care services • continence service • night sitting • equipment services • practical support with day-to-day living • crisis response • post-discharge support • care management • intermediate care • reablement • end of life care • use of antipsychotic medication in line with NICE guidelines • residential care • services for people with dementia and learning disabilities • services for people with early-onset dementia • awareness raising • day support.

See also the Commissioning Framework in the Dementia Commissioning Pack.

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C.4 Outcomes

Please describe the outcomes that the action plan will help deliver. No. Outcome Related NICE Quality Standard 1 2 3 4

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Priority 1: Capacity building for carers, care-home workers, domiciliary care workers and other support staff

Actions for delivering priority Responsibility Date Action 1 (Outline any specific action you are going to take to address the weaknesses identified in the priority area)

Action 2 Action 3

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Priority 2:

Actions for delivering priority Responsibility Date Action 1 (Outline any specific action you are going to take to address the weaknesses identified in the priority area)

Action 2 Action 3

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Priority 3:

Actions for delivering priority Responsibility Date Action 1 (Outline any specific action you are going to take to address the weaknesses identified in the priority area)

Action 2 Action 3

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Priority 4:

Actions for delivering priority Responsibility Date Action 1 (Outline any specific action you are going to take to address the weaknesses identified in the priority area)

Action 2 Action 3

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C.5 Training needs analysis

When undertaking a dementia training and skills analysis, reference should be made to the Common Core Principles for Supporting People with Dementia, developed by Skills for Care and Skills for Health on behalf of the Department of Health.11

Please describe the analysis that has been carried out to identify the priority for skills development for carers, domiciliary care workers and care home workers, as well as for workers providing other services that are used by people with dementia (e.g. support workers in sheltered accommodation, community nurses). The description should include who will receive training, how the training will be delivered to best meet the needs of the trainee group(s) and the content of the training (competences). Respondents may wish to refer to the scoping study report and to the report on existing training and education provision to support the implementation of the National Dementia Strategy (2009),12 and to the Workforce Development Strategy for adult social care.13

11 Department of Health, Skills for Care and Skills for Health (2011), Common Core Principles for Supporting People with Dementia. Leeds and Bristol: Skills for Care and Skills for Health. 12 Department of Health, Skills for Care and Skills for Health (2010), Working to Support the Implementation of the National Dementia Strategy Project: Scoping study report; Department of Health, Skills for Care and Skills for Health (2010), Working to Support the Implementation of the National Dementia Strategy Project: Mapping existing accredited education/training and gap analysis report. London: Department of Health, Skills for Care, Skills for Health. 13 Skills for Care (2011), Capable, Confident, Skilled: A workforce development strategy for people working, supporting and caring in adult social care. Leeds: Skills for Care.

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C.6 Training delivery

The response should describe how training will be delivered and by whom, as well as how the dementia training will be included in standard induction training for all staff. The response should include consideration of existing training materials developed by the Social Care Institute for Excellence, consideration of delivery approaches, such as the Gloucestershire link worker scheme,14 and options such as mentoring, coaching, active learning, buddying, distance learning and computer-based training. As a matter of good practice, it is essential that people with dementia and their carers should be involved in training delivery, and the joint training of health and social care staff should be promoted to ensure a common and mutually reinforcing understanding of needs and how to support people with dementia effectively.

14 See: www.gloucestershire.gov.uk/index.cfm?articleid=22616

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C.7 Training numbers and activity

The response should include a description of who will receive dementia training and the numbers to be trained to either a basic standard or an advanced standard. An advanced standard may be considered to be Qualifications and Credit Framework level 4 and above.15

Recipient Basic Advanced Carers Care-home workers Domiciliary care workers Other services, e.g.:

Community nurses Staff at GP surgeries Wardens

15 Department of Health, Skills for Care and Skills for Health (2010), Working to Support the Implementation of the National Dementia Strategy Project: Scoping study report; Department of Health, Skills for Care and Skills for Health (2010), Working to Support the Implementation of the National Dementia Strategy Project: Mapping existing accredited education/training and gap analysis report. London: Department of Health, Skills for Care, Skills for Health.

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C.8 Awareness raising and communications strategy

The response should include the issue of how dementia awareness raising activity will be delivered, and should also explain the approach and content of a strategy for communications about the project to improve dementia care.

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C.9 Sustainability

The response should include a description of arrangements that will be put in place to ensure that improvements can be sustained once the project comes to an end.

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C.10 Reporting requirements

The response should outline the kind of report that will be provided as a measure of progress against the action plan. This should include a description of key milestone dates and a key outcome measure for each priority area in the action plan.