Help Shape the Future of Specialist Inpatient Dementia ... Releases/Help Shape the Future of... ·...

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1 Help Shape the Future of Specialist Inpatient Dementia Services on the Island 2015 - Onwards

Transcript of Help Shape the Future of Specialist Inpatient Dementia ... Releases/Help Shape the Future of... ·...

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Help Shape the Future of Specialist

Inpatient Dementia Services on the

Island

2015 - Onwards

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Contents

Executive Summary - ........................................................................................................................... 3

1 Introduction .................................................................................................................................... 4

2 Specialist Inpatient Dementia on the Isle of Wight .................................................................. 5

3. Future provision ............................................................................................................................... 8

3.1 The right number of beds for now and for the foreseeable future ...................................... 8

3.2 A model of care (way of delivering the service) that facilitates excellent care ................. 9

3.2.1 Location of Facilities .......................................................................................................... 9

3.2.2 Service Design .................................................................................................................. 10

3.3 An environment designed to support the provision of excellent care .............................. 11

3.4 A provider who can deliver consistent excellent care ........................................................ 12

3.5 Represents value for money (and other issues) ................................................................. 13

3 Consultation ................................................................................................................................ 14

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Executive Summary -

The Isle of Wight has agreed a long term dementia Strategy called “Living Well with

Dementia”. This is a plan designed to improve and increase the services available for

people with dementia; in part responding to the predicted increase of 40% in the next 12

years in people living with dementia due to our ageing population.

A small number of people with dementia will require specialist inpatient treatment and

assessment. This is normally provided by a specialist provider of mental health services in

an Inpatient unit designed for those with dementia.

The Island already has a unit called Shackleton Ward based at St Marys Hospital in

Newport. It has 7 beds. A few years ago a similar ward was based in Ryde, it originally had

many more beds but improved community services reduced the demand to the current

levels.

The current unit is now very busy and has been determined as not suitable for use long term

- for example it does not provide easy access to a garden and because it is in an old acute

ward, some design compromises have been made, and due to the predicted increase in

people with dementia it is likely that the unit size will need to grow.

We have had some initial discussions with those closely involved around the future of

inpatient care and now wish to discuss ideas that have emerged from these conversations in

more detail with all stakeholders. This will help us commission the right service in the future.

The document asks for your views including;

How many beds should the service have?

What is the best location?

How should care be delivered?

The document suggests some ‘leading’ answers to this question but we want your views.

We have arranged for feedback by email, phone or via open events through which we would

welcome people attending to share their views. The consultation continues until the 24th

August 2015 when these views will be compiled and a report with a recommendation is

presented to the Clinical Commissioning Group for consideration.

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1 Introduction

Early in 2015 the Isle of Wight Clinical Commissioning Group with its Partners published the

Dementia Strategy, “Living well with Dementia”. The strategy sets out the work planned for

the future and recognises the success of the transformational work already completed. The

CCG wishes to continue this work and focus on the future of specialist inpatient services.

Dementia is predicted to become the biggest health and social care challenge of this

generation. In the UK there are over 850,000 people living with dementia. With an ageing

population the number is predicted to continue to increase by 40% over the next 12 years.

The impact of dementia on the individual and their families is profound, family carers are

often frail older people themselves with high levels of depression, physical illness and a

diminished quality of life.

Dementia is an umbrella term describing a progressive decline in mental functions, such as

memory, language, orientation and judgement. This can impact the ability to carry out daily

activities. The symptoms gradually get worse over time and the condition is currently

incurable, interventions can lessen the symptoms and improve the quality of life for people.

Age is the most significant known risk factor for dementia. After the age of 65, the risk of

developing Alzheimer's disease doubles approximately every five years. With 1 in 14 people

over 65 and 1 in 6 over 80 having some form of dementia.

Due to our elderly demographics and high diagnosis rate it is estimated to be 2658 people

living with dementia, this is predicted to increase significantly. This increase in dementia

prevalence is due to people living longer as a consequence of better healthcare and

improved standards of living. This presents a number of challenges, directly for those people

who develop dementia, their families and carers, and indirectly for the statutory and

voluntary sector services that provide care and support.

Although most people with dementia will not require specialist inpatient care, for a small

number of people per year, this is an important provision to help support and assess

individuals at their most vulnerable.

This consultation has three aims:

To identify a preferred ‘model’ or ‘way a service is provided’ for the future

To identify specific preferences such as preferred locations, size and design

To understand the priorities and future needs to, as far as possible, future proof our

requirements

The consultation is based on work completed in a pre-consultation stage; a set of

discussions that took place in April and May with various local stakeholders, designed to

enable a final consultation to be as well thought out and focused as possible.

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2 Specialist Inpatient Dementia on the Isle of Wight

The Island currently has one specialist inpatient ward, provided by Isle of Wight NHS Trust

at St Marys Hospital, Newport. As the diagram below shows, most people with dementia

receive care in the community, from their GP, memory services, local authority or third

sector. Individuals may live at home or in some cases they may live in residential or nursing

accommodation.

Rarely an individual requires specialist inpatient treatment and this inpatient provision is

based at St Marys Hospital, Newport and also provided in Shackleton Ward which has 7

inpatient beds. This unit was previously based in Ryde but was relocated in June 2013 due

to a decline in the former ward environment.

Significant improvements in community services across the Island over the past 5-10 years

for those with dementia have already resulted in more people being supported out of hospital

environments. As a result specialist inpatient dementia bed usage dropped from around 20

beds to around 6 in 2011/12. The beds available at the current ward experience a high level

of occupancy.

The current service costs the NHS £1.46m per year for 7 beds, around half of all expenditure

on specialist NHS dementia care. The remainder will be distributed between services

including diagnostic services, post diagnostic support, memory groups and Admiral Nurses

supporting people to make informed choices and live well with dementia in the community.

The replacement ward now at St Marys Hospital was not intended to be a permanent

solution, in 2011 a consultation was undertaken to consider the long term re-provision of

inpatient beds which recommended a purpose built facility at St Marys hospital in Newport;

although a number of other options were popular.

Specialist

Inpatient Care

Care in the community such as through the Memory

Service

Care in the community through primary care and Dementia Alliance (3rd Sector), etc

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The ward is located on the first floor of St Mary Hospital and can only be accessed by lift or

stairs. The ward, converted from an Acute Medical Ward, consists of 7 single bedrooms,

shared dining and living space as well as single sex space for privacy. The ward has

access to a dedicated garden but patients along with staff or carers have to leave the ward

to get there, using the stairs or lift. As a major healthcare site there are good transport links

to the site.

Examples of the strengths and areas of improvement of the existing environment include;

Example strengths;

Being attached to the Hospital has allowed easy, less traumatic access to Hospital

services such as for an X-ray, which formally may have required transport by

Ambulance.

Dedicated and passionate staff that have specialist skills in dementia care.

Example areas to address include;

The ward design does not facilitate the best dementia care, for example safe space

to move is limited and during the summer the unit is very hot due to ventilation

issues.

The ward has no easy garden access directly from the ward and access for dementia

patients via stairs or lifts is not ideal; normally they are based on the ground floor.

No room for additional bed capacity if needed.

In 2014/15 occupancy was reported at 92%; i.e. on average 92% of beds are occupied at

any one time, compared to 87% in the previous year. The recommendation nationally is that

the ideal level is 85% but practically many Trusts run occupancy above this level.

The Island had the highest recorded prevalence of dementia in the UK during 2011/12. It is

estimated that there are 2658 people living with dementia on the Island , this is predicted to

increase by 40% in the next 12 years.

Prevalence is higher in older age groups and there will be proportionate growth in these

groups as the following graph shows.

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Graph 1: Isle of Wight: Estimated Prevalence of Dementia: Number of People Age 65+ -

Persons by Age and Year, showing substantial increase during period covered.

Based on these issues the CCG has identified five priority areas to address through this

consultation and its outcome. These are;

To commission a future service that

a. Provides an environment designed to support the provision of excellent care

b. Delivers a model of care (way of delivering the service) that facilitates

excellent care

c. Is delivered by a provider who can deliver consistent excellent care

d. Has the correct number of beds for the present and in the foreseeable future

e. Represents value for money so that it can provide the widest provision of

services with the money available to it

0100200300400500600700800900

65-69 70-74 75-79 80-84 85-89 90+

nu

mb

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of

pe

op

le a

ge

d

age group

2013 2016 2020

Data Source: Projecting Older People Population Information System

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3. Future provision

In planning future provision we have already explored some of the views of key stakeholder

and we would now like to test these and confirm this further with a wider audience.

3.1 The right number of beds for the present and for the foreseeable

future

We need to ensure that any future facility that is commissioned has the right number of

beds. If there are too few then individuals cannot be promptly treated because admission

could be delayed. If there are too many then it becomes expensive to run, reducing

available expenditure for other important health services.

From the research and discussions that we have already conducted we believe that, with no

changes to other services, we do not currently have enough specialist inpatient beds. This

is based on current bed occupancy is 92% which is relatively high. We also know;

That on occasions it has been difficult to admit to Shackleton because occupancy is

at its fullest.

In some cases Dementia admissions go to the Older People ward at Severances on

the St Marys Hospital site rather than Shackleton because Shackleton is full.

That demand is increasing as the population gets older.

There are shortages of specialist placements nursing homes which can delay

discharge.

We also know that future improvements or changes to community provision for dementia can

impact on the demand for inpatient services.

There are currently 7 beds in Shackleton but when we spoke to stakeholders in April they

suggested the right number currently is between 7 (same) and 12. The CCG will make use

of some specialist forecasting work to forecast this for the next 10-15 years however we are

interested in any views you may have and why.

We believe that any facility commissioned will have to show how it can be expanded at a

later date should demand increase in 5 – 10 years.

Q1. Based on your

experience how many

specialist dementia

beds do we need now

and why have you

reached this view?

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3.2 A model of care (way of delivering the service) that facilitates

excellent care

3.2.1 Location of Facilities

The location of a service is important as it enables access by patients and relatives via

public transport, makes wider medical support simpler and, where possible, helps

engagement of patients in the wider community.

From discussions already taken place, we believe that a central Island location, potentially

Newport would be best, but not that it is absolutely essential.

When we spoke to stakeholders in April we were told that a setting in “the community and

away from the St Marys Site” had advantages such access to local shops as part of patient

rehabilitation work and were often near housing populations. A number of stakeholders felt

that public access was good for a wide range of locations, not just Newport, for example the

former ward was based in Ryde. Finally some staff felt that the move of ‘Old’ Shackleton in

Ryde to St Marys Hospital in Newport had benefited in easier access to hospital services

such as Diagnostics for patients e.g. individuals no longer required transporting by

Ambulance for an X-ray.

Q2. If we had a new

inpatient unit; what

would be the best

geographic location and

why?

What issue is most

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3.2.2 Service Design

Whilst we wish to commission specialist acute inpatient care, there are different innovative

approaches which have been taken nationally and internationally to provide the care. In

making a future choice we are interested in any proposal that may create additional benefits.

We believe from discussions that there may be three realistic alternatives.

A standalone unit provided by a single NHS organisation – This is providing care in a

very similar way as we do now; a ward dedicated to dementia with specialist nurses input,

typically as part of a NHS provider offering wider services for the group of patients. n an

initial discussion the majority of people felt this was the most favoured and it is the most

commonly commissioned option nationally.

Community Beds with Specialist NHS Input – This would involve purchasing beds within

community settings, for example a specialist nursing home, with the care provided from the

home but the specialist input from a larger more specialist NHS provider.

This option was explored in detail in a number of interviews; some people felt that existing

services had demonstrated that this was possible; like community rehabilitation.

Independent providers felt that they already had a track record of successfully supporting

patients with behaviours that were quite challenging, taking many patients discharges from

Shackleton Ward. Others felt that the independent sector skills were not experienced with

the level of acute care required; Shackleton often admitted people from these environments

(rather than to); and finally that nursing homes also suffered from problems of recruiting

nurses which might result in service viability issues.

A unit provided as part of a wider linked development- Various versions of this were

discussed, exploring the potential to link acute care to nursing care to residential care and

beyond. There has been some success abroad by bringing communities of people together

who could benefit, for example in having a shared area or shared support. A model

successfully implemented in Holland was given as an example

(https://youtu.be/LwiOBlyWpko). There was broad interest in this option and exploring the

benefits of co-located services or even homes.

Q3. What do you think

is important about how

the care is provided?

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3.3 An environment designed to support the provision of excellent care

The current ward environment, adapted from a previous acute medical ward, is not suitable

for long term provision. During our initial discussions we identified that any future provision

should have;

Ground floor access

Direct access to a generous garden

More patient space to move within a safe space.

Built in dementia ‘friendliness’, like colour and robustness of design.

The experiences from the adaptation suggest that a significantly better solution would be

derived from a purpose built environment rather the refurbishment of an existing area. This

is because of the difficulties of adapting an existing environment to meet the needs of this

complex group. The cost is not always reduced and it is likely any build may require some

flexibility for future expansion.

Q4. What do you think is

important in the design

of specialist inpatient

areas for dementia?

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3.4 A provider who can deliver consistent excellent care

Ultimately, when a service is commissioned, providers respond to the specification and

contract to provide the service described however we are interested in what we should take

into account when considering a suitable provider.

Most people felt a large NHS provider remained the preferred provider of specialist beds due

to historic expertise and enhanced governance systems. However there is a view that the

independent sector should not be overlooked; some independent providers have good

records in dementia nursing care and argue they could deliver potentially improved value

and are able to be more flexible around provision; such as commissioning and building on a

more flexible basis than the NHS.

Q5. What do you think is

important attribute that a

provider of care must have

(the organisation rather

than the individuals)?

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3.5 Represents value for money (and other issues)

The CCG must spend its money wisely on behalf of the population, and getting the future

provision right enviably is complex. There are factors now that we need to consider. We

have identified some;

Cost – Money spent in one place means it can’t be spent elsewhere. We know

specialist care in Hospital typically costs £250 per person per night; whilst residential

home support costs in the region of £100. What is being provided is significantly

different but it does suggest alternative approaches may be available that could

reduce costs whilst maintaining quality. We also know that investment in other

services, like memory clinics, can reduce demand later, on more specialist services.

If you have any specific views on this we would be interested to hear from you.

Long term growth – Any permanent change to provision, particularly if it relied on

heavy capital investment needed to take into account long term demand changes

and have the flexibility to expand if required. We feel we need to consider forward at

least by 10 years.

Vanguard - The health and social care system is working to develop a more modern

integrated approach, focusing more community provision. This might influence any

preferred model but so far we have not heard any evidence that it will.

Institutions – There are risks with just continuing ‘as is’ with what some described

as institutional like care on an institutional site.

Q6. Do you have a view on

these and what other

issues do you think are

important? And why?

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3 Consultation Process

The views of stakeholders including service users, carers, social services, independent

providers and, primary and secondary care is considered vital in developing healthcare

locally. This proposal was put together following a 6 week pre-consultation period involving

discussions with stakeholders involved with Dementia. This has helped us include the best

options available, narrow down our options to realistic alternative, and identify where wider

views would be of greatest value.

The consultation is phase 2 of a 5 phase process:

Consultation process

This report will be made available and circulated widely for comment to local stakeholders

including;

Primary Care, particularly GP’s & Nurses

Secondary Care, particularly staff in existing dementia related services

Independent Sector, particularly those involved with dementia care

Carers and Service Users

Voluntary sector, particularly those in related provision

Key local representatives

CCG

Isle of Wight NHS Trust

The Isle of Wight Council, particularly Social Services

General public

A copy of this document is available on our website: http://www.isleofwightccg.nhs.uk/

•Pre-Consultation: Understand existing provision and options considered possible and therefore worth consulting widely on.

Phase 1

•Public Consultation: Exploring our short listed options and capturing important issues to take into acount when commissioning a new and improved service.

Phase 2

•Agreeing a final proposal based on feedback from phase 2 for the Clinical Commissioning Group to agree.

Phase 3

•Commissioning the agreed solution from Phase 3. Phase 4

•Agreed solution starts to be provided. Phase 5

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Drop in events

There are two public events at which you are welcome to attend to understand more

and provide comments directly to the team conducting this consultation. There will be a

team of people to explain this proposal to you, using a series of displays and to record your

feedback. The event is a drop in event with no fixed time as everyone arriving will be given

a personal presentation and time to discuss their thoughts with one of our team.

23rd July 2015, School of Nursing, St Marys Hospital, Newport – 4 pm -7 pm

20th August 2015, Riverside Centre, Newport- 5 pm-7 pm

We have two events for those involved in the provision of services, like

social services or health staff at which individuals are welcome to attend to understand

more and provide comments directly to the team conducting this consultation. There will be

a team of people to explain this proposal to you, using a series of displays and to record

your feedback. The event is a drop in event with no fixed time as everyone arriving will be

given a personal presentation and time to discuss their thoughts with one of our team.

23rd July 2015, School of Nursing, St Marys Hospital, Newport – 12 pm -4 pm

20th August 2015, Riverside Centre, Newport - 3 pm-5 pm

We are all very willing to speak to you individually or as a group, on requested. Contact

Martin Robinson, as below, to arrange this.

Comments can be submitted by email to : [email protected]

Comments can be submitted by online questionnaire by visiting:

https://www.surveymonkey.com/s/IOWinpatientdementia

Comments can be submitted by post to:

Martin Robinson

MH & LD Commissioning

Isle of Wight Clinical Commissioning Group

Building A, The APEX, St Cross Business Park, Monks Brook, Newport,

Isle of Wight, PO30 5XW

Tel: (01983) 822099

This consultation ends on the 24th August 2015

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FEEDBACK SHEET: Send to: Martin Robinson, MH & LD Commissioning, Isle of Wight

Clinical Commissioning Group, Building A, The APEX, St Cross Business Park, Monks

Brook, Newport, Isle of Wight, PO30 5XW

Q1. Based on your experience

how many specialist dementia

beds do we need now and why

have you reached this view?

Q2. If we had a new inpatient

unit; what would be the best

geographic location and why?

Q3. What do you think is

important about how the care

is provided?

Q4. What do you think is

important in the design of

specialist inpatient areas for

dementia?

Q5. What do you think is

important attribute that a

provider of care must have (the

organisation rather than the

individuals)?

Q6. Do you have a view on these

and what other issues do you think

are important? And why?

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