1. National perspective Dr Nick Cartmell N Somerset Conference 3.11.14

2. NHS | Presentation to [XXXX Company] | [Type Date]2 Diagnosis rates Reaching the national aspiration Section 1

3. National focus for 2015 A huge priority for DoH and NHSE Two thirds diagnosed (66%) by April 2015 Need much greater annual growth now New Intensive Support Team for Dementia… …that’s me! NHS | Presentation to [North Somerset Conference] | [3.11.14]3

4. Where we had got to, August 2014 NHS | Presentation to [North Somerset Conference] | [3.11.14]4

5. What are the challenges? Diagnosis rates are limited because: Estimated prevalence is only an estimate No allowance for local variation No allowance for deprivation They depend on the accuracy of GP QOF registers NHS | Presentation to [North Somerset Conference] | [3.11.14]5

6. What can we do? Data accuracy: GP QOF registers Patients receiving AChIs Patients diagnosed by MAS Patients with related Read Codes Those at risk and eligible for the Dementia DES Those in the new 2% Unplanned Admission DES Care home residents Consider greater primary care role in diagnosis There is still time and there is extra money! NHS | Presentation to [North Somerset Conference] | [3.11.14]6

7. NHS | Presentation to [XXXX Company] | [Type Date]7 Dementia prevention Reducing your risk Section 2

8. Evidence for prevention Big European RCTs, linked through the European Dementia Prevention Initiative (www.edpi.org):www.edpi.org MAPT 2009 PreDIVA 2011 FINGER 2014 HATICE ongoing Supportive evidence from lack of expected prevalence growth in the UK: CFAS II (2013) NHS | Presentation to [North Somerset Conference] | [3.11.14]8

9. A new hope for dementia “Prevention is better than (no) cure” Wide overlap with other disease prevention strategies: Cardiovascular (smoking, BP, cholesterol) Diabetes (obesity, exercise levels) Also: Better education (hard wire your brain) Avoid or tackle depression and social isolation And the best bits: Never too young to start yet works even if diagnosed! NHS | Presentation to [North Somerset Conference] | [3.11.14]9

10. Getting the message out there Dementia is now the most feared condition in over-50yr olds but few know it’s preventable. National publicity (PHE) Local joint strategy (H&WBB, CCG, DsPH) Local publicity (BBC SW, local papers, posters) Publicise at GP HealthCheck Publicise at other local health initiatives Emphasise at time of MCI diagnosis Tell everyone you know! NHS | Presentation to [North Somerset Conference] | [3.11.14]10

11. NHS | Presentation to [XXXX Company] | [Type Date]11 Secondary care resources Making best use Section 3

12. Tighter budgets, growing demand CCGs and LAs are facing big challenges: Static or shrinking budgets Growing, and ageing, populations Need to improve services for dementia Money tied up in acute hospitals Clever and innovative commissioning is essential! NHS | Presentation to [North Somerset Conference] | [3.11.14]12

13. Possibilities? 1.Shift demand into Primary Care to free up CMHTs for more challenging work Primary care diagnosis with specialist out-reach support Streamline prescribing guidelines (AChIs) 2.Link dementia with other frail elderly commissioning Unplanned admissions work Better advance care planning Reinvest admissions savings into community/Primary care Include mental health in Virtual Hubs NHS | Presentation to [North Somerset Conference] | [3.11.14]13

14. Questions and Suggestions? Thank you! Please share your ideas or examples of better ways of working: nickcartmell@nhs.net http://dementiapartnerships.com “In a gentle way you can shake the world” - M Gandhi NHS | Presentation to [North Somerset Conference] | [3.11.14]14