1. Improving general hospital care for people with dementia: why, how and with whom? Nye Harries DH SW

2. Dementia care in acute hospitals Royal College of Psychiatrists 1 identified that on average in a 500-bed district hospital: 330 beds will be occupied by older people 330 beds will be occupied by older people 220 of these will have a mental health disorder 220 of these will have a mental health disorder of which 102 will have dementia of which 102 will have dementia (depression and delirium form most of the remainder) (depression and delirium form most of the remainder) 1. Who Cares Wins: improving the outcome for older people admitted to a general hospital, Royal College of Psychiatrists, 2005

3. Who care wins on outcomes Research studies cited in the RCP report highlight a range of important outcome measures for this group: increased mortality increased mortality longer lengths of hospital stay longer lengths of hospital stay greater rate of institutionalisation in a care home following their acute stay

4. National Dementia Strategy Objective 8: Improved quality of care in general hospitals To improve the quality of care and health outcomes for people with dementia To provide a comprehensive mental health assessment and advice on planning of care. Develop explicit care pathways Senior clinician lead Includes community hospitals too!

5. NAO estimate excess cost over £6 million pounds per year per acute hospital. One SW review site (2009): data showed that FNOF with dementia diagnosis had 25% longer stay in hospital Dementia is a know risk factor for delayed transfers Financial & performance impact

6. Typical problems in the acute setting. Recognition of dementia. Majority unknown to mental health services. Crisis admissions. Discharge planning, limited options for rehabilitation, intermediate care, step down beds to facilitate discharge home. Poor risk assessment false assumptions

7. Problems... Poor recognition and care, with higher risks in hospital of : –Malnutrition & dehydration –Inadequate pain relief –Over sedation –Poor end of life care

8. Improving general hospital care : key challenges Seeing dementia/cognitive impairment as a whole Trust issue, not just elderly care Securing executive sign-up Making the link with the Trust “performance” agenda – LoS. Demonstrating the value of effective pathways, input of liaison. Ensuring good data – eg clinical coding

9. Breakdown of RUH Inpatient Bed Days by age cohort, 2008 / 09 Age 0-15 6% Age 16-64 28% Age 65-79 28% Age 80+ 38%

10. RUH inpatient bed days by age for Surgery/Ortho/MAU/Gen Med: 2008/09 Number of Bed Days General Surgery OrthopaedicsA&EGeneral medicine 80+ 65-79 16-64 0-15

11. What levers could help you? Extra focus on LoS reduction in 2010/11 Sharing data from the new national audit C-QUIN, with commissioners Trust Quality Accounts Sharing data from the new audit Patient Related Outcome Measures (PROMs)

12. Who are your potential allies? Director of Nursing & Chief Executive LINKs Council Overview & Scrutiny Committee Trust Non-Executives Alzheimer's Society Commissioners

13. www.southwestdementiapartnership.org.uk

14. . Thank you nye.harries@dh.gsi.gov.uk