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Topic on a Page - Dementia

Data Sources:

Public Health England (PHE):

Dementia Profile

Dementia: comorbidities in patients data briefing

Dementia Partnerships:

Dementia Prevalence Calculator

Supporting Information:

Lincolnshire Joint Strategy for Dementia

Needs and Evidence Base Review of Dementia Published: September 2014

Dementia Partnerships

Connect to Support Lincolnshire

Public Health England (PHE):

Dementia Data & Analysis – a guide for health professionals

The King's Fund:

Dementia

Local Government Association (LGA):

Dementia friendly communities: guidance for councils

LGA: Dementia support guide for councils

Department of Health and Social Care:

After a diagnosis of dementia: what to expect from health and care services

NHS Evidence:

Delerium

Dementia

Alzheimer's disease

Social Care Institute for Excellence (SCIE):

Alzheimers

Using technology to support people with dementia

Dementia and housing

HM Government:

The Care Act 2014

Mental Capacity Act 2005

NICE:

Clinical Knowledge Summary: Dementia (August 2016)

Pathway: Dementia Overview

Pathway: Dementia, disability and frailty in later life: mid-life approaches to delay or prevent onset overview.

Dementia: assessment, management and support for people living with dementia and their carers [NG97]

Dementia [QS184] Published June 2019

Dementia – discussing and planning support after diagnosis

Lincolnshire Police:

Herbert Protocol

Alzheimer's Society:

Dementia Family Support Service

Dementia friendly housing charter

Dementia friendly rural communities guide

NHS England:

Implementation guide and resource pack for dementia care

House of Commons Library Briefing Papers:

Dementia: policy, services and statistics overview

World Health Organisation (WHO):

WHO Guidelines: Risk reduction of cognitive decline and dementia

Linked Topics:

Topic last reviewed: Oct-19

JSNA Topic: Dementia

Background

Dementia is one of the most pressing challenges for health and social care services both nationally and locally. Dementia is a progressive and terminal disease caused when brain tissue is damaged. The condition is defined by a number of symptoms that includes loss of memory, mood changes, and problems with communication and reasoning. As a progressive condition people with dementia and their family carers have to cope with changing abilities over time. These include an increasing and fluctuating impairment in the person's capacity to make decisions about major life events and circumstance, as well as day-to-day situations.

There are many types of dementia, the most common are:

  • Alzheimer's Disease; which affects the structure and chemistry of the brain leading to the death of brain cells;
  • Vascular dementia; which occurs when the oxygen supply to the brain is cut, for example by a stroke or progressively by a series of mini strokes resulting in the death of brain cells.

Dementia is one of the most severe and devastating illnesses a person can experience. Not only does it have a significant impact on the individual it also has a profound and negative effect on family members who, in many cases, provide the major share of care and support. Although dementia is primarily a condition associated with older people, there are also a significant number of people who develop dementia earlier in life.

It is estimated that currently there are 850,000 people in the United Kingdom living with dementia. This figure is likely to rise to one million by 2025 and by 2051 it is estimated it will be two million (Source: Alzheimer's Society

In Lincolnshire the number of people aged 65 and over, estimated to be living with dementia in 2019 was 6.8% (12,216) which is the same as the 2016 percentage. This figure is predicted to increase by 35.5 % by 2030 (12,216 to 16,558) however by 2035 it is predicted to increase by 54.15% (12,216 to 18,831) which is higher than the predicted national increase of 51.21% (728,671 to 1,101,818) for 2035 (Source: POPPI).

Dementia is one of the top five underlying causes of death. In 2017 the leading cause of death for men and women aged 80 years and over was dementia, accounting for 15.1% of male deaths (0.8% increase from 2016) and 23.2% of female deaths (1.0% increase from 2016) (Source: Nomis: Mortality Statistics).

Context

National Strategies, Policies & Guidance

Prime Minister's Challenge on Dementia 2020 initially published in 2012 with the second phase being launched in 2015, this sets out plans to improve dementia care, focusing on raising diagnosis rates and improving the skills and awareness need to support people with dementia and their carers. It also has details of plans to improve dementia research.

Challenge on dementia 2020: implementation plan (March 2016) sets out how the 50 specific commitments made in the Prime Minister's Challenge on Dementia 2020 will be met. It sets out priority actions and the organisations responsible for reducing risk of developing dementia, health and care support, awareness of dementia and social action and dementia research. The aim is to make England the world-leader in dementia care, research and awareness by 2020.

Dementia 2020 Challenge: 2018 Review (February 2019) This review looked at progress on actions set out in the Challenge on Dementia 2020 implementation plan as well as looking at what else needs to be done. Stakeholders from health and social care and the charitable sector commented on the review.

NICE Guidance: Dementia: assessment, management and support for people living with dementia and their carers [NG97] (rev. June 2018) covers preventing, diagnosing, assessing and managing dementia in health and social care, and includes recommendations on Alzheimer’s disease. It aims to improve care for people with dementia by promoting accurate diagnosis and the most effective interventions, and improving the organisation of services.

NICE Guidance: Dementia [QS184] (June 2019): This quality standard covers prevention of dementia, assessment and management of dementia and access to health and social care support. It describes what a high-quality dementia service should look like and identifies areas for improvements. There are 7 quality statements highlighting priority areas.

The Care Act 2014 introduced a legal right for carers to access an assessment of their needs to determine if they are eligible for support, subject to the eligibility criteria. If the carer is eligible a support plan would be created and a personal budget arranged to meet the carers' individual needs. The Act also sets out the duty for local authorities to provide information and advice on what type of care and support is available, e.g. post diagnosis support or independent financial advice about care and support and how to access it. Information is available to all individuals regardless of eligibility level. This is to improve independence and wellbeing of local people and help to prevent or delay the need for on-going care and support.

The Department of Health publication Dementia a state of the nation report on dementia care and support in England (2013) outlines the extent of the challenge presented by dementia and current and future steps needed to combat it.

Local Strategies & Plans

Lincolnshire Joint Dementia Strategy 2018-2021 includes detail on progress and achievements since the implementation of the Lincolnshire Joint Dementia Strategy for Dementia 2014-2017. The new strategy provides information on Lincolnshire's priorities for dementia services in the county for the next three years, reaffirming the Council's commitment to support people to live healthy lives to reduce the risk of developing dementia, improve identification and early diagnosis and provide meaningful support and services to enable people to live well with dementia.

Dementia has been identified as one of the most important health and wellbeing issues facing the county. It is a priority in the new Joint Health and Wellbeing Strategy and the Dementia Steering Group will lead on activity to ensure the objectives of the strategy are delivered.

The Lincolnshire Sustainability and transformation plan sets out the framework for joint delivery of better quality health and care services to be developed around the needs of the local population so that they are fit for the future. Priority areas are the development of neighbourhood working and social prescribing to support people in their communities. A Sustainability and Transformation Partnership has been formed with health and social care professionals, voluntary groups, care providers and the public to achieve the commitments within the plan.

What is the picture in Lincolnshire?

What the data is telling us

Estimated Prevalence
A report by the Alzheimer's Society in 2014 called Dementia UK Update provides age specific estimated rates of dementia prevalence for males and females. When these rates are applied to latest population estimates and future projections for Lincolnshire it is estimated in 2019 12,216 people aged 65 and over were living with dementia in Lincolnshire: this accounts for 6.8% of the population aged 65 and over or 1.6% of Lincolnshire's entire population (Source: POPPI).

Registered Prevalence
Recorded dementia prevalence is the number of people with dementia recorded on the practice register as a proportion of all people registered at each GP practice in each CCG area. This is a measure of recorded prevalence and not actual prevalence and therefore under-reports groups who are less likely to be registered with a GP such as ethnic minority populations, homeless people, migrants and travellers. Therefore caution should be taken when interpreting this indicator as the higher than average value may mean that the prevalence of the condition is high in an area, but it could also indicate that detection is better.

Recorded prevalence of dementia nationally for all ages was 0.8% in 2017/18. Lincolnshire East CCG (1.0%) is higher than the national average. South Lincolnshire CCG (0.9%) and Lincolnshire West (0.8%) are similar to the national average, although South West Lincolnshire (0.7%) is below the level of England (Source: PHE: Dementia Profile).

When looking at people aged over 65, recorded prevalence of dementia nationally for all was 4.33% in December 2018. Lincolnshire West (4.37%) has the highest prevalence in Lincolnshire and is similar to the national average. The other CCGs all have a significantly lower recorded prevalence with South West Lincolnshire (3.59%) having the lowest recorded prevalence in the Central Midlands. (Source: PHE: Dementia Profile)

Diagnosis Rates of Dementia
The difference between the estimated and registered prevalence of dementia in people aged 65+ is called the diagnosis rate. In 2018, West Lincolnshire CCG (68 %) had the highest rate of diagnosis for dementia of all CCGs in Lincolnshire, and South West Lincolnshire CCG had the lowest rate (52.1 %). (Source: PHE: Dementia Profile).

Emergency hospital admissions of people aged 65+, with dementia
The directly age standardised rate of emergency hospital admissions of people with dementia in Lincolnshire for people aged 65+ (3,095 per 100,000 population) is significantly lower than the national rate (3,609 per 100,000 population) for 2017/18. This equates to 5,559 emergency admissions. Lincolnshire East CCG had the highest rate at 3,080 per 100,000 population and West Lincolnshire CCG the lowest at 2,629 per 100,000 population. (Source: Public Health England Profiles)

Mortality
In 2017 there were 1,703 (948 per 100,000 population) deaths of people with dementia aged 65 and over in Lincolnshire. This number includes all cases with dementia mentioned; either as an underlying cause of death or a contributory factor. This is of a similar level to the England rate of 903 per 100,000. All Lincolnshire CCGs had similar rates of mortality to the national average, with Lincolnshire West having the highest mortality rate of 1,111 per 100,000 population and South Lincolnshire had the lowest mortality rate of 829 per 100,000 population. (Source: PHE: Dementia Profile)

Trend

Estimated Prevalence
The number of people aged 65 and over experiencing dementia is projected to increase to 18,831in 2035; a 54.15% increase compared to 2018 figures (Source: POPPI). At the same time the rates of dementia prevalence are also projected to increase to 7.86% of people aged 65 years and over or 2.3 % of the entire population of Lincolnshire. Lincoln, Boston, North Kesteven and South Holland are estimated to have the highest proportion of people aged 65 and over experiencing dementia (7%). It is projected that South Kesteven will experience the greatest increase in number of people with dementia by 2035 from 2,289 to 3,817 cases (a 66.75% increase). (Source: POPPI)

The projected changes are due to population numbers increasing and the population profile shifting towards a higher proportion of older people:

  • The number of people aged 65 and over in Lincolnshire is projected to increase by just over 60,000 between 2019 and 2035, a 33.5% increase. At the same time the entire population is expected to increase by 7.7%.
  • People aged 65 and over were estimated to account for 23.7% of the Lincolnshire population in 2018; by 2035 the proportion of population aged 65 and older is projected to increase to 29.5%.
  • In Lincolnshire, the number of people aged 85 and over is projected to almost double by 2035 (from estimated 22,400 in 2018 to 42,400 in 2035). (Source: POPPI)

Registered Prevalence
Recorded dementia prevalence for all ages has increased in each CCG over the past 6 years, although with the exception of South West Lincolnshire CCG, all Lincolnshire CCGs have consistently recorded significantly higher prevalence than the national average. When looking at the population of people aged 65+ Lincolnshire East CCG, South Lincolnshire CCG and Lincolnshire West CCG have all seen an increase since recordings began in September 2015, whereas South West Lincolnshire has seen a reduction over the same period.

Emergency hospital admissions of people aged 65+, with dementia
Lincolnshire has had a steady rate of Emergency hospital admissions of people aged 65+, with dementia since 2012/13, although the national rate has increased. In 2012/13 Lincolnshire had a similar rate to the national average, but since 2014/15 Lincolnshire has had a significantly lower rate.

Mortality
There has been an increase in the number of deaths in Lincolnshire for people aged 65+ with dementia of 60.68% since 2011. This has mirrored the national picture which has increased by 43.11%. (Source: PHE: Dementia Profile)

Key Inequalities

The prevalence of dementia increases with age and is higher for women than for men (there is a greater number of older women than older men). Women also have a slightly higher risk of developing Alzheimer’s disease, but have a lower risk than men of vascular dementia. In 2018, 61.5% of people in Lincolnshire suffering from dementia were estimated to be female (Source: POPPI: Lincolnshire Dementia).

The behavioural and disease factors that can increase someone's likelihood of developing dementia are not evenly spread in the population and this creates a general inequality towards populations experiencing deprivation.

There is also inequity in service provision for some groups. Dementia care services are usually designed for older people, consequently the provision of appropriate care for younger people with dementia (under 65 years old) is often lacking. Nationally it is estimated that one in twenty people living with dementia are under the age of 65 (Source: Alzheimer's Society). The number of people under the age of 65 with dementia in Lincolnshire in 2019 is estimated at 211 (Source: PANSI). Whilst this number is relatively small the life circumstances of this group are likely to be different from those of older people.

Younger people with dementia will face different issues, especially if they are still working when diagnosed. They may face discrimination at work and often have to give up work earlier than they would like. As well as health and care services, this age group also needs access to wider services which support their wellbeing and addresses issues such as employment, financial planning and relationships. (Source: Alzheimer's Society, Dementia 2014 – Opportunity for Change)

Changing specific risk factors and behaviours can reduce the risk, or delay the onset of dementia. The greatest reduction in the number of adults in the general population displaying four behavioural risk factors (smoking, lack of physical activity, consuming alcohol, and poor diet) was seen in higher socioeconomic and more highly educated groups. People from unskilled households are more than 3 times more likely to adopt behavioural risk factors than people from professional groups (Source: NICE – Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset [NG16])

A report by the Institute of Health Equity (2016) finds that:

  • The cumulative experience of the social determinants of health throughout a person's life impact on health inequalities in older age; including increasing the risk of poor mental health, mild cognitive impairment (MCI) and dementia. Compared with people from higher socioeconomic groups, lower socioeconomic groups are more likely to experience physical, social and economic environments, and adverse childhood experiences that result in these inequalities, and will have fewer resources to cope when experiencing poor health outcomes in later life.
  • Social isolation and loneliness, lack of mental stimulation, and physical inactivity in later life increases the risk of poor mental health, including depression, and the risk of mild cognitive impairment and dementia. These later life circumstances can also increase the risk that cognitive decline will occur at a faster rate, and that mild cognitive impairment and dementia will start at an earlier age.
  • Older people identified as being lonely are 1.63 times more likely to be diagnosed with clinical dementia than those who are not lonely and older people with weak social ties have a 50% higher risk of mortality, comparable to the risks caused by smoking or obesity.
  • Older people with a history of social isolation, poverty and living in areas of deprivation have limited access to mental stimulation and there is a social gradient experienced in the access to and ability to use stimulating resources; including education courses, leisure activities, civic engagement and ongoing, good quality employment.
  • exercise in mid and later life helps to prevent poor mental health, improves cognitive functioning, and can reduce the symptoms and impact of cognitive impairment and dementia, as exercise is associated with increased brain capacity.

(Source: Inequalities in Mental Health, Cognitive Impairment and Dementia among older people, 2016)

A report by the All-Party Parliamentary Group on Dementia (2013) stated that people with dementia from a Black, Asian and Minority Ethnic (BAME) background are less likely to receive a diagnosis or support, and are more likely to have dementia at a younger age. (Source: Dementia does not discriminate, 2013)

Commissioners and providers of health and care services should ensure they fully consider groups with protected characteristics which are at risk of developing and living with dementia when commissioning and providing services. (Source: Prevalence of dementia in population groups by protected characteristics 2015)

The All Party Parliamentary Group report, 'Dementia does not discriminate' (2013) finds there are nearly 25,000 people with dementia from BAME groups and it estimates that this figure is set to rise to 170,000 by 2051. This is a significantly greater leap than the two fold increase expected amongst the rest of the population, as people who moved to the UK between the 1950s and 1970s are reaching their 70s and 80s. Despite the increase, awareness of the condition in BAME groups in low.

Current Activity & Services

Public Health currently provides a range of services to facilitate healthy lifestyles to reduce obesity, excessive alcohol consumption, smoking, high blood pressure and high cholesterol. For further information see the following JSNA Topics:

An agreement to provide a community based Dementia Support Service was awarded by Lincolnshire County Council for a three-year term to the Lincolnshire Partnership Foundation Trust (LPFT) with effect from 1 October 2019. The objective of this service is to support people live as well as possible with dementia by providing help and support as soon as possible. The service is available to people with dementia, as well as their carers and families. The service will be able to support people before they receive a diagnosis as people with a minor cognitive impairment and those who are going through the diagnosis process can also access the service.

The Dementia Support Service can help build resilience, confidence and promote independence as well as supporting carers to continue in their caring role. It can help people plan for the future and assist in advance care planning and decision making.

The Lincolnshire Partnership Foundation Trust (LPFT) offer a seamless pathway between referral by a GP to a memory clinic for diagnosis, onto receiving community based support as the Dementia Support workers will be based at different memory clinics across Lincolnshire.

Lincolnshire County Council reaffirms its commitment to offering a community based dementia support service in the Joint Dementia Strategy 2018-21.

In June 2019 a countywide Admiral Nurse Service launched in Lincolnshire which is jointly commissioned by Dementia UK, Lincolnshire County Council and St Barnabas. Admiral Nurses are qualified nurses with a professional specialism in dementia. They provide specialist dementia support for families when times are challenging or difficult. By adopting a whole family approach Admiral Nurses work alongside people with dementia, families and carers to provide expert guidance and practical solutions that can be difficult to find elsewhere. They also provide education, leadership, development and support to other colleagues and service providers. The upskilling of colleagues allows the expertise of Admiral Nurses to reach beyond the families on their direct caseload.

The service is available to people with dementia and their family carers with complex needs who are registered with a GP practice in the following CCGs:

  • Lincolnshire West CCG
  • Lincolnshire East CCG
  • South West Lincolnshire CCG
  • South Lincolnshire CCG

Family carers of people with dementia will be able to access support it they are out of the county as long as the person with dementia has ordinary residence in Lincolnshire. The main referral pathway will be through health and social care professionals and neighbourhood working.

Neighbourhood working has been developing for a number of years in Lincolnshire. Neighbourhood working involves health, social care, voluntary organisations and charities working together to find solutions to health and wellbeing challenges for local populations in Lincolnshire. For people with Dementia, neighbourhood working will aim to support them to remain safe, well and happy in their own homes by ensuring all relevant organisations work in partnership.

There are many independent activity and support groups across Lincolnshire listed on the Connect to Support Lincolnshire website. The Alzheimer's Society has also developed a range of dementia cafes, activity groups and Singing for the Brain sessions throughout the county that can be found on their website Alzheimer's Society support connect.

The Managed Care Network (MCN), which is managed by LPFT, is an alliance of mental health groups and organisations that provide activities and services to give people support, structure and choice in their lives. At present MCN supports local dementia projects in the Boston, Spalding, Stamford, and Gainsborough localities.

Dementia Friendly Communities (DFCs) bring together national and local organisations to connect, share best practice and take practical action on dementia. The Lincolnshire DFCs and Dementia Action Alliances (DAAs) are well placed to provide local insights and feedback, promote local partnerships and lead local initiatives. To date, Bourne, Grantham, Boston, Skegness, Louth, West Lindsey and Lincoln have been accredited as Dementia Friendly Communities under the national scheme administered by the Alzheimer's Society.

Dementia Friendly Communities aim to create communities around the UK which make daily living activities easier and more accessible to people living with dementia.

The Herbert Protocol was launched in 2017 in Lincolnshire by the Lincolnshire Police. This is a national scheme that encourages people to record vital information about vulnerable people so that the police can access information as quickly as possible if that person goes missing.

The Care Home Dementia Ambassadors Programme was launched in March 2019. The main objective of the Dementia Ambassador is to offer up to ten minutes a week to make a difference to an individual who has been touched by the condition of dementia. This can improve the health and wellbeing of patients, care home residents, carers and families.

The ambassador ensures that the principles of dementia care and good person centred practice are integral in everyday practice in care homes. Ambassadors are trained in various subject related topics in support of excellence in dementia care, including:

  • Delirium and Dementia
  • Oral Care and Dementia
  • Living with Dementia
  • Autism and Learning Disabilities with Dementia
  • Polypharmacy
  • Person Centred Care and Dementia
  • Research and Dementia

There are currently 122 dementia ambassadors in Lincolnshire. Ambassadors are expected to share learning with colleagues and promote staff confidence and competency. A series of webinars linked to Dementia and delivered by Industry experts across health and social care is scheduled to commence in January 2020.

Unmet Needs & Gaps

The dementia diagnosis rate ambition has always been a notional and indicative target intended to improve diagnosis rates and access to post-diagnostic support.

Lincolnshire diagnosis rates recorded at March 2019 are:

  • Lincolnshire East CCG – 66.4%
  • Lincolnshire West CCG – 69.7%
  • South Lincolnshire CCG – 64.2%
  • South West Lincolnshire CCG – 58.6%

The Lincolnshire average in March 2019 was 65.5%. The national average at the same point was 70.2%.
(Source: NHS Digital Recorded Dementia Diagnoses)

These data sets support the Prime Minister's Challenge on Dementia 2020, which aims to improve the national rate of dementia diagnosis. The National Clinical Director for Dementia CCG letters confirms the ambition of diagnosing two-thirds of the estimated number of people with dementia, in all regions. Lincolnshire is currently is not achieving this ambition but has improved year on year.

Local Views & Insights

Engagement
In developing Lincolnshire's Joint Dementia Strategy 2018-21 a stakeholder network was created that included representatives from Lincolnshire County Council, CCGs, ULHT, LPFT and the Alzheimer's Society. As well as this carers and people with dementia were identified by the Alzheimer's society for their input into the strategy.

The engagement activities included workshops, focus groups, meetings, emails and a survey.

Comments from carers and people with dementia were around what helped them live well and these were personal for each individual. Some common themes were around spending time with people in similar situations, regular exercise and knowing more about the condition, diagnosis and prognosis. Areas that people thought needed improving were around joined up working with a more integrated pathway so that people know where to go for help.

Stakeholders were also engaged with throughout the process of commissioning the new Dementia Support Service. Practitioners from health and social care were approached to learn from their experience of working with people with dementia and their families. People with dementia and their carers and families were also approached for their views.

The engagement was conducted in a variety of ways; there was an online and paper survey as well as this commissioning officers attended support groups and activity groups across the county. To engage with practitioners a survey was sent out electronically and various team meetings were attended by the commissioning officers.

The findings from this engagement were that a lot of practitioners and people in the community were unaware of what support was available for them to access. The most important issue people spoke about was having someone to contact, and knowing who to contact at different phases of the dementia journey.

Most individuals fed back that having support pre-diagnosis and therefore support while going through the diagnosis process would be one of the key areas for improvement. Lincolnshire County Council has therefore extended the Dementia Support Service to provide support to individuals with Mild Cognitive Impairment (MCI) and to people when they are initially referred to the memory clinics for assessment.

People with dementia and their carers were also included on the evaluation panel for the procurement of the Dementia Support Service.

Partnerships and Forums
The Dementia Officers Group is a special interest group of commissioners and providers which promotes good practice in dementia care and support. Membership consists of staff from the statutory health and social care agencies as well as representatives from voluntary sector organisations. The group is chaired by an officer with responsibility for commissioning or providing dementia services either for the NHS or local authority.

The Dementia officer group will ensure the objectives of the Joint Health and Wellbeing Strategy are delivered and improve health and wellbeing outcomes identified through their delivery planning. They will report on its progress to the Joint Health and Wellbeing Board (JHWB) and the Sustainability Transformation Partnership (Lincolnshire STP).

Risks of not doing something

The quality of life for a person with dementia often depends on receiving a timely diagnosis. A diagnosis allows someone with dementia, and their carers, to access services and advice to help them manage their condition and receive the service they need.

Dementia costs society an estimated £26 billion a year, more than the costs of cancer, heart disease or stroke. This includes over £4 billion in healthcare costs and over £10 billion in social care costs. Unpaid carers save the UK economy £11 billion per year. The Alzheimer's Society also estimates the total annual cost per person with dementia in different settings as:

  • People in the community with mild dementia - £25,723
  • People in the community with moderate dementia - £42,814
  • People in the community with severe dementia - £55,197
  • People in care homes with dementia - £26,738

(Source: Dementia 2014 – Opportunities for Change).

Research has also estimated that by 2030, dementia will cost companies more than £3 billion, with the number of people leaving employment to care for people with dementia set to rise from 50,000 in 2014 to 83,100 in 2030. Yet if companies increased their employment rate of dementia carers by 2% over the years to 2030 by for example offering more flexible working arrangements, the retention of skilled and experienced staff would deliver a saving of £415 million. (Source: Prime Minister's Challenge on Dementia 2020)

Some common unhealthy behaviours can increase the risk of dementia therefore the earlier in life that healthy lifestyle changes can be made, the greater the likelihood of reducing or delaying the onset of dementia. Estimated savings from preventing or delaying dementia for 1 year for the public sector is £15,050 per person with dementia (Source: NICE - NG16). This can be broken down as:

  • NHS - £5,285
  • Local authorities - £5,537
  • Central government - £4,228

Adult Social Care Activity and Finance Report, England - 2017-18 gives a published spend by Lincolnshire County Council of £4,339,000 on service users with a primary support coding of Memory and Cognition who received a service, or services, from LCC.

Other attributable dementia spending for 2019/20 includes; £300,000 allocated to the Dementia Support Service.

People with dementia, along with the general population, are prone to develop physical conditions as part of living and the aging process. However people with dementia can have more complex needs than those of the general population because of the condition, which can potentially result in difficulty with assessment or treatment prolonging the individual’s recovery period from the physical condition.

People with dementia who are admitted into hospital tend to stay in hospital for longer, they are also more likely to be readmitted and more likely to die than people without dementia that are admitted for the same reason. In some cases individuals with dementia are admitted into hospital for conditions that if they did not have dementia, they would not have been admitted for. National estimates are that 25% of people in hospitals have dementia (Prime Ministers Challenge on Dementia 2020).

What is coming on the horizon?

National developments
The Prime Minister’s Challenge on Dementia 2020 includes ambitions to boost dementia research, train more health and care staff, follow up timely diagnosis with greater access to help, advice and support for people with dementia and their carers, increase public awareness and create more dementia friendly public and private organizations and communities.

The 2018 review on the progress of the commitments set out in The Prime Ministers Challenge on Dementia 2020 includes revised actions needed to reach the aim of England being the best country in the world for dementia care by 2020. The revised actions are around reducing the risk and in some cases preventing dementia, improving health and care delivery for people with dementia, increasing awareness of dementia and including more people in Dementia research.

Local developments
The Lincolnshire Joint Strategy for Dementia 2018-21 has been published setting out the Councils aims and what work we will do to achieve these by 2021.

Lincolnshire is an Integrated Personal Commissioning (IPC) demonstrator site, with dementia being an identified cohort for IPC delivery. IPC is a new voluntary approach to joining up health and social care for people with complex needs. This proposal makes a triple offer to services users, local commissioners and the voluntary sector to bring health and social care spend together at the level of the individual. In Lincolnshire, Neighbourhood Teams are seen as integral to the delivery of IPC.

Join Dementia Research (JDR) and ENRICH continue to be the two main research programmes developed to meet the Prime Minister's Challenge.

Lincolnshire Partnership Foundation Trust (LPFT) has registered as a Join Dementia Research Champion – the first NHS trust in the country to register as a whole organisation. JDR is included within the Lincolnshire Joint Strategy for Dementia and numbers registered are reviewed regularly as part of the countywide action plan. 674 people are currently registered (data-cut 1 September 2019).

LPFT are completing visits to all GPs in the county to support them in becoming JDR Champions. Funding has been secured from the Clinical Research Network East Midlands to complete a mail-out of JDR information to patients from practices who become Champions.

Over 40 Lincolnshire care homes are registered on the ENRICH programme which aims to improve the lives of people in care homes and many care homes are already taking part in research studies. The Trust collaborates with the University of Lincoln to host a Lincolnshire ENRICH Forum. Meetings are held three times a year and aim to offer research opportunities across the county.

What should we be doing next?

Areas requiring further progress include:

  • Improve awareness of how healthy lifestyle choices can reduce personal risk of developing dementia.
  • Develop service specifications for an integrated countywide dementia pathway, taking into account NICE and NCCMH guidance, including Public Health England guidance for people with dementia and learning disabilities.
  • Continue to improve diagnosis rates by implementing a county wide pathway for identification, referral and timely diagnosis. Also, to focus on people with Mild Cognitive Impairment (MCI) as they have an increased risk of developing dementia.
  • All Lincolnshire local authorities to respond to LGA Dementia Friendly Communities guidance.
  • Alzheimer's Society aim to engage with the Lincolnshire Sustainability and Transformation Plan (STP) to ensure it reflects sufficient dementia commitment, and to continue to support and develop activity around local Dementia Action Alliances to encourage greater dementia awareness and to promote community based solutions for people affected by dementia. The aim of the STP is to provide excellent and sustainable health and care services.

 

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