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Topic on a Page - Dementia

Data Sources:

Public Health England (PHE):

Dementia Profile

Dementia Partnerships:

Dementia Prevalence Calculator

Supporting Information:

Lincolnshire Joint Strategy for Dementia

Needs and Evidence Base Review of Dementia Published: September 2014

Dementia Partnerships

Lincolnshire Care Services Directory 2017/18

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

Joseph Rowntree Foundation:

Building dementia friendly communities

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 – 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: Jun-18

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.

Dementia is one of the top five underlying causes of death. In 2016 the leading cause of death for men and women aged 80 years and over was dementia, accounting for 14.3% of male deaths (0.6% increase from 2015) and 22.2% of female deaths (1.0% increase from 2015)

In 2016 in Lincolnshire there were 1,951 deaths in males aged 80 years and over, 264 of these were due to dementia which accounts for 13.5% of all male deaths. The female deaths in the same age range were 2,506 and 555 were due to dementia which accounts for 22.1% of all female deaths. (Source: Nomis: Mortality Statistics)

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 2017 was 6.8% (11,752) which is a 0.1% increase on the 2015 figure. This figure is predicted to increase by 50.56 % by 2030 (11,688 to 17,694) however by 2035 it is predicted to increase by 73.82% (11,688 to 20,427) which is higher than the predicted national increase of 70.14% (702,039 to 1,194,419) for 2035 (Source: POPPI).

Context

National Strategies, Policies & Guidance

Living Well with Dementia – A National Dementia Strategy (Department of Health (DoH), 2009) set out a vision for transforming dementia services with the aim of achieving better awareness of dementia, early diagnosis and high quality treatment at whatever stage of the illness and in whatever setting. In 2010 the DoH published an implementation plan for the strategy – Quality Outcomes for People with Dementia.

It focused on four priority areas:

  • Good quality early diagnosis and intervention for all (updated to timely diagnosis)
  • Improved quality of care in general hospitals
  • Living well with dementia in care homes
  • Reduce use of antipsychotic medication.

NICE Guidance: Dementia: assessment, management and support for people living with dementia and their carers [NG 97] (June 2018) covers diagnosing and managing dementia (including Alzheimer's disease). It aims to improve care by making recommendations on training staff and helping carers to support people living with dementia.

NICE Quality Standard for Dementia Care [QS 1] (June 2010) includes ten statements covering a range of key issues including dementia training for staff, diagnosis, support for carers and end of life care. This quality standard describes what a high-quality dementia service should look like and can be used for benchmarking.

NICE Quality Standard for Dementia: Independence and Wellbeing [QS 30] (April 2013) sets out ten quality statements and it applies to all social care settings and services working with and caring for people with dementia.

Prime Minister's Challenge on Dementia 2020 launched in 2012 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.

The Care Act 2014 requires local authorities to assess carers’ needs for support. The Act introduced a legal right for carers to access support services, in accordance with national eligibility criteria. This package should include a support plan and access to a personal budget. This must be tailored to address the specific needs of carers for people with dementia. Local authorities have a duty to provide information and advice about 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. This is aimed at improving independence and wellbeing of local people and helping 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 Strategy for Dementia 2014-2017 sets out the local plan to improve local services, at all stages of the dementia journey, in order to meet the national quality outcomes for dementia. Adult Care and strategic partners will refresh the Lincolnshire Joint Strategy during 2018 to produce an updated strategic vision which sets the dementia agenda for Lincolnshire until 2020.

The Five Year Sustainability and Transformation Plan Lincolnshire STP was published on the 6th December 2016 and sets out the framework for joint delivery of better quality health and care services.

Adult Care Market Position Statement 2015 -2018 aims to provide key market intelligence to providers to assist with business and investment decisions.

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.

What is the picture in Lincolnshire?

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 2017 11,688 people aged 65 and over were living with dementia in Lincolnshire: this accounts for 6.7 % of the population aged 65 and over or 1.6% of Lincolnshire's entire population (Source: POPPI).

When national prevalence rates are applied to the number of population by age registered with individual GP practices within the Clinical Commissioning Groups (CCG), Lincolnshire East CCG has the highest estimated rate at 1.7% (4,104), which reflects the older age profile of its population. Lincolnshire West CCG has the lowest estimated rates at 1.3% (3,096). South and South West Lincolnshire CCGs have estimated rates of 1.6% (2,533) and 1.5% (1,907) respectively. (Source: NHS England (registration required))

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 0.765% in 2016/17. Both Lincolnshire East CCG and South Lincolnshire CCG (1.0%) have the highest recorded prevalence in the Central Midlands and this is significantly higher than the national average. Lincolnshire West (0.8%) is also significantly higher than the national average, although South West Lincolnshire (0.7%) is of a similar level to England (Source: PHE: Dementia Profile).

When looking at people aged over 65, recorded prevalence of dementia nationally for all was 4.33% in September 2017. Lincolnshire West (4.20%) 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 (3.2%) 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 2017, West Lincolnshire CCG (67.8%) had the highest rate of diagnosis for dementia of all CCGs in Lincolnshire, and South West Lincolnshire CCG had the lowest rate (52.3%). (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 in Lincolnshire for people aged 65+ (3,095 per 100,000 population) is significantly lower than the national rate (3,482 per 100,000 population) for 2016/17. This equates to 5,122 emergency admissions. Lincolnshire East CCG had the highest rate at 3,233 per 100,000 population and South West Lincolnshire CCG the lowest at 2,519 per 100,000 population. (Source: Public Health England Profiles)

Mortality
In 2016 there were 1,378 (845 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 868 per 100,000 population. All Lincolnshire CCGs had similar rates of mortality to the national average, with Lincolnshire West having the highest mortality rate of 888 per 100,000 population and South West Lincolnshire had the lowest mortality rate of 779 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 20,427 in 2035; a 74.77% increase compared to 2017 figures (Source: POPPI). At the same time the rates of dementia prevalence are also projected to increase to 8.4% of people aged 65 years and over or 2.5% of the entire population of Lincolnshire. Lincoln, Boston 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 2,185 to 4,164 cases (a 90.6% 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 nearly 70 thousand between 2017 and 2035, a 40.2% increase. At the same time the entire population is expected to increase by 10.2%.
  • People aged 65 and over were estimated to account for 23.3% of the Lincolnshire population in 2017 ; by 2035 the proportion of population aged 65 and older is projected to increase to 29.6%
  • In Lincolnshire, the number of people aged 90 and over is projected to more than double by 2035 (from estimated 7,900 in 2017 to 19,000 in 2035). Two out of 100 people are projected to be aged 90 and over in 2030, compared to 1 in 100 in 2015.

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 been consistently recorded significantly higher prevalence than the national average. When looking at the population of people aged 65+ Lincolnshire East CCG and Lincolnshire West CCG have both seen an increase since recordings began in September 2015, whereas South Lincolnshire CCG and South West Lincolnshire have been 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 43.2% since 2011. This has mirrored the national picture which has increased by 37.5% (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 2017, 61% 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 2018 is estimated at 207 (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.
  • Physical 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) states 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: Public Health England 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 Family Support Service (DFSS) was awarded by Lincolnshire County Council for a three- year term to the Alzheimer's Society with effect from 1 October 2015 and has now been extended by one year to October 2019. The objective of this service is to offer information and support to people with dementia, their carers and family members, and to help them navigate the complexities of the care system. The Lincolnshire Joint Strategy for Dementia 2014-2017 recognised the need for a consistent source of support to be made available to all Lincolnshire families affected by dementia. The DFSS was developed to address this need.

In its first two years of operation DFSS responded to over 3,000 referrals.

From October 2016 the DFSS has extended its scope to include the three acute care hospitals in Lincolnshire and Lincolnshire patients in Peterborough City Hospital. DFSS staff work with clinical teams using their specialist knowledge to support patient pathways and help achieve positive outcomes. Their role also looks at ways to help prevent readmission, consider any gaps in support at home and promote collaboration with community services as part of discharge planning. In addition, the DFSS offers hospital teams Dementia Friends information sessions designed to show how anyone can make a difference by being more dementia aware.

Lincolnshire County Council will ensure continuity by recommissioning a community based dementia support service when the current agreement expires.
(See: Dementia Family Support Service)

The Alzheimer's Society has developed a range of dementia cafes, activity groups and Singing for the Brain sessions throughout the county, as have a number of independent groups listed in the Lincolnshire Care Services Directory.
(Source: Alzheimer's Society support connect)

The Dementia Support Network (DSN) was set up in 2015 by CCGs and LCC to provide funding for community groups to develop local, innovative services to support families affected by dementia. The network was managed by Lincolnshire Partnership NHS Foundation Trust (LPFT) which made a series of awards in 2015 – 2016 which supported 32 projects across the county.

In 2016 the DSN was absorbed by the Managed Care Network (MCN), also managed by LPFT. The MCN 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.

The Dementia Action Alliance (DAA) is now represented by local DAAs in all local authority districts of Lincolnshire. The DAA brings together national and local organisations to connect, share best practice and take practical action on dementia. The Lincolnshire DAAs are well placed to provide local insights and feedback, promote local partnerships and lead local initiatives. To date, Bourne, Grantham, Boston, Skegness 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.

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 2018 are:

  • Lincolnshire East CCG – 65.0%
  • Lincolnshire West CCG – 68.0%
  • South Lincolnshire CCG – 52.1%
  • South West Lincolnshire CCG – 61.64%

The Lincolnshire average in March 2018 was 61.6%. The national average at the same point was 66.7%.
(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.

The Dementia Support Network (DSN) formerly provided funding specific to dementia projects and groups. The DSN ceased in December 2016. Some support to dementia community groups is now provided by the Mental Health Promotion Fund through the Managed Care Network.

Local Views & Insights

Engagement
In developing the Lincolnshire Joint Strategy for Dementia 2014-2017, engagement with patient and carer groups had already started with Lincolnshire Carers Partnership having highlighted a number of perceived gaps in the existing dementia pathway. Formal public consultation through focus groups, meetings and questionnaires was undertaken between May and July 2013. (Source: Lincolnshire dementia consultation report 2014)

The consultation format provided scope for the people responding to make comments and suggestions about their own experiences, and also present ideas for improvement to care and support for people with dementia, their families, and carers in Lincolnshire. An online questionnaire formed the main basis of the consultation and was drafted with assistance from a range of stakeholder and user groups throughout Lincolnshire, and was led by Public Health.

Regular information about the consultation was cascaded to all Lincolnshire County Council staff. The Council also promoted information about the consultation to the general public, and regular updates and reminders were also sent out via the Lincolnshire County Council twitter account throughout the duration of the consultation period. Hard copies of the consultation questionnaire were also made available on demand and at various events held in Lincolnshire, including the Lincolnshire Show.

Details of the strategy consultation were added to the Lincolnshire County Council corporate consultation calendar, which the public can view to see what consultations are taking place and what policies and developments they can influence.

Facilitated groups were also set up to gather consensus views on the consultation.

The key themes drawn from the consultation that influenced the strategy are:

  1. The need for services to be better integrated, both between health and social care and the third sector in general, as well as between community and hospital based services
  2. Families feel unsupported after a diagnosis and find it very difficult to get the information, advice and support to manage living with dementia that they need
  3. People who self-fund their care particularly need information and financial advice.
  4. Carers feel they are not identified and their needs are not adequately recognised. Services are not always available when needed or delivered in the most acceptable way
  5. Access to respite care suitable for people with dementia is difficult in many localities.

This work was directed by a Dementia Core Group consisting of senior representatives of a range of statutory and non-statutory agencies supported by the Dementia Officers Group, which includes membership from all areas of health and social care.

The key themes reflected in the consultation also correspond broadly with national survey findings especially the need to support carers. (See Dementia Report 2015)

In 2017 a survey by Lincolnshire County Council received responses from 127 people who identified themselves as caring for a person with dementia. Although statistically insignificant, the responses tended to echo the key themes of the 2014 report. Of the 127 responses, 29% of carers said they received no support services, although 50% reported they had accessed information and advice services. Although 44% of dementia carers said they felt they had some encouragement and support in their caring role, 24% reported they had no encouragement or support.

Partnerships and Forums
The Dementia Officers Group is an established special interest group of commissioners and providers which promotes good practice in dementia care and support, and to press for progress in developing high quality services for people in Lincolnshire affected by dementia. This objective is achieved by exchanging information, guidance, advice, examples of good practice, and by co-ordinating activity. Membership of the group is open to individuals in any sector, working in the field of health or social care in Lincolnshire, who have a professional interest in dementia, and who support the aims of the group. The group is chaired by a senior officer with responsibility for commissioning or providing dementia services either for the NHS or local authority.

The work of the group has been limited by the lack of any formal status in relation to any of the statutory agencies. The group has pointed out the commitment in the Lincolnshire Joint Strategy for Dementia 2014-2017 to set up a Dementia Programme Board to be responsible for strategy implementation and governance.

A refreshed version of The Lincolnshire Joint Strategy for Dementia, scheduled for publication in July 2018, recommends reconstituting the Dementia Officers Group as a sub-group of the Lincolnshire Health and Wellbeing Board with responsibility for monitoring implementation of the Joint Strategy.

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

Analysis of the Short and Long Term Care (SALT) returns for 2016-17; gives a published spend by Lincolnshire County Council of £4,041,000 on service users with a primary support coding of Memory and Cognition who received a service, or services, from LCC at any point during the financial year.

Other attributable dementia spending for 2016/17 includes; £300,000 allocated to the Dementia Family 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.

If the complex needs of such individuals remain unaddressed, then a likely outcome is that emergency hospital care is required. (Source: Reasons why people with dementia are admitted to a general hospital in an emergency. Public Health England 2015). 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.

What is coming on the horizon?

National developments
During his tenure as Prime Minister, in 2012 David Cameron launched the Government’s five year vision for dementia known as The Prime Minister’s Challenge on Dementia. This statement was updated latterly as the Prime Minister's Challenge on Dementia 2020

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.

In 2016, in a letter to the Alzheimer's Society CEO Jeremy Hughes, Theresa May, confirmed her commitment to dementia as part of her role as current Prime Minister.

Local developments
A refreshed Lincolnshire strategy (2017- 2020) will be published in 2018 based around a review of progress on the existing strategy actions and proposals for a way forward to 2020.

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. The Alzheimer's Society is working with the IPC Board nationally, including NHS England, to support local sites.

In Lincolnshire, Neighbourhood Teams are seen as integral to the delivery of IPC. There is ongoing representation from the DFSS at the IPC Neighbourhood Team Working Group and the Mental Health IPC working Group. A key challenge to the project remains the extent to which voluntary and statutory agencies will be equally able to develop the necessary levels of integration.

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

LPFT has registered as a Join Dementia Research Champion – the first NHS trust in the country to register as a whole organisation.

Around 30 Lincolnshire care homes are registered on the ENRICH programme which aims to improve the lives of people in care homes. LPFT host regular ENRICH forum events and produce an ENRICH electronic newsletter. Many care homes are already taking part in research studies.

What should we be doing next?

Areas requiring further progress include:

  • Effective governance arrangements and oversight for dementia strategy implementation.
  • The refreshed Lincolnshire Joint Strategy for Dementia should be aligned to national policy as articulated in the Prime Minister's Challenge on Dementia 2020. Aspects particular to Lincolnshire will include ambitions to meet the national diagnosis rate targets on a consistent basis.
  • All Lincolnshire local authorities to respond to LGA Dementia Friendly Communities guidance.
  • The Dementia Family Support Service (DFSS) is due to be recommissioned from October 2019 by LCC in partnership with CCGs. This key service for people with dementia and their families aims to deliver support in the most effective manner possible, and that any scope for improvement is acted upon.
  • 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.

 

If you need to contact us about this topic, please email JSNA@lincolnshire.gov.uk

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