A new approach for tackling dementia was rolled out across the capital today with the publication of guidelines to improve the quality of life for people with dementia and their carers.
Around 64,600 people in London have dementia, including 1,560 people under the age of 65. This number is forecast to rise by 14 per cent by 2021.
The Dementia services guide, published by Healthcare for London, offers advice to the NHS and local authorities on how to get the right services in place for people with dementia and provides practical information on the checks that should be undertaken at every stage – from the GP surgery, through to ambulance and hospital care and care in the community.
The guidelines aim to improve services for people with dementia in London through supporting people to live at home for longer and preventing unnecessary hospital stays.
Older people with dementia occupy 20 per cent of acute hospital beds across England. Around 70 per cent of these may be medically fit to be discharged. Better community care for people with dementia would help prevent unnecessary hospital stays.
The guidelines also aim to ensure people are diagnosed earlier and to improve dementia training for health professionals.
Only 37 per cent of the population estimated to have dementia in London are recorded on primary care disease registers and the London guidelines aim to support GPs to increase this so that care can be provided earlier.
Just 31 per cent of the capital’s GPs believe they have received sufficient basic and post-qualification training to diagnose and manage dementia. The Dementia Services Guide highlights the core skills required by the workforce and identifies the need for improved training.
The London guide builds on the Government’s national five year plan Living well with dementia: A National Dementia Strategy (2009).
Dementia accounts for the biggest proportion of mental health expenditure in the UK costing around £17 billion per year – more than expenditure on stroke, cancer and cardiovascular disease combined.
The new guidelines were developed in partnership with carers, service commissioners, clinicians and third sector stakeholders from across London. The guidelines provide one of the most comprehensive frameworks for tackling dementia in England.
The guidelines, which have been approved for implementation by London’s health and social care commissioners, recommend:
Dr Geraldine Strathdee, Consultant Psychiatrist and Co-Clinical Director for the Healthcare for London mental health project, said: “These guidelines signal a new approach to care in the capital with greater communication between acute physical care, mental health care and social care services.
“We have produced these practical guidelines so dementia can be identified earlier in order that people with dementia, their carers and families, get the right support. We want to prevent people with dementia having to go to or stay in hospital unnecessarily, extend their quality time at home and improve the quality of care they receive.
“The majority of people with dementia in London are cared for at home and are not known to health and social services. This means they may not be getting the care and support they need.
“Wherever you live in London you should be able to access a high quality service and these guidelines, based on the best research and clinical evidence and the real daily experience of users and carers, will help to address the current inequalities in local services.”
Joan Mager, Chief Executive of NHS Richmond and senior NHS lead for the project, said: “People with dementia deserve better quality care and their families need more support. Too often, the first time a diagnosis of dementia is made is when someone is admitted to hospital as an emergency. The progress of dementia can be slowed if help is received earlier and this can also improve their quality of life and those close to them.
“The prospect of dealing with a higher number of people with dementia in future creates special demands for carers, social services and the NHS. This guide goes a long way to identifying the needs and requirements presented by an ageing population in the capital, and could provide a blueprint for services nationwide.
“I now look forward to working with colleagues across health and social care in transforming these guidelines into reality.”
The guidelines highlight a number of examples of good practice in London which include the Croydon memory service which has doubled the number of dementia assessments and helped overcome the stigma attached to a diagnosis of dementia. Assessments at the service are carried out with both the patient and unpaid carer in their home, with the aim of maintaining a person’s independence and quality of life.
Another example is NHS Lambeth which is commissioning a joint physical health/cognitive clinic at St Thomas’ Hospital while NHS Newham has commissioned a diagnostic memory clinic featuring early intervention, assessment and follow-up care co-ordination.
Alzheimers Society London Area Manager Maggie Owolade said: “The Alzheimer’s Society is delighted to support the publication of this guide which shows that the health and social care needs of people with dementia in London are being taken seriously. One in three people over 65 die with dementia and in the next 10 years dementia will affect increasing numbers of families in the capital.
“In London the Alzheimer’s Society supports people with dementia and their carers through our dementia information services, peer support networks, day services and dementia cafes. We look forward to working with services in London to offer increasing levels of support to help people with dementia and their families get on with living their lives.”
Carer case study
Carer Hasmukh Shah was a member of the team which helped in the development and drafting of the service guide.
He gave up his job as an accountant in financial services in the City six years ago to look after his father who was living with dementia and who subsequently died in 2007. Now he looks after his mum 82, who also has dementia.
Hasmukh, 54, from Ilford said: “I think the guide will help raise awareness of dementia and help ensure carers, families and doctors as well as other involved professionals are all talking. This way health and social care come together instead of people feeling they have got to sort things out on their own which is what tends to happen now.
“The guide will not only benefit people with dementia but carers themselves because commissioners of services in future will more easily recognise that people living with dementia have special needs.
“Clinicians and carers need to listen to the needs of the person with dementia and what they like and want. Care really needs to be more personalised.
“I think the guide’s emphasis on early intervention makes so much sense too. Keeping the minds of people with dementia highly stimulated is so important.
“When people start to repeat things without realising, get lost or get confused easily, these are the points when families, loved ones or carers need to intervene and take stock.
“Mental exercise, keeping engaged with board games or even, as with my mother, enjoying a game of Sudoku can make such a difference to someone’s sense of well-being and also gives them a sense of achievement and engagement.
“Other activities such as jigsaw puzzles, ball games, card games, painting, colouring, reading, writing, music, needlework, crochet, knitting, craftwork, prayers, meditation, walks in the park, cooking are all beneficial stimulation too.”
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