Improving general hospital care for

people with dementia:

why, how and with whom?

Nye Harries
DH SW
 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

 220 of these will have a mental health disorder
 of which 102 will have dementia
(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
 Who care wins on outcomes

Research studies cited in the RCP report highlight a

range of important outcome measures for this group:

increased mortality
longer lengths of hospital stay
greater rate of institutionalisation in a care home
following their acute stay
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!

 Financial & performance impact

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

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
 Problems...
Poor recognition and care, with higher risks
in hospital of :

– Malnutrition & dehydration

– Inadequate pain relief
– Over sedation
– Poor end of life care
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

Breakdown of RUH Inpatient Bed
Days by age cohort, 2008 / 09

Age 0-15
6%

Age 80+ Age 16-64

38% 28%

Age 65-79
28%
 RUH inpatient bed days by age for
Surgery/Ortho/MAU/Gen Med: 2008/09

80+
Number
of 65-79
Bed 16-64
Days
0-15

General Orthopaedics A&E General medicine

Surgery
 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)

Who are your potential allies?

Director of Nursing & Chief Executive

LINKs
Council Overview & Scrutiny
Committee
Trust Non-Executives
Alzheimer's Society
Commissioners
www.southwestdementiapartnership.org.uk
 .

Thank you

nye.harries@dh.gsi.gov.uk