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NHS EAST SUSSEX CLINICAL COMMISSIONING GROUP

COMMISSIONING INTENTIONS PLAN

DEMENTIA SERVICES

2016-2018

EXECUTIVE SUMMARY

The NHS utilizes different approaches to deliver quality care and support for the UK population. The CCGs or commission groups support this agenda by working directly with patients in boroughs. In East Sussex, our CCG is tasked with working with the community and the health department towards the management of Alzheimer’s disease. The Alzheimer’s disease is a type of dementia which affects adults especially at old age of 65 years and over causing poor functioning of the brain. Eventually, this elderly person is forced to depend on the help of caregivers to deliver on their mandate, and the help of assistive tools to be safe and efficient within their environments. In extreme cases, they also need financial support since at their age, most of these populations ae not working and their pensions are inadequate to meet their growing needs.

At East Sussex, the population of older people (65+) is highest than any other age group and expected to grow in future. East Sussex is a preferred retirement location due to its peaceful and healthy environment. This is causing many elderly persons to migrate to the location. Ostensibly, dementia prevalence in the region continues to increase compared to the UK’s national average and the elderly population is also increasingly dependent on the government. Our CCG recognizes this growing demand for support and thereby seeks to ensure better aging for these elderly people through implementation of specific initiatives that would ensure better care. Since the CCG aims at working for two years prior to seeking an extension for the quality work, the overall initiatives will be divided into: adult social care, health and wellbeing of our older people, and mental health and dementia. The main objective will be to understand the current challenges, control the issues then provide alternatives together with the community.

CONTENTS

Executive Summary

Introduction

Who we are

Focusing on dementia

Aging Well – Our vision for dementia services in East Sussex

Our mission

Our Partners

Financing Services

Our Older Population

The Health Issues of our Older Population

Our Priorities for Dementia Services

Looking to the Future

References

Introduction

Who we are

We are NHS East Sussex Clinical Commissioning Group (CCG). We are responsible for providing high quality effective health services for the whole of the population of East Sussex whether they are based in hospitals settings or the community.  Our core activities are in the following areas of care and we are responsible to both our local NHS Commissioning Board and to NHS England for ensuring that our services are accessible, appropriate and both outcome effective and financially efficient

Our Core Responsibilities:

• Planned care and hospital care
• Urgent and emergency care
• Rehabilitation care
• Community health services
• Mental health and learning disability services

Focusing on dementia

The UK National Health Service allows for the formation of commission groups as an initiative towards promoting social care in different parts of the country. As a member of the East Sussex NHS CCG, we believe that committing to universal care provides an opportunity to ensure and guarantee universal health. We have focused on different groups of people within the borough for years and therefore for this year, we would like to focus on the elderly in the region with the Alzheimer’s disease, a type of Dementia. Alzheimer’s disease is a mental condition characterized by the deterioration of the brain functions. One of the most common effect of the poorly functioning brain is the inability to memorize and this condition affects people right from the middle age to the elderly.

It is however notable that in the UK, Alzheimer’s disease affects the elderly at about 65 years and over. According to the NHS Choices (2017), (a website founded by the UK government department of National Health Services to provide health services and products conveniently to UK residents), there are currently 850,000 people suffering from the Alzheimer’s disease in the UK. This population is projected to increase even as the baby boomer population (people born between 1946 and 1964) continues to retire at a relatively high rate. Ostensibly, demand for care facilities and personnel is expected to increase in the UK.

Although there are renowned Alzheimer’s support organizations like the Alzheimer’s Society that assist the affected persons and their relatives to remain manage the condition among their families, the demand for more care facilities remains relatively high especially in regions like East Susses since it is a popular retirement destination for the elderly in the UK. According to the UK’s Office for National Statistics, the highest population of the elderly in the UK prefer leaving in the coastal cities and towns (like East Sussex) and thus these cities are widely populated by the elderly (Collinson, 2015). Although there are numerous reasons related to this settlement pattern, one common argument is that coastal environments support the health and well-being of the elderly who are mainly faced with lifestyle diseases (City Metric, 2015). Consequently, it is important to commission Alzheimer’s social care programs in the region since the elderly Alzheimer’s patients will increase demand for access to care for the population. The CCG consisting for six people each will also assist the NHS department in the UK in managing the rising number of Alzheimer patients in the UK and promote the overall wellbeing of the population.

Aging Well – Our vision for dementia services in East Sussex

The overall vision of the East Sussex CCG is to: Ensure healthy aging free of Dementia and the Alzheimer’s disease. Old age (65 years and over) has highly been associated with dementia and other lifestyle diseases, and this has greatly caused people in different societies to fear the possible conditions associated with aging. Although the cause of Alzheimer’s disease is not clearly known, it is evident that elderly people are among the most vulnerable population. The commissioning will seek to restore hope among the elderly and those who are aging about their future. It will also seek to increase access to care facilities and services for the elderly leading to better outcomes in elderly care in the region.

Our mission

To deliver quality, affordable and safe care for proper aging and guarantee longer life with dementia through focusing on Alzheimer’s patients. This mission reiterates the commitment to quality through services and products offered, affordability for increased access to care, safety for guaranteed care and facilities, and focus on the elderly in East Sussex who prefer the borough as a retirement destination for its clean, peaceful and safe environment.

The mission and vision will be guided by the following key values:

• Our patients will always be our priority
• Maximize resources and facilities to ensure better health
• Transparency and integrity will be mandatory
• Safety and professionalism will always be applied in every task
• Adopt innovative products and services
• Customers should always be respected and appreciated
• Prioritize innovations while appreciating local initiatives
• NHS and other industrial based regulations will be upheld as a mandate to ensure safe delivery of services and continued better health

Our Partners

            The CCG understands that there are already existing initiatives by different people and organizations towards the management of dementia and most important Alzheimer’s in the region. This planned initiative will seek, to not only support the initiatives but to also increase the outcomes already being witnessed in the region. Working together with local partners will therefore be a key strategy towards ensuring this goal is met. Our key partners throughout the life of the CCG will include:

• Local elderly people (with or without dementia)
• Dementia based hospitals and organizations
• Community Health workers already in the area
• Social care homes and rehabilitation centers
• NHS and other healthcare officials in the community

Financing Services

Each year the Department of Health makes an assessment of the amount of funding our CCG needs to deliver healthcare in East Sussex.  For the period covering this plan – 2016-2018, we have received £877,986,000.  The pie-chart below sets out how we have decided to allocates this funding across our core responsibilities.

Our Older Population

Fig 1: An illustration of the Adult population and care needs within East Sussex by the Public Health Profiles

            According to this table, the population of the elderly in East Sussex, aged between 64 and 75 years, 75 and 84 years and those over 85 years of age are 12.5%, 7.9% and 3.86% respectively. Comparatively, East Sussex has had a relatively higher percentage of elderly persons compared to England in general. According to the Public Health profiles, the population of elderly during the same period was: 9.3% for those between 64 and 75 years of age, 5.3% for those between 75 and 84 years of age and 2.30% for those at 85 years and over. East Sussex has a generally higher population of elderly persons compared to England as a country.

Fig. 2: Projected Population Growth in East Sussex 2010-2026

Focus on East Sussex Annual Monitor (2012)

            According to the East Sussex Annual Monitor, it is clear that the population of persons aged between 55 to 59 years of age and those over 90 years of age is likely to increase more than all other age groups by 2026. In fact, the statistics illustrate that the population of the other age groups is likely to reduce during the stated period (2010 to 2026). East Sussex will therefore be predominantly inhabited by the elderly and aging populations. Old age is widely associated with different disease including dementia which refers to a mental disorder associated with impaired judgement and reasoning, poor memory and personality issues (NHS, 2017). Alzheimer’s disease is a type of dementia popular among the elderly since its causes can be associated with the different issues throughout one’s development into old age. This commissioning group is therefore relevant and critical to the well-being of these elderly populations towards ensuring that they age gracefully.

            Comparatively, the UK has a relatively high population of the elderly, aged 65 years and over. These populations, just like in East Sussex, prefer coastal towns and districts. Nonetheless, as illustrated by the Public Health Profiles, East Sussex borough has a higher population of elderly people than the UK’s national average. The 2009/2010 report on the health of the elderly in England by the NHS also recorded that despite the high population of elderly people in East Sussex, these elderly people in East Sussex have higher life expectancy compared to the overall elderly population in England. This illustrates that the elderly in the East Sussex region are likely to live longer than those in the rest of the UK. The CCG is therefore keen to support these statistics by tackling dementia issues especially regarding the Alzheimer’s disease. By improving the health of the elderly dementia patients, they are able to lead more productive lives leading to longer livelihoods.

One illustrator of better outcomes is the increase in the independence of these elderly people in the region. It is clear that elderly patients with Alzheimer’s and other types of dementia’s require constant support in mobility, purchase of necessities, use of medication and survival within different environments. By 2010, the dependency ratio of the elderly in East Sussex was 0.38%, which was found to be 0.13% higher than the UK’s national overage. This illustrates the increasing need to focus on the elderly in the East Sussex borough towards ensuring their well-being can be improved for better independence either in mobility, access to care or even in their financial well-being.

The Health Issues of our Older Population

In this section, we focus further on the health issues affecting the older population in East Sussex. Three figures that narrow down on the population are used:

Fig 1: An illustration of the Adult population and care needs within East Sussex by the Public Health Profiles.

            Notably, dementia prevalence in East Sussex has increased to 1.09% which makes it higher than the national average of 0.73%. This can be attributed to the high population of elderly persons living or migrating to the area. Other health challenges in East Sussex that remain relatively higher compared to the national averages are learning disabilities, deaf and persons with hearing disabilities, blind and partial blindness, and a high population of elderly depending on government and community support. The elderly population in East Sussex is therefore in great demand for proper and quality care towards ensuring that they age gracefully.

            Our focus as a CCG is to ensure elderly people in East Sussex are able to remain healthy and properly assisted regardless of their conditions. We specifically focus on dementia since it has remained one of the most prevalent health challenges within the East Sussex population and among the older population. Accordingly, we narrowed the statistics to the population of elderly persons with dementia and the findings illustrated that dementia continues to increase within the population.

Fig 2: Dementia prevalence among elderly in East Sussex

Fig 3: Dementia and Alzheimer’s prevalence among the elderly in East Sussex compared to the national statistics as noted by the Public Health Profile.

Other statistics as illustrated in Figure 2, show that:

• The ration of impatient service use to recorded diagnoses for dementia patients in East Sussex is lower than the national average.
• Short Stay emergency admissions due to dementia for people over 65 years of age is highest in East Sussex compare to the South East Region and the country in general.
• Inpatient admissions due to Alzheimer’s is also generally high but lower than the regional and national averages.

Our Priorities for Dementia Services

Assessment of Needs for Effective Resources Distribution

            As a social care program, it is critical to ensure that the services offered are adequately able to meet the population’s needs. This will also contribute to the increased uptake of the programs and set activities. For this reason, this CCG will not view the elderly in East Essex as being financially equal but will seek to engage with smaller individual groups or even persons within the communities to understand their specific needs in receiving dementia related care. In this regard, an enquiry will be conducted at the initial stage of the implementation phase where the targeted population will be provided with an opportunity to state their healthcare needs. Some of the questions that would be considered as most critical or most relevant include:

• What mental illness or dementia condition have you been diagnosed with?
• In case you have not been able to receive any diagnosis regarding your mental health yet you feel you deserve such a diagnosis, what are some of the reasons you feel have contributed to this?
• Are you aware of the care facilities within East Essex that you can visit to test whether you have Alzheimer’s?
• Are financial challenges an inhibitor to your ability to receive treatment or personal assistant?
• Do you need a personal assistant but are limited by your budget?
• Do you have any other drug, alcohol or related addictions?
• Do you face other disabilities like hearing and sight challenges?
• Can you live independently or what other assistive tools will be required within your environment as guided by your physician?
• How best do you feel the CCG can support you?

The findings of this initial research will influence the following strategies that seek to ensure better implementation of the projects. Follow up researches will also be conducted on a monthly basis to even determine that the groups are within their operational mandates. Similarly, care providers in institutions of care or at home will also be engaged towards ensuring that they contribute and even feel part of the improvements. The questions to be asked will include:

• What care activities do you provide to the elderly person with Alzheimer’s under your care?
• How do your responsibilities affect your personal life?
• Do you receive any support in your life regarding the responsibilities you have and what support do you expect from your organization and NHS organs in the borough?
• Does the income you receive sustain your other responsibilities or what suggestions could you provide regarding the salary you receive?

Adult Social Care

          In our East Sussex CCG we understand that social care has to do with the ability to promote the well-being of adults through better access to care and sustaining their ability to meet these goals. Based on the listed statistics regarding the health of older people in the borough, the following measures are considered critical for the improvement and wellbeing of the population:

• First, the continuous assessment of the needs of the population. Although we have already established the dementia prevalence and the extent to which Alzheimer’s disease has spread in the population, the group will continuously monitor and asses these two conditions continuously. Through interaction with the community, the condition will be assessed on a routine basis to even understand whether the efforts of the CCG are effective within the population.
• The CCG was also formed to work with the community and this means that we are tasked to work with both service providers and users within the East Sussex region. In this regard, we aim at coordinating on the health programs through advising care givers and those in need of care, coordinating the provision of care and ensuring the realization of the care goals through informing the population on the following:
  • Care homes and how families can ensure their elderly are comfortable within these facilities
  • Access to funding by the elderly and their caregivers, and how they can generate money for the future needs.
  • House and hospital organization towards ensuring safety and improved care for future independence of the elderly.
  • Emergency phone numbers to contact and other important contacts that can be used to reach local hospitals, care providers and care homes.
• The CCG will also focus on providing emotional support through continuous counselling and speaking with the elderly within East Sussex, whether they are based in care homes or at home. Bi-weekly counselling will be conducted and in the process, specific supplies issued. Supplies that could be issued include: assistive tools and technologies, hospital equipment among others as noted through the research and bi-weekly engagements.
• The CCG will also seek to ensure that the adults with most vulnerable conditions or the worst level of Alzheimer’s receive preferential care. This will involve visiting inpatients in dementia centers and based on the physicians’ assessments identify the needs of the patients and ensure they are supported. This process will aim at reducing mortality rates due to dementia at the moment and protect the patients in future.
• There are two types of care options available to the elderly with Alzheimer’s: residential/nursing care and personal care. We will focus on reaching each patient in either of the care facilities or preferred care approach. In the sessions, we will not only seek to engage them for their needs but also interact through meals, entertainment and other social activities they may prefer. This will aim at reminding them of the importance of a fulfilled life.
• The carers in these facilities or in-charge of the Alzheimer’s patients also face numerous challenges in the implementation of their goals. The CCG will constantly engage them in different ways especially in understanding their challenges and finding possible solutions. Just like their patients, we will seek to document their problems and advise or counsel them towards ensuring they effectively accomplish their tasks.

Older People’s Health and Wellbeing

            Our older population is rapidly increasing and their wellbeing remains at stake considering the high and rising prevalence of dementia within the population. An increase in dementia implies an increase in the related conditions like Alzheimer’s, increase in inpatient admissions for the conditions, increase in emergencies due to Dementia, demand for care homes and carers and even an increase in support from the UK government. Notable, the support ratio for these elderly people in East Sussex was at 10,997 per every 100,000 people. This was higher than the regional and national averages. To promote the health and wellbeing of the population, some of the initiatives have already been mentioned in the adult social care initiatives. Other initiatives include:

• We will review the current policies and care structures set up in order to assist elderly persons in East Sussex as set by the NHS and the borough’s government then conduct a complete overhaul and re-structuring of the policies. Although this may take some time due to the formalities of policy making and restructuring, we will aim at engaging all stakeholders in the region and produce a better structure. With the increasing prevalence of dementia and relatively high number of emergencies, current policies and structure are arguable ineffective.
• The CCG will also set up a primary care facility in a central location that will be accessible in any day of the week so that the elderly who would be inaccessible through community initiatives could visit the center for further assistance.
• Continuous teaching and learning is considered critical for the population and care-givers. To ensure this, we will seek the help of Community Education Providers Network (CEPN). The CEPN will be guided on how to the CCG expects to manage the increasing Alzheimer’s prevalence and tasked with the provision of a learning program to be implemented through partnership with the CCG. These learning sessions will also seek volunteers to work with the CCG either in distribution, training or care-giving. Paid workers will also be sought through these sessions as long as they are trained.

Mental Health Dementia and Neurology

            Dementia is a critical health challenge in East Sussex. The aforementioned initiatives aim at ensuring overall improvement of the health of elderly people with the condition. The focus on these people is guided by the increased vulnerability of the population and the increased need for support due to their inability to support themselves. The main challenges inhibiting the management of dementia and other mental health issues can therefore be summarized as follows:

• Increased dependency on government among the elderly with dementia.
• Inadequate community initiatives to support the dementia patients.
• Lack of effective policies and structures to ensure the protection of the population and wellbeing of the dementia patients.
• Inability to utilize a long-term view in the treatment and management of dementia and related mental health conditions.

The possible solutions as explained and will be implemented by the CCG include:

• Promoting independence through the empowering and supporting the elderly. Through education, they will be informed on how to continue managing the condition; through provision of assistive devices, they will increase their own safety and support their wellbeing; finally, through community initiatives, they are able to lead fulfilled lives as they get to feel appreciated and part of the community.
• We will introduce primary care mobile centers that will always be stationed at a central location in every district to offer preventive care and even offer related care services like training, information and advice or counselling as demanded by the patient.
• The dementia policies in the location will be overhauled and re-aligned to the national dementia policies but based on the emerging challenges and future dynamics within the borough.
• Provide assistive tools based on improved technologies and even seek partnerships with biotech companies in developing appropriate technologies for the dementia patients.
• Increase community participation especially through volunteering for corporative improvement of the wellbeing of the population.
• Engage families in the care for the Alzheimer’s since most of the elderly people in East Sussex live in solitude. This increases demand for emergency services especially if the Alzheimer’s patients are unaware of what it takes to live independently. Engaging families ensures shared responsibility in the wellbeing of the elderly family members.

Looking to the Future

Our CCG seeks to deliver on its mandate within the two-year period projected. This implies that any current strategies will have to meet current and future expectations of the NHS regarding health and wellbeing of the East Sussex population. Ostensibly, we focus on delivering our mandate through adult social care, health and wellbeing of our older people and mental health and dementia. We therefore seek to control the extent to which Alzheimer’s has spread in the population then manage future cases since the elderly population in East Sussex will continue to grow in future. In this regard, the CCG will first seek to restructure the set policies in the management of Dementia and Alzheimer’s. These policies will then be reviewed every 6 months to ensure that they are actually able to meet the recommended standards. Furthermore, based on the routine interaction with the patients, community and health practitioners, the continuous research done on a monthly basis regarding the needs of the groups will continue to be done and used for analyses. The analyses will seek to determine:

• Whether the current initiatives are meeting current objectives
• How effective are the initiatives?
• Whether the dementia prevalence is effective.
• Whether the community is being more receptive to assisting the dementia patients.
• Whether there are any inefficiencies in the service delivery by the CCG.
• Whether the initiatives can be adjusted to meet future goals.
• What new initiatives can be introduced to meet the needs of the patients better?

By the end of the two-year period, the CCG will seek to conduct an overall review that would be presented to the NHS illustrating the impact of our efforts. To ensure this is effectively accomplished, an internal review will be done on a routine basis and an audit conducted to ensure that all resources are sufficiently utilized. In the future, we seek to expand our approach to the rest of England but we will seek to continue working with the East Sussex population for another 3 more years beyond the set period.