UCLPartners Update on Dementia Charlie Davie, Director - Academic - - PowerPoint PPT Presentation

Charlie Davie, Director - Academic Health Science Network, UCLPartners

UCLPartners Update on Dementia

21 April 2015

Information Education

How will we achieve it?

Work with our partners to:

• Discover new treatments and

methods for improving health

• Develop discoveries through clinical

trials

• Implement changes at scale across

the partnership

• Evaluate how the system is working

and what can be done next

• Educate the workforce and develop

capabilities

• Use information to its best effect

throughout the system

Population

Our aim: to bring together leaders to translate cutting-edge research and innovation into measurable health and wealth gains for the population

11 higher education institutes and research networks 26 boroughs and local councils 23 healthcare organisations acute and mental health trusts; community providers 20 Clinical Commissioning Groups (CCGs)

The geography and partners

Industry partnerships in research and translation of innovation into health and wealth

Six million population

Sian Jones, Senior project manager 27000 Trained, UCLPartners

27000 Trained: Leading a cultural change in dementia care

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27,000 Trained

2014-2015 Objectives

• Train an additional 15,000 staff in Tier 1 Dementia Awareness
• In collaboration with ELFT – develop a Tier 1 training package to support their

Community based ‘Still Here’ film

• New communities of practice – Dentists, LAS, Pharmacists, Optometrists
• Pan London Dementia Leads network
• Development of Tier 2 training resources and pilot.

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The project has…

Trained 27, 822 staff across North Central & East London (over 10%

• f total national

mandate) Trained 50 New Tier 1 Trainers; 204 trainers now trained in total Ensured training is now mandatory in 12 Trusts; every new staff member will receive Dementia Training Ensured training is still delivered “face to face” in all Trusts Facilitated new relationships between commissioners, providers and education teams (CEPNS) Created 11 new collaborations with new professional groups &

• rganisations

Had 2 Presentations accepted for the UK Dementia Congress Been shortlisted for HSJ Innovation in Mental Health 2014 Kept the patient at the centre of everything we do through our relationships with national charities

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Building a culture of Dementia awareness: 2015-2016

Key themes of work

1. Awareness

• Tier 1* Sustainability, collation of numbers for HEE reporting, Quality assurance monitoring of training

2. Partnership Networking

• Support engagement with Community Education Provider Network ( 10 across HENCEL)
• New Communities of Practice – continue to collaborate with Dentists, LAS, Pharmacists and Optometrists in the

development of resources and materials

• Development of a Community of Care network

3. Tier 2*

• Pilot of training resources, Train the trainer, Launch of resources
• Ambition to train staff in Tier 2 across HENCEL

4. Evidence of impact

• Influence of training on provision of care for people living with dementia and their carers in a healthcare setting

* London Dementia Strategic Clinical network: Guide to Dementia training for Health and Social care staff.

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Learning indicators

Key themes of work

1. Awareness

• Tier 1* Sustainability, collation of numbers for HEE reporting, Quality assurance monitoring

2. Partnership Networking

• CEPN engagement
• New Communities of Practice continued
• Development of a Community of Care network

3. Tier 2*

• Continued Pilot of training resources, Train the trainer, Launch of resources
• Ambition to train staff in Tier 2 across HENCEL

4. Evidence of impact

• Influence of training on provision of care for people living with dementia and their carers in a healthcare setting

* London Dementia Strategic Clinical network: Guide to Dementia training for Health and Social care staff.

For more information Sian Jones Senior Project Manager Tel: 07957 548619 Email: sian.jones@uclpartners.com

Piers Kotting, Programme Director, Office of the National Director for Dementia Research | National Institute for Health Research (NIHR)

Join Dementia Research

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Key issues for delivery of clinical research:

Speed of recruitment Screen failure rates Retention rates Increase public awareness Improve use of data

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JDR increases public awareness:

2/3rds of people willing to take part in dementia research Fewer than I in 5 know how to find

• ut about it

Directly via internet Through charity helplines Through NHS memory clinics

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Aggregates & structures data about patients & their consent Aggregates & structures data about research studies Matches patients to studies Enables researchers to contact patients

JDR improves use of data:

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Launched 24 Feb 2015

6,026

people registered

986

enrolled

37

studies

86

sites

Progress to date

Piers Kotting Programme Director, Office of the National Director for Dementia Research | National Institute for Health Research (NIHR) Email: piers.kotting@nihr.ac.uk

• Dr. Anna Moore, Director Integrated Mental Health

Mental Health Programme

Integrated Mental Health Programme

THRIVE: Transforming CAMHS More Than Mentors: Neer Peer Mentoring

Pathway Transformation Meta-analysis Modelling Causes of Breaches

MH in the ED Physical Health in MH Settings Primary Care & Commissioning

Informatics Platform Building Capability

Integrated Mental Health

Improving MH in Children & Young People Urgent & Emergency Care Pathway Education & Capability Informatics

Miranda Wolpert Rita Harris Melanie Jones Sally Hodges Peter Fuggle Rachel James Andy Wiener Caroline McKenna Duncan Law Peter Fonagy

The THRIVE Model

Challenges in current CAMHS

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The THRIVE Model

Drawing a clearer distinction than before between:

• Treatment and support
• Self-management and intervention
• More systematic integration of shared decision making and routine collection of preference data

We are aware there are a number of initiatives across the country who use “Thrive” in their title. We use the term to reflect our core commitment to young people “thriving” and to represent our commitment to provision that is Timely, Helpful, Respectful, Innovative, Values-based and Efficient.

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Improving quality & efficiency: rethinking CAMHS

• Improved quality & efficiency through
• enabling workforce planning
• embracing digital
• systematic implementation of evidence base
• improving capacity and access
• effective integration

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Service Development

• Increased interest in self-management and promotion of resilience
• Proliferation of digitally based support
• Community focus
• School-based interventions support mental health
• Peer support can promote effective parenting
• Integration of mental health in paediatric primary care supports community resilience

Resource

• This group accounts for about 25% of YP and families accessing CAMHS
• Accounts for 5% of CAMHS provision cost

Getting Advice and Signposting

Need

• These are the YP and their families adjusting to life circumstances
• Mild or temporary difficulties
• Capable of community or self-support
• Or chronic, fluctuating or ongoing severe difficulties for which they decided to manage their
• wn health

Provision

• The THRIVE Model suggests: provision within educational or community settings
• Education as lead provider
• The education language is a language of wellness
• Health input coming from experienced health workers who support, diagnose & signpost

using shared decision making

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Service Development

• Increasingly sophisticated evidence on what works for whom in what circumstances
• Increasing agreement on how service providers can implement those approaches
• Shared decision making to support patient preference
• Rigorous use of ROMs
• 33% of YP will be “recovered” even after the best evidence-based interventions

Resource

• This group accounts for about 55% of YP and families currently accessing CAMHS
• It accounts for the 15% of the cost of CAMHS provision
• Pbr analyses suggest this is a middle costing service in the payment system

Getting Help

Need

• This group would benefit from focused, evidence-based treatment with clear goals
• This group falls into the scope of NICE guidance
• Around 45% of families in this group fall into one NICE guidance
• The rest of families have multiple problems

Provision

• The THRIVE Model suggests: health services as main providers
• Language of treatments and outcomes
• Health input should involve specialised technician in different treatments
• Explicit charters for children and families:
• Treatment should involve explicit agreement at the outset as to what success would look like
• How would success occur and when

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Service Development

• Emerging consensus that some conditions are likely to require extensive or intensive treatment
• Psychoses, Eating disorders, Emerging personality disorders

Resource

• This group accounts for the 10% of YP and families accessing CAMHS
• Accounts for the 80% of the cost of CAMHS provision
• This is the final, and more expensive group for payment systems
• Individual payment agreements will have to be arranged, given the wide range of costs within this

group (similar to inpatient provision)

Getting More Help

Need

• This group represents those YP and families who would benefit from extensive long

term treatment

• Inpatient care
• Extensive outpatient interventions

Provision

• The THRIVE Model suggests: health as main provider
• Language of health: treatment and health outcomes
• Health input consists in health workers specialised in different treatments

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Service Development

• The most contentious aspect of the model
• A substantial minority do not improve, not even with the best EBPs (33%)
• There must be an explicit recognition of the needs of young people and their families

where there is no current treatment available and they remain at risk

• Focus on co-ordinated multi-agency working
• Single accountable organisation/clinician

Resource

• This group might require significant input
• Many services increasingly recognise this group as
• Not ready for treatment
• In need of ongoing monitoring
• The might have been offered high intensity treatment, but they are missing

appointments, or making no progress.

• This group should be disaggregated within the payments system

Getting Risk Support

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Thrive

• Systematic use of shared decision making enables
• Person centred approach to care to be systematised
• Segmenting population, taking a needs based approach enables:
• Alignment with best evidence based practice in child mental health
• Alignment with emerging payment systems
• Better value
• Clarity about what care takes place within segments enables:
• Options for more targeted quality improvement
• Greater clarity about agency leadership
• Options for more targeted performance management

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Next Steps

• Utilising CYP architecture for delivery
• Implementation in Camden
• Discussions with rest of UCLP geography
• Vanguard application
• NHS Innovation Application

For more information please contact: www.uclpartners.com @uclpartners Anna Moore Director, Integrated Mental Health Email: anna.moore@uclpartners.com