Minutes:
The Chairman welcomed Len Wilson (Rotherham Rotary Club), Jenny and Tony Drew (Stag Medical Centre Patient Participation Group), Hilda Mayo and Wendy Wagner (Dementia UK) who gave the following powerpoint presentation:-
Why we need Admiral Nurses in Rotherham
- Admiral Nurses were Registered Mental Health Nurses who worked with family carers and people with dementia, in the community and other settings
- Working collaboratively with other professionals, they sought to improve the quality of life for people with dementia and their carers
- They used a range of interventions that helped people live positively with the condition and develop skills to improve communication and maintain relationships
- They could reduce admissions to hospital and residential care, reduce the costs of delays in transfers of care, reduce carers’ need to access GP care as a result of their caring role as well as reducing the overall spending on care
- CCGs had a duty to engage the local population (including carers) and professionals in shaping local health services and to commission services for people in local areas
- Improving the diagnosis, treatment and care of people with dementia in England and support for their carers was a key part of the NHS Mandate and one of the Secretary of State’s key priorities
- One of the key improvement areas under Domain 2 of the Clinical Commissioning Group Outcomes Indicator Set (CCGOIS) 2013/2014 was Enhancing quality of life for people with dementia (NHS England 2013)
The Problem
- Funding had to be sustainable after a Project
- Making a case that had credibility
- Ensure academic support to carry out a service evaluation
- The service needed to be in Primary Care
The Size of the Problem
- There were currently over 820,000 people living in the UK with dementia
- Two thirds of people with dementia lived at home and most were supported by unpaid carers.
- Carers for people with dementia saved the UK over £8B
- The economic cost of Dementia care was more than cancer, heart disease or stroke
It is a Lottery
- Only 117 Admiral Nurses in the UK for 820,000 people diagnosed with dementia
- Families in need had a 1:7000 chance of accessing this critical service
How many Admiral Nurses do we need?
- As a guide, Dementia UK would recommend one Admiral Nurse to each 10,000 of the population aged over 65
- The Rotherham population aged over 65 was approximately 45,600
- The projected population aged 65 and over to 2015 was 47,800
But we must not forget
-
People in Rotherham aged 30-64 predicted to
have early onset dementia, projected to
2015
was 69
Carers’ Needs
- Critical points when carers’ need for information, advice and help were particularly acute….these were also points at which they were likely to encounter professionals and service providers
- Failure to recognise carers’ needs at these points risked the breakdown of care-giving and the carer’s health and other costs for carers and wider society
Need to Shift
- We also need to shift the perceptions of dementia from being ‘just mental health’ to that of a ‘life limiting neurological condition’
Need to Adopt
- A palliative care approach from diagnosis to end of life care and afterwards - Nice Dementia Guidance 2006
There is a Saving
- Admiral Nurse Services were associated with lower distress scores over an 8 month period - Woods et al (2003)
- The person with dementia remained at home for longer, admissions to acute hospital and long term care were reduced, reduced demand on CMHTs, improved care co-ordination and that there was also added ‘brand value’
Less Stress for Carers and Professionals
- “Identified a 31% reduction in stress for carers since we introduced the service in 2010” - Knowsley Admiral Nurse Service (2013)
- “…eased the load on other Professionals” - East Flintshire Admiral Nurse Evaluation (2009)
Academic Credibility
- Enlisted Professor Kate Gerrish from the Collaboration for Leadership in Applied Health Research and Care [CLAHRC] to agree to do a small scale service evaluation when we get an Admiral Nurse (s) in post
- Would progress with a costing for the research when a Service was up and running
- In any event our enquiry had spurred Sheffield Mental Health Services to look at the provision of Admiral Nurses
- Commitment to research the cost effectiveness of Admiral Nurses in Rotherham when the time came
Request the CCG to Commission Admiral Nurse Provision in Rotherham
- Ensure the new nurse provision was trialled in the Community/Primary Care
- Make funding available on a trial basis to identify if the dependency on secondary care provision for people and families living with dementia was reduced
- Seconding an Admiral Nurse (s) for a trial period to assess the outcomes of employing Admiral Nurses in Rotherham and carry out a service evaluation
And Finally
- This was the sort of work that raised awareness, educated positively and reduced stigma and fundamentally supported the intentions of the Dementia Challenge
- £100,000 would fund 2 Admiral Nurses to run a pilot for 1 year which would include the Service evaluation
Discussion ensued on the presentation with the following issues raised/clarified:-
- Highlighted the level of need/increasing need
- A Dementia Advisor could network, signpost and give advice and support but an Admiral Nurse, who was a medically specialised nurse, worked with a family suffering from the complexities of Dementia i.e. relationship difficulties, family breakdown, support someone in employment, preventing a person going into longer term care sooner than necessary
- An Admiral Nurse received professional development and competency assessment throughout their career on an annual basis and monthly top ups. They were also clinically supervised
- Work was taking place on smoothing the pathway for those suffering with Dementia and seeking help from the most appropriate agency when required
- Evidence collected by Healthwatch Rotherham showed that the public felt the number of people crossing their doorstep to be a challenge – would an Admiral Nurse be another person added to that number
- Admiral Nurses worked with the high need complex cases and the family unit rather than just the person themselves
- Once allocated an Admiral Nurse you were never discharged from the Service but dipped in and out as required
The Chairman thanked Len, Jenny, Tony, Hilda and Wendy for their presentation.