Derbyshire Community Health Services Trust

Derbyshire Community Health Services NHS Trust is a large and complex organisation employing more than 5,000, staff. It is one of the largest provider organisations in the country, offering a range of different services. On an average day: •1,050 families are supported by our Health Visiting Service •1,960 patients will be supported by our district nurses •150 people will be seen in our diagnostic and treatment centres •400 patients are seen within the therapy services •500 patients are seen by our community podiatry service •An average of 293 patients are cared for as inpatients in our community hospitals.

Updated:
3 February 2015
Location:
East Midlands
Sectors:
Health, Hospitals and Hospital Trusts
Local Alliances:
Derbyshire Dementia Action Alliance

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

Enhancing the DCHS liaison Service - We plan to augment the older peoples psychiatric liaison service which works in support of patients who use the non-mental health services provided by DCHS. The current service is provided by one experienced mental health nurse and we plane to phase in a second experienced specialist nurse by mid-summer 2013 followed by further enhancements to the staffing of the team during the remainder of 2013-2014. The purpose of the service is to provide specialist assessment and care planning to those older people in non-specialist DCHS services but that have mental health care needs including of course, dementia. This aim supports Objective 8 of the National Dementia Strategy, DH 2010. In addition, this service will formally provide training/coaching/support to non-specialist clinical colleagues in the care of the person with dementia.

 The Dementia CQUIN - As a requirement of the Dementia Commissioning for Innovation and Quality (CQUIN) 2013-2014, we are working to provide evidence to our commissioners of the many ways in which we support the carers of people who live with dementia. We are organising a series of carer focus groups in order to establish the areas of support most needed by carers, we are also planning a process to enable us to measure the ways in which we provide support to carers based around carer experiences of these support approaches. Currently, we provide information to carers signposting them to potential sources of continued help, that they may require, across the dementia journey.

 Outreaching the Living Well with Dementia programmes - We currently deliver well established programmes of ‘Living well with dementia’ from our mental health day services. These programmes are consistently evaluated well by both the individuals with dementia and their carers. The programmes consist of a 6 week assessment and educational package and are divided into two parallel components, a ‘patient’ and a ‘carer’ programme. The carer programme allows us to assess the needs of the carers, providing support to them both immediate and longer term. This is provided in the form of education, professional and peer support, information about the illness and preparing for the future as well as about the services that are available and signposting to these. We are well progressed with our plans to ‘outreach’ these programmes initially during the summer of 2013, from our day services in north East Derbyshire into a number of the traditionally ‘hard to reach’ ex mining communities of that area.

 Arts in Health research work – DCHS will continue to build upon the work it has undertaken over the last 5 years to develop ‘Dementia Friendly care environments. We have invested already significantly in ‘Arts in Health’ work in our specialist mental health in-patient areas through schemes such as the Kings Fund, Enhancing the Healing Environment. We will shortly commence some research work in partnership with Manchester Metropolitan University, Arts faculty, to look in more depth at the value of the visual arts and its place in the care and treatment of people with dementia.   

 Working with ‘third sector’ agencies - DCHS is committed to work closely with local voluntary groups in order to develop areas of work designed to provide community friendly approaches to the frail elderly. This will include the further development of ‘befriending’ as well as working with the local Alzheimer’s society in support of Dementia Friendly communities. In the spirit of developing these important aspects of partnership working, DCHS will be attending and participating in the NDVA event to be held on the 10/7/2013.

  

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

Enhancing the DCHS Liaison Service – whilst we are able to fund the second full time specialist nurse into the Liaison Nurse/Practice Development Lead role in the medium term, we have applied to the CCG for funding following their invitation to submit bids for ‘Transformational Monies’ to cover this and a number of other posts to provide the team requirements. The risks associated are in the bids being successful, in order to gain the necessary funding for the full service described. In addition, the long term availability of such funding will need to be discussed with the CCGs and any risk arrangements explored.

The Dementia CQUIN - The challenges/risks associated with this work have largely been mitigated through the robust planning activities of the associated CQUIN Leads Task and Finish sub group. These challenges have included, 

  • The requirement to understand more fully, what areas of support are most required by carers,
  • The development of a process in order to capture the necessary evidence of the carers experience of how we provide this support to them.
  • The timescales (being tight) in order to formulate the approach required for achieving the above 2 elements.
  • The establishment of nominated ‘specialist leads’ accessible to support through training, coaching and advice non-specialist clinical colleagues in identifying and caring for people living dementia. This last point is associated with the enhancement of the DCHS Liaison Service, since the 2 Liaison Nurse/Practice Development Leads, who we will initially bring into service, will be the nominated leads

Outreaching the Living Well with Dementia programmes – This has formed a large part of a formal project to merge the current 2 small North East Derbyshire OPMH day services. The merger will augment the teams giving us the capacity to provide both a day hospital centred service as well as the outreach service. This project is the subject of formal and robust planning which is well advanced. The challenges and risks identified as part of the project plans have been mitigated through the planning approaches.

Arts in Health research work – The purpose and formal, structured approach for this work has been the subject of a detailed research proposal which, has been independently scrutinised and accepted by the research ethics committee as well as by DCHS’ own research department.

 

 

2. Actions

  • Improve the care of older people with mental health problems using DCHS non-specialist clinical services

    Status:
    Planning

    2013 - Fourth Quarter update

    In progress

    2013 - Third Quarter update

    In progress

    2013 - Second Quarter update

    New member

  • Support non-specialist clinical colleagues in developing care skills appropriate to people living with dementia

    We aim to support non-specialist clinical colleagues in developing care skills appropriate to people suffering with dementia in order to improve the dementia care skills of all colleagues in the organisation. 

    Status:
    Planning

    2013 - Fourth Quarter update

    In progress

    2013 - Third Quarter update

    In progress

    2013 - Second Quarter update

    New member

  • Support specialist assessment and treatment of patients (suspected of having a mental health co-care need) referred into the Clinical Navigation Service

    Status:
    Planning

    2013 - Fourth Quarter update

    In progress

    2013 - Third Quarter update

    In progress

    2013 - Second Quarter update

    New member

  • Supporting carers (Dementia CQUIN 2013-2014)

    Status:
    Planning

    2013 - Fourth Quarter update

    In progress

    2013 - Third Quarter update

    In progress

    2013 - Second Quarter update

    New member

  • Extending accessibility to the ‘Living well with dementia’ programmes to historically hard to reach communities in support of people living withi dementia and their carers

    We aim to extend the accessibility of our 'Living Well with Dementia' programme to reach historically hard to contact communities, we wish to be able to provide our services to these communities that are difficult to reach to. 

    Status:
    Planning

    2013 - Fourth Quarter update

    In progress

    2013 - Third Quarter update

    In progress

    2013 - Second Quarter update

    In progress

  • Creating 'dementia friendly' care environments utilising 'arts in health' approaches

    Status:
    Planning

    2013 - Fourth Quarter update

    In progress

    2013 - Third Quarter update

    In progress

    2013 - Second Quarter update

    New member

  • Working with third sector agencies to develop enhanced support to people living with dementia

    We will work with third sector agencies to develop enhanced support to people living dementia to develop and improve their services. 

    Status:
    Planning

    2013 - Fourth Quarter update

    In progress

    2013 - Third Quarter update

    In progress

    2013 - Second Quarter update

    In progress