Nottingham Insight

Introduction

Dementia encompasses a range of brain disorders resulting in a progressive and severe loss of brain function. It affects over 5% of people over 65. The number of people living with dementia in Nottingham will reach over 4,000 by 2035, almost doubling from 2017. Dementia has superseded cardiovascular disease as the leading cause of death.

This needs analysis considers dementia of all causes. There is significant overlap with the Carers and Care Homes JSNAs, and there is signposting to these where appropriate.

The Department of Health’s Living Well With Dementia (2009) strategy on dementia provides a framework through which this needs analysis will be conducted. The Prime Minister’s Challenge on Dementia 2020 requires action on 5 themes: global leadership, risk reduction, healthcare, social action and research.

Unmet needs and gaps

1. There remains poor awareness of dementia risk factors among the general public – see section 4, Prevention. Although there are many existing interventions and services that target dementia risk factors locally, the links between these risk factors and dementia are not made explicit.
2. Uptake of NHS Health Checks overall remains poor – see section 4, Prevention. The 40- to 64-year-old age group has not been sufficiently targeted. The dementia component within the NHS Health Check targets only people over 65, despite there being evidence that risk factor modification should occur in early life.
3. Current local Memory Assessment Services are not accredited by the Memory Services National Accreditation Programme (MSNAP) – see section 5, Diagnosis.
4. BME groups continue to experience inequities in access to diagnostic services and consequently social support – see section 2, Diversity.
5. Following diagnosis, there are few options for support for BME groups which are sensitive to specific cultural needs. This is a pertinent issue as people from BME groups are more likely to develop dementia at a working age.
6. Although the number of people with dementia using inpatient services in Nottingham is reducing, it is not reducing as quickly as the national benchmark – see section 2, Severity. There needs to be greater work to understand what more can be done to reduce utilisation of inpatient services by people with dementia, to meet the national benchmark.
7. There is poor awareness that dementia is a terminal illness – both in the general public and among health professionals – see section 5, Dying. Consequently, advance care planning and access to palliative care services is limited. This has shifted dementia deaths from the community to the hospital.
8. The performance of community services in reducing admissions to hospital is not being measured.
9. Information about available services and support is needed on paper and verbally through formal and informal networks.

Data regarding service utilisation is not shared with commissioners.

Recommendations for consideration for commissioners

1. Commissioning should reflect NHS England’s Well Pathway for Dementia and Nottingham City’s Dementia Framework for Action
2. Map service provision currently available in the city to identify gaps and areas of duplication
3. Train GPs and healthcare workers across the city regarding risk factors for dementia and interventions that can prevent dementia.
4. Increase uptake of diagnostic services in BME groups, possibly through the use of community outreach programs
5. Increase rates of diagnosis of dementia subtypes / information sharing with community care providers to assist targeted care provision
6. Develop a robust plan to generate evidence showing a reduction in hospital admissions due to dementia following the provision and development of community dementia services
7. Increase choice and control in care homes for service users
8. Increase percentage of care homes rated ‘Good’ or ‘Outstanding’ by the Care Quality Commission from 45.3% to 60% by 2019
9. Form a City-wide joint approach to supporting people with dementia
10. Increase learning for family carers, supporting carers to understand the different types of dementia, support self care
11. Continue to develop local services to meet standards for Nottingham City to achieve dementia-friendly status
12. Develop a dementia-friendly employer framework and encourage organisations to sign up to committed actions
13. Write sustainable development plans that specifically consider dementia
14. Provide specialist end-of-life care for people with dementia through palliative care services integrated in the community
15. Educate health professionals and the public that dementia is a terminal illness

Louis Choo, F2 Doctor, NCC, louis.choo@nhs.net

Sharan Jones, Insight Specialist, NCC, sharan.jones@nottinghamcity.gov.uk

Shade Agboola, Public Health Consultant, NCC, shade.agboola@nottinghamcity.gov.uk