Sampling the Debenham experience
NHS England’s National Director for Dementia and National Director for the Frail Elderly report on an innovative project in sleepy Suffolk:
Debenham is a picturesque village in Suffolk.
Since 2009 it has developed a unique approach to the care and support of older people and, specifically, the carers of people with dementia.
This is based on a collaborative social movement where the community has taken responsibility for the welfare and support of older people.
It grew from conversations between an inspirational group of local people who were committed to improving things for their community united by the common mantra of: “If it is not good enough for my mother, it is not good enough.” www.the-debenham-project.org.uk
The Debenham project relies on volunteers with around 150 people giving freely of their time. The list from which help is galvanised is impressive: the local County and District Councils, the local NHS, charities such as Sue Ryder and Age UK, businesses and a plethora of local organisations.
A number of activities are prominent within the Debenham project’s ambitious work-plan. Activity and support sessions – jointly with the wonderfully named “CAMEO” (Come and Meet Each Other) – lunch clubs, advice centres, medication support, information cafes, an exercise club, support for people attending specialist memory service, a domestic care registry and an emergency “on call” facility. Help with transport is also planned.
The Project has been nationally recognised with interest from universities, praise from the PM, receipt of a UK Point of Light award and the 2014 aspiring age award.
The Debenham project held a day-long meeting to celebrate the success of the initiative and to consider the current challenges, opportunities and potential to spread best practice.
It was our privilege to be there to learn all about what was happening. In the morning we heard about the work to develop dementia friendly Suffolk, and the toll that a diagnosis of dementia brings.
One of the most striking facts being that one third of people with dementia get out the house less than once a week, a figure which would raise eyebrows if it was in physical health.
We heard about the key role of the Sue Ryder Foundation and its delivery of community based care, and the need to get support from the commissioners of health care with the added benefits of joint health and social care commissioning.
The imperative of supporting frail older people in hospital and when they get home was emphasised, as was the key contribution of integrated neighbourhood teams and how they interface with the local community.
They had been built as a partnership of 12 local agencies and were described as providing a “bubble around the person.” Much time had been, and continues to be, devoted to the partnership colleagues getting to know each other.
All in all, a bold vision was presented of caring for the whole community across health and social care.
What can we learn from Debenham? Four things, probably none of which are new but having an example to prove them is enviable.
First, when a geographical area is cohesive, inspirationally led and with some added stardust, anything is possible and much can be achieved. The need to fill a gap in the provision of care is essential and gets people motivated. The financial support garnered is modest – the estimate is £85 per family helped per annum.
Second, what are the challenges of spreading that good practice? The Debenham project is a model for community support, needs modest investment but the societal return is palpable. There is no mandate around Debenham, it was not created as a top down process – it needed leadership but it depends on community.
Third, and as if we needed to be told this, it is an excellent way of communicating good practice. It acts as a focus for getting people together to look at thorny problems and come up with local solutions. There cannot be Debenham projects everywhere but there could be elements. Perhaps there is a bit of Debenham in us all.
Fourth, and interestingly, it is possible to begin with community based care for people with dementia, but this can be readily spread to people with frailty: in many ways they have similar needs, that is, co-ordinated, person-centred care delivered by people who are skilled at building relationships.
Alistair Burns, CBE FRCP, FRCPsych, MD, MPhil
Alistair Burns is Professor of Old Age Psychiatry at The University of Manchester and an Honorary Consultant Old Age Psychiatrist in the Greater Manchester Mental Health NHS Foundation Trust. He is the National Clinical Director for Dementia and Older People’s Mental Health at NHS England and NHS Improvement.
He graduated in medicine from Glasgow University in 1980, training in psychiatry at the Maudsley Hospital and Institute of Psychiatry in London. He became the Foundation Chair of Old Age Psychiatry in The University of Manchester in 1992, where he has variously been Head of the Division of Psychiatry and a Vice Dean in the Faculty of Medical and Human Sciences, with responsibility for liaison within the NHS. He set up the Memory Clinic in Manchester and helped establish the old age liaison psychiatry service at Wythenshawe Hospital. He is a Past President of the International Psychogeriatric Association.
He was Editor of the International Journal of Geriatric Psychiatry for twenty years, (retiring in 2017) and is on the Editorial Boards of the British Journal of Psychiatry and International Psychogeriatrics. His research and clinical interests are in mental health problems of older people, particularly dementia and Alzheimer’s disease. He has published over 300 papers and 25 books.
He was made an honorary fellow of the Royal College of Psychiatrists in 2016, received the lifetime achievement award from their old age Faculty in 2015 and was awarded the CBE in 2016 for contributions to health and social care, in particular dementia.
John Young
Professor John Young was previously National Clinical Director for Integration and Frail & Elderly Care, since the publication of these blogs he has left NHS England.