Showcasing achievements for the care of older people

The National Clinical Director for Dementia and Older People’s Mental Health visits North Central London, one of three Sustainability and Transformation Partnerships selected to explore innovative practices supporting work to implement the NHS Long Term Plan:

The publication of the Long Term Plan earlier this year marked a pivotal moment for older people’s care, and particularly their mental health care.

For the first time since the National Service Framework twenty years ago, our national strategy explicitly committed the NHS to improving the provision of mental health and physical health care for older people so they can stay well, better manage their long term conditions and live independently at home for longer.

Over the past few months, NHS England has been working with North Central London Sustainability and Transformation Partnership (NCL STP) to collect evidence on, and help demonstrate the impact of, Enfield’s Care Home Assessment Team (CHAT) and Camden and Islington’s Home Treatment Team.

With the publication of the Long Term Plan Implementation Framework now imminent, we are particularly excited to be visiting these teams today and to showcase the positive outcomes they achieve for older people, their families and the local health and social care system.

We believe these teams are fantastic examples of the community-based, integrated and holistic approaches we are looking to promote through the implementation of the Long Term Plan, including via the roll out of the Enhanced Health in Care Homes model and the expansion of community-based crisis care for older people. Such services are not only vital in providing timely support for older people’s mental health and dementia care needs in their own environment, they can also prevent unnecessary general and mental health hospital inpatient admissions, while reducing delays in hospital discharges.

Let us now turn to the facts of the day: What are those services for and what has been their impact so far?

CHAT is an integrated multidisciplinary mental and physical health care home support team with strong links to primary care, underpinned by seamless support from local geriatricians and a consultant psychiatrist. The team’s approach is particularly ground-breaking in that it promotes an integrated response across physical and mental health care.

Achievements since 2013 include:

  • 35% reduction in the number of A&E attendances and non-elective admissions.
  • 7% reduction in falls.
  • 99% of residents died in their preferred place.
  • 39% of residents have had their medication reduced or stopped.
  • 8,409 hospital attendances and 8,109 GP call outs have been avoided.
  • 7,606 care home staff and managers attended training on 59 subjects.

Camden and Islington’s Home Treatment Team is a unique emergency mental health crisis response and short-term treatment team for older people with either functional (e.g. depression or anxiety) or organic (i.e. dementia and delirium) mental health needs. Camden and Islington CCGs are already known for their prioritisation of older people’s mental health and dementia care: they have the first and second highest dementia diagnosis rates in the country.

Achievements for their Home Treatment Team since 2015 include:

  • 55% reduction in the average number of treatment days (from 20 days in 2015 to 9 days in 2018).
  • 57% of patients did not need to be re-referred to the team.
  • 63% of older adults who received crisis mental health support were discharged to their normal place of residence.
  • 13% of all referrals were to support reducing delays in hospital discharges.
  • 64% of referrals received treatment (≥2 appointments) as well as an assessment.

To find out more on how the Enfield, Camden and Islington Teams set about building their achievements please have a look at the new evaluation reports on the NCL STP website.

Today is a great day to learn about and celebrate best practice in older people’s mental health and dementia care. And this is just the start. We are keen to work with colleagues to learn from and showcase the very positive work that is happening across the country.

This is why we are supporting the first National Positive Practice in Mental Health Awards for Older People’s Mental Health & Dementia, which will take place on Thursday 11 July 2019 in Bristol. Nominations are closing this week, and we would encourage colleagues to nominate, so we can continue to shine a light on the work of our fantastic sector, which too often goes unrecognised.

On your marks, get set, nominate!

For further information, go to:

Professor Alistair Burns

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.

Carolyn Piper

Carolyn Piper is North Central London STP’s Programme Manager for Dementia.

Over the past few months she has been working with NHS England to identify, evaluate and share best practice in dementia and older people’s mental health care in North Central London.

Carolyn works with providers, commissioners, clinicians, people living with dementia, carers and the voluntary sector across the STP.

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