Dementia Assessment and Referral data collection – Sept 2015, Q2 2015/16

The September 2015 and Quarter 2 2015/16 data for the Dementia Assessment and Referral data collection in England by NHS England were released on 2^nd December 2015 according to the arrangements approved by the UK Statistics Authority.

The collection’s purpose is to improve the identification of older patients with dementia and delirium, to monitor appropriate assessment and to support effective communication between providers and general practice as part of Commissioning for Quality and Innovation (CQUIN).

The Dementia Assessment and Referral collection changed at the start of April 2015 to reflect the extension of the 2015/16 CQUIN^[1] to include community service providers (community and mental health trusts) as well as acute trusts for the Find and Assess/Investigate measures and to provide an overview at Clinical Commissioning Group (CCG) level for the Refer/Inform measure.

Three measures are reported – the number and proportion of patients aged 75 and over admitted as an emergency for more than 72 hours:

1. who have a diagnosis of dementia or delirium or to whom case finding is applied; [Find][i]
2. who, if identified as potentially having dementia or delirium, are appropriately assessed; and, [Assess/Investigate][ii]
3. where the outcome was positive or inconclusive, have a care plan on discharge meeting locally agreed standards and shared with general practice. [Refer/Inform][iii]

Measures i) and ii) are reported by Acute Trusts and Community Service Providers, measure iii) is reported by CCGs using data obtained from trusts and providers, as detailed in the 2015/16 CQUIN Guidance. CQUIN is an incentive scheme in which additional payments are made to trusts and providers; for these measures, payments are made for achievement of at least 90% at specified times in the year.

Note on Data Quality

The data presented cover both Acute Trusts and Community Service Providers. Acute Trusts have maintained a good response rate similar to previous months. The response from Community Service Providers has been low but deemed sufficiently complete to publish results for those organisations which responded.

The response from CCGs has been deemed too low quality both in terms of coverage and completeness to publish at this stage (hence there are no published data associated with measure iii) at this stage).

Monthly Publication – September 2015

Key points – Acute Trusts – September 2015

The total number of data returns submitted by NHS Foundation and Non-Foundation Trusts providing acute funded care remains at 145 in September 2015. These totals include 3 nil returns, the same as in August. The nil returns are excluded from the results presented below.

The key results for acute trusts on the number and proportion of patients aged 75 and over admitted as an emergency for more than 72 hours i) who have been identified as having dementia or delirium or asked the dementia case finding question and ii) who are appropriately assessed are as follows:

• Overall, for patients, 7% of admitted patients were initially identified or given case finding for potential dementia in September 2015, compared with 90.8% in August.
• Of the patients initially identified or found as potentially having dementia, 95.5% were further appropriately assessed in September 2015, compared with 95.8% in August.
• The percentage of acute trusts in September 2015 achieving at least 90% in measures i) and ii) was as follows:
  •   79.6% of the trusts (113 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia, an increase from 77.5% (110 trusts) in August
  • 88.0% (125 trusts) achieved at least 90% in carrying out further appropriate assessments, remaining the same as in August;
• 108 acute trusts (76.1%) achieved at least 90% in both measures in September 2015, an increase from 73.9% (105 trusts) in August.

Key points – Community Service Providers – September 2015

Only a small number of Community Service Providers have been able to submit data so far and are presented in the data.[iv] The total number of data returns submitted by Community Service Providers was 12 in September 2015, the same as in August. These totals both include 2 nil returns. Nil returns are excluded from the results presented below.

The key results for community service providers on the number and proportion of patients aged 75 and over admitted as an emergency for more than 72 hours i) who have been identified as having dementia or delirium or asked the dementia case finding question and ii) who are appropriately assessed are as follows:

• Overall, for patients,5% of admitted patients were initially identified or given case finding for potential dementia in September 2015, down from 92.8% in August.
• Of the patients initially identified or found as potentially having dementia, 97.0% were further appropriately assessed in September 2015, an increase from 89.5% in August.
• The percentage of community service providers in September 2015 achieving at least 90% in measures i) and ii) was as follows:
  • 50.0% of the providers (5 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia compared with 70.0% (7 trusts) in August.
  • 80.0% (8 trusts) achieved at least 90% in carrying out further appropriate assessments compared with 70.0% in August.
• 5 providers (50.0%) achieved at least 90% in both measures in September 2015.

 Quarterly Publication – Quarter 2 2015/16 (July, August and September combined)

Key points – Acute Trusts – Quarter 2 2015/16

The total number of NHS Foundation and Non-Foundation Trusts providing acute funded care who submitted data was 147 in Quarter 2 2015/16, a decrease by 1 trust from in the previous quarter. This total includes 3 acute trusts that submitted nil returns for the whole quarter, compared to 5 nil returns in Quarter 1 2015/16. The nil returns are excluded from the results presented below.

The key results for acute trusts on the number and proportion of patients aged 75 and over admitted as an emergency for more than 72 hours i) who have been identified as having dementia or delirium or asked the dementia case finding question and ii) who are appropriately assessed are as follows:

• Overall, for patients, 9% of admitted patients were initially identified or given case finding for potential dementia in Quarter 2 2015/16, slightly higher than in Quarter 1 2015/16 (90.4%).
• Of the patients initially identified or found as potentially having dementia, 95.5% were further appropriately assessed in Quarter 2 2015/16, compared with 94.8% in Quarter 1 2015/16.
• The percentage of acute trusts in Quarter 2 2015/16 achieving at least 90% in measures i) and ii) was as follows:
  •  78.5% of the trusts (113 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia, similar to the 77.6% (111 trusts) in Quarter 1 2015/16
  • 88.9% (128 trusts) achieved at least 90% in carrying out further appropriate assessments, compared with 86.7% (124 trusts) in Quarter 1 2015/16;
• 108 acute trusts (75.0%) achieved at least 90% in both measures in Quarter 2 2015/16, compared with 107 trusts (74.8%) in Quarter 1 2015/16.

Key points – Community Service Providers – Quarter 2 2015/16

Only a small number of Community Service Providers have been able to submit data so far and are presented in the data.[v] The number of Community Service Providers submitting data was 12 in Quarter 2 2015/16. This total includes 1 nil return for the whole quarter and this is excluded from the results presented below.

The key results for community service providers on the number and proportion of patients aged 75 and over admitted as an emergency for more than 72 hours i) who have been identified as having dementia or delirium or asked the dementia case finding question and ii) who are appropriately assessed are as follows:

• Overall, for patients,7% of admitted patients were initially identified or given case finding for potential dementia in Quarter 2 2015/16, compared to 90.1% in Quarter 1 2015/16.
• Of the patients initially identified or found as potentially having dementia, 93.8% were further appropriately assessed in Quarter 2 2015/16, compared with 94.8% in Quarter 1 2015/16.
• The percentage of community service providers in Quarter 2 2015/16 achieving at least 90% in measures i) and ii) was as follows:
  • 54.5% of the providers (6 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia, compared with 55.6% (5 trusts) in Quarter 1 2015/16
  • 63.6% (7 trusts) achieved at least 90% in carrying out further appropriate assessments, compared with 88.9% (8 trusts) in Quarter 1 2015/16.
• 5 providers (45.5%) achieved at least 90% in both measures in Quarter 2 2015/16.

The full data tables and a more detailed quarterly commentary can be found on the NHS England website:

http://www.england.nhs.uk/statistics/dementia/

[i] The proportion of patients aged 75 years and over to whom the dementia case finding is applied following an episode of emergency, unplanned care to either hospital or community services;

[ii] The proportion of those identified as potentially having dementia or delirium who are appropriately assessed;

[iii] The proportion of those identified, assessed and referred for further diagnostic advice in line with local pathways agreed with commissioners, who have a written dementia care plan of agreed local standards on discharge which is shared with the patient’s GP. CCGs are expected to report this indicator as an aggregate across providers based on provider audits of patient case notes.

[iv] In order to meet the full CQUIN payments, Community Service and Other Providers will need to achieve a 90% level of assessment from the start of Quarter 3. This may have impacted on the quality of response.

[v] In order to meet the full CQUIN payments, Community Service and Other Providers will need to achieve a 90% level of assessment from the start of Quarter 3. This may have impacted on the quality of response.

[1] Commissioning for Quality and Innovation (CQUIN) Guidance 2015/16 for further information please see http://www.england.nhs.uk/nhs-standard-contract/15-16/