The December 2015 and Quarter 3 2015/16 data for the Dementia Assessment and Referral data collection in England by NHS England were released on 2^nd March 2016 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).

[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.

Monthly Publication – December 2015

Key points – Acute Trusts – December 2015

The total number of data returns submitted by NHS Foundation and Non-Foundation Trusts providing acute funded care was 145 in December 2015, one more than in November. This total includes 3 nil returns, the same as November. 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, 89.4% of admitted patients were initially identified or given case finding for potential dementia in December 2015, compared to 90.4% in November.
• Of the patients initially identified or found as potentially having dementia, 95.0% were further appropriately assessed in December 2015, compared with 94.9% in November.
• The percentage of acute trusts in December 2015 achieving at least 90% in measures i) and ii) was as follows:
  •  78.9% of the trusts (112 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia, a decrease from 82.3% (116 trusts) in November
  • 88.7% (126 trusts) achieved at least 90% in carrying out further appropriate assessments, compared with 86.5% (122 trusts) in November;
• 105 acute trusts (73.9%) achieved at least 90% in both measures in December 2015, compared with 75.9% (107 trusts) in November.

Key points – Community Service Providers – December 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 17 in December 2015, one more than in November. The total included 1 nil return, compared to 0 in November. 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, 90.1% of admitted patients were initially identified or given case finding for potential dementia in December 2015, up from 86.7% in November.
• Of the patients initially identified or found as potentially having dementia, 95.4% were further appropriately assessed in December 2015, compared to 97.9% in November.
• The percentage of community service providers in December 2015 achieving at least 90% in measures i) and ii) was as follows:
  • 75.0% of the providers (12 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia compared with 56.3% (9 trusts) in November
  • 75.0% (12 trusts) achieved at least 90% in carrying out further appropriate assessments compared with 81.3% (13 trusts) in November.
• 11 providers (68.8%) achieved at least 90% in both measures in December 2015, compared with 8 providers (50%) in November.

Quarterly Publication – Quarter 3 2015/16 (October, November and December combined)

Key points – Acute Trusts – Quarter 3 2015/16

The total number of NHS Foundation and Non-Foundation Trusts providing acute funded care who submitted data was 145 in Quarter 3 2015/16, a decrease by 2 trusts from in the previous quarter. This total includes 3 acute trusts that submitted nil returns for the whole quarter, the same as in Quarter 2 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, 90.1% of admitted patients were initially identified or given case finding for potential dementia in Quarter 3 2015/16, similar to Quarter 2 2015/16 (90.9%).
• Of the patients initially identified or found as potentially having dementia, 95.1% were further appropriately assessed in Quarter 3 2015/16, compared with 95.5% in Quarter 2 2015/16.
• The percentage of acute trusts in Quarter 3 2015/16 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, compared to the 78.5% (113 trusts) in Quarter 2 2015/16
  • 87.3% (124 trusts) achieved at least 90% in carrying out further appropriate assessments, compared with 88.9% (128 trusts) in Quarter 2 2015/16;
• 104 acute trusts (73.2%) achieved at least 90% in both measures in Quarter 3 2015/16, compared with 108 trusts (75.0%) in Quarter 2 2015/16.

Key points – Community Service Providers – Quarter 3 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 16 in Quarter 3 2015/16. One other provider only submitted a nil return and is excluded from the results 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, 87.3% of admitted patients were initially identified or given case finding for potential dementia in Quarter 3 2015/16, similar to 89.7% in Quarter 2 2015/16.
• Of the patients initially identified or found as potentially having dementia, 95.9% were further appropriately assessed in Quarter 3 2015/16, compared with 93.8% in Quarter 2 2015/16.
• The percentage of community service providers in Quarter 3 2015/16 achieving at least 90% in measures i) and ii) was as follows:
  • 56.3% of the providers (9 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia, compared with 54.5% (6 trusts) in Quarter 2 2015/16.
  • 81.3% (13 trusts) achieved at least 90% in carrying out further appropriate assessments, an increase from 63.6% (7 trusts) in Quarter 2 2015/16.
• 8 providers (50.0%) achieved at least 90% in both measures in Quarter 3 2015/16, compared with 5 providers (45.5%) 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/

[iv] In order to meet the full CQUIN payments, Community Service Providers will need to achieve a 90% level of achievement from the start of Quarter 3.

[v] In order to meet the full CQUIN payments, Community Service Providers will need to achieve a 90% level of achievement from the start of Quarter 3.

[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/