The March 2016 and Quarter 4 2015/16 data for the Dementia Assessment and Referral data collection in England by NHS England were released on 1st June 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:

• who have a diagnosis of dementia or delirium or to whom case finding is applied; [Find][i]
• who, if identified as potentially having dementia or delirium, are appropriately assessed; and, [Assess/Investigate][ii]
• 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 (hence there are no published data associated with measure iii)).

Monthly Publication – March 2016

Key points – Acute Trusts – March 2016
The total number of data returns submitted by NHS Foundation and Non-Foundation Trusts providing acute funded care was 144 in March 2016, including 4 nil returns, the same as in February. 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, 89.6% of admitted patients were initially identified or given case finding for potential dementia in March 2016, compared with 90.2% in February.
• Of the patients initially identified or found as potentially having dementia, 94.8% were further appropriately assessed in March 2016, compared with 95.4% in February.
• The percentage of acute trusts in March 2016 achieving at least 90% in measures i) and ii) was as follows:
  • 79.3% of the trusts (111 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia, compared with 83.0% in February.
  • 87.9% (123 trusts) achieved at least 90% in carrying out further appropriate assessments, compared with 86.5% (122 trusts) in February;
• 108 acute trusts (77.1%) achieved at least 90% in both measures in March 2016, compared with 76.6% (108 trusts) in February.

Key points – Community Service Providers – March 2016

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 19 in March 2016, including 0 nil returns; the same as in February.

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, 81.1% of admitted patients were initially identified or given case finding for potential dementia in March 2016, compared to 81.6% in February.
• Of the patients initially identified or found as potentially having dementia, 88.6% were further appropriately assessed in March 2016, compared to 87.9% in February.
• The percentage of community service providers in March 2016 achieving at least 90% in measures i) and ii) was as follows:
  • 78.9% of the providers (15 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia compared with 63.2% (12 trusts) in February.
  • 57.9% (11 trusts) achieved at least 90% in carrying out further appropriate assessments, the same as in February.
• 10 providers (52.6%) achieved at least 90% in both measures in March 2016, compared with 9 providers (47.4%) in February.

Quarterly Publication – Quarter 4 2015/16 (January, February and March combined)

Key points – Acute Trusts – Quarter 4 2015/16

The total number of NHS Foundation and Non-Foundation Trusts providing acute funded care who submitted data was 145 in Quarter 4 2015/16, the same as in the previous quarter. This total includes 4 acute trusts that submitted nil returns for the whole quarter, one more than in Quarter 3 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, 90.0% of admitted patients were initially identified or given case finding for potential dementia in Quarter 4 2015/16, the same as in Quarter 3 2015/16.
• Of the patients initially identified or found as potentially having dementia, 95.1% were further appropriately assessed in Quarter 4 2015/16, the same as in Quarter 3 2015/16.
• The percentage of acute trusts in Quarter 4 2015/16 achieving at least 90% in measures i) and ii) was as follows:
  • 81.6% of the trusts (115 trusts) achieved at least 90% in carrying out initial identification (using case finding) for potential cases of dementia, compared to the 79.6% (113 trusts) in Quarter 3 2015/16.
  • 88.7% (125 trusts) achieved at least 90% in carrying out further appropriate assessments, compared with 87.3% (124 trusts) in Quarter 3 2015/16;
• 108 acute trusts (76.6%) achieved at least 90% in both measures in Quarter 4 2015/16, compared with 104 trusts (73.2%) in Quarter 3 2015/16.

Key points – Community Service Providers – Quarter 4 2015/16

Only a small number of Community Service Providers have been able to submit data and are presented in the data.[v] The number of Community Service Providers submitting data was 19 in Quarter 4 2015/16 compared with 17 in Quarter 3 2015/16. There were no nil returns in the latest quarter.

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, 81.3% of admitted patients were initially identified or given case finding for potential dementia in Quarter 4 2015/16, similar to 87.4% in Quarter 3 2015/16.
• Of the patients initially identified or found as potentially having dementia, 89.2% were further appropriately assessed in Quarter 4 2015/16, compared with 95.9% in Quarter 3 2015/16.
• The percentage of community service providers in Quarter 4 2015/16 achieving at least 90% in measures i) and ii) was as follows:
  • 68.4% of the providers (13 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 Quarter 3 2015/16.
  • 57.9% (11 trusts) achieved at least 90% in carrying out further appropriate assessments, a decrease from 81.3% (13 trusts) in Quarter 3 2015/16.
• 10 providers (52.6%) achieved at least 90% in both measures in Quarter 4 2015/16, compared with 8 providers (50.0%) in Quarter 3 2015/16.

Overall Summary – 2015/16

Key Points – Acute Trusts

The year slightly improved on the levels of performance achieved in the previous year.

• Overall, for patients, 90% of admitted patients were initially identified or given case finding for potential dementia in 2015/16 on average, compared with 88% on average in 2014/15.
• Of the patients initially identified or found as potentially having dementia, 95% were further appropriately assessed in 2015/16 on average, compared with 94% on average in 2014/15.

Key Points – Community Service Providers

The first year of data collection for CSPs saw a gradually improved response and a performance level comparable with that for acute trusts, though based on much smaller numbers.

• Overall, for patients, 87% of admitted patients were initially identified or given case finding for potential dementia on average in 2015/16, compared with 90% on average for acute trusts.
• Of the patients initially identified or found as potentially having dementia, 94% were further appropriately assessed on average in 2015/16, compared with 95% on average for acute trusts.

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 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/