Dementia Centred

Pauline Cameron's picture

By Pauline Cameron

August 18th, 2016

Dementia "Postcode Lottery" in England

NHS England has released a “Dementia Atlas” showing figures on areas relating to dementia across England.

At DSDC we have had a look at the atlas and the reporting associated with the release, across the media we have seen headlines such as patchy care, disparity in care, postcode lottery....

This is not news to any of us, it is clear that no area in England is perfect in their provision around dementia. However, the picture is likely to be more complex than what the headline numbers and the headlines we have seen in the press indicate. 

Though the atlas allows you to look at several metrics, it only does this in one dimension, there is no facility to investigate how more than one factor interacts with each other. For example comparing Vale Royal in Cheshire, one of the North’s most affluent areas, with Newham in East London, one of the most deprived areas in the country, might not be a fair comparison. It is maybe not surprising when more are able to die at home in Cheshire than in Newham! Could part of the answer be found in socioeconomic factors? 

Care Plan review

One of the indicators reported on is Care reviewed in the last 12 months*. The NICE Quality Standards: Home care for older people stipulate that a care plan should be in place within 6 weeks of starting using the home care service and this should be reviewed at least once a year**. No areas in England currently live up to this standard, with rates as low as half in Somerset to one in seven in North East Lincolnshire.

As dementia is a progressive and degenerative condition it is important to continuously review the individual’s care needs. The aim of a good care plan is to enable the person with dementia to live as independently as possible for as long as possible in their own home. A person living with dementia could have needs around safety, nutrition, pain management, activities, social interaction and their environment. 

As the condition progresses there are likely to be physical changes which require a change in medication and/or other care aspects. These needs will be individual to the person living with dementia and similarly the frequency with which a review is necessary depends on the person, their condition and their circumstances. 

If a person lives alone and is not reviewed regularly their needs might not be fully understood or revised as required. This can lead to the person having a lower quality of life and more negative experience of dementia and needing more expensive and institutional care earlier than otherwise. Our Leaf model, shown below, illustrates this. 

At DSDC it is our experience that a 6-12 month review cycle depending on the person is desirable. To provide person-centred care and ensure the best quality of life for a person living with dementia, all professionals and family carers need to be involved.

Our work with organisations takes a holistic view on dementia care incorporating social, psychological and environmental issues.

We agree that regular reviews are important, but of equal importance is the ability of staff to identify and address issues that are identified as they come to light, therefore our Best Practice Programme focuses on how staff can spot the ‘red flags’ and put in place measures to address those.

At DSDC we work with organisations to deliver realistic and affordable service improvement plans, delivered through proven training methods, including:

*This metric shows the number of patients with a diagnosis of dementia who have had their care reviewed (face-to-face) in the preceding 12 months as a proportion of all patients on the disease register with dementia.

** From NICE guidelines: Older people who use home care services have a discussion with a member of their care team about whether they are happy with their care and if it is helping them in the way that they want. This should happen within 6 weeks of starting to use the service and then at least once a year. Older people can involve a family member or carer in the review of their care if they wish. The home care provider should agree how often a review is needed but the older person and their family member or carer should know who to contact in case they want to arrange a review at a different time.