NHS Cornwall and the Isles of Scilly started to prioritise improving dementia care following a county-wide review of services in 2007. The PCT has a three-year strategy to improve dementia care and has established a programme board. Services are jointly commissioned by the PCT and the council.
The PCT has made dementia one of its World Class Commissioning priorities. NHS Cornwall and the Isles of Scilly is using “high quality commissioning” to improve dementia services without increasing funding.
The PCT decommissioned £616,000 of homeward bound unit beds, reinvesting the funding in a dementia liaison service, an arts for homes scheme for care homes, advocacy and care and support services.
Memory clinics have been re-designed without extra costs by being very clear with providers about service specifications and setting out delivery plans.
The PCT has re-engineered the role of its older people’s mental health teams so that dementia is treated as a long-term condition. Patients are case managed from diagnosis to end of life.
One practice-based commissioning consortium based in the county has used £56,000 of savings (accrued from reduced emergency admissions) to fund a practice-based memory nurse for two years. The nurse is helping GPs to find people with dementia and to manage their care.
The PCT has introduced innovative new services. A 1950s touring bus promoting dementia services has been visited by more than 250 patients. 20,000 bookmarks highlighting services have been distributed and a dementia nurse specialist has a regular phone-in advice slot on Radio Cornwall.
Twenty three memory clinics have been opened across the county. A partnership scheme with the voluntary sector, the Rotary Club and mental health providers has seen 13 memory cafes open, with more are planned.
A dementia liaison service links up care homes, mental health services, and GPs. A public dementia helpline has been launched in conjunction with the Alzheimer’s Society and Age UK (Age Concern Help the Aged).
The county’s Arts for Health scheme, where painting and music therapy is offered in care homes, has won two public sector awards.
The PCT set up a GP academy where 60 clinicians received training from psychologists and psychiatrists of old age and were shown how to use a dementia toolkit. Training is being offered to all care homes and hospitals, to develop a liaison / link worker in each.
Integrated Care Pilot
An integrated care pilot covering dementia services is running in Newquay. GPs are being trained to carry out opportunistic testing for dementia, for instance when patients come in for flu vaccinations.
The PCT is a demonstrator site for the Department of Health’s dementia peer support scheme. It is also a demonstrator site for telehealth and telecare, with dementia patients receiving telecare support.
Progress / Achievements
Chronic disease registration for dementia is now at 68% in Newquay and 39% in the rest of the county (compared with the national average of 33%). The approach used in the Newquay integrated care pilot, and more widely in the county, therefore appears to be working.