Dementia Services in the United Kingdom

Report
Ritchard Ledgerd
Clinical Researcher
United Kingdom
Norway
33,383 occupational therapists
3,756 occupational therapists
Number of OT’s per 10,000 head of
population = 5
Number of OT’s per 10,000 head of
population = 8
70% work in jobs funded by the government
95% work in jobs funded by the government
30 universities offering 60 education
programmes
6 universities offering 6 education
programmes
All programmes WFOT Approved
All programmes WFOT Approved
72% join their national occupational therapy
association
91% join their national occupational therapy
association
92% female
91% female
National Health Service (public) no charge
Health Service no charge
Average life expectancy
Male =79.5
Female = 82.5
Average life expectancy
Male = 79.4
Female = 83.4
Number of people with dementia set to
double by 2040
Number of people with dementia set to
double by 2040
General overview of health & social care
provision in the UK
General Practitioners
(Primary Care)
Community Health Services
(Intermediate Care)
Community Mental Health
Services (Intermediate Care)
Hospitals - Physical
(Acute)
Hospitals - Psychiatric
(Acute)
Social Services/Care
Including 6 weeks reablement
Costs of care
Costs of care in 2008:
£10.5 billion on dementia
£4.5 billion on cancer
£2.7 billion on stroke
£2.3 billion on coronary heart disease
Approximately 1.5 billion hours of unpaid care is provided to
people living in the community through informal care equating
to £12 billion a year.
(Comma-Herra et al., 2007).
UK Policy and Strategy Documents
National Dementia Strategy (Department of Health, 2009)
Ensure better knowledge about dementia and reduce stigma
Ensure early diagnosis support and treatment
Develop services to meet peoples needs better
17 objectives
Quality Standards in Dementia
(National Institute for Clinical Excellence, 2010)
Covers the care provided by health and social care staff in direct contact with
people with dementia in hospital, community, home-based, group care,
residential or specialist care settings
UK Policy and Strategy Documents
Improving Dementia Services in England (National Audit Office, 2010)
Report on the National Dementia Strategy
Dementia Commissioning Pack (Department of Health, 2011)
Provides practical resources for health and social care commissioners
to work together to improve the quality of both specialist dementia
services and general health and care services for people with dementia and
their carers
The Prime Minister’s challenge on dementia (Department of Health,
2012)
There are 3 dementia challenge champion groups: driving
improvements in health and care, creating dementia friendly
communities and improving dementia research
Guideline on supporting people with dementia and their
carers in health and social care
National Clinical Practice Guideline Number 42 (2006)
Care plans should always include an assessment and
care-planning advice regarding ADLs, and ADL skill
training from an occupational therapist
British Association/College of Occupational Therapists
Providing 10 sessions of occupational therapy to those with dementia over 5 weeks
improves functioning and reduces burden on the care giver. Effects remain significant
after 3 months (Graff et al 2008).
Postponing entry into residential care by just one year through adapting peoples
home saves £28,080 per person (Allen et al 2010).
Evaluations from local telecare interventions reveal savings around emergency
hospital and residential care admissions i.e. £85,837 as a result of saved bed days
(Bowes et al 2006).
Examples of useful websites
Centre for Evidence Based Medicine www.cebm.net
Centre for Health Evidence
www.cche.net
Critical Appraisal Skills Programme
http://www.casp-uk.net/
Database of Abstracts of Reviews of
Effects(DARE) http://www.crd.york.ac.uk/crdweb/
Trip Database http://www.tripdatabase.com/
Research funding
In 2012 pledge to double funding for dementia research to over £66
million (688,865,752 NOK) by 2015. £13 million (135,685,678) for social
sciences research on dementia.
£36 million (375,819,776 NOK) over 5 years for a new National Institute
for Health Research (NIHR) to pull discoveries into real benefits for
patients.
In December 2013, the UK Government hosted a G8 summit on
dementia
Committed to identify a cure or a disease-modifying therapy for
dementia by 2025 and to increase the amount of funding for dementia
research.
Dementia Services in the United Kingdom
Replaced Day Hospital Services
4-6 weeks from referral
Memory
Services
Multidisciplinary
Diagnosis and Assessment
Role of the occupational therapist
Variation in delivery of services
People have access to personally tailored occupational therapy to assist them with
their occupational and functional needs and to help maintain their health and
wellbeing, independence and community living
Dementia Services in the United Kingdom
Multi-disciplinary including
social care and Admiral Nurses
Core mental health
assessment and duty rota
Complex and enduring
mental health needs
Care coordination and
generic working
Community
Mental Health
Teams
Functional and
organic diagnosis
Role of the occupational therapist
Variation - access and staff
Dementia Services in the United Kingdom
Usually doctors, nurses,
occupational therapists and
support workers
Variation and access
Intensive time limited support
at home
Crisis
Teams
Functional and
organic diagnosis
Role of the occupational therapist
Rapid response
Dementia Services in the United Kingdom
Community
Groups
Inpatient
Units
Care
Homes
National research studies
Facilitating Early
Diagnosis – Dementia
(FED-D)
Carer Supporter
Programme (CSP)
Remembering Yesterday
Caring Today (RYCT)
Promoting
Independence in
Dementia (PRIDE)
CBT and Anxiety in
Dementia
Prevalence of Visual
Impairment and
Dementia (ProViDe)
Dementia and Physical
Activity (DAPA)
Home Treatment
Programme
Cognitive Stimulation
Therapy/Maintenance/
Individual
Valuing Active Life in
Dementia (VALID)
National research studies
Background
• Researchers in The Netherlands developed a Community Occupational
Therapy in Dementia Programme (COTiD) for people with mild to
moderate dementia and their family carers (Graff et al., 2006)
• Ten x 1 hour sessions of home based occupational therapy.
• COTiD improved the person with dementia’s ability to carry out activities,
quality of life and mood
• Carers quality of life, mood and sense of competence also improved
• The effect sizes of all primary outcomes were higher than those found in
trials of drugs or other psychosocial interventions and still present at 3/12
• Cost effective, total mean costs £1279 (13,321 NOK) lower in intervention
group
COTiD-UK
Community
Occupational
Therapy
in
Dementia UK
Aim
The VALID programme aims to adapt, develop,
evaluate and implement an occupation based
intervention (COTiD-UK) which will promote
independence, meaningful activity and quality of life
for people with dementia and
their family carers living in the community.
Hypotheses:
1. COTiD-UK will significantly improve Activities of Daily Living (ADL)
abilities in people with dementia
2. COTiD-UK will significantly improve quality of life of people with
dementia and their family carers
3. The Programme will demonstrate cost effectiveness
Intervention & Manual Development
Next Stages
• Pilot Study – 3 sites (October 2014 – January
2015)
25 dyads control group
25 dyads in treatment group
• Randomised Controlled Trial (February 2015 –
Dec 2015)
240 dyads in control group
240 in treatment group
More information
www.ucl.ac.uk/valid

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