I was startled when our nursing director pointed out that at any one time there could be up to 400 patients with dementia occupying beds in our hospitals.
That is roughly 40 per cent of our bed stock. While dementia was not, of course, their primary reason for admission, this is a sobering statistic.
Our dementia coalition, led by CEOs, is attempting to create the conditions for a perfect storm
The national dementia strategy gives a sense of the scale of the challenge. There are currently 700,000 people in the UK with dementia and it costs the UK economy £17bn a year. The forecast is that in the next 30 years the number will double to 1.4 million and costs treble to over £50bn per year.
Currently only about one
third of people with dementia receive a formal diagnosis or have contact with specialist services at any time in their illness. The strategy lays out a vision to transform dementia care over the next five years and clearly highlights the benefits of early diagnosis.
The economic case for tackling dementia is unequivocal. Investment in prevention, early intervention and community-based support can be substantially resourced, over 10 years, by reductions in hospitalisation and admissions to long-term institutional care. The strategy calls for urgent action in the following areas:
- good-quality early diagnosis and intervention for all;
- improved community personal support services;
- implementing a strategy for carers;
- improved quality of care for people with dementia in general hospitals;
- living well with dementia in care homes;
- an effective workforce;
- a joint commissioning strategy for dementia.
In our Darlington patch, together with PCT, mental health, SHA and local government colleagues, we are having a bash at applying large-scale change methodology to help us implement a local strategy. Large-scale change is about creating the conditions where change is enabled free of organisational boundaries and is being sponsored nationally by the NHS Institute of Innovation and Improvement. The premise is that the world changes dramatically if you can collectively create momentum through harnessing networks of relationships between people who share a common vision of what is possible.
In my experience of life and work this sort of change is usually emergent, has great impact and does not originate from any plans or strategies from on high. The skill is to build a web of connections between people and discrete local initiatives.
While these initiatives remain separate and apart they have no influence beyond the local setting. However, if they become connected, allowing exchange of information and learning, they can suddenly emerge as very powerful levers.
Margaret J Wheatley describes this as an “emergent phenomenon” and suggests that this guarantees power and influence far in excess of any sum of individual and separate efforts, empowerment of those involved and surprises - or as the large scale change merchants call it, “the WOW factor”.
Our dementia coalition, led by CEOs, is therefore attempting to create the conditions for a perfect storm that is intended to redefine behaviours, redesign systems and restructure working practices.
We have deliberately set out to foster a sense of purposeful direction and attempt to understand what prevents high-quality performance, tackling these constraints, actively upsetting the current order of things and facilitating active engagement of all stakeholders across our health and social care economy.
For patients and their carers we aim to overhaul our current arrangements so we can deliver much more care in the community and at home. We also intend to use lean methodologies to reduce hand-offs and unlock constraints in the pathway. This will mean focusing on improving advice, assessment and early intervention to maximise quality of life for patients and minimise hospital admission.
Bespoke training of staff from all sectors involved will enable greater deployment of specialist and knowledge-based treatment and assessment away from hospital and clinic settings. We want to reduce hospital admission and for those people who do need to come in, we want reduce their length of stay and ensure high-quality planned and supported discharge. We want to make sure that the experience of all of our services, wherever provided, is good and ensures dignity and respect. Most of all we want people with dementia and their carers and families to be partners in their care plans.
We have established a Dementia Coalition Board to steer the work and provide a powerful lever for the energy, leadership and resources needed to cultivate and then sustain the deep changes in the approach we seek. We are really keen to see this initiative succeed so it can be applied to other multi-agency areas, such as treating people with alcohol problems.
It’s only when you do this sort of work that you realise the sheer rock face of complexity that whole systems change presents. But, as in the words of Henry Mintzberg, the Canadian guru of emergent strategy, “Mould-breaking strategies grow initially like weeds; they are not cultivated like tomatoes in a hothouse.”
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