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  • 1

    Help Shape the Future of Specialist

    Inpatient Dementia Services on the

    Island

    2015 - Onwards

  • 2

    Contents

    Executive Summary - ........................................................................................................................... 3

    1 Introduction .................................................................................................................................... 4

    2 Specialist Inpatient Dementia on the Isle of Wight .................................................................. 5

    3. Future provision ............................................................................................................................... 8

    3.1 The right number of beds for now and for the foreseeable future ...................................... 8

    3.2 A model of care (way of delivering the service) that facilitates excellent care ................. 9

    3.2.1 Location of Facilities .......................................................................................................... 9

    3.2.2 Service Design .................................................................................................................. 10

    3.3 An environment designed to support the provision of excellent care .............................. 11

    3.4 A provider who can deliver consistent excellent care ........................................................ 12

    3.5 Represents value for money (and other issues) ................................................................. 13

    3 Consultation ................................................................................................................................ 14

  • 3

    Executive Summary -

    The Isle of Wight has agreed a long term dementia Strategy called Living Well with

    Dementia. This is a plan designed to improve and increase the services available for

    people with dementia; in part responding to the predicted increase of 40% in the next 12

    years in people living with dementia due to our ageing population.

    A small number of people with dementia will require specialist inpatient treatment and

    assessment. This is normally provided by a specialist provider of mental health services in

    an Inpatient unit designed for those with dementia.

    The Island already has a unit called Shackleton Ward based at St Marys Hospital in

    Newport. It has 7 beds. A few years ago a similar ward was based in Ryde, it originally had

    many more beds but improved community services reduced the demand to the current

    levels.

    The current unit is now very busy and has been determined as not suitable for use long term

    - for example it does not provide easy access to a garden and because it is in an old acute

    ward, some design compromises have been made, and due to the predicted increase in

    people with dementia it is likely that the unit size will need to grow.

    We have had some initial discussions with those closely involved around the future of

    inpatient care and now wish to discuss ideas that have emerged from these conversations in

    more detail with all stakeholders. This will help us commission the right service in the future.

    The document asks for your views including;

    How many beds should the service have?

    What is the best location?

    How should care be delivered?

    The document suggests some leading answers to this question but we want your views.

    We have arranged for feedback by email, phone or via open events through which we would

    welcome people attending to share their views. The consultation continues until the 24th

    August 2015 when these views will be compiled and a report with a recommendation is

    presented to the Clinical Commissioning Group for consideration.

  • 4

    1 Introduction

    Early in 2015 the Isle of Wight Clinical Commissioning Group with its Partners published the

    Dementia Strategy, Living well with Dementia. The strategy sets out the work planned for

    the future and recognises the success of the transformational work already completed. The

    CCG wishes to continue this work and focus on the future of specialist inpatient services.

    Dementia is predicted to become the biggest health and social care challenge of this

    generation. In the UK there are over 850,000 people living with dementia. With an ageing

    population the number is predicted to continue to increase by 40% over the next 12 years.

    The impact of dementia on the individual and their families is profound, family carers are

    often frail older people themselves with high levels of depression, physical illness and a

    diminished quality of life.

    Dementia is an umbrella term describing a progressive decline in mental functions, such as

    memory, language, orientation and judgement. This can impact the ability to carry out daily

    activities. The symptoms gradually get worse over time and the condition is currently

    incurable, interventions can lessen the symptoms and improve the quality of life for people.

    Age is the most significant known risk factor for dementia. After the age of 65, the risk of

    developing Alzheimer's disease doubles approximately every five years. With 1 in 14 people

    over 65 and 1 in 6 over 80 having some form of dementia.

    Due to our elderly demographics and high diagnosis rate it is estimated to be 2658 people

    living with dementia, this is predicted to increase significantly. This increase in dementia

    prevalence is due to people living longer as a consequence of better healthcare and

    improved standards of living. This presents a number of challenges, directly for those people

    who develop dementia, their families and carers, and indirectly for the statutory and

    voluntary sector services that provide care and support.

    Although most people with dementia will not require specialist inpatient care, for a small

    number of people per year, this is an important provision to help support and assess

    individuals at their most vulnerable.

    This consultation has three aims:

    To identify a preferred model or way a service is provided for the future

    To identify specific preferences such as preferred locations, size and design

    To understand the priorities and future needs to, as far as possible, future proof our

    requirements

    The consultation is based on work completed in a pre-consultation stage; a set of

    discussions that took place in April and May with various local stakeholders, designed to

    enable a final consultation to be as well thought out and focused as possible.

  • 5

    2 Specialist Inpatient Dementia on the Isle of Wight

    The Island currently has one specialist inpatient ward, provided by Isle of Wight NHS Trust

    at St Marys Hospital, Newport. As the diagram below shows, most people with dementia

    receive care in the community, from their GP, memory services, local authority or third

    sector. Individuals may live at home or in some cases they may live in residential or nursing

    accommodation.

    Rarely an individual requires specialist inpatient treatment and this inpatient provision is

    based at St Marys Hospital, Newport and also provided in Shackleton Ward which has 7

    inpatient beds. This unit was previously based in Ryde but was relocated in June 2013 due

    to a decline in the former ward environment.

    Significant improvements in community services across the Island over the past 5-10 years

    for those with dementia have already resulted in more people being supported out of hospital

    environments. As a result specialist inpatient dementia bed usage dropped from around 20

    beds to around 6 in 2011/12. The beds available at the current ward experience a high level

    of occupancy.

    The current service costs the NHS 1.46m per year for 7 beds, around half of all expenditure

    on specialist NHS dementia care. The remainder will be distributed between services

    including diagnostic services, post diagnostic support, memory groups and Admiral Nurses

    supporting people to make informed choices and live well with dementia in the community.

    The replacement ward now at St Marys Hospital was not intended to be a permanent

    solution, in 2011 a consultation was undertaken to consider the long term re-provision of

    inpatient beds which recommended a purpose built facility at St Marys hospital in Newport;

    although a number of other options were popular.

    Specialist

    Inpatient Care

    Care in the community such as through the Memory

    Service

    Care in the community through primary care and Dementia Alliance (3rd Sector), etc

  • 6

    The ward is located on the first floor of St Mary Hospital and can only be accessed by lift or

    stairs. The ward, converted from an Acute Medical Ward, consists of 7 single bedrooms,

    shared dining and living space as well as single sex space for privacy. The ward has

    access to a dedicated garden but patients along with staff or carers have to leave the ward

    to get there, using the stairs or lift. As a major healthcare site there are good transport links

    to the site.

    Examples of the strengths and areas of improvement of the existing environment include;

    Example strengths;

    Being attached to the Hospital has allowed easy, less traumatic access to Hospital

    services such as for an X-ray, which formally may

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