3. Integrated Support for Change
3.1 The strategy recognises that key to improving dementia services will be the transformation of health and social care services - towards an integrated, cost-effective whole-system approach which shifts the emphasis from high-cost long term care settings to preventative and community-based services which are co-produced by those with dementia and their families and carers.
3.2 The Dementia Demonstrator Sites project looks to demonstrate the benefits of this approach and influence the wider agenda on fundamentally reshaping care for older people. Its ambition is to provide an example of how national improvement support for both incremental and step-changes across all sectors can be effective in supporting the streamlining, integration and outcomes-focus of entire local systems; and to produce an economic analysis of the impact of these changes.
3.3 While the strategy said that it would support one demonstrator site, the level of interest in and quality of applications from local partnerships persuaded us to select 3 sites. Eleven initial applications were received from which the successful sites - Perth and Kinross, Midlothian and North Lanarkshire - were selected. Selection was on the basis of the strength of their applications and because the 3 sites also represented a geographic and social spread, with, for example, the relative deprivation and long-term unemployment in North Lanarkshire contrasting with the more rural and more relatively affluent areas of Midlothian and Perth and Kinross. Following the finalisation and agreement of project plans and the putting in place of national support and a governance structure, the project formally began in early 2011 and will run for fifteen months.
3.4 The final project plans capture ongoing and planned local activity within the 3 sites - such as early identification, enablement support, the implementation of integrated care pathways and the strengthening of intermediate care - designed to help drive a shift away from institutional care and from unnecessary admissions into acute care; and to align with the key challenges identified by the national strategy. All projects adopt a local outcomes-focussed approach to assessment, care planning and review; and associated local activity includes consideration around issues like housing and transport.
3.5 Key to the success of the project will be its evaluation and here the role of national support is important. As part of the evaluation, all 3 sites are using the cost-consequence analysis model, which will capture all the relevant costs (resource use) and the non-financial consequences such as improvements in patient satisfaction and improved quality of care. The evaluation will also measure outcomes based upon core common indicators used by the 3 sites aligned with the national dementia benchmarking framework. In addition, the sites agreed to develop a common approach - in working with the third sector and others - to an ongoing assessment for individuals during the progress of their dementia using the Talking Points model. This individual support would be aggregated and continued over time as part of sustaining activity beyond the immediate life of this project.
3.6 Working relationships between the 3 sites are being maintained by monthly meetings with the site project leads, and other meetings as appropriate, the results of which are fed back to the project's core governing group. A strategy for spreading learning from the project is being finalised; and a national learning event is planned for this autumn, to assist all of those involved in this strand of the strategy to reflect on and share further activity and learning up to that point.