Is Dudley council setting out a new model for dementia care?

Dudley's initiative aims to help people with dementia stay independent for as long as possible. Photograph: David Levene for the Guardian

One of the most pressing problems for local authorities and the new clinical commissioning groups (CCGs) is how to provide services to people in their areas diagnosed with dementia. As the ageing population imposes even greater demands on health and social care services, a local authority in the Midlands has developed its own strategy for dementia that brings services together to support people at home.

The dementia gateway service developed by Dudley metropolitan borough council (DMBC) has been operating since November 2011 and aims to integrate early diagnosis and medical intervention for people with dementia with social care to keep the person independent and in their own home for as long as possible.

The care pathway is based on a multidisciplinary team approach, involving initial assessment by dementia nurses, with input from old age psychiatrists, mental health specialists, and dementia advisers, all of whom were part of the steering group that devised the pathway.

Matt Bowsher, assistant director, quality and commissioning at DMBC, says: "We wanted to develop a person-centred approach to dementia care based on listening to our clients and responding to their needs, and to help people avoid having premature links with 'serviceland' for as long as possible. We needed to adapt services to the needs of clients and their families rather than have a rigid system which delivered the same service to all clients."

The council estimates that it will have around 4,365 people diagnosed with dementia by 2015, but this is predicted to rise by 50% to 6,435 by 2030. There are currently around 58,200 people aged over 65 in its population of 312,000.

The government's strategy for personalisation of social care, "Making it Real", launched in 2009, prompted the council to review the way it provided dementia care and led to the setting of the steering group. Last year, prime minister David Cameron set a Dementia Challenge for councils to improve their services to local people.

"We now support high numbers of people, including some of working age, to live well with dementia at home by providing information and advice and making links to universal services so that people can still pursue their personal interests and hobbies through our adult community enablement team," says Bowsher.

The council has a dementia adviser linked into acute hospital services, who liaises with the early supported discharge team. The adviser links with the person and their relatives within a day or two of their admission to hospital, liaises with ward staff and supports an inpatient clinic. This setup enables the NHS to achieve its CQUIN targets.

The gateway offers therapeutic and creative activities to clients, and short and long-term respite to carers, as well as interventions to people living with dementia, which maintain or build on their skill levels while also reducing the need for drug therapy or early admission to residential or nursing home care. The council also works in an integrated way with its own adult social commissioners and the CCG commissioners to ensure that services are co-ordinated.

"We originally had only one dementia nurse specialist, but we now have three," says Annette Darby, dementia services manager at DMBC. "There are now three ways that clients can be progressed through the system: through GP referral to our nurse specialists, through community mental health nurses and through social workers. Our dementia advisors are also being trained to undertake the assessment of need – technically known as an MAF1/MAF2/Support Plan – to deal with presenting issues."

The CCG was involved in the service from the outset (formerly as the PCT) and believes the pathway has been very successful. Paul Maubach, the CCG's chief accountable officer, says: "We think the service is a really good example of collaboration between local authority and CCG. Dudley was in the bottom third of detection and diagnosis rates for England, and there was actually a reluctance for some GPs to diagnosis patients with dementia, because they did not feel there were adequate support services in place. Now that's changed and the gateway service has diagnosed around 400 cases in the last two years. We have a much higher rate of referral to services now and a clear pathway for patients."

He also says that the three dementia centres run by the service provide a valuable focal point for treatment and support for clients and their families. Both the council and the CCG acknowledge the crucial role played by the voluntary sector in supporting people who have been diagnosed and their families.

Janice Connolly, the Midlands locality manager for the Alzheimer's Society, says that it offers a range of services in the Dudley area and across the Midlands. "We run around 18 dementia cafes across the Midlands region and four of these are in the Dudley area.

These are monthly sessions where the person diagnosed and their family can meet others in the same situation, and this can help greatly with information-sharing and mutual support. We also run a helpline for crisis support and give advice on accessing social and domiciliary care."

The service has now gained national recognition, winning praise from health minister Norman Lamb at a recent conference and even from health secretary Jeremy Hunt. The NHS director general of social care has also paid a visit to Dudley in recent weeks to see first-hand how the service works.

As councils struggle to find resources for improving dementia care, the Dudley model could prove to be a blueprint for the future around the country.

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A look to die for? How Liverpool council is fighting sunbed obsession

There is strong evidence linking sunbed use to skin cancer, and tanning machines are particularly damaging to people under the age of 35. Photograph: Frank Augstein/AP

A stroll down County Road in Liverpool reveals why the city is often referred to as the sunbed capital of the UK. Shops offering tans sit beside cafes and clothes stores. Now nail salons and hairdressers, even gyms, frequently offer sunbed facilities alongside other services. We estimate there are at least 200 sunbed businesses in the city, but there could be more as these outlets don't have to be licensed.

In Liverpool young people in particular regularly use sunbeds. In 2009 Cancer Research UK revealed half of 15- to 17-year-old girls in the city had used a sunbed, compared to 11% nationally.

One of the key priorities identified by our health and wellbeing board, in its new role, is skin cancer prevention. Skin cancer is the fastest growing cancer among 18- to 35-year-olds and is largely preventable. There is strong evidence that links sunbed use to skin cancer and these tanning machines are particularly damaging to people under the age of 35.

This is why last week we launched a campaign that educates young people in our city about the dangers of sunbeds. The campaign is also asking the government to grant local authorities the power to license sunbed businesses, so we can keep track of where they are and how they are operating.

Our campaign is not just about advertising our message and hoping people will listen, we are looking at the motivations of sunbed users and leveraging the truly collaborative approach to tackling behaviour change that the local authority's new public health role brings.

We involved young girls in the campaign development to get an understanding of why they use sunbeds and to ensure the campaign spoke to them. These girls say they feel better about themselves with a tan. Responding to this insight, we have a fake tan brand supporting the campaign by teaching girls how to use fake tan, to get the tanned look, without the health risks.

We also spoke to mums and discovered many are unaware of the risks themselves and don't speak to their daughters about sunbeds in the same way they would about drinking, smoking or unprotected sex. We'll be educating both teenagers and engaging with their parents via our schools, so they feel confident having these conversations.

It was only recently that councils became responsible for public health, as part of the health and social care bill, but it's already evident the transfer brings advantages. We're able to use the wide range of functions local authorities discharge to change behaviour in our city.

This isn't the first time we've taken a collaborative approach of combining the efforts of the NHS and the local authority in Liverpool.

In 2006 we played a pivotal role in influencing parliamentary vote in favour of legislation on smoking. Now, with public health being the responsibility of the council, there is an even greater opportunity to influence health through almost every area of policy, from planning and licensing to education, housing and economic growth.

We are asking the government to grant all local authorities (not just Liverpool), the power to license sunbed businesses and tighten regulations. We want to work with the sunbed industry to ensure a number of minimum standards are met – such as provision of goggles, skin assessments and approved educative materials about the risks.

We want to protect young people, who are most vulnerable, from the dangers of sunbeds and to ensure the rest of the population can make an informed choice about using them.

We hope that by asking for these powers across England and by sharing our learning we can encourage other authorities to take a similar approach to tackling this problem.

Paula Grey is joint director of public health at Liverpool city council.

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

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View the original article here

A look to die for? How Liverpool council is fighting sunbed obsession

There is strong evidence linking sunbed use to skin cancer, and tanning machines are particularly damaging to people under the age of 35. Photograph: Frank Augstein/AP

A stroll down County Road in Liverpool reveals why the city is often referred to as the sunbed capital of the UK. Shops offering tans sit beside cafes and clothes stores. Now nail salons and hairdressers, even gyms, frequently offer sunbed facilities alongside other services. We estimate there are at least 200 sunbed businesses in the city, but there could be more as these outlets don't have to be licensed.

In Liverpool young people in particular regularly use sunbeds. In 2009 Cancer Research UK revealed half of 15- to 17-year-old girls in the city had used a sunbed, compared to 11% nationally.

One of the key priorities identified by our health and wellbeing board, in its new role, is skin cancer prevention. Skin cancer is the fastest growing cancer among 18- to 35-year-olds and is largely preventable. There is strong evidence that links sunbed use to skin cancer and these tanning machines are particularly damaging to people under the age of 35.

This is why last week we launched a campaign that educates young people in our city about the dangers of sunbeds. The campaign is also asking the government to grant local authorities the power to license sunbed businesses, so we can keep track of where they are and how they are operating.

Our campaign is not just about advertising our message and hoping people will listen, we are looking at the motivations of sunbed users and leveraging the truly collaborative approach to tackling behaviour change that the local authority's new public health role brings.

We involved young girls in the campaign development to get an understanding of why they use sunbeds and to ensure the campaign spoke to them. These girls say they feel better about themselves with a tan. Responding to this insight, we have a fake tan brand supporting the campaign by teaching girls how to use fake tan, to get the tanned look, without the health risks.

We also spoke to mums and discovered many are unaware of the risks themselves and don't speak to their daughters about sunbeds in the same way they would about drinking, smoking or unprotected sex. We'll be educating both teenagers and engaging with their parents via our schools, so they feel confident having these conversations.

It was only recently that councils became responsible for public health, as part of the health and social care bill, but it's already evident the transfer brings advantages. We're able to use the wide range of functions local authorities discharge to change behaviour in our city.

This isn't the first time we've taken a collaborative approach of combining the efforts of the NHS and the local authority in Liverpool.

In 2006 we played a pivotal role in influencing parliamentary vote in favour of legislation on smoking. Now, with public health being the responsibility of the council, there is an even greater opportunity to influence health through almost every area of policy, from planning and licensing to education, housing and economic growth.

We are asking the government to grant all local authorities (not just Liverpool), the power to license sunbed businesses and tighten regulations. We want to work with the sunbed industry to ensure a number of minimum standards are met – such as provision of goggles, skin assessments and approved educative materials about the risks.

We want to protect young people, who are most vulnerable, from the dangers of sunbeds and to ensure the rest of the population can make an informed choice about using them.

We hope that by asking for these powers across England and by sharing our learning we can encourage other authorities to take a similar approach to tackling this problem.

Paula Grey is joint director of public health at Liverpool city council.

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

A look to die for? How Liverpool council is fighting sunbed obsession

There is strong evidence linking sunbed use to skin cancer, and tanning machines are particularly damaging to people under the age of 35. Photograph: Frank Augstein/AP

A stroll down County Road in Liverpool reveals why the city is often referred to as the sunbed capital of the UK. Shops offering tans sit beside cafes and clothes stores. Now nail salons and hairdressers, even gyms, frequently offer sunbed facilities alongside other services. We estimate there are at least 200 sunbed businesses in the city, but there could be more as these outlets don't have to be licensed.

In Liverpool young people in particular regularly use sunbeds. In 2009 Cancer Research UK revealed half of 15- to 17-year-old girls in the city had used a sunbed, compared to 11% nationally.

One of the key priorities identified by our health and wellbeing board, in its new role, is skin cancer prevention. Skin cancer is the fastest growing cancer among 18- to 35-year-olds and is largely preventable. There is strong evidence that links sunbed use to skin cancer and these tanning machines are particularly damaging to people under the age of 35.

This is why last week we launched a campaign that educates young people in our city about the dangers of sunbeds. The campaign is also asking the government to grant local authorities the power to license sunbed businesses, so we can keep track of where they are and how they are operating.

Our campaign is not just about advertising our message and hoping people will listen, we are looking at the motivations of sunbed users and leveraging the truly collaborative approach to tackling behaviour change that the local authority's new public health role brings.

We involved young girls in the campaign development to get an understanding of why they use sunbeds and to ensure the campaign spoke to them. These girls say they feel better about themselves with a tan. Responding to this insight, we have a fake tan brand supporting the campaign by teaching girls how to use fake tan, to get the tanned look, without the health risks.

We also spoke to mums and discovered many are unaware of the risks themselves and don't speak to their daughters about sunbeds in the same way they would about drinking, smoking or unprotected sex. We'll be educating both teenagers and engaging with their parents via our schools, so they feel confident having these conversations.

It was only recently that councils became responsible for public health, as part of the health and social care bill, but it's already evident the transfer brings advantages. We're able to use the wide range of functions local authorities discharge to change behaviour in our city.

This isn't the first time we've taken a collaborative approach of combining the efforts of the NHS and the local authority in Liverpool.

In 2006 we played a pivotal role in influencing parliamentary vote in favour of legislation on smoking. Now, with public health being the responsibility of the council, there is an even greater opportunity to influence health through almost every area of policy, from planning and licensing to education, housing and economic growth.

We are asking the government to grant all local authorities (not just Liverpool), the power to license sunbed businesses and tighten regulations. We want to work with the sunbed industry to ensure a number of minimum standards are met – such as provision of goggles, skin assessments and approved educative materials about the risks.

We want to protect young people, who are most vulnerable, from the dangers of sunbeds and to ensure the rest of the population can make an informed choice about using them.

We hope that by asking for these powers across England and by sharing our learning we can encourage other authorities to take a similar approach to tackling this problem.

Paula Grey is joint director of public health at Liverpool city council.

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

More people learning how to restart a heart could save 100,000 lives per year across Europe, says the European Resuscitation Council

Main Category: Cardiovascular / Cardiology
Also Included In: Public Health
Article Date: 25 Jul 2013 - 2:00 PDT Current ratings for:
More people learning how to restart a heart could save 100,000 lives per year across Europe, says the European Resuscitation Council

The very first 'European Restart a Heart Day'-to teach members of the public how to help restart the heart of someone who has suffered a cardiac arrest-will be held this autumn, organised by the European Resuscitation Council (ERC). The initiative, which takes place on October 16, is aimed particularly at Europe's younger people, aims to improve the very low numbers of people surviving out-of-hospital cardiac arrests. On the day, Members of European Parliament will be taught how to resuscitate a victim and use an automated external defibrillator (AED). A poster campaign and flyers will be distributed in different languages, and events will be held across multiple European countries with the support of their national resuscitation organisation.

Every year, around 350,000 Europeans suffer an out-of-hospital (OOH) cardiac arrest. OOH cardiac arrests occur anywhere, for example in the street, at work, or while exercising or doing other strenuous activity. The vast majority happen at home. Currently, less than 1 in 10 of these patients survive. Bystander cardiopulmonary resuscitation (CPR) by lay people increases survival by 2-3 times, however, today it is delivered in only 1 in 5 out-of-hospital cardiac arrest. Increasing this rate may save 100,000 lives in Europe per year. "Unfortunately, only a small minority of cardiac arrest victims receive this vital help in time to save their life," says Professor Maaret Castrén, Karolinska Institutet, Sweden, and chair of the ERC.

Bystander CPR rates vary widely across Europe, with Andalusia in Spain as low as 12%, Germany 15%, through to very high rates in the Netherlands (61%) and Sweden (59%).The actual survival rate varies with the setting, with some countries (generally those in Eastern Europe) having survival as low as 6%, whereas countries with an excellent record in bystander CPR such as the Netherlands and Norway see survival rates as high as 40%. "If we could improve rates of bystander CPR in Europe to the levels seen in these best-performing nations, then around 100,000 lives could be saved each year across Europe," says Prof Castrén. "We are certain that if more people were trained (e.g. in key public places such as airports, gyms, hotels etc.) and if more AED's were placed on strategic points, 50% of the deaths by cardiac arrest could effectively be prevented," she adds.

To put these numbers in context, the estimate of 350,000 OOH cardiac arrest deaths is equivalent to 1,000 deaths per day every day of the year across Europe: 2 full jumbo jets crashing with no survivors each and every day. By comparison, 28,000 people die across Europe each year in road accidents, but despite this the figure invested in road and car safety each year is much higher than that invested in CPR.

The ERC's Restart a Heart campaign comes following a European Parliament declaration in June 2012 calling on Member States to establish a European Cardiac Arrest Awareness Week aimed at improving awareness and education of the public, doctors and other health care workers .

In addition to children aged 12-16 years and young adults, the European Restart a Heart Day will also educate teachers, parents, opinion leaders and politicians about how to give this vital assistance. The ERC will mobilise the support of all national resuscitation organisations in Europe to help promote the campaign, which will include posters, flyers, tips on CPR and event ideas for schools, youth organisations, and sports clubs.

There will also be a multilingual website packed with useful information and explaining how to deliver CPR correctly, and a video demonstration, a CPR app, a Twitter hashtag and a special Facebook page to share experiences and stories. Politicians in the European Parliament in Brussels will also be treated to a special resuscitation demonstration and training session on European Restart a Heart Day.

"CPR is easier than most people think and saves lives," adds Professor Castrén. "People are understandably nervous about doing CPR but our campaign will show that it is a straightforward procedure that can be performed by most people. Members of the general public really have the power and ability to save lives in these circumstances. Even a modest increase in the proportion of the public doing CPR in this scenario could save many lives."

Make sure it is safe to approachCheck for any response from the victimShout for helpTilt head back, lift the chin and check for breathingCall the emergency services and state your name, location and the situationPlace the heel of one hand in the centre of the chestPlace other hand on top and interlock fingersCompress the chest to the rhythm of "Stayin' Alive" until an AED or emergency services arriveIf willing, provide two rescue breaths between every 30 compressions, otherwise pump the chest continuouslyDon't worry, you cannot do any harmIf possible change CPR operator every 2 minIf someones has come to help ask them to try to find and automated external defibrillator (AED)If an AED arrives, switch it on immediately and follow the instructionsOnce the emergency services arrive, you can relax and celebrate the fact that your hands could restart a heart and save a lifeDoing something is ALWAYS better than doing nothingWell done!Now spread the word and let your friends and family know that they too can save lives.

Simon Gillespie, Chief Executive at the British Heart Foundation, said:

"The number of people dying unnecessarily from a cardiac arrest in the UK is completely unacceptable and a needless loss of life.

World-beaters like the Netherlands and Norway are proof that if more people are trained in vital CPR and have access to a defibrillator then survival rates will increase.

We desperately need life-saving skills taught as standard in our schools and new laws requiring defibrillators in busy public places where a cardiac arrest can occur.

The ERC says every year there are around 385,000 cardiac arrests out of hospital, with survival rates currently less than 1 in 10. In the UK, around 30,000 cardiac arrests outside of hospital are attended by emergency services annually, with survival rates around 20 per cent.

The ERC states if survival rates increased to 40 per cent, as seen in best-performing nations like Norway, around 100,000 more lives in Europe could be saved every year. The British Heart Foundation estimates that figure could be around 6,000 in the UK.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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