This discussion paper outlines a proposal to establish pilots of Dementia Clinical Networks in line with the action set out in the Prime Minister’s Dementia Challenge when pilots will be launched in September 2012.

National network development

Dr Kathy McLean, National Clinical Transitions Director is developing proposals concerning the role and function of clinical networks within the reformed NHS.  It is proposed that networks will have a role in supporting commissioners to improve service level outcomes and service improvements.  The development of Dementia Clinical Networks in NHS South of England is consistent with the national direction regarding network development.

Professor Alistair Burns, National Clinical Director for Dementia is supportive of the development of clinical networks to support the continuation of improvement in services across the country.  Networks support the provision of accessible, broad, local expert advice and support for commissioners and providers (including primary care provision) around key, complex care pathway design and implementation would enable rapid improvements in quality and performance, the spread of evidence and best practice and function as a pivotal knowledge management resource. 

Purpose

A Dementia Clinical Network would provide a forum through which to drive the continued improvement of services for people living with dementia, and their carers/families. It would act as a bridge and conduit across health and care systems in order to influence, inform and support whole systems working.

A key function of the Dementia Clinical Network would be to contribute to engagement on clinical service redesign across wider health communities. The Network will ‘add value’ to the continued improvement of services for people with dementia by offering a systems overview, identifying, and responding to opportunities to influence system change and improvement which would otherwise not be available. This might include, for example, bringing together stake holders to address and respond to service gaps; map and review existing services; collaborate in the (re)design of care pathways; address specific quality and patient safety issues; support quality, service improvement projects; develop guidance; and negotiate new ways of working with other sectors.

The Dementia Clinical Network will be underpinned by the principle of strong public and service user engagement and involvement and reflect this in all aspects of its work. This includes formal engagement with patients, service users, self advocates, carers and families.

Functions

Working with the principle of strong public and service user engagement and involvement, it is proposed that the Dementia Clinical Network would broker, facilitate and support delivery of the Prime Minister’s Challenge on dementia (published 26 March 2012).

Provide and promote strategic leadership,

• providing and maintaining a strategic overview of the health and care needs of people with dementia within the given population;
• engaging with key agencies, local networks and stake holder groups to ensure that the wider determinants of the health and wellbeing of people with dementia and their carers/families are reflected in sub national and local strategies and delivery plans;
• advising the NHS Commissioning Board, Health and Wellbeing Boards and Clinical Commissioning Groups about the priorities for delivery of health, social care, and public health outcomes for people with dementia and the quality standards that deliver them;
• brokering and supporting essential strategic partnerships with Public Health England, HealthWatch England, local government, Local Strategic Partnerships, social services, clinical commissioning groups, Health and Wellbeing Boards, Clinical Senates,  training and service providers in the public, independent and voluntary and community sector providers, regulators and professional bodies;
• facilitating whole systems working: identifying and brokering opportunities for delivering better services and better outcomes across the health and care system, through
• earlier diagnosis and interventions
• better care in hospital
• better care in care homes
• dementia friendly communities
• prescribing in line with NICE guidelines
• addressing carers’ needs.
• ensuring patient and public engagement and that of their carers and families and involvement are appropriate, robust and proportionate;
• promoting transparency, openness and accountability in the delivery of better outcomes for people with dementia;

Provide a source of expertise for Health and Wellbeing Partnership Boards and Clinical Commissioning Groups

• maintaining an overview of, and being consulted about commissioning and service redesign proposals;
• ensuring that local priorities both reflect and are informed by the wider determinants health and wellbeing for people with dementia and their carers/families, drawing on evidence and expert opinion;

 Support service improvement

• acting as a conduit, working with clinical commissioning groups and service providers to ensure the effective implementation of national policy and guidance,
• ensuring that local and sub national issues inform national policy and priorities;

 Support and advise on the design and delivery of care across systems

• to ensure that the principles of quality, innovation, prevention and productivity underpin commissioning and service delivery;

 Provide expertise in quality and safety assurance

• identifying, brokering and facilitating opportunities to improve quality and safety across care settings.

Population footprint

In order to deliver these functions a Dementia Clinical Network would need to have sufficient ‘reach’ to engage with local health and care economies, and to be able to work with and across health and care systems sub-nationally and nationally. This may be achieved through a sub-regional footprint, thus indicating perhaps 10-12 Dementia Clinical Networks across England with at least 3 in the South of England.

Governance

Membership will include individuals and groups able to reflect the needs and views of people living with dementia and their carers/families. This will include representation from, and expertise of,

• people with lived experience (2 carers, 2 people with lived experience)
• Clinical Commissioning Groups – a minimum of 2 GP leads for dementia
• clinicians and practitioners
• geriatrician
• old age psychiatrist
• psychologist, memory services
• GP
• community nurse
• social worker
• public health specialist
• workforce lead
• care home manager
• voluntary and community sector partners (Alzheimer’s Society; Dementia UK)
• Director of Social Services
• Director of Public Health
• Strategic Health Authority.

 Whereas it is anticipated that membership of the Network will include people with lived experience, it is acknowledged that they will be able to reflect the perspectives of people using services rather than represent them. A key function of the Network will be to ensure that it achieves robust engagement with, and the involvement of, people with lived experience.

Members of the Network who have lived experience will be invited to attend in pairs in order to ensure that appropriate support is in place.

Process for establishing the Clinical Network

A formal consultation about the purpose, functions and membership of the Clinical Network will be co-ordinated by the Strategic Health Authority.