North London Partners in health and care

Showcasing best practice in dementia and older people’s mental health care

A big day out with North Central London (NCL) STP blogs Professor Alistair Burns

NHS England/NHS Improvement’s  National Clinical Director for Dementia and Older People’s Mental Health, Professor Alistair Burns visited North Central London (NCL) on Monday 29 April, one of three Sustainability and Transformation Partnerships (STPs) selected in England to explore innovative practices in dementia and older people’s mental health care aimed at supporting NHS England and NHS Improvement’s work to implement the Long Term Plan.

The publication of the Long Term Plan earlier this year marked a pivotal moment for older people’s care, and particularly their mental health care. For the first time since the National Service Framework twenty years ago, our national strategy explicitly committed the NHS to improving the provision of mental health and physical health care for older people so they can stay well, better manage their long term conditions and live independently at home for longer.

Over the past few months, NHS England has been working with NCL STP to collect evidence on, and help demonstrate the impact of, Enfield’s Care Home Assessment Team (CHAT) and Camden and Islington’s Home Treatment Team.  With the publication of the Long Term Plan Implementation Framework now imminent, we are particularly excited to be visiting these teams today and to showcase the positive outcomes they achieve for older people, their families and the local health and social care system.

We believe these teams are fantastic examples of the community-based, integrated and holistic approaches we are looking to promote through the implementation of the Long Term Plan, including via the roll out of the Enhanced Health in Care Homes model and the expansion of community-based crisis care for older people. Such services are not only vital in providing timely support for older people’s mental health and dementia care needs in their own environment, they can also prevent unnecessary general and mental health hospital inpatient admissions, while reducing delays in hospital discharges.

Let us now turn to the facts of the day: What are those services for and what has been their impact so far?

CHAT is an integrated multidisciplinary mental and physical health care home support team with strong links to primary care, underpinned by seamless support from local geriatricians and a Consultant Psychiatrist. The team’s approach is particularly ground-breaking in that it promotes an integrated response across physical and mental health care.

 Achievements since 2013 include the following:

  • 35% reduction in the number of A&E attendances and non-elective admissions
  • 7% reduction in falls
  • 99% of residents died in their preferred place
  • 39% of residents have had their medication reduced or stopped
  • 8,409 hospital attendances and 8,109 GP call outs have been avoided
  • 7,606 care home staff and managers attended training on 59 subjects.

 Camden and Islington’s Home Treatment Team is a unique emergency mental health crisis response and short-term treatment team for older people with either functional (e.g. depression or anxiety) or organic (i.e. dementia and delirium) mental health needs. Camden and Islington CCGs are already known for their prioritisation of older people’s mental health and dementia care: they have the first and second highest dementia diagnosis rates in the country.

 Achievements for their Home Treatment Team since 2015 include:

  • 55% reduction in the average number of treatment days (from 20 days in 2015 to 9 days in 2018)
  • 57% of patients did not need to be re-referred to the team
  • 63% of older adults who received crisis mental health support were discharged to their normal place of residence
  • 13% of all referrals were to support reducing delays in hospital discharges
  • 64% of referrals received treatment (≥2 appointments) as well as an assessment. 

To find out more on how the Enfield, Camden and Islington Teams set about building their achievements please have a look at the new evaluation reports 

Alistair Burns
Alistair Burns is Professor of Old Age Psychiatry at The University of Manchester and an Honorary Consultant Old Age Psychiatrist in the Greater Manchester Mental Health NHS Foundation Trust. He is the National Clinical Director for Dementia and Older People’s Mental Health at NHS England and NHS Improvement.

Carolyn Piper
Dementia Project Manager, North London Partners in Health and Care.

  • Enfield's Care Home Assessment Team delivered by Barnet, Enfield and Haringey Mental Health NHS Trust.
  • Camden and Islington's Home Treatment Team delivered by Camden and Islington Mental Health NHS Trust.