Summary
Strategic Issue 1
There is a higher prevalence of Dementia in Hartlepool than regionally and nationally and due to the ageing population, the numbers are likely to grow by 40% by 2040 putting increased pressure on services that are already stretched.
What needs to be done
Acknowledge the higher prevalence of Dementia in Hartlepool. Invest in community awareness and screening programmes and collaborate with primary care to improve early diagnosis and risk factor management. Use data-driven strategy to determine geographical locations in the Borough requiring intervention and population groups.
Strategic Issue 2
There are rising hospital admissions and low annual review rates. Rising hospital admissions suggests there are gaps in community-based care, the low annual review rates within primary care indicate missed opportunities to manage symptoms and adjust care plans which may explain increasing hospital admissions.
What needs to be done
Increase annual review rates to ensure appropriate management of symptoms and care plans and provide support to carers. Use data-driven strategy to highlight GP surgeries with low annual review rates to provide support.
Strategic Issue 3
There are high rates of modifiable risk factors such as physical inactivity, uncontrolled diabetes, hypertension, hearing loss, and tobacco and alcohol use.
What needs to be done
Provide community intervention on modifiable risk factors such as physical inactivity, smoking cessation, alcohol-use and social isolation through community hubs and data-driven location strategy. Support GP surgeries with the management of modifiable risk in co-morbid conditions such as diabetes and hypertension through health literacy and education and annual reviews.
Strategic Issue 4
The majority of patients with Dementia die within care homes, this reflects a need for quality end of life care and advance care planning.
What needs to be done
Provide support to care homes on Dementia by upskilling staff, providing guidance and training and ensuring quality end of life care and advance care planning for residents.