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Innovation as a societal response to dementia


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This is the talk I will be presenting as a basis for discussion for the World Innovation Summit 2016 in Cumbria.

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Innovation as a societal response to dementia

  1. 1. Innovation as a societal response to dementia Dr Shibley Rahman MRCP(UK) PhD MBA LLM #WHIS16 Cumbria – March 2016
  2. 2. Policy vs people First and foremost, the emphasis should not be on ‘policy’ but on ‘people’, and meet the needs of all patients and carers individually and collectively. Thanks to Gareth Presch and Amir Hannan.
  3. 3. Economist Burton Malkiel says that “a blindfolded monkey throwing darts at a newspaper’s financial pages could select a portfolio that would do just as well as one carefully selected by experts.”
  4. 4. Innovation as a societal response to dementia #WHIS16 1. A reminder about what an ‘innovation’ is 2. Giving up on “The one last push” argument 3. Barriers to and drivers for dementia care innovation 4. Ethics and “responsible innovation” in dementia 5. Examples of ‘good’ innovation in dementia
  5. 5. The NHS Institute for Innovation and Improvement (2009, p 2) states: ‘Innovation is about doing things differently or doing different things to achieve large gains in performance.’
  6. 6. Scientific and financial challenges have meant that, between 1998 and 2012, there were 101 unsuccessful attempts to develop drugs for Alzheimer’s disease, with only three drugs gaining approval for treating symptoms of the disease. (source – Independent, 2015)
  7. 7. Clifford Barclay Lecture Prof Nikolas Rose LSE 2005
  8. 8. Barriers to innovation in dementia policy (after IBM, 2006) 1. Inadequate funding: the need for adequate start up funds 2. Risk avoidance: “project fear” 3. Time commitments: requires resource allocation 4. Incorrect measures: e.g. quality of dementia diagnosis as opposed to sheer number 5. “Siloing”: deliberately establishing boundaries
  9. 9. Illinca et al., 2012
  10. 10. Baker, 2002
  11. 11. Drivers of innovation relevant to dementia (1) • Rising patient, community social expectations regarding service and quality (effect of media/Prime Minister Dementia Challenge 2012) • Greater involvement of persons with dementia and carer • Demographic, social, and market changes • Financial pressures to decrease costs, ‘do more for less’ • Re-orienting ‘value’ • Change in regulations
  12. 12. Drivers of innovation relevant to dementia (2) • NHS need for long term resilient models of care • Increased demand for accountability and “responsible innovation” • New technologies and social media • Changing macroeconomic situation in UK and globally
  13. 13. Process innovation • became an important topic with the rise of the quality and continuous improvement movements • and, then again, with the more recent attention directed at change management, organisational learning and knowledge management. e.g. Electronic patient records/electronic prescribing
  14. 14. Service innovation • This is oriented toward improving the features and functionality of existing products and services e.g. radical redesign of the pathway for people with dementia and carers
  15. 15. Strategic innovation • What is now required to ensure organisational success is to question boundaries (e.g. funding budgets, ‘who to have in the room’, changing from disease to health models, asset based principles). • e.g. shifting power to patients, carers, families and communities as cocreators and producers of healthcare
  16. 16. Greenhalgh et al., 2004
  17. 17. Ethical issues in dementia globally Gauthier et al., 2013
  18. 18. “Responsible research and innovation is a transparent, interactive process by which societal actors and innovators become mutually responsive to each other with a view to the (ethical) acceptability, sustainability and societal desirability of the innovation process and its marketable products (in order to allow a proper embedding of scientific and technological advances in our society).” (Von Schomberg, 2011)
  19. 19. Gnosall primary care dementia service model • In the UK, the Gnosall model of primary care memory clinics was launched in 2006. • Specialist services, families and primary care providers worked together to screen patients for cognitive decline, focussing in particular on patients with a vascular history. • ‘Eldercare facilitators’ including nurses organised assessment, provided further support and linked with specialist services which were provided at a monthly memory clinic in every GP practice provided by a psychiatrist. • This reduced the waiting time for a diagnosis of dementia to just 4 weeks, and reported significant savings to the NHS, while also showing high levels of service users and professionals satisfaction.
  20. 20. NHS London “Dementia and prescribing antipsychotics Project” (2014) • GPs prescribe most of the antipsychotics for certain symptoms in primary care via repeat prescribing, although they are often initiated by prescribers outside primary care. • They were reluctant to discontinue prescribing in spite of the associated risks and evidence that many patients will have no worsening of symptoms when discontinued.
  21. 21. Strategic innovation Improvement in poor availability and access to non- pharmacological options to manage certain symptoms Service innovation • Undertake an audit and reduction exercise; and • Identify local experts to provide clinical support to GPs and champions to facilitate collaborative working between primary, acute and mental health teams.
  22. 22. ‘Dementia friendly’ wards
  23. 23. Innovation as a societal response to dementia #WHIS16 1. A reminder about what an ‘innovation’ is 2. Giving up on “The one last push” argument 3. Barriers to and drivers for dementia care innovation 4. Ethics and “responsible innovation” in dementia 5. Examples of ‘good’ innovation in dementia