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

2. Innovation as a societal response
to dementia
Dr Shibley Rahman
MRCP(UK) PhD MBA LLM
#WHIS16 Cumbria – March 2016

3. 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.

4. 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.”

5. 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

7. 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.’

11. 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)

12. Clifford Barclay Lecture
Prof Nikolas Rose LSE 2005

14. 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

15. Illinca et al., 2012

16. Baker, 2002

17. 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

18. 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

19. 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

20. 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

21. 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

22. Greenhalgh et al., 2004

24. Ethical issues in dementia globally
Gauthier et al., 2013

25. “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)

31. 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.

32. 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.

33. 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.

34. ‘Dementia friendly’ wards

35. 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