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Dementia commissioning – a missed opportunity

Published online by Cambridge University Press:  02 January 2018

Sudip Sikdar*
Affiliation:
Mersey Care NHS Trust, Liverpool, UK, email: sudip.sikdar@merseycare.nhs.uk
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Abstract

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Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2013

Iliffe Reference Iliffe1 makes important points about complex conditions but offers a very limited view of the possibilities for commissioning dementia services.

Any qualified provider broadens the options and there is no reason why the whole system needs to be commissioned from a single provider. In acute hospitals, services may be provided by liaison psychiatry or physicians or both. Liaison psychiatry could extend into the community 2 or intermediate care services. In care homes, where frailty is common, there might be an alliance of community geriatrics and old age psychiatry with the independent sector. Home treatment may include joint health and social care, memory services, and care advisors.

What is crucial is that the whole system has to be commissioned and commissioners see the whole system and bind the component parts together. This point is made in the National Institute for Health and Care Excellence dementia commissioning guide with reference to dementia clinical networks. Reference Mynors-Wallis3 Networks define a whole system where local providers are clearly identified to meet local need and operate a unified, interactive dialogue, not a care pathway that patients do not follow.

The new commissioning environment creates an exciting opportunity to think more imaginatively and this will be needed to meet the dementia challenge. This has to be more than the ‘is it the GP or the specialist?’ question.

References

1 Iliffe, S. Commissioning services for people with dementia: how to get it right. Psychiatrist 2013; 37: 121–3.Google Scholar
2 World Health Organization. Dementia: A Public Health Priority. WHO, 2012.Google Scholar
3 Mynors-Wallis, L. Safe Patients and High-Quality Services: A Guide to Job Descriptions and Job Plans for Consultant Psychiatrists (College Report CR174). Royal College of Psychiatrists, 2012.Google Scholar
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