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The dementia service that could save the NHS millions

An evaluation of a two year pilot in Norfolk, which Care Minister Norman Lamb deemed, “exactly the sort of preventative care I want to see” has saved over £440,000 for health and social care in the area in just the first 10 months.

The Admiral Nursing service, supported by four partner organisations in Norfolk has had a positive impact on families affected by dementia providing much needed appropriate support and is a “life line” to carers.

Admiral Nurses are registered nurses specialising in dementia who support the whole family affected, providing both high-level emotional and practical support to enable them to deal with the complexities of the condition.

Through this robust community based service they’re able to reduce a family’s contact time with GPs, nurses and social workers and avoid unnecessary hospital admissions and care home costs.

The Norfolk Admiral Nurse Service is currently running as two year project in Mid-Norfolk and was developed after Dementia UK approached the Norfolk and Suffolk NHS Foundation Trust (NSFT) and Age UK Norfolk to develop a pilot to assess the value of the Admiral Service in the county. Funding from the People’s Health Lottery, which covers the Age UK Norfolk Admiral Nurse Lead post was enhanced by a contribution from NSFT to increase the number of Admiral Nurses to three in the area.

There are estimated to be 16,400 people with dementia in Norfolk and this figure is projected to rise to 25,512 by 2034.

The evaluation of the initial 10 months of service provision offers an insight into the challenges and successes of the pilot and provides strong evidence of the immense value of the service to the carers and families of people with dementia.

From the very start of the Admiral Nurse pilot there has been huge demand for the service, with over 230 referrals in just 10 months.

During the evaluation, carers consistently reported that their first contact with the Admiral Nurse Service was at a point where they were feeling very stressed and “needed extra support.” 75% carers reported low mood, depression and anxiety prior to support.

The evaluation found that the combination of the counselling role and knowledge and information provided by the Admiral Nurse had profound effects on the carers, improving their mental health and increasing their ability to carry on; 12 cases were identified which without the support of the Admiral Nurse would have resulted in the carer being referred to mental health services.

Patsy Jones cares for both of her parents, one has vascular dementia following a stroke, the other has Alzheimer’s type dementia.

“The Admiral Nurse Service has provided a complete lifeline and sanity to me, it has completely turned my life around. In the past year my life since receiving this support my life has gone from total chaos to now having some order. My Admiral Nurse has been amazing support. If this support was removed I would be devastated.”

The evaluation also highlights the positive impacts of the Admiral Nurse Service on professional caseloads and health and social care budgets.

94% of Health and Social Care professionals surveyed said that contact with Admiral Nurse Service had increased their confidence in dealing with dementia patients and their carers.

The evaluation suggested that Admiral Nurses reduced the contact time between other services and avoided eight mental health bed admissions.

Professionals reporting reduced contact time:

  • 60% GPs

  • 16% Nurses

  • 100% Social Workers

Dr Neil Ashford, Consultant in Old Age Psychiatry at Norfolk and Suffolk NHS Foundation Trust, said,

“The Admiral Nurse Service has provided rapid and easy access to specialist, highly skilled support for carers of people with dementia.” He goes on to say, “It is absolutely clear that the Admiral Nurse Service should be routinely available as a standard provision to all carers of people with dementia.”

A cost/benefit analysis undertaken as part of the evaluation estimated that the Admiral Nurse pilot resulted in savings of direct savings to health and social care of over £443,593* over the period from June 2013 and April 2014.

  • £63,074 Acute Health Care costs - reduced hospital admissions due to early identification and management of health conditions and support with end of life care.

  • 8 mental health hospital admissions.

  • £20,760 Continuing Health Care costs.

  • £16,992 (approx.) Improving Access to Psychological Therapies /Counselling.

  • £342,767 care home costs.*

*These figures are underestimates as the analysis was carried out on only 50% of the total number of cases, on top of which the analysis does not take into account indirect savings.

The government’s care minister and North Norfolk MP Norman Lamb lent his support to growing calls for more Admiral Nurses to be recruited. He told the Eastern Daily Press,

“This is exactly the sort of preventative care I want to see. The results of this brilliant work appears to be better care for patients and enable people to remain independent with support for longer, but crucially ease pressure on the health and care system. I strongly support extending this approach to the whole county and making it mainstream”

Admiral Nurses have an invaluable role in supporting timely diagnosis and offering post-diagnostic support, one of the key commitments made in the Prime Minister’s Dementia Challenge.

There are 800,000 people affected by dementia in the UK, and currently there are just 124 Admiral Nurses in England to support them and their families. This means that after a diagnosis many families are left to navigate the tricky health and social care system alone.

Dementia UK is calling on the government to put Admiral Nursing on the national commissioning guidance. It’s currently a post-code lottery as to whether or not families have access to Admiral Nursing. Find out where there are Admiral Nurses on Dementia UK’s website.

Jan Burt is a carer for her husband Victor who has dementia. She does not have an Admiral Nurse and is currently campaigning to bring Admiral Nursing to East Sussex.

“Unless you have been a carer of a loved one with dementia, you cannot fully appreciate that any help and support that can be given to make the life of a carer less stressful is welcomed. There needs to be more practical and emotional support, easy access to information and dementia trained professionals who care about the carer as well as the person being cared for.”

Hilda Hayo, Chief Admiral Nurse at Dementia UK says,

“We’ve always had such strong anecdotal evidence of the value that Admiral Nurses bring to families affected by dementia. This overwhelming and positive feedback needed to be strengthened with research that proves that Admiral Nurses also save funds.

"Informal carers in the UK save the country £8billion in care costs. Empowering them with counseling, information and a range of interventions to improve communication with their loved ones through Admiral Nursing will save not only millions of pounds in unnecessary hospital visits and care home costs, but also give them the tools to live positively with the condition.

"We’re hugely grateful to our partners on the Norfolk project for breaking down the costs saved in the area and are so pleased to be able to prove that Admiral Nurses demonstrate great value for money.”

Zena Aldridge, Admiral Nurse Lead in Norfolk commented,

“The evaluation makes a robust case for continuing the Admiral Nurse Service beyond the two year pilot period and extending the service to cover the whole of Norfolk.

"We are also keen to work with health and social care professionals to create joined-up services so that the right support is available at the right time for those living with and caring for someone with dementia”

Kate Rudkin, Head of Operations at Age UK Norfolk, said,

“The evaluation shows that Admiral Nurses in Norfolk provide value for those receiving the service as well as value for money.”

Family carers, people with dementia and professionals can call the dedicated Admiral Nursing DIRECT helpline on 0845 257 9406, which is staffed by experienced Admiral Nurses and able to provide both practical and emotional support, or by email at ​