Dementia Strategy

Transcription

1 Dementia Strategy

2 Content Foreword - Dan Grimes, Managing Director for the Division of Salford Health and Social Care Page 1 Introduction - Dr Emma Vardy, Consultant Geriatrician and Clinical Dementia Lead Page 2 Service user word cloud Page 5 Dementia Strategy Page 6 Alignment of the Salford Royal Dementia Strategy to the NHS England Transformation Page 7 Framework: The Well Pathway for Dementia Coming into hospital Page 8 Ongoing care Page 10 Leaving hospital Page 12 End-of-life care Page 14 Training and education Page 15 Acknowledgements Page 16 References Page 17 Dementia Strategy

3 Foreword Dan Grimes - Managing Director for the Division of Salford Health and Social Care has an extremely strong track record of delivering improvements in clinical outcomes, patient experience and transformational efficiencies and is committed to saving lives and improving lives and to becoming the safest organisation in the NHS. To achieve our objectives we will: Pursue quality improvement to become the safest, highest quality health and care service Improve care and services through integration and collaboration Support high performance and improvement Deliver better care at lower cost by becoming more efficient and reducing waste Our dementia strategy supports the delivery of these key strategic objectives and has been developed with input from across our integrated care organisation and multi-disciplinary and multiprofessional teams. Involvement with patients and carers has been a key consideration as we have developed this strategy aligned to our locality aims to increase coproduction and focus on personalisation and social action in communities. The voices of those living with dementia and those who support their care can be heard throughout this strategy. This strategy also aims to respond to the national dementia strategy Living Well with Dementia (2009) and respond to its aims to: Raise awareness and understanding Early diagnosis and support Living well with dementia Living well with dementia: A National Dementia Strategy Putting People First Our aims for how we deliver and improve dementia care are ambitious but we believe that this strategic framework and associated operational plan provides the firm footing and organisational commitment we need to deliver truly personalised, holistic, patient-centred care to enable people within our communities to live well with dementia. Dementia Strategy

4 Introduction Dr Emma Vardy - Consultant Geriatrician and Clinical Dementia Lead People with dementia admitted to hospital have longer length of stay, are more likely to readmitted and more likely to die than patients without dementia admitted for the same reason (CQC, Care update, March 2013). The report Fix dementia care from the Alzheimer s Society identified dementia to account for 25% bed occupancy. Yet people with dementia are often frightened in hospital, become more confused and have on average twice the length of stay. Counting the cost (Alzheimer s society, 2009) highlighted that people with dementia often leave hospital with poorer health and well-being than when they arrived, the longer the hospital stay the worse the effect on dementia symptoms and physical health. Those with dementia who fell spent nearly four times as long in hospital with a fall, which in turn may account for the increased likelihood that those with dementia will be discharged into a care environment as opposed to home. The Health Foundation Shine report on a project completed at the Royal Free London NHS Foundation Trust, reported that of patients with dementia who had a delayed discharge 41.8% developed an acute medical condition and 19% died. These reports along with the Prime Ministers challenge on dementia 2020 have set the standards for care of people with dementia in hospital. The Dementia Action Alliance has recently updated their statements and of these particularly relevant to care in hospital is this one: We have the right to an early and accurate diagnosis, and to receive evidence based, appropriate, compassionate and properly funded care and treatment, from trained people who understand us and how dementia affects us. This must meet our needs, wherever we live. There are 1959 people (65 plus yrs) living with a diagnosis of dementia in the Salford Clinical Commission Group (CCG) area, with a further estimated 293 without a diagnosis. There were 2491 individual admissions for people with dementia admitted to Salford Royal NHS Foundation Trust for the financial year 2016/17. We have developed this 3 year strategy ( ) to build on the work completed and set out the aim to make Salford a place of excellence for dementia care in Greater Manchester. Our vision is divided into the following 5 themes underpinned by: 1. Person-centred care 2. Good communication 3. Patient safety 4. Well trained staff These have provided the foundation for the development of our strategy. Dementia and Delirium Steering group members have gathered patient and carer feedback which has complemented the carer feedback provided by the Royal College of Psychiatrists National Dementia Audit We have also taken a multi-professional approach through the dementia and delirium steering group in order to develop themes centred on the person with dementia rather than any particular professional group. Dementia Strategy

5 The dementia and delirium steering group was established after the first round of the National Audit of Dementia and provides oversight on the work within this area in the Trust. The group includes leading staff from many directorates, the mental health liaison team, community services, therapy and allied health care staff, Salford CCG, memory assessment and treatment service, critical care, research and development and social services. In the last financial year the group has focussed on the following key elements: 1. John s Campaign: A national initiative for the right for people with dementia to have their carers with them at any time during an admission to an acute hospital. People with dementia often become frightened and fail to thrive when admitted to hospital. Salford Royal is committed to ensuring that John s Campaign is embedded across the organisation ensuring that carers for people with dementia are welcomed and visiting hours are relaxed. 2. National Audit of Dementia: An audit to collect data to assess care delivery for people with dementia admitted to hospital. Data submission was completed for round 3 in October 2016; including staff questionnaires and a survey of carer experience. 3. Delirium screening: In 2016 working closely with the EPR (electronic patient record) team we introduced a delirium screening tool (4AT) to be completed in those at risk on admission to hospital through the Emergency department. This is a current Quality Improvement project, which is part of a wider Global Digital Exemplar (GDE) programme. This is to standardise pathways for the detection and management of dementia and delirium. 4. Guidelines and pathways: The guideline for the assessment and management of delirium was revised and updated in January A guideline for the assessment and management of dementia is being finalised for imminent launch. 5. Care transitions and information sharing: The steering group has worked to join up pathways to enhance information sharing for those professionals caring for people with dementia between Salford Royal NHS Foundation Trust and Greater Manchester Mental Health NHS Foundation Trust. The first steps included enhanced access to healthcare records to relevant clinical staff and direct pathways for referral for diagnostic assessment to the Memory Assessment and Treatment Service in Salford. Image from Department of Health: Living well with dementia: A National Dementia Strategy Dementia Strategy

6 The strategy describes the priorities for Salford Royal NHS Foundation Trust for the next 3 years and will operate and adapt in the context of existing and emerging local and national initiatives: 1. National dementia audit. The results of the organisational and patient case note audit will be provided to the Trust in July Dementia United: A 5 year transformation programme to make Greater Manchester the best place in the world to live for people with dementia. The pledges are: Pledge 1: improve the lived experience of people with dementia and carers Pledge 2: reduce variation through the development of a common evidence-based commissioning framework for dementia diagnostic and post-diagnosis support services, with accompanying monitoring of performance using agreed measures. Pledge 3: post-diagnostic support model for people living with dementia Pledge 4: co-production and re-design health and care systems with patients and their carers to ensure services meet their needs Pledge 5: adoption of technology with a central theme of connectedness 3. Integrated Care Organisation (ICO): The new ICO led by Salford Royal joins up adult health care and social services, including mental health. A new dementia ICO group has been established in June 2017 to review and transform the Salford Dementia Pathways in the next 2 years, across primary care, secondary care and end of life care, including third sector providers based on best practice guidance and local needs assessment data. This adopts a collaborative approach to transformation working with all relevant partners in the ICO Primary care (SPCT), Mental health (GMMH) and the third sector. This strategy is an exciting opportunity to create care and support for people with dementia and carers which combines innovative ideas and practices from around the country and indeed the world. It provides the Trust with possibility of being a regional and national leader in the assessment, care and treatment of those with dementia or delirium in the acute hospital. The Trust has the chance to become a truly dementia friendly and delirium focused organisation providing the care which we would all seek to receive for ourselves or loved ones. This strategy has been developed by listening to people with dementia and their carers and we will continue to do so as we work towards implementing the pledges made. This is the founding document for an ongoing dynamic process and will evolve and adapt as circumstances and knowledge change. Dementia Strategy

7 Word cloud constructed using service user feedback when asked the following questions: 1. If you could have the best dementia care what would that look like? 2. What can we do to improve? Dementia Strategy

8 Dementia Strategy Over the next three years we will work with people with dementia and their families to provide excellent care Coming into hospital Ongoing care Leaving hospital End-of-life care Workforce training and culture Completion of the hospital passport by carers to ensure holistic care is delivered Screening on admission for delirium and further standardised memory assessment for those without known dementia Introduce a dementia friendly hospital outpatient appointment system Patients should be cared for in an environment which is suitable for people with dementia Minimise ward and bed moves to those indicated for clinical reasons only Support people with dementia to take part in meaningful activities Implement John s Campaign across the organisation Ensure co-ordinated discharge planning commences on admission People with dementia and carers will be involved and supported in discharge planning Promote a home first approach and reduce the number of people discharged to institutional care Good communication with community teams around discharge Timely discharge earlier in the day Recognise end of life and provide care and support for people with dementia and carers Ensure wishes of person with dementia and carer around end of life care are recognised, documented and accessible between all relevant care teams Support to achieve preferred place of death where possible Ensure availability of ongoing support from Bereavement team for families and also relatives who have dementia Dementia training to be a mandatory requirement for all clinical facing staff Dementia friends training for all non clinical staff Ensure training is aligned to guidelines set by Health Education England Active Dementia champions in all clinical areas Dementia Strategy

9 Alignment of the Salford Royal Dementia Strategy to the NHS England Transformation Framework: The Well Pathway for Dementia PREVENTING WELL DIAGNOSING WELL SUPPORTING WELL LIVING WELL DYING WELL Risk of people developing dementia is minimised Timely accurate diagnosis, care plan, and review within first year Access to safe high quality health and social care for people with dementia and carers People with dementia can live normally in safe and accepting communities People living with dementia die with dignity in the place of their choosing I was given information about reducing my personal risk of getting dementia I was diagnosed in a timely way I am able to make decisions and know what to do to help myself and who else can help I am treated with dignity and respect I get treatment and support, which are best for my dementia and my life I know that those around me and looking after me are supported I feel included as part of society I am confident my end of life wishes will be respected I can expect a good death Coming into hospital Ongoing care Leaving hospital End of life care Workforce training & culture Dementia Strategy

10 Coming into hospital When we first arrived at hospital in A&E we had to keep asking what was happening, what they were doing, who were they, as even down to the porter they did not introduce themselves or make us feel involved, we were left in a cubicle and felt even if somebody kept bobbing in to tell us at least something we would be happy. When put in EAU we felt a bit better as staff were more friendly and wanted to know more about my mum (seeing as she has dementia) and would not be able to tell them herself. My mother is getting more and more confused. I wish we can understand why she is worse every time she comes to hospital. We would like to know a diagnosis as soon as possible. Coming into hospital can be a frightening and confusing experience for anyone but especially a person with dementia. People with dementia occupy around a quarter of acute hospital beds ( Fix dementia care from the Alzheimer s society) and tend to have a longer length of hospital stay than people without dementia admitted for the same reason (CQC, Care update, March 2013). A person with dementia is also at risk of becoming more confused when they are in hospital and developing a condition called delirium. People with dementia are more at risk of developing delirium; people without dementia can also experience a delirium. Overall this affects 1 in 8 acute hospital admissions. The risk of death is as high as that of myocardial infarction and sepsis. Detection of delirium improves care and outcomes and NICE recommends those at risk admitted to hospital are assessed for delirium and have a range of interventions to prevent it. We have an information leaflet that explains to carers and families about what delirium is and what they can do to help it improve. Dementia Dementia and Delirium Team DementiaTeam@srft.nhs.uk University Teaching Trust G W. Design Services,, All Rights Reserved Document for issue as handout. Unique Identifier: TE 18 (15). Review date: June Consent I may need more time and help to say yes or no to treatment. University Teaching Trust My Hospital Passport Getting to know me My name is: I like to be known as : Photograph (optional) Adult Safeguarding As part of the Blue Butterfly Scheme a hospital passport should be completed on admission by someone who knows the person with dementia well. By knowing more about the person with dementia we can ensure optimum communication in order to provide compassionate personalised care, and try to reduce the distress caused by being in an unfamiliar environment. In addition to finding out whether someone has a known diagnosis of dementia or have delirium we also assess people to see whether they may have undiagnosed dementia using the Find, Assess, Investigate, Refer (FAIR) assessment. Dementia Strategy

11 Where someone has possible undiagnosed dementia they are offered further specialist assessment and if appropriate are referred to a memory assessment service (NICE). It is important that diagnosis is timely, when the patient wants it or the carer needs it. Whilst we have hospital passports we know that not everyone with a diagnosis with dementia has one completed when they are admitted to hospital. The FAIR assessment has a high level of completion but we know anecdotally that we still miss some people who have undiagnosed dementia. We have recently introduced a delirium screening tool into the hospital admission documents but we know that completion rates are low. We also know that people with dementia are more likely not to attend for hospital appointments, a significant factor being that appointments may not always be sent to a carer. We pledge to: Ensure that we know as much as possible about the person with dementia on admission to hospital by engaging carers in completion of the hospital passport ; with appropriate access to medical records Develop robust pathways to identify people with possible dementia in hospital and offer follow-up for a timely diagnosis Embed assessment tools for delirium and raise staff awareness of the importance of making a prompt diagnosis Introduce a dementia friendly hospital outpatient appointment system Dementia Strategy

12 Ongoing care The ward was like a nursing home. They need some facilities rather than patients just sitting around. All my mother was doing was getting out of bed sitting at the side. No telly because she wouldn t be able to work it. Dad was moved about regularly, which confused him considerably, from one ward to another. Moving beds five times in five days although necessary is confusing for patients. Provision of high standard person-centred and compassionate care is what we expect for all. It is especially important for people with dementia. Hospital can be a distressing place for people with dementia and minimising and alleviating distress is paramount. Hospital stays are recognised to be detrimental for people with dementia; they are more likely to have longer lengths of stay and poorer outcomes. The National Dementia Strategy and The Prime Minister s Challenge recognised the need to improve the hospital environment for people with dementia. In 2012 the Dementia Action Alliance launched the Right Care: a call to action to create dementia friendly hospitals. All acute trusts in England were asked to make a public commitment to become dementia friendly. is a dementia friendly hospital charter member. We know that not every ward in the organisation is dementia friendly and that improvement is needed to optimise orientation and minimise distress. We plan to work with Enhancing the Healing Environment (The Kings Fund) to ensure our clinical areas and the general hospital estate are dementia friendly. During a patient s stay in hospital, it may be necessary to move ward areas for a variety of reasons. We are aware that for a person with dementia this increases the risk of delirium and length of stay. We aim to care for patients in the most appropriate clinical area for their specific health needs and minimise ward moves, moving patients only where it is essential for clinical reasons. Transfer of patients late at night should be eliminated. Behavioural and psychological symptoms of dementia (BPSD) can be challenging for ward staff and distressing for the person with dementia and their family and friends. The Mental Health Liaison Team service are available to support ward teams for specialist advice around BPSD and other areas of care for people with dementia should this be needed. Antipsychotic medication and sedative medication has significant side effects and use should be kept to a minimum. We know that it is important to engage people with dementia in meaningful activity whilst an inpatient to prevent both physical and cognitive decline during their stay. We have a number of volunteers who wish to be involved more in the care of patients with dementia, for example, through supporting ward-based activities. However, provision is not consistent across the organisation. We have engaged with the occupational therapy staff who provide assistance and direction in activities such as chair-based exercise groups. We would like a dedicated patient activity co-ordinator to work in clinical areas to further support these volunteers and those patients with dementia. Dementia Strategy

13 Eating and drinking difficulties are common in people with dementia and can be made worse during hospital admission. There are multiple recognised reasons for this; some of which relate to the environment and the manner in which food is provided. We have a multi-disciplinary trust working group for nutrition in dementia. The group looked at improving the food available and what assistance is required. A new dysphagia and dementia pathway (Risk Feeding) has been developed for use in the acute setting. Apetito is the new catering supplier who will implement picture menus, finger foods and always ensure different choices are available daily. Wards have a supply of snacks for patients who may want these between meals or instead of meals. This allows more flexibility for patients who do not wish to eat a full meal. We have protected meal times across our ward areas, where we ask that all non-emergency activity stops so that staff can concentrate on assisting patients with their meals up to and including feeding. We welcome and encourage carers and family members to assist their relative. There is evidence to suggest that patients with dementia are more likely to increase their dietary intake if a familiar face is assisting them. We support John s Campaign. This is a national campaign for the right for people with dementia to have their carers with them at any time whilst they are in hospital. This supports the patient s needs and carers needs and promotes person centred care. We recognise the value of carers and actively encourage them to visit to maintain relationships and support their loved one. We pledge to: Care for patients in a suitable environment Minimise ward and bed moves to those only for indicated clinical reasons Develop a trust-wide policy for the management of the behavioural and psychological symptoms of dementia Support people with dementia to take part in meaningful activities whilst in a ward environment Support John s Campaign and ensure that carers know that they are welcome Dementia Strategy

14 Leaving hospital We have tried our best to manage things at home. It s not working. We are exhausted. We don t know our choices. We don t know what we need to do. Not happy when she was discharged the first time. Promised support, got none. I had made arrangements for my mother to be admitted to a Residential Retirement Home when she was finally released from Hospital. The hospital staff were uncertain as to when my mother was to be discharged as they were waiting for blood tests and her medication to be sorted out. When I rang they told me she would be discharged but it would probably be around tea time. They were still waiting for her medication to be sorted. At 8.30 p.m. that night!!!! People with dementia who are admitted to hospital may be discharged home, transferred to intermediate care or to a residential or nursing placement. People with dementia are more likely to be discharged to institutional care than those without. The process is complex and such transitions may be daunting and anxiety-inducing for people with dementia and carers. The discharge process is also often complicated if it is proposed the person return to their own home. Risks surrounding mobility, frailty, continence, medications and environmental safety can be heightened due to behavioural and psychological symptoms. The preference of people with dementia is often to go home, however, in many cases the assessment of professionals within the multi-disciplinary team may be that the risk to the individual is too high. Sometimes placement in institutional care must be made in the individual s best interest. This occurs within the framework of the Mental Capacity Act The discharge process is complex and Patient Pathway managers work with the multi-disciplinary team to facilitate discharge. The multi-disciplinary team (MDT) may include Consultant Geriatrician, Mental Health Liaison Consultant/Nurse, a ward based nurse who knows the patient well, Physiotherapist, Occupational Therapist and Social Worker. The MDT works with people with dementia and their carers to assess care needs to determine the most appropriate type and place of care. Dementia Strategy Comprehensive Specialist Mental Health Needs Assessments are sometimes required. Where specialist skilled care for the person with dementia is necessary this combines in-depth patient knowledge and awareness of the support network available. This approach has the advantage of reducing the patient s length of stay, risk of readmission and further inappropriate transfers of care. Patient pathway managers and Social Workers can advise people with dementia and carers about care homes in Salford and the funding processes. All people with dementia need integrated physical and mental health care. The Memory Assessment and Treatment Service, Community Mental Health Team and the Directorate of Ageing and Complex Medicine provide accessible and dementia-friendly mental and physical health services for patients. The teams offer patients home visits and assistance in the form of coping strategies to facilitate engagement and maintain independence at home. 12

15 Model of optimal integrated care for people with dementia Volunteers and third sector organisations Memory Assessment and Treatment Team Integrated physical and mental health care for people with dementia living at home Ageing and Complex Medicine Team Primary Care teams Community Mental Health Teams Mental Health Care Homes Service Integrated physical and mental health care for people with dementia living in Care Homes Care Homes Practice Third sector voluntary agencies, for example Age UK, can provide support in the community to those people with dementia and carers who do not require/do not want a formal care package from Social Services. They also run carers groups in the community. These services are often more suitable for those people in the early stages of dementia who may require small packages of support to continue with their day to day activities. The Mental Health Care Home service, together with Care Homes Practice and the Ageing and Complex Medicine Directorate Community Geriatricians provide physical and psychiatric care for people with dementia living in care homes in Salford. Our aim is to facilitate a timely discharge process for people with dementia from hospital and we plan to improve this process by: Planning discharge from point of admission as we recognise people with dementia who are admitted into hospital have poorer outcomes and are at high risk of delirium as well as a longer length of stay. Ensuring that discharges occur before 11am to allow patients time to settle in their discharge environment before the evening. Getting take home medications ready on time and preferably the day before discharge to an institutional bed. Discharge people with dementia from the ward and not the discharge lounge as we recognise that rapid changes in environment are detrimental to the person with dementia. We know that there are opportunities for services to work more closely and pathways are being reviewed and opportunities identified within the remit of the Integrated Care Organisation. We pledge to: Ensure discharge planning commences on admission involving the relevant professionals to prevent unnecessarily prolonged inpatient stay Promote a home first approach by positive risk taking to enable the person with dementia to be as independent in their own home for as long as possible, reducing the number of people who move into institutionalised care from hospital Provide continuity of co-ordinated care through good communication with community services and healthcare professionals Ensure the discharge process is efficient so that people go home earlier in the day and are not discharged in the evening. We will ensure that patients are discharged from their ward and not via the discharge lounge Support carers through the different transitions of functionality in the journey of the person with dementia by providing effective post-discharge coordination and connections with ongoing care giving services Dementia Strategy

16 End-of-life care I want support to make decisions around my mother s death and final days of life. I know what my mother wants. She always wanted to spend her last days at home. I need help to make her wishes come true. I have had a good life. I just want to go in peace. Just let me go home. I don t want to die alone in hospital. Dementia is a life limiting illness. It is important to have conversations about end-of-life care early so that patients and caregivers have the opportunity to make decisions and plans about their care in the final stages of their lives. People with dementia should be offered personalised end-of-life care, respecting their wishes, to enable a good death. End-of-life care includes supporting patients physical, emotional and spiritual needs, and support for family members. Unfortunately people with dementia are often admitted to hospital at the end stages of life and conversations around the wishes of the person with dementia and their family have not always been timely. Pain, poor food and fluid intake, incontinence and communication difficulties create challenges in providing end-of-life care in Dementia. Educating carers and staff in the recognition of distressing symptoms, such as observational scales (e.g Abbey Pain Scale), can improve the detection of distress and subsequent management. The Gold Standards Framework prognostic indicator guidance can help clinicians identify appropriate times and opportunities to discuss and facilitate end-of-life care for patients. Patient s wishes and arrangements for end-of-life care need to be documented and accessible to all staff treating them. Some people with dementia may have explicit end-of-life decisions made via the Memory Assessment and Treatment clinics and their General Practitioner but this information is currently not easily shared with hospital teams. Both community geriatricians and general practitioners are involved in creating an advanced care plan for frail older people in the community but we know there are still people admitted to hospital as no plan is in place. Clinical teams work closely with palliative care, patient pathway managers, social work staff and district nurses to ensure timely discharges for people with dementia at end of life where this is what the patient and/or family wish. Patients can be referred to the community Macmillan team through the Palliative care team if they live at home or to the End of Life Care Homes team if they live in a residential or nursing home within Salford for support during the final stages of their illness. We pledge to: Recognise end of life care and provide support for people with dementia and carers to make decisions. Ensure dignity is maintained and pain is recognised and treated early Ensure patients wishes around end of life care are recognised, documented and accessible by all relevant care teams through advanced care planning Promote best practice as per The Gold Standards Framework and End of Life Register Support people with dementia to achieve preferred place of death where possible Ensure availability of ongoing support from the Bereavement team for families and also for relatives who have dementia themselves Dementia Strategy

17 Training and education Ward Staff: had received training and awareness and health care assistants accessing the usual experience training of dementia, they better understood how my mother viewed the ward, this was helpful when they tried to support her to walk, seeing it through her eyes. I don t think the ward staff understand why my mother is like this. She does not want to be rude. This is not her. I hope they know that this is her dementia. I would like the service to see me as a person, rather than just that person with dementia. People with dementia have complex needs, particularly in hospital where they are in unfamiliar surroundings and out of their normal routine. Dementia Care Training is vital to ensure that staff are equipped with the knowledge and skills they require to care for people who have dementia. Communicating effectively, getting to know the person and delivering care with compassion and understanding are paramount. Non-pharmacological management of behavioural and psychological issues is important in reducing the prescribing of anti-psychotic and other sedative medication for people with dementia. Staff awareness of delirium is important in prevention and minimising associated harms. Understanding the complexities of discharge planning in dementia can reduce the patient s length of stay and readmission to hospital. The Prime Ministers Challenge on Dementia specifies that by 2020 all NHS staff will have received dementia training appropriate to their role. The Dementia Core Skills Education and Training Framework (Health Education England, 2015) helps to achieve these aims by supporting the development and delivery of appropriate and consistent dementia education and training for the health and social care workforce. At staff training is available at tiers 1 and 2 as outlined in the education and training framework (Tier 1, basic awareness; Tier 2, basic skills; Tier 3, leadership). Electronic Learning packages are available to all members of staff and a face to face dementia care study day is available to staff who work closely with people with dementia. This training is facilitated by the Lead Nurse for Dementia and Delirium and the Mental Health Liaison Team. They provide monthly face to face training and training for nurses in preceptorship, those on the care certificate programme, and to those who are new to the Trust. Biannual training figures are submitted to Health Education England for monitoring. Training is available to all members of staff regardless of discipline or grade. Currently training in dementia awareness and care is not mandatory and we know that some staff groups have less training than others. We have dementia champions and these are a vital group of staff to disseminate and help to implement new knowledge around dementia care. The champion is often not the lead for a clinical team and champions need to be empowered to create changes in practice and environment. We want to be more ambitious about staff training. Our vision being annual updates, Salford-specific on-line training and further development courses for those groups who have greater clinical contact with people with dementia. We also need to ensure that training aligned to all 3 tiers of the Dementia Core Skills education and training framework is available; currently Tier 3 training is lacking and requires further development. We pledge to: Ensure that all staff have mandatory dementia training appropriate to their role Develop new training packages that are based on national guidance as set out by Health Education England Provide dementia friends training for non-clinical staff Have identified and active dementia champions in all ward areas Dementia Strategy

18 Acknowledgements The strategy was authored by: Dr Emma Vardy, Consultant Geriatrician and Clinical Lead for Dementia and Delirium, Sr Louise Nutt, Lead Nurse for Dementia and Delirium, Salford Royal NHS Foundation Trust Dr Nilika Perera, Consultant in Liaison Psychiatry, Mental Health Liaison Team, Clare Kelly, Assistant Director of Nursing for Safeguarding, Salford Royal NHS Foundation Trust Sr Josephine Williams, Mental Health Liaison Team Advanced Practitioner, Mental Health Liaison Team, Salford Royal NHS Foundation Trust Dan Grimes, Managing Director for the Division of Salford Health and Social Care, We also wish to thank other members of the Salford Royal Hospital dementia steering group for their contribution to the development of this strategy, in particular: Dr Alexander Thomson, Consultant Geriatrician, Salford Royal NHS Foundation Trust Paul Walsh, Integrated Commissioning Manager (Older People), Salford City Council/Salford Clinical Commissioning Group Dr Ross Overshott, Consultant in Liaison Psychiatry, Mental Health Liaison Team, Dr Jenny Walton, Clinical lead for Older people at Salford Clinical Commissioning Group Sr Caroline Sellears, Dementia Clinical Nurse Specialist, Care Homes Medical Practice, Jane Mort, Clinical Lead Occupational Therapist, Salford Royal NHS Foundation Trust Matron Cathy Gorse, Matron for Neurosciences, Salford Royal NHS Foundation Trust Thanks to William Payne for administrative support. Thank you to all of the people with dementia and their carers who provided us with their feedback and views which helped to shape this strategy. Dementia Strategy

19 References: Living well with dementia, a national dementia strategy, Department of health, Care Quality Commission, care update, March Fix dementia care, Alzheimer s society, January Counting the cost, Alzheimer s society, Health foundation, Shine report, My discharge: a proactive case management for discharging patients with dementia, Royal Free London NHS Foundation Trust, Prime Ministers Challenge on dementia 2020, Department of Health. The Dementia Action Alliance, the Dementia statements, Johns Campaign, National audit of dementia, Royal College of Psychiatrists. Dementia United, NHS England Transformation Framework: The well pathway for dementia. NICE quality standards Delirium, Right care, a call to action. Dementia action alliance, Enhancing the healing environment, Kings fund. Gold standards framework prognostic indicator guidance, Dementia core skills education and training framework, Skills for health, skills for care and Health Education England, Department of Health,

20 Stott Lane Salford, M6 8HD G Design Services.. All Rights Reserved This document MUST NOT be photocopied. Unique Identifier: TE08(17) Review Date: July 2019