Dementia Strategy 2013-2018 MICB4336
Executive summary The purpose of this document is to set out South Tees Hospitals Foundation Trust s five year strategy for improving care and experience for people with dementia who attend or are admitted to our acute and community hospitals. Our strategic aims are to: Modernise our approaches to communicating, seeking and acting on feedback from people with dementia and their carers. Become a dementia friendly organisation with environments and processes that cause no avoidable harm to patients with dementia. Deliver person centred care that supports the patient with dementia and their carer Develop partnership to improve care and outcomes Develop a skilled and effective workforce able and unafraid to champion compassionate person centred care. Our strategic aims are ambitious and will require the contribution of many. We recognise and welcome the opportunity to work in partnership with Tees Esk and Wear Valley NHS Foundation Trust and Middlesbrough, Redcar and Cleveland and Hambleton and Richmond Councils as well as our local clinical commissioning groups. These collaborations will aid and support our own work and contribute to improving the health and outcomes of those with dementia and their carers living within our local community now and in the future. As you read this strategy, most of you will have met or cared either personally or professionally for someone with a diagnosis of dementia. At South Tees Hospitals Foundation Trust (STHFT) we strive to consistently deliver high quality care that meets the needs of our patients and their families in our hospitals and community services. Our organisational vision is to set the national standard for excellence in patient safety, quality and continuous improvement. This strategy is the means by which we will drive improvements for patient with dementia, for whom care is often complex and admissions to hospital can be life changing. Our dementia strategy presents the rationale for action and it encompasses our values as an organisation. It commits us to a tough set of local and national objectives and markers of best practice. These will guide our journey to being recognised nationally as a centre of excellence in dementia care. To do this and to achieve the best, will require strategic planning, commitment and leadership at all levels within our organisation and the contribution of our entire workforce. As we proceed along our journey the care we offer patients with dementia will be exemplary. Care that we will all have confidence in, should we or our loved ones need help. Professor Tricia Hart Chief Executive Introduction
What our patients and carers expect We asked patients, carers and the public what was important to them. This is what they said: 5. We need support and information in times of change or as symptoms get worse and we should be able to contribute and accompany our loved ones. 1. Staff that care, show compassion and understand the effects of dementia on the whole family. 2. Hospitals with the right equipment and consistency around visiting hours and access for families. 3. Care that is set around what the person needs and who they are. 4. We should be listened to, able to influence and contribute to the care of our relative. Information obtained from: Patient experience event held 19th December 2012 Real-time patient experience video December 2012
Context Dementia is a collective term for diseases of the brain that can affect reasoning, perception and memory (Banerjee 2009). Dementia is progressive and there is no known cure. It predominantly affects older adults with 5% of people aged over 65 years and 20% of those aged over 80 years having a dementia diagnosis. Within acute hospitals, older adults occupy 60% of all beds and 40% of those are considered likely to have a dementia diagnosis (NAO 2007). Dementia however is not a normal part of growing old. 15,000 people under 65 years have dementia and it can affect those of any age, ethnicity, gender or social class. We also know that having a learning disability such as Downs increases a person s risk to one in three of developing dementia at a much earlier age (Alzheimer s society 2011). Within the North East of England 32,563 people have dementia (DNEEDU 2011). This number is expected to double in the next 30 years due to our aging population and environmental and social factors such as smoking and changing attitudes to exercise and diet. National care costs, currently estimated to be 23 billion per year are predicted to treble (NAO 2007, Banerjee 2009, DOH 2009). Within the United Kingdom 670,000 people have dementia (Matthews et al 2013). The anticipated health and social care needs of people with dementia has been identified by the Government as a major priority and challenge (DOH 2012). The Government s National Dementia Strategy s primary aim is that all people with dementia and their carers should live well with dementia (DOH 2009). Its objectives are themed around three broad aims. These are; better knowledge about dementia and removal of stigma, improving dementia diagnosis rate and developing a range of services for people with dementia and their carers which fully meets their changing needs over time. Our strategy reflects these aims. At STHFT our mission, vision and values are focussed on the delivery of high quality, safe, integrated care for all. We aim for continuous improvement of all our services. Patient safety and experience are central to these. We know from a number of national reports such as Counting the Costs 2009, Banerjee 2009, and The National Audit of Dementia 2013 that care for patients with dementia can and should be improved. We have a moral duty to our patients to act and initiate change and an economical duty to ensure resources are used effectively to ensure the delivery of high quality care.
The National Audit of Dementia led by the Royal College of Psychiatrists in 2010 and 2013 identified a number of key findings that required action to ensure care for patients with dementia in acute hospitals improved and met national standards of best practice. The following represents a summary of key national findings and drivers for change. People with dementia admitted to hospital do not consistently receive the necessary assessments; The majority of the hospital workforce receive no mandatory diagnosis-specific training; The majority of hospitals have no clear procedure for identifying people with dementia and sharing information about care needs with staff; Most staff felt that staffing levels were insufficient to meet patient needs; There was a need for additional guidance on involving families in patient care, discharge and support arrangements; Discharge, delayed transfers and readmission of people with dementia are areas of need; The majority of hospitals are unable to identify the cohort of people with dementia within reported figures such as falls; The physical ward environment is generally not appropriate for people with dementia (National Audit of Dementia 2011). People with dementia stay on average one week longer during an acute admission than someone with the same physical illness, rising to two week following a fractured hip (Counting the Cost 2009). 25% of patients with dementia (205,000) are receiving antipsychotic medication of whom only 20% (41,000) are receiving them appropriately (Banerjee 2009). Inappropriate prescribing of anti-psychotics is leading to an additional 1800 deaths, 1500 strokes and increased risk of falls and cardiovascular events per year (Banerjee 2009). Regionally (South Tees, Redcar and Cleveland & North Yorkshire) have some of the lowest rates of diagnosis in the United Kingdom (Alzheimer s society 2012). There is a clear need for significant work to be done to ensure care, outcomes and patient experience meet the needs and expectations of our local population and commissioners. Although commissioned by Professor Tricia Hart, our Chief Executive, this strategy will be owned by the Trust s Dementia Programme Board, who will take strategic responsibility for delivery of these aims and objectives over the next five years. However it is expected that all staff including the executive team will contribute to the achievement of the strategic aims. We have agreed five strategic aims which will improve the care provided to our patients with dementia, their families and carers across our hospitals and community setting. These are in response to the National Dementia Strategy s (2009) ambitions for excellence in dementia care, The Prime Minister Challenge on Dementia care (2012), The Call to Action - The Right Care by the Dementia Action Alliance (2012) and the National Dementia Audit (2011). The programme board will commission five work streams (see diagram 2 on following page) to lead the necessary service improvements required, to achieve these ambitious aims and objectives. Progress will be reported to the Trust Board by the Clinical lead for dementia and chair of the programme board annually. The Trust has conducted a self-assessment against these objectives in May 2013 prior to the launch of this strategy. There s much to be done to improve care. The results are detailed in the five associated strategic aim documents. The five responsible work streams and specialist centres will produce an improvement plan each year to meet the aims. These improvement action plans focus on the Trust and specialist centres actions required to meet the strategy s strategic aims and objectives. They will provide evidence of progress and strategy achievement. This strategy for dementia care makes it clear that everyone can make a difference to the care of people with dementia and collective action and collaboration is required to achieve our shared purpose.
Diagram 2 Programme board Modernising our approaches to communicating, seeking and acting on feedback from people with dementia and their carers. We will become a dementia friendly organisation with environments and processes that cause no avoidable harm to patients with dementia. The care we deliver will be person centred - supporting the patient with dementia and their carer Developing partnership to improve care and outcomes To develop a skilled and effective workforce, with recognised levelled competency, able and unafraid to champion compassionate person centred care.
Dementia Strategy 2013-2018 Quality of care and patient safety The care we deliver will be person centred - supporting the patient with dementia and their carer. We will become a dementia friendly organisation with environments and processes that cause no avoidable harm to patients with dementia. Organisational capability To develop a skilled and effective workforce, with recognised levelled competency, able and unafraid to champion compassionate person centred care. Courage Commitment Care Compassion Our shared purpose By 2018, South Tees Hospital Foundation Trust will be a dementia friendly organisation and externally recognised as such; delivering compassionate person centred care, in the right place, every time for each patient with dementia. Communication Competence Business sustainability Developing partnership to improve care and outcomes Partnerships and engagement Modernising our approaches to communicating, seeking and acting on feedback from people with dementia and their carers.
Strategic Aims Strategic Aim 1: Modernising our approaches to communicating, seeking and acting on feedback from people with dementia and their carers. Objectives: We will critically analyse patient and carer feedback, care planning and delivery and outcomes related to dementia care to determine effectiveness and action improvements. By year 5 our outcomes relating to patient safety and incidences of harm (pressure sores, hospital acquired fractures, failed discharges, inappropriate antipsychotic prescribing, safe guarding, complaints etc) in patients with dementia will show a year on year reduction (annual % reduction to be confirmed after collection of year one baseline data). By year 5 When surveyed 90% of our patients and carers will feel supported and rate our dementia care as good/excellent. Strategic Aim 2: We will become a dementia friendly organisation with environments and processes that cause no avoidable harm to patients with dementia. Objectives: By year 5 All our care environments used by those with dementia will be fully compliant with best practice recommendations contained within the supporting documentation. By year 5 All service and environmental improvements will consider impact of change on patients with dementia. Strategic Aim 3: The care we deliver will be person centred - supporting the patient with dementia and their carer. Objectives: By year 5 The principles of person centred care will be observable and measurable within care planning, delivery and process redesign. By year 5 When surveyed 90% of our patients and carers will feel supported. We will critically analyse patient and carer feedback, care planning and delivery and outcomes related to dementia care to determine effectiveness and action improvements. By year 5 our outcomes relating to patient safety and incidences of harm (pressure sores, hospital acquired fractures, failed discharges, inappropriate anti-psychotic prescribing, safe guarding, complaints etc) in patients with dementia will demonstrate a year on year reduction (annual % reduction to be confirmed after collection of year one baseline data).
Strategic Aim 4: Developing partnership to improve care and outcomes. Objectives: We will develop partnerships and processes to streamline care, prevent admission and support and enable the discharge planning process. People with dementia in our hospitals can access specialist assessment and treatment from a psychiatric liaison service which is able to respond to their needs. By year 5 Our patients with dementia and their carers will feel listened to, valued, treated with respect and supported during the admission and discharge process. Each year we will increase the number of volunteers who will engage in care activities for patients with dementia and provide social support and interaction. Strategic Aim 5: To develop a skilled and effective workforce, with recognised levelled competency, able and unafraid to champion compassionate person centred care. Objectives: By year 5 100% of all clinical staff will have undertaken dementia awareness training and have the necessary skills and values to care effectively (HEE 2013). We will reduce year on year the number (annual % reduction to be confirmed after collection of year one baseline data) of patient safety incidents (falls, fractures, pressure sores and inappropriate anti-psychotic prescribing) to patients with dementia and frailty. All clinical and psychological care will be based on the needs of the individual with dementia and will maintain their dignity and personhood. Delivering the strategy year by year Each strategic aim has been aligned with the five work streams of the dementia strategy. Each work stream will be led by a senior clinician within South Tees Hospital Foundation Trust. The work streams will progress service improvements and the clinical change required to achieve the strategy objectives and markers of best practice. Each work stream will then meet independently of the programme board to action clinical and organisational change. The lead of each work stream will then report progress and exceptions to the programme board biannually. The programme board will then report progress to Improving Patient Pathways Programme Board, Formal Management Group and Trust Board. A number of the markers of best practice require divisional actions and these will be collated and sent biannually from the clinical lead for dementia/or lead nurse to each divisional manager for action. Specialist centres will report progress and exceptions to the programme board, which will then be reported to Improving Patient Pathways Programme Board, Formal Management Group and Trust Board.
Process for delivery Stage 1 Corporate RAG (red-amber-green) rating of measures of best practice Stage 2 Work streams to lead corporate programmes of work Stage 3 Clinical Lead and Lead Nurse for Dementia to circulate annual divisional action plans to stimulate local divisional action. Divisional progress will then be reported biannually via presentation of the action plan at divisional performance reviews and then via work stream lead then to dementia board. Stage 4 Corporate annual reviews - rag rating year 2 year 5. Repeat stages 1-3. What success will look like Our progress and success must be transparent to our peers, commissioners, patients with dementia and their carers. Each work stream will be able to chart and present progress and change through RAG rating of the measures of best practice. Measurable key performance indicators relating to patient experience, patient safety and outcomes will be published annually on the STHFT dementia webpage. Becoming a dementia friendly hospital however can only truly be measured through the eyes of our patients and carers. We will each year be able to demonstrate measured improvements in patient and carer experience using the CUPID (capture, understand, plan, improve and disseminate) principles detailed within the Trust s patient experience strategy.
Key documents Alzheimer s Society (2012) My Life Until The End: Dying Well with Dementia Alzheimer s Society top tips for nurses Alzheimer s Society - Dementia 2012: A national challenge (March 2012) Banerjee S. (2009) Department of Health. The use of antipsychotic medication for people with dementia: time for action. A report for the Minister of State for Care Services. London. Common Core Principles for Supporting People with Dementia (Skills for Health and Skills for Care,2011) for the Department of Health Workforce Advisory Group Counting the Cost (2009) Alzheimer s Society Dementia North East England- Demographic Update (DNEEDU) (2011) Dementia Action Alliance National Dementia Group http://www.nr- foundation.org.uk/wp-content/uploads/2011/08/dementia-north-east- England1.pdf Dementia CQUIN Dementia UK - Admiral Nurses Competency Framework DeNDRoN/National Institute for Health Research - Dementia Nursing Research Department of Health (2009) Living well with Dementia: A National Strategy Department of Health (2011) National dementia strategy: Equalities action plan Department of Health: Dementia Commissioning Pack (July 2011) Department of Health (2012) Prime Minister s challenge on dementia Department of Health: Commissioning Services for People with Dementia HEE- A mandate from the government to Health Education England (2013) Mental Capacity Act (2005) National Audit Office (2007) Improving services and support for people with dementia. HC604 National Audit Office (2010) Improving dementia services in England an interim report NHS Institute/Dementia Action Alliance Call to Action, The Right Care, Creating Dementia Friendly Hospitals Matthews FE etal (2013) A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the cognitive function and aging study I and II, The lancet, Published online July 16th 2013 www.thelancet.com NHS Choices: Dementia, If you re worried, see your doctor NICE Dementia Pathway (May 2011) NICE Quality Standards for dementia NICE (2006) Dementia; Supporting people with dementia and their carers. Clinical Guidelines 42 London Progress report to the Prime Minister on his challenge on dementia (November 2012) Royal College of Nursing - Dementia National Strategies and Standards Royal College of Nursing: Principles of Nursing Practice Royal College of Nursing - Measuring up to the Principles Royal College of Nursing: Dignity in Dementia - Improving Care in General Hospital Settings (2011) Royal College of Psychiatrists (2013) National Audit of Dementia Dementia Action Alliance (2012) The Call to Action- The Right Care