South Tyneside and Sunderland Healthcare Group Our dementia STRATEGY 2018-2021 City Hospitals Sunderland and South Tyneside NHS Foundation Trusts working in partnership
Introduction Dementia has become one of the most important and challenging healthcare issues we face as our population ages. Across the South Tyneside and Sunderland Healthcare Group, we place great value on providing compassionate, dignified and safe, high quality care to everyone using our services. We are fully committed to improving dementia care for our patients, providing tailored support to relatives and carers and developing our own staff to equip them with the skills and training they need to care for people living with dementia. Everyone working in our organisations, regardless of role or position, has a duty to understand the issues faced by patients living with dementia so that we can all provide exceptional care and support. Each and every one of us will come across a patient using our services who has dementia and we all need to have the knowledge, confidence and compassion to help. Providing excellent, personalised care for patients living with dementia and their carers, is the ultimate test of our determination to drive through quality improvements in patient care and experience as we aspire to become recognised as a truly outstanding provider of healthcare services. This document sets out our strategic ambitions for continuously improving services and the care of people living with dementia and their families. It has been developed with the support of nurses, doctors and managers in both Trusts and will rely on continued partnership working across the health and care sector in South Tyneside and Sunderland to ensure success in the years ahead.
What is dementia? Dementia is a collective term for over 100 diseases of the brain that can affect memory, communication skills, reasoning and the ability to carry out daily activities. It causes changes to the structure and chemical balance of the brain, affecting the very essence of a person and its progressive nature is devastating both to individuals and their loved ones. Dementia is a life limiting diagnosis, the natural course of which leads to increasing dependence and vulnerability. One in six people aged over 80 will experience dementia In 2015 there were 850,000 people living with dementia Two thirds of people with dementia are women 25,000 from black and minority ethnic groups 40,000 were less than 65 years of age There are 670,000 family carers in the UK which saves 11 billion a year (Alzheimer s Society 2014)? There is no known cure for dementia 60% of all acute hospital beds are occupied by older adults with 40% of these people considered likely to have a dementia diagnosis Strategic aims and objectives In order to succeed in being recognised locally, regionally and nationally as a centre of excellence in providing integrated dementia care, we have developed six ambitious strategic aims and objectives to deliver: 1 Person centred care 2 A competent and compassionate workforce 3 Evidence based pathways of care and assessment 4 Strong partnerships and engagement 5 Dementia friendly environments The financial cost of dementia to the UK is 26 billion per annum 33% of people with dementia live on their own in the community 6 Clear accountability and governance
1. Person centred care How will we deliver person The care we deliver will be person centred, empowering the patient with dementia, and their carer, as part of a therapeutic relationship with professionals which promotes safety and supports communication and wellbeing. Carers and staff have so much to learn from each other - they need to work together to get the best for the person who has dementia. We will find innovative methods of communication and act on feedback from people with dementia and their carers to improve the services we deliver. Our ambitions for patient outcomes: The staff who care for me will know about me as a person and communicate appropriately to all those involved in my care and also to me. The people who are important to me will be partners in my care with health care professionals and be able to assist with my personal care, should they wish to do so. centred care? By improving the use of This Is Me document across both Trusts in hospital and community settings, as championed by the Carers Associations and care homes, to encourage people to bring this to the attention of health care professionals when receiving care either at home or in hospital By ensuring the primary carer for the patient is clearly identified and that there is a clear carer pathway developed when the patient is admitted to hospital or is receiving community support By ensuring our ward teams have a flexible and personalised approach allowing carers to visit patients with dementia outside of usual visiting times and in line with the principles John s campaign By embedding a positive culture of patient and carer led decision making based on unbiased information and genuine choice. Performance against the six key standards required to achieve better collaboration and partnership with carers Increase in percentage of family members involved in the care planning process to create a shared plan of care
2. A competent and compassionate workforce The care of patients with dementia must be delivered by a courageous, skilled and effective workforce, with recognised levels of competency appropriate to their responsibilities and colleagues who are able to champion, compassionate and person centred care for people living with dementia and their carers. Our ambitions for patient outcomes: The staff that care for me will be compassionate and competent to enable me to retain my independence within my abilities and ensure that I maintain the best health outcomes possible within the limitations of my condition How will we deliver a competent and compassionate workforce? By ensuring dementia awareness training is a core competency for all colleagues across the Healthcare Group regardless of role or position By further developing our education and training in dementia care and delirium for all clinical staff and ensuring the delivery of evidence based practice By raising awareness of dementia and the impact for patients and families by holding annual events in line with the Alzheimer s Society s Dementia Awareness Week By establishing a cohort of volunteers to work with people with dementia, both in hospital and in the community, to provide social support and interaction. Number of staff working in dementia high intensity areas receiving bespoke training appropriate to that area Development of new roles to support a career framework across care of the elderly nursing and dementia care Reduction in the vacancy rates in medicine and older person s wards and team establishments by supporting staff in dementia awareness Volunteers in place who will engage in care activities for patients with dementia providing social support and interaction.
3. Evidence-based pathways of care and assessment The care of patients with dementia must be delivered in line with evidence-based practice and ensure equality of access to specialist dementia services and seamless transfers of care for people living across South Tyneside and Sunderland. South Shields Sunderland Our ambitions for patient outcomes: My care will be individualised to my needs and will be delivered by people with the right skills to ensure I have the best health outcomes I will be safe when moving between wards, services and when going home from hospital How will we deliver evidencebased pathways of care and assessment? By meeting all local and national performance and quality standards with regard to recording and communicating cognitive assessments on admission to hospital and appropriate communication with GP on discharge By ensuring the Mental Capacity Act (2005) and Deprivation of Liberties is applied appropriately in line with legislation By ensuring all appropriate patient assessments are in place, in line with best practice guidance, with care planning aligned to enhanced care guidance By reducing the number of people with dementia given anti-psychotic medicines in order to maximise benefits while reducing side effects. Putting in place specialist discharge support to ensure seamless discharge, with decisions made in partnership with patients and carers By delivering personalised and person centred end-of-life-care for people with dementia By improving outpatient care for people with dementia and their carers. Reduction in the number of in-hospital ward transfers, other than for clinical need, both in and out of hours Reduction in avoidable harms such as pressure ulcers and falls associated with a diagnosis of delirium or dementia Reduction in prescription of antipsychotic drugs. Improved experience of discharge processes and end-of-life-care evidenced through positive patient stories, compliments and a reduction in complaints Improved experience of outpatient services evidenced by a decrease in % of patients with a dementia diagnosis not brought to their appointments.
4. Strong partnerships and engagement We will develop partnerships across the health and care system through strong engagement and ensuring pathways are developed to streamline care, prevent admission and support and enable the discharge planning process for the benefit of patients. People with dementia in the care of our services will be able to access specialist assessment and treatment from psychiatric liaison services which are responsive to their needs. Our ambitions for patient outcomes: I will receive the specialist care I need in a timely fashion, whether in hospital, at home, or in the care of community services How will we deliver strong partnerships and engagement? By working in partnership with other providers of health and social care to ensure that patients and their families have access to the help and support they need to enable them to remain living in their place of choice By working with local mental health trusts to share skills, knowledge and innovative pathways of care across acute and community services By developing opportunities for staff to experience and learn from services provided across the Healthcare Group, or other healthcare providers and develop rotational opportunities to support this process Working in partnership with other directorates and other providers of health and social care, including the third sector to develop a directory of services to support people with dementia to access the support they need. Up-to-date directory of dementia services available for patients and their carers Opportunities available for staff to shadow or rotate through other health services, both internal and external to the Healthcare Group, in order to learn new skills and appreciate the role of other services in providing integrated dementia care.
5. Dementia friendly environments We will become a dementia friendly organisation with environments and processes that support patients with dementia and promote independence and safe care. Our ambitions for patient outcomes: I will be able to find important facilities in ward areas, including toilets and bathrooms, as they are clearly signposted in a way that is easy to understand How will we deliver dementia friendly environments? All wards and patient areas will be considered for upgrade in line with dementia friendly environments guidance when being refurbished, with the participation of patients and families where possible, to ensure the environment: promotes meaningful interaction between patients, their families and staff promotes well-being promotes mobility encourages eating and drinking promotes continence and personal hygiene promotes orientation is calm, safe and secure A business case will be drawn for each upgrade to ensure transparency of, and agreement to, the cost implications. Increasing percentage of service areas which are refurbished in line with dementia friendly environments guidance Positive patient and family feedback on service environments
6. Clear accountability and governance Further reading on national dementia strategies Each Trust currently has a Dementia Strategy Group who will own this strategy and take responsibility for the delivery of these aims over the next three years by building on the strengths and weaknesses, current innovations, past successes and the different resources available for the delivery of high quality dementia care. As work takes place on the potential merger of both Trusts the Dementia Strategy Group would become one in the future. A bi-annual workshop to share learning, best practice and the continuing development of the dementia services across both Trusts The shared Patient Carer and Public Experience Committee across both Trusts will hold the Dementia Strategy Groups accountable for progress against six strategic ambitions and measures of success Progress will be measured using local measures and feedback from the National Dementia Audit The Dementia Strategy Groups will develop an action plan describing the priority areas for South Tyneside and Sunderland and the timescales for delivery of quality improvements. These action plans will build on the National Dementia Audit Action plans already in existence Our dementia strategy has been shaped by a number of important national policies and best practice guidelines as detailed below. Both Trusts are members of Dementia Action Alliance and have taken part in each round of the National Audits of Dementia which have led to a number of successful local initiatives over the years to improve the care of patients with dementia and their families. Whilst much of the focus has historically been on acute hospital services, our new dementia strategy spans all services across the Healthcare Group in recognition that out of all people living with dementia, two thirds live in the community while one third lives in a care home: National Institute of Health and Care Excellence and the Social Care Institute for Excellence (June, 2018) - Dementia: assessment, management and support for people living with dementia and their carers https://www.nice.org.uk/guidance/ng97 Department of Health (2009) - Living well with dementia: A national dementia strategy https://assets.publishing.service.gov.uk/ government/uploads/system/uploads/ attachment_data/file/168220/dh_094051. pdf Royal College of Psychiatrists (2010/11, 2012/13 and 2016/17) - National Audits of Dementia https://www.rcpsych.ac.uk/ workinpsychiatry/qualityimprovement/ nationalclinicalaudits/ thenationalauditofdementia.aspx Prime Minister s Challenge (2012) - Prime Minister s Challenge on dementia 2020 https://www.gov.uk/government/ publications/prime-ministers-challengeon-dementia-2020/prime-ministerschallenge-on-dementia-2020 Dementia Action Alliance(2015) - Dementia Friendly Hospital Charter https://www.dementiaaction. org.uk/assets/0001/8146/daa_ Dementia_Friendly_Hospital_Charter_ Booklet_06-2015.pdf Department of Health (2016 refreshed edition) - Making a difference in dementia; nursing vision and strategy https://assets.publishing.service.gov.uk/ government/uploads/system/uploads/ attachment_data/file/554296/dementia_ nursing_strategy.pdf
Royal College of Nursing, RCN Foundation (2016) - The triangle of care. Carers included: a guide to best practice for dementia care https://professionals.carers.org/sites/ default/files/the_triangle_of_care_carers_ included_best_practice_in_dementia_ care_-_final.pdf Health Education England in collaboration with Skills for Health (2015) - Dementia core skills education and training framework https://hee.nhs.uk/our-work/dementiaawareness/core-skills Department of Health (2016) - Dementia 2020 citizens engagement programme: Toolkit for engaging with people with dementia and carers https://assets.publishing.service.gov.uk/ government/uploads/system/uploads/ attachment_data/file/564973/dementia_ toolkit.pdf Dementia Action Alliance (October, 2012) - The Right Care: A Call to Action on Improving the Care of People with Dementia in Acute Hospitals https://dementiapartnerships.com/ resource/the-right-care-creatingdementia-friendly-hospitals/ Royal College of Nursing (2013) - Dementia: Commitment to the care of people with dementia in hospital setting. https://dementiapartnerships.com/wpcontent/uploads/sites/2/rcnhospitalcare. pdf The Butterfly Scheme - http://butterflyscheme.org.uk/ Care Quality Commission (CQC, October, 2014) - Cracks in the Pathway https://www.cqc.org.uk/sites/default/ files/20141009_cracks_in_the_pathway_ final_0.pdf Alzheimer s Society (2014) - Opportunity for Change https://www.alzheimers.org.uk/sites/ default/files/migrate/downloads/ dementia_2014_opportunity_for_ change.pdf John s campaign - https://johnscampaign.org.uk Alzheimer s Society (January, 2016) Fix Dementia Care: Hospitals https://www.alzheimers.org.uk/sites/ default/files/migrate/downloads/fix_ dementia_care_-_hospitals.pdf Alzheimer s Society (2016) - This is me https://www.alzheimers.org.uk/sites/ default/files/migrate/downloads/this_is_ me.pdf NHS England (July, 2017) - Implementation Guide and Resource Pack for Dementia Care https://www.england.nhs.uk/wp-content/ uploads/2018/01/implementation-guideand-resource-pack-dementia-guide.pdf NHS Improvement (October, 2017) - Dementia assessment and improvement framework https://improvement.nhs.uk/ documents/1857/improving_dementia_ care_final_v5_111017.pdf
How to find out more and get involved Our patient experience lead across the Healthcare Group is: Julie Porter, Lead Nurse for Patient Experience julie.porter@chsft.nhs.uk For more information visit: www.chsft.nhs.uk www.stft.nhs.uk www.facebook.com/chsft/ www.facebook.com/stnhsft/ @SunderlandRoyal @SunderlandEye @STFTrust