South West Dementia Partnership

Improving Dementia Care in General Hospitals

The South West regional conference on improving dementia care in general hospitals, jointly organised by the South West
Dementia Strategy Group and the British Geriatrics Society, was held at Exeter Racecource on Tuesday 26 January 2010.

The conference brought together leads for improving dementia care in hospitals from acute and community hospital settings to
consider how to develop and measure an effective process of change based on practical examples from across the South West.
Conference delegates also sought to identify how to align this agenda with trustsʼ corporate and performance management
priorities across the region.

This document summarises the discussion from the delegate workshops: Local experiences, progress and constraints; Aspirations
and ideas for supporting progress.

For more information on work across the South West region to improve dementia care in general hospitals visit the South West
Dementia Partnership website http://www.southwestdementiapartnership.org.uk/implementation/hospital-care-conference/

Living well with dementia across the South West

 What is preventing good quality care in our local hospitals?

What do we want to do locally to What is preventing us from making What have we tried so far and with
move things on? progress? what results?
• Establish joint commissioning • Inconsistency of terms for acute • Audit by acute and PCT to look at
steering group hospitals bed usage
• Involve commissioning at all levels • No targets • Investment in community services
• Clear local targets • Pathway is not understood • Ongoing debate about ʻwhose
• Link dementia to QIPP agenda • Tariffs resourcesʼ
Commissioning

• Negative impact of CHC to be • No regionally agreed

removed assessment process
• Need to invest to save • Diverse funding streams/
• Agreed definitions for rehab/IC constraints
care • NHS blame culture decreases
• Commissioned third sector support innovation
• Developing an understanding of
how community will share funds
released from acute sector

2
 What is preventing good quality care in our local hospitals?
What do we want to do locally to
move things on?
• Raise clinical primary care
responsibilities
• Improve psychiatric liaison services
for older people
• Improve local integration
• Increase awareness of dementia
care issues within acute sector
Service Development
• Engage other acute specialties e.g.
cardiology
• Engender greater whole systems
approach
• Establish specialist co-ordinators
• Community hospital engagement in
NDS
• Communication issues need to be
addressed
• Explore different ways of doing
things
• Learning from good practice
• Improve environment
• Improve IT systems with sharing
across sectors/agencies
• Specialist liaison nurses on all
wards
What is preventing us from making What have we tried so far and with
progress? what results?
• Division/lack of co-ordination • Evidence of partnership working
between acute trusts and MH • Building on whatʼs working well
trusts • Investment in community services
• Lack of end of life planning • In reach CPN – care homes and
• Lack of preventative work complex discharges
• No regular visits to care homes • Pathways with structure to aid
• Lack of GP awareness and decision making
involvement in homes/residential • Ward nurse to do CHC screens and
care assessments
• Lack of rigorous quality • Volunteer led work
assurance/regulation of care • Review case notes for
homes • Involving third sector
• Bureaucracy • Breaking down professional barriers
• Lack of confidence in telecare
• Acute hospitals not fit for
purpose for dementia care
• Delayed discharge issues
ongoing
• Individual notes not integrated
across the system
• No shared language across
partners
3
 What is preventing good quality care in our local hospitals?
What do we want to do locally to
move things on?
• Culture change
• Education for all
Leadership & Workforce Development
• Mandatory training with CQC target
• Define workforce in terms of need/
complexity
• Clarify roles
• Meaningful engagement of chief
executives and dementia
champions
• Awareness raising programme for
workforce around dementia issues
What is preventing us from making What have we tried so far and with
progress?
• Culture/language barriers
• Lack of successful multi-agency
working
• Poor understanding of the needs
of people with dementia
what results?
• Involve non-executive directors
• Need to achieve drive from
clinicians and management that is
county wide
• Local champions but success too
early to judge
• Appoint people
• Training piecemeal at present
• Whole staff awareness now
mandatory
4
 What is preventing good quality care in our local hospitals?

What do we want to do locally to What is preventing us from making What have we tried so far and with
move things on? progress? what results?
• Strategic carer involvement in care • Using patient stories and
Service User & Carer Involvement

journey experiences to comment on need

• Improve information given to SUʼs for change
and carers • Patient complaints get managers
ears

5
 What will be better this time next year?

What is going well locally? If we repeat this event next year
what will be in place locally? What
will people with dementia & carers
experience?
• Plans agreed with funding
streams identified
• Improved links with
Commissioning
Who and what else do we need to do
in order to make progress locally?
• Strong commissioning lead to corral
delivery and facilitate working
across tariffs and boundaries

commissioning Incorporation of • QIPP

dementia related CQUIN into
2010/11 contract
• County-wide implementation
plan

6
 What will be better this time next year?
What is going well locally?
• Lots in Bristol – liaison team
support
• Networking and collaboration
Service Development
• Higher profile
• Progress towards a more robust
care pathway
• Enthusiasm within elderly care
dementia guidelines
• All trusts engaged in both National
Audit and ward Audits
• Team working and networking
If we repeat this event next year
what will be in place locally? What
will people with dementia & carers
experience?
• Developed liaison services
• Reduced rate of admissions
• Delivery of action plan
• All at risk patients admitted
• Appropriate in-hospital
environment
• Outreach/in reach specialist
expertise available to all areas
regardless where admitted
• More joined up thinking
• Lots of small steps
• Leading to dementia care
pathway with effective options
Who and what else do we need to do
in order to make progress locally?
• Services to go to patients and not
the other way around
• Ownership of problem across the
whole pathway
• General hospitals need to include
dementia in core business
• ʻStop silo workingʼ quality accounts
• Sharing knowledge, tools and
resources via website
• Partnership/multipartnership
involvement
• Audit use of tranquilisers and audit
7
 What will be better this time next year?
What is going well locally?
Leadership & Workforce Development
• When the going gets tough the
tough wonʼt get going!
• Moves towards education
• Somerset Dementia Strategy
Group
If we repeat this event next year
what will be in place locally? What
will people with dementia & carers
experience?
• Exec lead and dementia lead will
be driving through an action plan
for dementia
• Local champions and increased
awareness
• Menu for awareness training
• Rolling workshops – hospital/
community
• Education for staff
• People in practice, training
education and tools
Who and what else do we need to do
in order to make progress locally?
• Regular ring-fenced mandatory
training
• SW Dementia leads to meet
• Alison Moon to write out explaining
her role
• Leadership and proper support to
operationalise
• Dementia champions at all levels
• Board level sign-up
• Cross directorate leadership Sell the
business case
• Corporate lunchtime sessions
8
About the South West Dementia Partnership

The South West Dementia Partnership brings together organisations from health and social care, the voluntary sector and people
using dementia services to drive forward improvements. The partners include:
• NHS South West
• Government Office for the South West
• Department of Health
• Association of Directors of Adult Social Services
• Alzheimerʼs Society

The review of dementia services across the South West undertaken in 2009 identified some common challenges across the region.
We have developed a South West Dementia implementation programme and are working to deliver improvements. The programme
is overseen by a multiagency steering group.

The South West Dementia implementation programme is led by:

• David Francis, Policy Implementation Project Manager, Department of Health South West, david.francis@dh.gsi.gov.uk; m –
07909 914710
• Kate Schneider, Programme Lead, Dementia and Mental Health, South West Strategic Health Authority,
kate.schneider@southwest.nhs.uk; m – 07973 732766