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Commitment 11 of the National Dementia Strategy:
Quality and Excellence in Specialist Dementia Care (QESDC)
Welcome and Setting the Scene
Beardmore Conference CentreSeptember 2014
Hugh Masters Associate Chief Nursing Officer
Scottish Government
Implementing Commitment 11 of the National Dementia Strategy
• What is the history? • What is a ‘Specialist Dementia Care’
area?• Why is it important now?• What are the expectations?
Implementing Commitment 11 of the National Dementia Strategy
• What do you think is the history? • What do you think is a ‘Specialist
Dementia Care’ area?• Why do you think it important now?• What are your expectations?
THE HISTORY?
Why are we here today?• Dementia dialogue events 2012-13 – these
settings/Advanced dementia/end of life care• Background work was developed from ground
up by MHN leads – 18 months ago• NES ‘Supporting change’ developed• Commitment 11 included in the second National
Dementia Strategy for Scotland• Commitment 11 Implementation and Monitoring
group has met and developed since August last year – stakeholder workshop last October
• Communication with boards April 2014• MWC report ‘Dignity and Respect’
THE SETTINGS?
Setting the Scene
There are around 1,800 NHS or NHS-paid for dementia continuing care or dementia specialist care beds in Scotland, providing some of the most complex, intensive and challenging care for people in the advanced stages of their dementia, frequently combined with other acute care needs associated with age and end of life
NHS Scotland Inpatient Facilities by NHS Board and Specialty:
Psychiatry of Old age ISD Scotland September 2013
Indicator Financial Year Ending 31st March
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013(2)
Average Available Staffed Beds 3,545 3,299 3,207 3,100 2,965 2,823 2,645 2,484 2,355 2,222% Occupancy 82.1 80.2 78.8 78.4 75.8 73.6 74.6 74.7 75.5 75.4
Mean Stay (Days) per Episode 158.8 150.3 144.7 149.5 144.3 141.7 140.0 138.3 134.4 136.2
Throughput 1.9 1.9 2.0 1.9 1.9 1.9 1.9 2.0 2.1 2.0
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Average Available Staffed Beds
Average Available Staffed Beds
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
5,000
10,000
15,000
20,000
25,000
30,000
35,000
3,545 3,299 3,207 3,100 2,965 2,823 2,645 2,484 2,355 2,222
29,88629,069
28,35127,735
27,051 26,57725,751
24,760 24,195 23,728
Psychiatry of old age Average Available Staffed Beds
All Specialties Average Available Staffed Beds
-37%
-21%
Numbers of mental health residents at 31 March for selected NHS boards of treatment: changes over time
Mental Health Hospital Inpatient Care:
Trends up to 31 March 2013 Interim report for selected NHS boards of treatment Publication date – 29 July 2014
Discharges from mental illness specialties in Scottish hospitalsPercentage of patients discharged within 4 weeks of admission,
by sex and age Year ending 31st March 2012
WHY IS IT IMPORTANT NOW?
• The 20:20 Healthcare Vision - everyone is able to live longer healthier lives at home, or in a homely setting and, that we will have a healthcare system where:– We have integrated health and social care – There is a focus on prevention, anticipation and supported
self-management – Hospital treatment is required, and cannot be provided in a
community setting, day case treatment will be the norm – Whatever the setting, care will be provided to the highest
standards of quality and safety, with the person at the centre of all decisions
– There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission
Policy and Priorities
Scotland’s Dementia Strategies 2010-2016
Scotland’s National Dementia Strategy: 2013-16
Mental Welfare Commission for Scotland – Dignity and
Respect: Dementia continuing care visits report (2014)
• Hospitals can pose greater risks than for other patients
• Noisy, stressful, unfamiliar hospital environment can cause distress
• Difficult to communicate effectively with staff – nutritional issues, physical and cognitive functioning decline, tissue viability and falls
• Independence and autonomy can be quickly eroded
What we know…the costs to people with dementia and families
THE PRIORITIES?
‘The way we see dementia and dementia care models will reflect the way that the environment is designed
and organised’(Nele Spruytte 2014)
Berger and Luckman (1966) The social construction of reality
Develop a safe and therapeutic environment: Shifting the Paradigm
• Safe - Environmental changes – fabric• Staffing – attitudes, resource, specialist,
skill mix, working patterns• Therapeutic milieu – deeper changes to
culture/, for example? – Therapeutic models - ?Recovery– Dining and Social areas– Single rooms– Meaningful Activities– Visiting hours– Outdoor space
Develop a safe and therapeutic environment: Shifting the Paradigm
• Treatment and Cure focus• Single clinical speciality• Separate - Mental
Health/Geriatric specialists• Clinical milieu• Traditional staffing• Professional care• Secondary care
• Treatment, Reablement, Rehabilitation and Recovery
• Multiple conditions• Integrated holistic teams• Therapeutic milieu• New staffing skills, resource
and environment• Shared care with
carers/family• Primary and social care
?Old Paradigm ?New Paradigm
Develop a safe and therapeutic environment: Shifting the Paradigm
• Staffing – attitudes, resource, specialist, skill mix, working patterns
NHS Scotland Nursing and Midwifery Workload and Workforce Planning Tools
QESDC update – Nov 2014
• Self assessment• Scrutiny• Small grants• AS Nurse Consultant• Listening events and report• NES education programme• Dementia data benchmarking• Wider discussions – Continuing care, Care
home sector – workforce, recruitment and retention, specialist dementia care definitions,
Lets not forget the good news stories!
Good practice examples across Scotland – what services and
practitioners have already been doing:
For example:-Dementia Strategy actions – e.g. resources-Education and training – post/under graduate-OPAH mock inspections-MWC report audits and actions-Supporting Change
Overall, carers were positive about the quality of care within the units. 98% were satisfied with care
(89% ‘very satisfied’, 9% ‘fairly satisfied’)
(MWC 2014; p.45)