Commitment 11 of the National Dementia Strategy: Quality and Excellence in Specialist Dementia Care (QESDC) Welcome and Setting the Scene Beardmore Conference.

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)