NES
Item 8c
September 2013
NES/13/56
(Enclosure)
NHS Education for Scotland
Board Paper Summary
1.
Title of Paper
Scotland’s National Dementia Strategy 2013-16: Implications for NES
2.
Author(s) of Paper
Susanne Forrest
Colette Ferguson
Judy Thomson
Geraldine Beinkowski
3.
Purpose of Paper
To update the NES Board on Scotland’s second National Dementia Strategy
(2013-16) and the NES/SSSC work programme that will support delivery of the
strategy.
4.
Key Issues
Scotland’s second National Dementia Strategy was launched on the 3rd of June
2013. This 3 year strategy builds on the 2010 strategy, and contains 17 new
commitments to drive forward improvements in the care and treatment for
people with dementia and their families and carers across health and social
services.
This includes a commitment to continue to improve staff skills and knowledge
by building on the partnership work already undertaken by NES and SSSC in
taking forward a second Promoting Excellence workforce development plan
across the period of the new strategy.
5.
Educational Implications
NES and SSSC developed the Promoting Excellence Dementia Knowledge
and Skills Framework on behalf of the Scottish Government in 2011, and have
since taken forward a major programme of dementia workforce development to
support implementation of the framework.
The second NES/SSSC workforce development plan to support implementation
of the new strategy spanning 2013 -16 has been approved by the Scottish
Government.
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The ambitions set out in the strategy and the workforce development plan will
continue to have implications for the education and training of all the health and
social services workforce.
6.
Financial Implications
A fully coasted PID has been approved by the Scottish Government with
confirmed funding of £563, 819K for NES/SSSC for 2013/14 and equivalent
annual funding thereafter for 2014/15 and 2015/16.
7.
Which NES Strategic Objective(s) does this align to?
1. We will deliver consistent evidence based excellence in education for
improved care.
3. We will continue to build co-ordinated joint working and engagement with
our partners.
4. We will provide education in quality improvement for enhanced patient
safety and people’s experience of services.
8. We will develop flexible, connected and responsive educational
infrastructure which covers people, technology and educational content.
8.
Impact on the Quality Ambitions
Education, training and workforce development to support improvements in the
care of people with dementia are essential in terms of supporting all the Quality
Strategy ambitions of person centred, safe and effective care.
9.
Key Risks and Proposals to Mitigate the Risks
1. To ensure NES educational response is integrated with other national
programmes
2. To ensure NES takes forward an integrated cross directorate response to
supporting this agenda
Risk 1 is offset by NES participation in other national improvement
programmes
Risk 2 the purpose of this paper is to enable the NES Board to consider and
mitigate against any risk set out.
10.
Equality and Diversity Impact Assessment
A full EQIA has been completed.
The development of Scotland’s Dementia Strategies has been informed by
recognition that people with dementia often experience significant health
inequalities in the health and social care systems. The second strategy
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recognises the need to continue to address the needs of: younger people
diagnosed with dementia; people with dementia and a learning disability; and
other people/groups at risk of experiencing health inequalities.
The diversity of the workforce across health and social services brings
particular challenges in ensuring equitable access to education and our
workforce development plan takes account of this.
11.
Communications Plan
A Communications Plan has been produced and a copy sent to the Head of
Communications for information and retention:
Yes
12.
X
No
Recommendation(s) for Decision
The NES Board is invited:
•
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•
To note the content of this paper;
To discuss and seek clarification of any issues raised;
To endorse the partnership approach in taking this work programme forward.
NES
August 2013
SF/CF/JT
3
Scotland’s National Dementia Strategy 2013-16: Implications
for NES
1. Introduction and Background
Dementia is one of the foremost public health issues worldwide. As a consequence
of improved healthcare and better standards of living more people are living for
longer.
This means in Scotland that the number of people with dementia is expected to
double between 2011 and 2031. Statistics for 2013 show that 86,000 people in
Scotland have a diagnosis of dementia (Alzheimer Scotland, 2013). This presents a
number of challenges, most directly for the people who develop dementia and their
families and carers, but also for the health and social services that provide care and
support. Over time it is expected that a greater proportion of health and social
services expenditure will focus on dementia, and there is evidence of that change
already.
The Scottish Government (SG) made dementia a national priority in 2007, set a
national target on improving diagnosis rates in 2008 and published an initial 3-year
National Dementia Strategy in 2010, underpinned by a rights-based approach to
care, treatment and support. The first strategy focused on improving the quality of
dementia services through more timely diagnosis and on better care and treatment,
particularly in hospital settings. It began the process of the necessary service
transformation of care across all sectors.
Implementation of the first strategy was supported by the publication in 2011 of the
Standards of Care for Dementia in Scotland alongside the NES/SSSC Promoting
Excellence knowledge and skills framework. Since 2011 NES/SSSC have taken
forward a major dementia workforce development programme across the health and
social services sectors.
Scotland’s second National Dementia Strategy was launched on the 3rd of June
2013. This 3 year strategy builds on the first strategy and contains 17 commitments
to drive forward further improvements in the care and treatment for people with
dementia, and their families and carers, across health and social services. This
includes a commitment to continue to improve staff skills and knowledge by working
with NES and SSSC to take forward a second Promoting Excellence workforce
development programme across the period of the strategy.
This paper provides:
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An overview of the focus and commitments set out in Scotland’s second
National Dementia Strategy, noting the links with wider policy imperatives and
related NES work programmes.
Detail of the NES/SSSC dementia workforce development programme for
2013/16 and how this supports delivery of the commitments set out in the
strategy, and builds on activity already undertaken in 2011-13.
An outline of the other related national programmes that will support
implementation of the strategy.
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2. Scotland’s National Dementia Strategy (2013-16): an overview
The strategy and the 17 commitments set out (listed in Appendix I) is centred on
addressing 3 key challenges:
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To offer care and support to people with dementia and their families and
carers in a way which promotes wellbeing and quality of life, protects their
rights and respects their humanity.
To continue to improve services and support from when someone presents
for diagnosis, and throughout the course of the illness, including the support
needs of carers. This support must be truly person centred, and should
understand care and support from their perspective, alongside the
perspectives of service managers and clinicians.
To recognise that with increased life expectancy the challenge of providing
high quality care and support to people with dementia and their carers will
increase over time. This means that the process of redesign and
transformation of services needs to be embraced to ensure that services are
delivered effectively and efficiently.
The strategy notes that work on dementia is one strand of the wider work that SG is
taking forward to transform and improve health and social care services. Other key
strands of that work, with often related NES work programmes, include:
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Integration of Health and Social Care: the SG is taking forward legislation
to allow for the local integration of adult and older people’s health and social
care services in Scotland; the need to improve the response to dementia is
one of the key policy drivers for this work and health boards, local authorities
and the voluntary sector are involved in this process.
Reshaping Care for Older People/Change Fund: the SG is investing £300
million to facilitate changes in the way services are designed and care is
delivered, including services for people with dementia. Health and Social
Care Partnerships will set out their intentions for the future delivery of care for
people with dementia and their carers in their respective planning documents
and have the ability to develop plans together through joint commissioning
processes.
Carers Strategies: Caring Together: The Carers Strategy for Scotland 201015, which is underpinned by £98 million of investment between 2008 and
2015, recognises that carers must be seen as equal partners in the delivery of
care as their support enables people with dementia to live at home and in
their own communities safely, independently and with dignity.
Self-directed Support: self-directed support is a major reform to the way in
which social care and some healthcare services are delivered and give
greater choice and control to those who receive support; the Alzheimer
Scotland pilot on self-directed support in Ayrshire showed that self-directed
support offers benefits to people with dementia.
Palliative Care: Living and Dying Well; a National Action Plan for Palliative
and End of Life Care (2008) and Living and Dying Well: Building on Progress.
Work (2011) promote the provision of palliative and end of life care to all.
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2. NES/SSSC Dementia Workforce Development Programme - 2013/16
This section details the NES/SSSC dementia workforce development programme
for 2013/16 including: how this supports delivery of the commitments set out in the
second National Dementia Strategy; builds on our activity undertaken between
2011-13 to support delivery of the first Dementia Strategy.
A summary of deliverables from our first work programme (2011-13) is included in
Appendix II (Tables 1.1, 1.2 and 1.3) structured in terms of ‘Educational Resources
and Guidance’, ‘Training’ and ‘Infrastructure Development’. Key resources and
further information can be accessed from the Promoting Excellence web site on
http://www.knowledge.scot.nhs.uk/home/portals-and-topics/dementia-promotingexcellence.aspx.
Good progress has been made in the implementation of NES/SSSC 2011-13
workforce development programme. However, the ambitions of the programme are
significant - involving the education and training of the entire health and social
services workforce against the knowledge and skills levels of Promoting Excellence.
A high level summary of the 2013-16 programme against the 10 programme aims set
out in our Project Initiation Document is provided in this section. While Commitment 8
in the new Dementia Strategy relates specifically to Promoting Excellence, our
activities will support delivery of a number of the other commitments.
The NES/SSSC PID and work programme will also be incrementally reviewed and
updated on annual basis to respond to emerging issues and priorities as
implementation of the second dementia strategy progresses.
All activities undertaken in 2013-16 will:
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Reflect rights based, asset based, evidence based and personal outcomes
focussed approaches to improving the care, treatment, support and quality of
life for people with dementia and their families and carers, at all stages of
their dementia journey.
Be designed and implemented in a way that supports delivery of the
Dementia Standards and Quality of Life Outcome Indicators set out in
Prompting Excellence.
Adopt a co-production approach by actively and meaningfully involving
people with dementia and their families and carers, through continued
engagement and involvement with the Scottish Dementia Working Group and
National Dementia Carers Action Group.
Maximise the potential to support the significant cultural change required in
dementia care, support and services by synergising our activities with other
key change actions and improvement programmes.
Be designed in a way that is sensitive to the current fiscal and service
redesign climate and how this impacts on issues of access to education and
training for the health and social services workforce.
Support the integration agenda for health and social care by taking forward
education and training in a way that encourages shared learning, and service
development and improvement across the health and social services sectors.
Maximise the potential for taking forward specific activities in partnership with
other key agencies including: Alzheimer Scotland; NHS Health Scotland;
Health Care Improvement Scotland; NHS 24; the Joint Improvement Team;
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the Care Inspectorate; IRISS, and wider educational providers, including the
University and College sectors.
Synergise NES/SSSC activities both internally and externally with wider work
streams and initiatives including leadership, self directed support and the
carers strategy.
Contribute, alongside other agencies to build community capacity to support
improvements in the quality of life, experiences and outcomes for people with
dementia and their families and carers.
The programme will continue to be overseen by a NES/SSSC Programme Board
chaired by the Chief Executive of Alzheimer Scotland.
2.1
Aim 1 - To continue to embed and support infrastructures across the
Social Services sectors to facilitate the dissemination of education and
training.
The size, scale and diversity of the social services sector present particular
challenges. The total workforce figure is around 195,000.There are a total of 13,914
care services registered with the Care Inspectorate and approximately 2,700
employers. Across these diverse sectors there is a considerable task in reaching
and influencing training and learning, and in turn front line practice.
Continuing to build capacity within the Social Services Sector will support the further
implementation and embedding of Promoting Excellence on areas of practice where
the workforce has ‘direct and/or substantial’ contact with people with dementia
including care at home, housing support, day care of adults and care home services
for adults across the public, private and voluntary sectors.
Activities will include:
• Targeted engagement with employers in social services sectors or
geographical areas where contact has been limited to date.
• Development of a further 225 Social Services Dementia Ambassadors
• Ongoing support and development of existing Social Services Dementia
Champions and Ambassadors to enable them disseminate education and
training within the sector
• Connection and shared learning opportunities between social services
dementia champions, dementia ambassadors, staff trained to deliver
psychological approaches, and trainers in palliative and end of life care
These activities will specifically support delivery of Commitments 3, 6, 7, 8 and 12.
2.2
Aim 2 – To further extend engagement with, and reach of educational
resources and education to support health and social services
workforce development across all levels of Promoting Excellence,
targeting specific staff groups.
Given the ambition of the Promoting Excellence framework, and the scale of the
health and social services workforce this involves, there is a need to continue to
enhance engagement and reach to specific staff groups.
Activities will include:
• Medical Training – an exercise is being undertaken to explore the extent to
which the existing regulatory approved curricula deliver the relevant
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competencies, and ensuring that trainees are signposted to appropriate NES
or other resources in order to support them in achieving these competencies.
Primary Care – targeted education and training for Practice Nurses, Practice
Managers, General Practitioners and ‘Long term Conditions’ Teams and
Community Pharmacists.
Undergraduate Health and Social Services Professional Education –
ensuring all adult, mental health and learning disabilities nurses exit the
programmes at the Dementia Skilled level of Promoting Excellence;
supporting implementation of Promoting Excellence in AHP undergraduate
programmes; ensuring implementation of Promoting Excellence in all social
work and Mental Health Officer Award programmes
Strategic Leads, Clinical Leads and Operational/Service Managers in
Health and Social Services – targeted engagement and communication
activities; production of workforce development plans; shared action learning
opportunities.
These activities will specifically support delivery of Commitments 1, 2, 3, 6, 7, 8, 10,
11 and 12.
2.3
Aim 3 – To work with the Care Inspectorate and Health Care
Improvement Scotland, including the provision of dementia education
and training for Inspectors, to synergise implementation of Promoting
Excellence and the Dementia Standards.
The Care Inspectorate has appointed a lead manager for dementia and is identifying
a network of inspectors who will be able to focus on work around the Dementia
Standards, now being rolled out across care homes and care at home settings. The
Healthcare Improvement Scotland 'Older People in Acute Hospitals Inspection'
process and methodology is currently subject to external and internal review and the
inspection team is being expanded.
Activities will include:
• Development of a bespoke dementia learning resource and training
programme for Care Inspectorate and Healthcare Improvement Scotland
inspectors in adult care settings to support the recognition, understanding
and spread of good practice in dementia care in 2013/14.
• Between 2013-14 training to 75 Inspectors, and based on evaluation,
continuing to disseminate training to a further 100 inspectors in 2014/15.
These activities will specifically support delivery of Commitments 6, 7, 8, 10, 11 and
12.
2.4
Aim 4 – To continue to increase access to psychological interventions
and therapies for people with dementia and their families and carers
(including education and training for families/informal carers).
NES is leading a wider programme of work to support increased access to evidence
based psychological interventions/therapies in support of the Scottish Government
access to treatment target (HEAT target), including an older peoples work
programme and all future plans will synergise with this wider work.
In 2011-13 we undertook a range of activities to support increased access to
psychological therapies and interventions for people with dementia, and their families
and carers. This has included the development of a number of educational
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resources, and the training of 540 staff in low and high intensity interventions, using
capacity building and training for trainer’s models.
The new strategy commits to finalising and implementing a national commitment on
the prescribing of psychoactive medications, as part of ensuring that such medication
is used only where there is no appropriate alternative and where there is clear benefit
to the person receiving the medication. Reducing anti-psychotic prescribing for
people with dementia is contingent on additional evidence based non
pharmacological interventions being available
Activities will include:
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Establishing support, supervision and learning networks in 2013/14 to
enable existing psychological therapies training in ‘Stress and Distress in
Dementia’ to be consolidated within NHS Boards and Social Services
organisations to ensure future sustainability.
Further disseminating Training for Trainers in Stress in Distress in
Dementia in 2015-16, building on the network of 100 trainers already
trained.
Further increasing the availability of Cognitive Behavioural Therapy (CBT)
experts in NHS Boards providing support to people with dementia,
families and carers
Providing increased and more accessible education and support to
colleagues working in health and social care in remote and rural services
Delivering further training in group based Cognitive Stimulation Therapy
(CST), using a ‘training for trainers’ model
Developing, piloting and evaluating an additional CST ‘Training for
Trainers’ programme, to equip health and social care staff to support
carers in the delivery of individual based CST
Developing educational resources to support staff, and families and
carers, in supporting people with Fronto-temporal Dementia.
Developing additional resources and training to offer further education
and support to staff, and people with dementia and their families/carers, at
more advanced stages of the dementia journey.
These activities will specifically support delivery of Commitments 2, 3, 8, 12, 13 and
16.
2.5
Aim 5 - To continue to focus on education and training for the acute
general hospital workforce, attending also to further infrastructure
development and sustainability of the investment made to date.
Improving care in hospitals was the second of two key improvement areas in the first
Dementia Strategy, and a major previous focus of the 2011-13 NES/SSSC work
programme. The Midlothian Dementia Demonstrator project have shown that in
2008/9 that people with dementia accounted for 20.4% of the occupied bed days
used by people aged over 65, even though they only accounted for 5.4% of the total
population over 65. This is a trend predicted to be repeated in future years.
Challenges remain to ensure that, when admission to acute general hospitals is
unavoidable for people with dementia, they experience, on every occasion, safe,
effective, dignified and person-centred care.
The new dementia strategy sets out plans to undertake more work: to understand
why people with dementia are admitted to hospital; take more action on key areas
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such as unscheduled care, patient flow and delayed discharge; make the current
system of care in hospital work better for people with dementia in ensuring better
quality of care; and to begin to look at remodelling the wider system of care in the
wider context of the integration of health and social care.
The new strategy also commits to deliver key change areas set out in an 3-year ‘10Point National Action Plan’ (see Table 2) to maximise the impact of the investment
over the last 2 years in the capability and capacity of staff operating in those settings.
It will also support service transformation and help focus and coordinate a range of
initiatives taken forward over the last two years.
Table 2
10-Point National Action Plan to continue to improve dementia care in acute
general hospitals – key change areas
1. Identify a leadership structure within NHS Boards to drive and monitor
improvements
2. Develop the workforce against the Promoting Excellence Framework
3. Plan and prepare for admission and discharge
4. Develop and embed person-centred assessment and care planning
5. Promote a rights-based and anti-discriminatory culture
6. Develop a safe and therapeutic environment
7. Use evidence-based screening and assessment tools for diagnosis
8. Work as equal partners with families, friends and carers
9. Minimise and respond appropriately to stress and distress
10. Evidence the impact of changes against patient experience and outcomes
To support delivery of this agenda our activities will include:
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Preparing a further (4th) cohort of 100 health and social services staff as acute
general hospital champions in 2013.
Supporting the work and synergy of the cohort 1-4 Dementia Champions and
Dementia Ambassadors and wider networks of trainers in 2013-15 by
facilitating regional learning networks to share best practice, and maximise
integration of their activities across sectors.
Working alongside other national improvement programmes to support
implementation of a package of improvement measures for dementia care in
hospitals.
Preparing a further (cohort 5) health and social services dementia champions
in 2014/15 focussed on community hospitals and associated community
health and social services, including ‘hospital at home’ services and the
Scottish Ambulance Service.
Continuing to support, sustain and develop the Alzheimer Scotland Dementia
Nurse and AHP Consultants and Specialists, individually and collectively, by
providing further learning and development opportunities.
Develop an e-learning module in 2013/14 to equip staff working in acute care
settings with increased understanding of the factors which contribute to the
development of stress and distress in the context of dementia; appropriate
interventions to alleviate distress; how to evaluate the effectiveness of these
interventions; and how recognise when expert advice may be necessary.
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Develop an e learning module and mobile application on the management of
delirium in hospitals based on the Scottish Delirium Association pathway and
bundle.
These activities will specifically support delivery of Commitments 3, 6,7,8,10,11 and
13.
It is of note that Action 2 of the key change agents outlined in the SG ‘10-Point
National Action Plan’ will require NHS Boards to develop and deliver strategic plans
to develop the entire acute general hospital workforce against the Promoting
Excellence Framework. Some NHS Boards have already made good progress in this
respect. A consideration for NES is how we continue to mobilise our practice
education infrastructures across all directorates to support NHS Boards to deliver this
key change action.
2.6
Aim 6 - To undertake a range of activities to support work force
development in mental health continuing care and wider hospital
inpatient services
The focus of the first dementia strategy was on implementation of the Dementia
Standards in acute general hospitals. However, similar attention in the future needs
to be on other inpatient services, including NHS mental health services for people
with dementia, rural community hospitals and in psychiatry of old age wards.
Some NHS boards have already begun to make use of ‘mock’ inspections by
adapting the approach used for HIS inspections into care of older people in acute
general hospitals, and also using the pilot NES/SSSC ‘Supporting Change’
programme and process. The ‘Supporting Change’ pilot programme was developed,
delivered and evaluated by NES/SSSC in 2012-13 on behalf of the SG, adapting the
change and improvement processes originally developed for the acute general
hospitals dementia champions programme.
While these settings share many of the wider strategic and organisational issues that
acute general hospitals face, there are different and additional challenges. Scotland’s
second National Dementia Strategy notes that ‘ it is unlikely that care will always be
of the quality required under the Standards of Care for Dementia, nor that staff will
meet the expectations in respect of knowledge and skills set out under the Promoting
Excellence framework’. The Mental Welfare Commission will be considering the
application of the Dementia Standards in mental health services as part of its visits
programme in 2013-14 and early indications are that this visit programme will
highlight areas requiring development.
The new strategy commits to setting out plans to extend the work on quality of care in
general hospitals to other hospitals and NHS settings.
To support these agenda, our activities will include:
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Working alongside the Scottish Government ‘Commitment 11’ strategic group
to inform future educational developments.
Working directly with NHS Boards to provide bespoke local training, based on
the outcomes of self and peer assessment, and the priorities identified for
development.
Continuing to support facilitators who have undertaken the 2012-13
‘Supporting Change’ programme to disseminate training at the Dementia
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Skilled level of Promoting Excellence to inpatient mental health staff and care
home staff.
Working with our existing networks of trainers in Cognitive Stimulation
Therapy, Stress and Distress in Dementia and Palliative Care to support them
to reach and disseminate training to inpatient mental health staff.
These activities will specifically support delivery of Commitments 3, 6, 7,8,11 and 13.
2.7
Aim 7 - To undertake a range of activities to further support work force
development in the Care Home, Care at Home and Adult Day Care
Sectors.
As previously noted 65% of the social services workforce is based in care home,
housing support/care at home and adult day care settings. At over 127,000 staff,
many with full time working contact with people with dementia, their families and
carers, their learning and support needs are of high importance. In engaging with this
workforce, there are issues relating to the diverse level of qualification and training
staff have; the priority, funding and accessibility of training and learning; and the
support of employers. From delivering on the previous plan there is evidence of
considerable commitment to and enthusiasm for this work. The highest percentage of
Dementia Ambassadors is from these parts of the sector.
Many ambassadors are now also trained in programmes such as Palliative and End
of Life Care for people with dementia and/or Cognitive Stimulation Therapy, and
others have undertaken the pilot Supporting Change training. This heightened
interest, knowledge, commitment and confidence in delivering training from
ambassadors is also supporting staff within their units and teams to be better trained.
The new strategy commits to work with Scottish Care, SSSC, NES and others to
assess the need for, and take further action on, improving service response around
care homes, care at home and adult day care services. This will include attention to
staff training and support for the implementation of the post-diagnostic HEAT target
and the commitment on reducing inappropriate prescribing of psychoactive
medication for people diagnosed in care homes.
To support this activities will include:
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Further development of the Dementia Ambassadors programme with a focus
on the care at home, care home, housing support and adult day care,
targeting particular areas where response to engagement has been limited to
date.
Leadership development between 2013-16 for 90 Social Services Dementia
Ambassadors and Champions via SSSC’s ‘Step into Leadership’ resource to
develop their ability to provide leadership of the Promoting Excellence agenda
in and beyond their workforce.
Taking work forward via SSSC registration process by linking to National
Occupational Standards, particularly the Dementia Skills set to up skilling, by
qualification, these sectors of the social services workforce.
These activities will specifically support delivery of Commitments 2, 6, 7,8,12 and 13.
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2.8.
Aim 8 - To further develop and disseminate education and training in
Post Diagnostic Support based on the Alzheimer Scotland 5 pillar model
to support implementation of the Post Diagnostic Support HEAT target.
Post-diagnostic support was one of the key change areas in the first Dementia
Strategy. A new national HEAT target for dementia was established in April 2013
and sets out the commitment: ‘To deliver expected rates of dementia diagnosis and
by 2015/16, all people newly diagnosed with dementia will have a minimum of a
year’s worth of post-diagnostic support coordinated by a Link Worker, including the
building of a person-centred support plan’. This is a 3-year target, with services
expected to be delivering the commitment to everyone newly diagnosed by March
2016 (though Boards are collecting data from April 2013).
Previously NES/SSSC have commissioned and evaluated pilot post diagnostic
support training aimed at those who will be undertaking the Link worker role. We will
build on this initial work and:
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Develop national post diagnostic support training programmes and resources
in 2013-14 for managers, teams and front line health and social services staff
to support delivery of the post diagnostic support HEAT target;
Roll out and evaluate national and local training programmes to support
delivery of the post diagnostic support HEAT target in 2014-15, working
alongside other national improvement programmes.
Work with colleagues in General Practice to redevelop the Practice Based
Small Group Learning module on dementia in 2014, to reflect the particular
Scottish policy context and service improvement imperatives.
These activities will specifically support delivery of Commitments 1, 2, and, 8.
2.9
Aim 9- To undertake a range of activities to support health and social
services workforce development to enhance personalised and evidence
based community support for people at more advanced stages of their
dementia journey, and their families and carers, based on the Alzheimer
Scotland ‘8 Pillars Model’.
While the post-diagnostic commitment for everyone diagnosed on or after 1 April
2013 will also help drive wider changes in dementia services, there are a large
number of people with dementia who are at the stage of the illness when they require
more intensive support.
Alzheimer Scotland’s policy paper Delivering Integrated Dementia Care: the 8 Pillars
Model of Community Support proposes an integrated care model to address these
issues. The new strategy commits to test and evaluate a range of approaches to
providing better integrated care and support on the basis of the 8 Pillars model,
centred on a Dementia Practice Coordinator role.
To support this we will:
 Continue to develop infrastructures across the Health and Social Services
sectors to support the dissemination and reach of education and training to
support comprehensive, personalised and evidenced based approaches to
the community support of people with dementia.
 Continue to increase access to psychological interventions and therapies for
people with dementia and their families and carers (including education and
training for families/informal carers).
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Undertake a range of activities to further support work force development in
the Social Services Sector, in particular the Care Home, Care at Home and
Adult Day Care sectors.
Scope out the developmental needs of health and social service managers to
enable the transformational change required to deliver this model, and devise
and deliver development to meet these needs, likely to be based on a
leadership development and action learning models.
These activities will specifically support delivery of Commitments 3, 6, 8 and 12.
2.10
Aim 10. To work with partners to develop of a future focussed and
public facing digital platform, utilising technology to enhance
information, education, self help and management for people with
dementia, families and carers.
One of the themes that emerged from the National Dementia Dialogue that informed
the second strategy was a desire for greater access to skills and knowledge by
carers to improve their ability to provide effective support. Technology is one
mechanism that we can use to respond to this request for help. There is already a
range of electronic information and training resources prepared by Scottish public
and voluntary sector organisations aimed at people with dementia, their carers and
families, and those who work with them. From a user’s perspective, however, these
resources can be confusing and difficult to navigate.
To support this agenda we work in partnership with Alzheimer Scotland, NHS Health
Scotland, IRISS and NHS 24. In 2013/14 we will bring together an expert group to
oversee the project. We will scope existing resources and initiatives and establish
the technological requirements required to take this forward with a view to launch of
the site in 2014 and further build between 2014-16.
2.11
Impact Evaluation
The educational evaluation framework for the dementia work programme is based on
Kirkpatrick’s evaluation framework 1 outlined in Table 3. This framework will continue
to inform evaluation of the 2013-16 work programme and evaluation activities
undertaken will include both internal and external evaluation.
Table 3
Evaluation Framework
Level
Evaluation type
Evaluation description
Evaluation tools
4
Result
Management and service
users and carer reporting
systems (and relate change
to the trainee).
3
Behaviour
Effect on service
delivery.
Impact against quality of
life indicators for people
with Dementia.
Evaluation of learner’s
behaviour change
(impact of training).
Observation and interview
and other follow up over time
to assess change (including
relevance and
sustainability).
Evidence of local change
activity being taken forward.
1
Kirkpatrick, D. L. (1994). Evaluating Training Programs. San Francisco: Berrett-Koehler
Publishers
14
2
Learning
1
Reaction
Measuring knowledge,
skills and behaviours
before and after the
event to assess
knowledge
improvement.
How learners felt about
the training / learning
experience / resource.
Assessments before and
after the training.
Interview or observation
possible.
Feedback forms/surveys.
Verbal reactions.
To date we have evidence of impact at levels 1-3 of the framework collected via a
range of quantitative and qualitative internal and external evaluation approaches, for
example:
•
•
•
•
Consistently high ratings of the efficacy of educational resources and training
programmes in improving knowledge and skills.
Majority of participants reporting they have implemented knowledge in
practice, leading to improvements in care provided.
Significant shift towards a more positive approach to dementia care between
pre and post tests across training programmes.
Self and other independent reports of a range of activity being undertaken by
trainees in bringing about changes and improvements.
With also emerging evidence at Level 4, for example:
•
•
Decrease in antipsychotic medication prescribing in care homes attributed to
the dissemination of ‘managing stress and distress in dementia’ training.
Positive reference to the impact of the dementia champions in recent HIS
Older People in Acute Care Hospital Inspection reports.
Over the next phase of our work programme activity will be taken forward in a way
that closely attends to evaluating the impact of investment in educational
interventions against workforce development outcomes and, where possible, focus
on outcomes for people with a diagnosis of dementia and their families and carers.
Evaluation activities will focus on Level 4 of the evaluation framework, noting that
education is one of many elements which will support the delivery of the
transformational change agenda and the aspirations and outcomes of Scotland’s
second National Dementia Strategy.
3.
Other Related National Programmes
3.1
Scottish Government National Dementia Improvement Programme
Since 2008 SG has provided national improvement support and expertise to help
local services improve dementia services, initially focussing on supporting delivery of
the HEAT diagnosis target. Over the course of the first Dementia Strategy SG have
provided integrated improvement support across local health and social services
systems to help facilitate local whole-system change. Through 2012 they have
supported the work of post-diagnostic test sites in mapping and costing the new post
diagnostic support HEAT target.
The new strategy recognises that local systems need further redesign, and to help
facilitate that change, implementation of the strategy will be supported by a National
15
Dementia Improvement Programme. This will be led by the SG Joint Improvement
Team (JIT) and SG Quality and Efficiency Support Team (QUEST) with a number of
key improvement objectives over the next 3 years:
•
•
•
•
•
•
•
supporting the delivery of the post-diagnostic HEAT target across all Health
and Social Care Partnerships in Scotland, noting delivery of this target will
require services to engage in significant redesign work;
testing the Alzheimer Scotland ‘8 Pillars’ model for community based support
in 3 or 4 pilots looking at different environments (urban; rural; island), but also
within different hosting arrangements – primary care, local government and
an integrated service;
working with colleagues in primary care to identify specific initiatives that can
be taken forward to improve primary care services for individuals with
dementia and their families;
testing initiatives around community capacity/coproduction;
supporting the improvement work in general hospitals to deliver the 10-Point
National Action Plan (see section 2.5, Table 2);
working alongside the SG QUEST improvement work on unscheduled care
and patient flow to ensure that people with dementia receive appropriate
services based on their needs
supporting partnerships to effectively use data to drive improvement in
dementia health and social care services.
NES/SSSC are fully engaged with this programme and will in particular work closely
alongside JIT and QUEST in taking forward work on delivering the post diagnostic
HEAT target and the acute general hospitals improvement programme.
SG will also publish a ‘Dementia Benchmarking Framework’ in 2013 to enable
services to compare performance around key indicators of improvement.
3.2
Dementia Standards in Hospitals Implementation and Monitoring Group
In January 2012, an expert Dementia Standards in Hospitals Implementation and
Monitoring Group was established, chaired by the Chief Nursing Officer, and
including representation from Alzheimer Scotland, Healthcare Improvement Scotland,
the Mental Welfare Commission, NES, and cross disciplinary clinicians representing
healthcare services.
A major part of this group’s work has been to: scrutinise all the evidence in relation to
dementia care in hospitals in order to provide information on progress at a national
level; to highlight and learn from examples of best practice; and, where areas for
improvement were identified, to provide expert support and guidance.
The group developed the 10-Point National Action Plan (see section 2.5, Table 2); to
support the implementation of the Standards of Care for Dementia in acute general
hospital care and will be responsible supporting and monitoring implementation.
The group will also develop and test out plans for extending the work on quality of
care in general hospitals to other hospitals and NHS settings, as set out commitment
11 in the strategy, and the remit will be extended to include:
•
•
•
NHS mental health hospital services for people with dementia
rural community hospitals
psychiatry of old age wards.
16
As NES are members on this group we are well positioned to respond to emerging
agendas and our workforce development plan for 2013-16 takes account of the
extension of this groups remit and focus.
3.3
Health Care Improvement Scotland (HIS) Older People in Acute General
Hospitals (OPAC) Inspections
The NES Executive Team previously discussed a paper in October 2012 ‘Healthcare Improvement Scotland, Health Care Environment Inspectorate – Older
People in Acute General Hospitals’ - Emerging Issues from inspections and
implications for NES’.
It was noted at that time, that nationally consistent themes were emerging, identifying
a number of areas requiring improvement in the care of older people in acute general
hospitals, particularly in the areas of: the management of people with dementia and
cognitive impairment; and in treating vulnerable older people with compassion,
dignity and respect.
Subsequent HIS OPAC inspections have reinforced this issue, noting that the HIS
OPAC inspection process has been, and is currently subject to, both internal and
external review.
The findings of the ‘Francis Report – the final report of the Independent inquiry into
care provided by Mid Staffordshire NHS Foundation Trust’ and the impending
publication of ‘Vale of Leven Enquiry Report’ mean that care of people with dementia
and cognitive impairment will necessarily remain a key priority for NES across
Directorates.
4.
Issue for Consideration by the NES Board
The NES Board is invited:
•
•
•
To note the content of this paper;
To discuss and seek clarification of any issues raised;
To endorse the partnership approach in taking this work programme forward.
17
References and Links
Alzheimer Scotland (2013) Statistics: Number of people with dementia in
Scotland 2013 http://www.alzscot.org/assets/0000/7138/statistics-dementiascotland-2013.pdf
NES/SSSC Promoting Excellence in Dementia Care and Support web
site http://www.knowledge.scot.nhs.uk/home/portals-and-topics/dementiapromoting-excellence.aspx.
Scottish Government (2008) Living and Dying Well; a National Action Plan
for Palliative and End of Life Care.
http://www.scotland.gov.uk/Resource/Doc/239823/0066155.pdf
Scottish Government (2010) Scotland’s National Dementia Strategy.
http://www.scotland.gov.uk/Publications/2010/09/10151751/17
Scottish Government (2010) Caring Together: The Carers Strategy for
Scotland 2010-15.
http://www.scotland.gov.uk/Publications/2010/07/23153304/0
Scottish Government (2011) Promoting Excellence: A Framework for all
health and social services staff working with people with dementia and
their families and carers.
http://www.scotland.gov.uk/Publications/2011/05/31085332/0
Scottish Government (2011) Standards of Care for Dementia in Scotland.
http://www.scotland.gov.uk/Publications/2011/05/31085414/0
Scottish Government (2011) Living and Dying Well: Building on Progress.
http://www.scotland.gov.uk/Publications/2011/01/27090834/0
Scottish Government (2013) Scotland’s National Dementia Strategy 201316. http://www.scotland.gov.uk/Topics/Health/Services/MentalHealth/Dementia/DementiaStrategy1316
18
Appendix 1
Scotland’s Dementia Strategy 2013-16: Commitments
COMMITMENT 1: We will sustain and, where appropriate improve further,
dementia diagnosis rates.
COMMITMENT 2: We will transform the availability, consistency and quality of
post-diagnostic support by delivering the new post-diagnostic HEAT target.
COMMITMENT 3: We will test and evaluate a range of approaches to providing
better integrated care and support on the basis of the 8 Pillars model, centred on
a Dementia Practice Coordinator role.
COMMITMENT 4: We will commission Alzheimer Scotland to produce an
evidence based policy document outlining the contributions of AHPs to ensuring
implementation of the 8-Pillar model.
COMMITMENT 5: We will take further action to support safe and supportive
home environments and the importance of the use of adaptations and assistive
technology, in maintaining the independence and quality of life of people with
dementia and their carers.
COMMITMENT 6: We will take further action to support and promote best
practice in advance care planning, the assessment of capacity to consent to
treatment and adherence to proper procedures for making decisions for people
with dementia who lack capacity
COMMITMENT 7: We will publish a report on implementation of the dementia
standards to date.
COMMITMENT 8: We will continue to improve staff skills and knowledge by
working with NHS, NES and SSSC to take forward a second Promoting
Excellence training plan across the period of this Strategy.
COMMITMENT 9: We will work with NES, SSSC, NHS Health Scotland, NHS 24
and Alzheimer Scotland to develop and launch an innovative digital platform for
dementia, which will help inform and empower people with dementia and their
families and carers in being equal partners in care.
COMMITMENT 10: We will develop and deliver a 3-year National Action Plan to
improve care in acute general hospitals.
COMMITMENT 11: We will set out plans for extending the work on quality of care
in general hospitals to other hospitals and NHS settings
COMMITMENT 12: We will work with Scottish Care, SSSC, NES and others to
assess the need for, and take further action on, improving service response
around care homes, care at home and adult day care services. This will include
attention to staff training and support for the implementation of the postdiagnostic HEAT target and the commitment on reducing inappropriate
prescribing of psychoactive medication for people diagnosed in care homes.
19
COMMITMENT 13: We will finalise and implement a national commitment on the
prescribing of psychoactive medications, as part of ensuring that such medication
is used only where there is no appropriate alternative and where there is clear
benefit to the person receiving the medication.
COMMITMENT 14: We will take account of the expectations and experience of
people with dementia and their carers in taking forward the work on outcomes for
the integration of health and social care.
COMMITMENT 15: We will continue to support research through funding The
Scottish Dementia Clinical Research Network and supporting the work of the new
Scottish Dementia Research Consortium in its objective to bring together the
range of dementia research interests in Scotland and maximise the impact of and
funding opportunities for research capacity here.
COMMITMENT 16: We will undertake a brief piece of work focusing on the care
pathway for people with dementia in these groups (young onset, co morbid
dementia and equality issues) through diagnosis and support, through treatment
and care, taking account of the particular challenges for carers and family
members with the objective of identifying what further actions are required to
ensure that each of the key improvement areas – diagnosis, post-diagnostic
support, care co-ordination requires modification to take account of the needs of
different groups.
COMMITMENT 17: To oversee and ensure progress on the dementia agenda
and in implementing this Strategy, we will carry over from the first Strategy an
Implementation and Monitoring Group to co-ordinate, support and monitor
progress on the other commitments outlined in this Strategy.
20
Appendix II
Table 1.1 – Promoting Excellence Workforce Development Plan 2011-13
deliverables
Educational resources and guidance
Deliverable
Comment
Production of National Guidance on
Extensive range of existing educational
undergraduate and postgraduate
resources mapped and quality assured
dementia curriculum content
against the Promoting Excellence framework
and disseminated to support curriculum and
wider training developments
Informed about Dementia– Improving An educational resource to support all health
Practice DVD
and social services staff develop knowledge
and skills at the Dementia Informed level of
Promoting Excellence
Dementia Skilled – Improving
An educational resource to support all health
Practice Learning Resource and
and social services staff develop knowledge
Guidance for Assessors and
and skills at the Dementia Skilled level of
Trainers
Promoting Excellence.
Promoting psychological wellbeing
An educational resource to support health
for people with dementia and their
and social services staff develop knowledge
carers – Learning Resource
and skills in psychological support for people
with dementia at the Dementia Enhanced
level of Promoting Excellence
Acute General Hospital Dementia
An educational resource to support acute
Care
general hospital staff to develop context
specific knowledge and skills in support for
people with dementia at the Dementia Skilled
level of Promoting Excellence
Dementia care in the Emergency
An educational resource to support
Department
emergency department staff to develop
context specific knowledge and skills in
support for people with dementia at the
Dementia Skilled level of Promoting
Excellence
21
Table 1.1 – Promoting Excellence Workforce Development Plan 2011-13
deliverables (continued)
Educational resources and guidance
Deliverable
ACE-III online interactive training
module.
Think Capacity- Think Consent
Cognitive Rehabilitation in Dementia
– a resource for patients and carers.
Cognitive Rehabilitation in Dementia
– a resource for health and social
services staff.
Responding to Stress and Distress in
Dementia – a resource for dementia
caregivers.
Stress and Distress in Dementia
DVDs.
Pharmaceutical care for people with
dementia.
Up skilling newly qualified social
workers online resource.
Review of National Occupational
Standards for Health and Social
Care.
Comment
The ACE-III is a newly validated, evidencebased dementia screening tool that replaces
the ACE-R. The online interactive training
module will improve staff skills in the
detection of dementia at the diagnostic
stage.
An educational resource for acute general
hospital staff to support appropriate
application of the Adults with Incapacity Act
Educational materials which will support
people with dementia and their families and
carers in coping with the cognitive difficulties
associated with dementia.
Educational material to enable health and
social services staff to offer evidence-based
cognitive rehabilitation interventions. These
will enhance the support offered to people
with dementia, their families and carers in
coping with the cognitive difficulties
associated with dementia.
Educational materials for families, carers to
support them to respond to stress and
distress experienced by people with
dementia. This addresses stress or distress
experienced by both carers and people with
dementia.
Additional DVD materials for staff are under
development and offer examples of good
practice in assessment and interventions in
response to stress and distress in dementia.
A distance learning resource for pharmacists
and pharmacy technicians in primary and
hospital care focussing on the safe use of
medicines and pharmaceutical care for
people with dementia.
Online learning resource for social workers to
support knowledge and skill development
during the first year of practice in adult care
New Dementia Skills Set is being developed
and information/associated learning resource
developed.
22
Table 1.2 – Promoting Excellence Workforce Development Plan 2011-13
deliverables
Training
Deliverable
Cognitive Stimulation Therapy (CST)
382 health and social services, staff
trained using a capacity building model.
Psychological Interventions for Stress
& Distress in Dementia – Training for
Trainers
100 health and social services staff have
completed training which allows them to
train colleagues in supporting people
with dementia experiencing stress and
distress. Those trained as trainers have
already begun to roll this training out to
additional health and social care staff
throughout Scotland.
Acceptance and Commitment Therapy
(ACT)
19 staff trained in ACT based
Interventions for dementia caregivers.
Acute General Hospital Dementia
Champions
310 staff trained as acute general
hospital dementia champions. A further
120 are currently undertaking training.
Palliative Care in Dementia
143 health and social services staff
trained using training for trainer’s model.
Post Diagnostic Support Pilot
Training
90 health and social services staff
undertook the pilot training.
Supporting Change in Dementia
Continuing Care Services
55 facilitators from NHS mental health
services and care home sectors
prepared
Comment
CST is an evidence based low intensity
group based psychological intervention
shown to improve cognition and quality of
life for people with dementia.
The training is designed to develop capacity
in individualised, formulation-driven
psychological interventions in response to
the needs of people with dementia who are
distressed. The training is based on the
Newcastle model of formulation and
intervention; and is aimed at staff working
at both the Expertise and Enhanced Levels
of Promoting Excellence. Initial pilot
training was focussed on the dementia
demonstrator sites and has now being
rolled out across Scotland.
ACT is a high intensity psychological
therapy at the Expertise Level of Promoting
Excellence. Training was targeted at
qualified psychological therapists.
The training is at the Enhanced Level of
Promoting Excellence. Cohort 1 focussed
on NHS staff. Cohort 2 and included social
services staff.
A multi-agency ‘training for trainers’
Palliative Care and Dementia Programme
delivered by Alzheimer Scotland at the
Enhanced Level of Promoting Excellence.
A pilot programme based on the Alzheimer
Scotland 5 pillars model of post diagnostic
support. at the Enhanced Level of
Promoting Excellence. The programme
has been designed and evaluated to inform
future educational developments in this
area.
A programme designed to enable
assessment and improvement of inpatient
mental health services and care homes
against the Dementia Standards and
Promoting Excellence Framework, and
support dissemination of education at the
Dementia Skilled level.
23
Table 1.3 – Promoting Excellence Workforce Development Plan 2011-13
deliverables
Infrastructure Development
Deliverable
Promoting Excellence in Dementia
Leadership Programme for Alzheimer
Scotland Nurses and AHP
Consultants.
Local awareness and engagement
events to support generation of local
networks and nomination of
Dementia Ambassadors in social
services.
Learning networks for cohort 1 and 2
dementia champions.
Dementia Managed Knowledge
Network and the Promoting
Excellence web site established.
Support in use of the MKN and
establishment of communities of
practice.
Comment
A bespoke, year long leadership
development programme, developed and
designed in consultation with dementia nurse
consultants, based on the leadership
behaviours, knowledge and skills required to
support the delivery of national outcomes.
50 engagement workshops reaching over
800 social services staff, generating a total of
almost 150 dementia ambassadors.
There have been 11 subsequent regionally
based induction and development events for
ambassadors.
A number of Regional Learning Networks
have taken place. The Networks are
designed to sustain and continue
professional development by providing:
opportunities to build on previous learning;
share experiences and good practice; and
encourage the development of local and
national peer support systems.
The Promoting Excellence website provides
the detail of the education framework and the
education resources to support workforce
development.
The Dementia Managed Knowledge Network
is an open, community site which contains
pertinent information and links to raise
awareness of the wide range of resources
available.
Training events have taken place with a
number of groups including the Dementia
Nurse and AHP Consultants and Specialists,
the Dementia Champions and Dementia
Ambassadors.
The number of Communities of Practice
continues to grow. These are online
‘meeting’ areas where groups of people with
specific interests within the dementia field
can share experiences, good practice,
learning and resources in addition to
discussing pertinent issues and supporting
each other.
24