Commitment 11 of the National Dementia
Strategy:
Quality and Excellence in Specialist
Dementia Care (QESDC)
Welcome and Setting the Scene
Beardmore Conference Centre
September 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
Average Available Staffed Beds
4,000
3,500
3,000
2,500
2,000
Average Available Staffed Beds
1,500
1,000
500
0
2006
2007
% Occupancy
Mean Stay (Days) per Episode
Throughput
2013
Average Available Staffed Beds
2012
2011
2009
2005
2010
2008
2007
2006
2005
2004
2004
Indicator
Financial Year Ending 31st March
2008
2009
2010
2011
2012
2013(2)
3,545
3,299
3,207
3,100
2,965
2,823
2,645
2,484
2,355
2,222
82.1
80.2
78.8
78.4
75.8
73.6
74.6
74.7
75.5
75.4
158.8
150.3
144.7
149.5
144.3
141.7
140.0
138.3
134.4
136.2
1.9
1.9
2.0
1.9
1.9
1.9
1.9
2.0
2.1
2.0
35,000
30,000
29,886
29,069
28,351
27,735
27,051 26,577
25,000
25,751
24,760
24,195 23,728
-21%
20,000
Psychiatry of old age Average Available
Staffed Beds
All Specialties Average Available Staffed
Beds
15,000
10,000
5,000
3,545
3,299
3,207
3,100
2,965
2,823
2,645
2,484
2,355
2,222
0
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
-37%
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 hospitals
Percentage of patients discharged within 4 weeks of admission,
by sex and age Year ending 31st March 2012
WHY IS IT IMPORTANT NOW?
Policy and Priorities
• 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
Scotland’s Dementia Strategies 2010-2016
Mental Welfare Commission
for Scotland – Dignity and
Respect: Dementia continuing
care visits report (2014)
What we know…the costs to people with
dementia and families
• 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
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
?Old Paradigm
?New 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
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!
For example:
-Dementia Strategy
actions – e.g. resources
-Education and training –
post/under graduate
-OPAH mock inspections
-MWC report audits and
actions
-Supporting Change
Good practice examples across
Scotland – what services and
practitioners have already been doing:
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)