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/

South West Dementia Partnership

Improving Dementia Care in General Hospitals

Living well with dementia across the South West

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What is preventing good quality care in our local hospitals?

What do we want to do locally to move things on?

What is preventing us from making progress?

What have we tried so far and with what results?

• Establish joint commissioning steering group

• Involve commissioning at all levels• Clear local targets• Link dementia to QIPP agenda• Negative impact of CHC to be

removed• Need to invest to save• Agreed definitions for rehab/IC

care• Commissioned third sector support• Developing an understanding of

how community will share funds released from acute sector

• Inconsistency of terms for acute hospitals

• No targets• Pathway is not understood• Tariffs• No regionally agreed

assessment process• Diverse funding streams/

constraints• NHS blame culture decreases

innovation

• Audit by acute and PCT to look at bed usage

• Investment in community services• Ongoing debate about ʻwhose

resourcesʼ

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What is preventing good quality care in our local hospitals?

What do we want to do locally to move things on?

What is preventing us from making progress?

What have we tried so far and with what results?

• Raise clinical primary care responsibilities

• Improve psychiatric liaison services for older people

• Improve local integration• Increase awareness of dementia

care issues within acute sector• 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

• Division/lack of co-ordination between acute trusts and MH trusts

• Lack of end of life planning• Lack of preventative work• No regular visits to care homes• Lack of GP awareness and

involvement in homes/residential care

• Lack of rigorous quality assurance/regulation of care homes

• Bureaucracy• 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

• Evidence of partnership working• Building on whatʼs working well• Investment in community services• In reach CPN – care homes and

complex discharges• Pathways with structure to aid

decision making• Ward nurse to do CHC screens and

assessments• Volunteer led work• Review case notes for • Involving third sector• Breaking down professional barriers

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What is preventing good quality care in our local hospitals?

What do we want to do locally to move things on?

What is preventing us from making progress?

What have we tried so far and with what results?

• Culture change• Education for all• 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

• Culture/language barriers• Lack of successful multi-agency

working• Poor understanding of the needs

of people with dementia

• 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

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What is preventing good quality care in our local hospitals?

What do we want to do locally to move things on?

What is preventing us from making progress?

What have we tried so far and with what results?

• Strategic carer involvement in care journey

• Improve information given to SUʼs and carers

• Using patient stories and experiences to comment on need for change

• Patient complaints get managers ears

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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?

Who and what else do we need to do in order to make progress locally?

• Plans agreed with funding streams identified

• Improved links with commissioning Incorporation of dementia related CQUIN into 2010/11 contract

• County-wide implementation plan

• Strong commissioning lead to corral delivery and facilitate working across tariffs and boundaries

• QIPP

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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?

Who and what else do we need to do in order to make progress locally?

• Lots in Bristol – liaison team support

• Networking and collaboration• 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

• 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

• 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

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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?

Who and what else do we need to do in order to make progress locally?

• When the going gets tough the tough wonʼt get going!

• Moves towards education• Somerset Dementia Strategy

Group

• 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

• 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

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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

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