MIDLOTHIAN COMMUNITY CARE

PARTNERSHIP

Auditing the Standards of Care for Dementia in

Scotland

Jane Fairnie and Janice Flockhart

The Standards• Standards of Care for Dementia in Scotland• Action to support the change programme, Scotland’s

National Dementia Strategy• Development of the Standards co-ordinated for the

Scottish Government by the Mental Welfare Commission• Underpinned by The Charter of Rights for People with

Dementia and their Carers in Scotland and what people with dementia and their carers have identified as important to them and what they want from services

• Officially launched on 6th June 2011

6 Key Standards1. I have the right to a diagnosis2. I have the right to be regarded as a unique individual

and to be treated with dignity and respect3. I have the right to access a range of treatment, care

and supports4. I have the right to be as independent as possible and

be included in my community5. I have the right to have carers who are well

supported and educated about dementia6. I have the right to end of life care that respects my

wishes

How do we know how the Standards are applied in practice?

• As providers and commissioners of services we need to be sure that service providers are meeting the Standards

• We need a tool which allows us to measure Provider performance against the Standards

• Providers need to have a working knowledge of the Standards and where their own service delivery falls short of those Standards

• Providers need to plan for how they will meet shortfalls in practice / service delivery

Process• Selected SWOT as a tool which would simply and effectively

enable organisations to audit their service against the Standards

• Numbered the Standards for ease of reference• Contacted all 28 service Providers in Midlothian to

introduce the SWOT and engage them to participate• Also contacted NHS and LA teams – this process is ongoing• All Providers visited personally and all but 4 completed the

SWOT with input from Project Manager• Providers included Care Homes, Day Services, Care at

Home, RSLs and Specialist Services• 98% of Providers participated

SWOT ANALYSIS STANDARD 2. I HAVE THE RIGHT TO BE REGARDED AS A UNIQUE INDIVIDUAL AND TO BE TREATED WITH DIGNITY AND RESPECT 2.1 SERVICE USERS WILL ENSURE THAT THE ACTIONS OF THEIR STAFF AND THEIR POLICIES AND PROCEDURES DEMONSTRATE: 2.1.1 An awareness of what the person with dementia and their family may be experiencing. SCORE STRENGTHS What does your team do well? What unique resources can you draw on? What do others see as your strengths ?

Weaknesses What could your team do to improve? Where do you have fewer resources than others? What are others likely to see as weaknesses?

Opportunities What opportunities are open to you? What trends could you take advantage of? How can you turn your strengths into opportunities?

Threats What threatens your team or creates barriers to your team meeting this standard? What are others doing? What threats do your weaknesses expose you to?

Results

STANDARD 2. I HAVE THE RIGHT TO BE REGARDED AS A UNIQUE INDIVIDUAL AND TOBE TREATED WITH DIGNITY AND RESPECT2.1 SERVICE USERS WILL ENSURE THAT THEACTIONS OF THEIR STAFF AND THEIR POLICIES AND PROCEDURES DEMONSTRATE:2.1.1 An awareness of what the person with dementia and their family may be experiencing.

Expected Outcome for Standard 2.1.1

People who live with dementia and their carerswill experience increased understanding of theimpact that a diagnosis of dementia has had onthem both individually and as a family

Service areas for development for Standard 2.1.1.• Could improve links with Community Dementia

and Care of the Elderly Teams• Need to raise staff awareness and family support• Lack of any recent training for staff in dementia• Need to research dementia further to provide

more information for staff• Occasionally some staff recall negative past

family history which can sometimes impinge on working relationship

• Staff may not always have coping strategies

Service areas for development for Standard 2.1.1. cont:d

• Need to re-train team carers in recording

• Have more regular support and supervision

• Lack of training for new staff.

• Staff lone working means that managers cannot guarantee individual practice

• Volume of business – staff busy and managers not monitoring as much as they could

• Could have more regular meetings with family/carers

• Improve individualised care plans

Opportunities Identified to meet service gaps for Standard 2.1.1

• Establish better links with Health Teams• Include Health in In-service training• Create a Dementia Resources Folder• Big Lottery application submitted to focus on

staff training and awareness raising for tenants

• Include dementia in SVQ assessment• Increase management support of staff

Opportunities Identified to meet service gaps for Standard 2.1.1 cont:d

• Access information and advice through Alzheimer Scotland

• Open the Home to the local community through the Dementia Support Group so that people with dementia and their carers in Loanhead can be included

• Reminding staff to recognise their need to work within professional boundaries

• Training programme linked to Stirling University “Improving Dementia Care” +“Transitions in Dementia”

Opportunities Identified to meet service gaps for Standard 2.1.1 cont:d

• Create a Quality Assurance system• Development of Dementia Strategy• Training for staff in the residents’ experience• Training up a core group of managers to

cascade the DSDC training• Extend the training to evenings or times that

accommodate staff availability

Threats/Barriers to implementing opportunities to develop services to meet 2.1.1• Limited resources and time• Framework (local client database system) doesn’t always

show who is involved from Health• Other agencies not having an understanding of what

people with dementia and their carers are experiencing• There is not always a formal diagnosis of dementia• Local communities don’t always understand dementia• Lack of funding if Big Lottery application fails• Some older staff not keen to undertake SVQ assessment• Staff being motivated to come in for training in their own

time• Use of locum/agency staff

How these findings may influence service redesign in Midlothian

• Joined up working, building on successful Mental Health service redesign – co-located team

• Programme of staff development in dementia awareness delivered across all sectors to include time management

• Public Awareness raising programme in partnership with all providers

• Providers Forum for dementia to share best practice, problem solve and share resources

• Set up a local Communities of Practice on internet