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CONTENTS Page

1. Executive Summary 3 2. Introduction 6 3. Dementia – WHAT IS IT? 7 3.1 Dementia Defined 7 3.2 Dementia – Its Impact 7 4. National Context 8 4.1 Prevalence of Dementia 8 4.2 National Reports 8

4.2.1 National Dementia Strategy 8 4.2.2 National Audit of Dementia Care 9 4.2.3 The Right Care: A Call to Action 9 4.2.4 Dementia – Friendly Hospital Charter 9 4.2.5 Care Quality Commission – Cracks in the Pathway 2014 9 4.2.6 Fix Dementia Care: Hospitals (Alzheimer's Society, 2016) 9

5. Local Context 10 5.1 Patient Population 10 5.2 Current Acute Hospital Service Provision 10 5.3 National Audit of Dementia Care 10 5.4 The Right Care: A Call to Action 10 5.5 Dementia: Commissioning for Quality and Innovation 11 5.6 Care Quality Commission – Trust Inspections 11 6. Approach to Achieving Transformational Change 12 7. Strategic Objectives 2016-17 to 2018-19 13 8. Resource Implications 13 9. Implementing the Trust’s Dementia Strategy 14 10. Making Progress and Review Processes 14 11. Conclusion 14

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APPENDICES A Improving Dementia Care - Key Achievements (2013 to 2015) 15 B Annual Work Programmes 19 C National Audit of Dementia (general hospitals) 2012 -Summary of Key Findings 26 D Dementia Services – Yearly Action Plan Template 27 REFERENCES 28

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DEMENTIA STRATEGY: 2016-17 to 2018-19

1. EXECUTIVE SUMMARY 1.1 OVERVIEW

The increasing number of people living with dementia is a challenge to all health and social care organisations. The Care Quality Commission1 suggests that each year the number of people living with Dementia is growing and that most of the 400,000 older people living in care homes have dementia or a similar impairment. It also estimates some 40% of people over the age of 65 in hospital beds will be living with dementia. This document sets out the updated dementia strategy for Hull and East Yorkshire Hospitals NHS Trust, building on the progress made over the last few years. The strategy covers all aspects of care for patients living with dementia during their care within the Acute Trust, whether inpatient or outpatient and also recognises the needs of their relatives and carers. Whilst many of the actions relate to the Trust and the services it provides, it also acknowledges the importance of working with others both organisationally and individually and the need to strive to provide personalised care across organisational boundaries. As a consequence, it looks to its multi-disciplinary Dementia Programme Board to oversee the totality of service whether it is provided directly by the Trust or by others.

1.2 DOCUMENT STRUCTURE

The document is structured as follows: Section 2. Introduction This section sets out the Trust’s vision in respect of the provision of dementia care. This vision is:

Our vision is to provide safe, high quality, effective care

for every person with dementia

It also highlights that the strategy has been developed by the Dementia Programme Board, a multi-disciplinary group all being involved in the care of patients with dementia. Section 3. Dementia – What is It? In this section dementia is defined as a syndrome with progressive decline in memory, reasoning, communication skills and the ability to carry out daily activities. It also states that the syndrome can affect anyone, is a life-limiting diagnosis which leads to increasing dependency and vulnerability. Section 4. National Context Prevalence – Currently, some 816,000 people in the UK are estimated to be living with dementia and it is projected that this figure will increase to 1 million by 2025. The likelihood of dementia doubles every 5 years over the age of 65. National Reports – The number of national reports referenced in this section clearly indicates the increasing recognition of the demands dementia will place on services and the need to ensure that individual needs are met in an appropriate way. Key themes from the reports include: Raising awareness and understanding Early diagnosis and support Living well with dementia Highlighting of gaps in care Variation in the quality of care Emphasising the importance of providing both personalised and compassionate care Securing a commitment from Chief Executives to create dementia friendly organisations

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A need for hospitals to improve the standards of care Hospitals taking a proactive approach to monitoring and publishing performance related to dementia care

Section 5. Local Context This section provides an overview of the Trust’s position and identifies that of the 1.2m population served there are currently some 4741 people registered as having dementia. Based on diagnosis rates for the East Riding CCG (60%) and Hull CCG (77%) it is estimated that the number of people living with dementia locally is in excess of 7000 people. An outline is also given of the acute care provided by the Trust which is primarily based on an age-related model centred on its 5 Specialist Elderly Care Wards and its multi-disciplinary approach to care, involving mental health, Social Services and Therapy staff. The Trust’s establishment includes a Designated Lead Consultant and Lead Nurse. Also included in this section is information on the Trust’s position in respect of the relevant national reports related to dementia care previously referenced, specifically:

National Audit of Dementia (5.3) The findings of the 2012 audit are summarised in Appendix C together an indication of the action taken or still on

going with cross referencing to Appendices A and C.

The Right Care: A call to Action on Improving the Care of People with Dementia in Acute Hospitals (5.4) This confirms that the Trust continues to participate in the local Dementia Action Alliance.

Dementia: Commissioning for Quality and Innovation (CQUIN) (5.5) Confirms that through its improved service performance it has secured a cumulative income of over £2m.

Care Quality Commission (CQC) (5.6) This confirms that the Trust is responding to the CQC recommendations regarding dementia care and that it has put in

place a Dementia Quality Improvement Plan with agreed milestones for delivery.

Section 6. Approach to achieving Transformational Change This section outlines the approach taken to transformational change by the service which commenced in 2013. The service adopted the Royal College of Nursing SPACE methodology, centres its approach on staffing, partnerships, assessment, care and the environment.

Appendix A is referenced in this section and sets out the service improvements made to date.

Section 7. Strategic Objectives This section acknowledges that there is still work to be done, despite the progress made to date. It can be seen from the service’s ten objectives that the key focus for future improvements majors on improving the patient experience and quality of care, training, developing and supporting the workforce, enhanced partnership working and environmental improvements. All of this will only be achieved by improved governance and leadership. The activities needed to address the identified service objectives are referenced in this section and are set out in Appendix B. Similarly, the process to produce the service’s annual work programmes is explained. Section 8. Resource Implications This section identifies that in seeking approval to its strategy the service is not seeking any specific revenue or capital resources at this time. The strategy does, however, make reference to the need for some additional posts and potential capital funding. Any such requirements will be subject to a formal business case being submitted and considered for funding through established Trust’s processes. What it does seek, however, is organisational commitment to supporting the service’s medical and nursing leads in taking this strategy forward.

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Section 9. Implementing the Trust’s Dementia Strategy This section identifies that the Dementia Programme Board will oversee the process and progress of implementation of both the overall strategy and the annual work programmes. Section 10. Making Progress and Review Process Reference is made in this section to the Dementia Programme Board producing an Annual Report on dementia care within the Trust for submission to the Trust Board.

Section 11. Conclusion This conclusion section explains that the strategy provides a framework for a cohesive approach to the continued development of the Trust’s services for people with dementia. It also states it will take the organisation closer to its vision of:

Our vision is to provide safe, high quality, effective care for every person with dementia

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2. INTRODUCTION

The Hull and East Yorkshire Hospitals NHS Trust is committed to improving the care for patients with dementia and the support given to relatives and carers. This commitment was made in 2012-13 and whilst significant progress has been made, it is fully recognised that there remains much more to be done if the Trust is to achieve its shared vision2.

To provide safe, high quality, effective care for every person with dementia

This strategy has been developed by the Dementia Programme Board which has input from a wide range of clinical, non-clinical, carer, public and voluntary organisation representation. This document sets out the organisation’s strategic objectives in relation to improving the care given to patients with dementia. The delivery of its work programme, set out in Appendix B, will enable the Trust to continue to improve its services and contribute to the delivery of its dementia strategy, in accordance with national guidance. The Strategy will be reviewed annually; progress reported upon and it will be updated, as required, by the Dementia Programme Board, to ensure its continued relevance.

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3. DEMENTIA – WHAT IS IT?

In setting out this strategy it is considered appropriate to define dementia and its implications.

3.1 Dementia Defined Dementia is a term used to describe a syndrome with progressive decline in memory, reasoning, communication skills and the ability to carry out daily activities. There are over 100 diseases that cause dementia, the most common being Alzheimer’s disease. All forms of dementia cause changes to the structure and chemical balance of the brain and in turn death of brain tissue.

3.2 Dementia – Its Impact

Dementia affects all genders, ethnicities and social classes. It is a life-limiting diagnosis the natural course of which leads to increasing dependence and vulnerability. Risk is increased in the presence of factors such as vascular disease, learning disability or advanced age, but anyone can develop it. It can impact on all aspects of life for those diagnosed and their families.

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4. NATIONAL CONTEXT

4.1 Prevalence of Dementia There are an estimated 670,000 people living with dementia in England and 816,000 people in the UK3. By 2025, this is expected to reach 1million people diagnosed with dementia in the UK. The risk of dementia increases with age. The likelihood of dementia roughly doubles every 5 years over the age of 654. One in three people over 95 years of age have dementia and whilst dementia is predominantly a disorder of later life, there are over 40,000 people under the age of 65 with dementia. Dementia affects both men and women and around two thirds of people with dementia are women. It also affects all ethnic groups and social classes. 25,000 people with dementia in the UK are from Black, Asian and Minority Ethnic (BAME) groups. It is estimated that there are some 670,000 carers of people with dementia in the UK. Dementia is a significant challenge and a key priority for the NHS with an estimated 25% of acute beds occupied by people with dementia4. Some consider this to be an under estimate and suggest some hospitals are reporting levels as high as 40-50%. Hospital care for people with dementia has become an area of particular concern. People with dementia who are admitted to hospital have longer length of stays, are more likely to be readmitted and are more likely to die than patients without dementia admitted for same reason5.The outcomes for people with dementia are poor compared to people without dementia and their families often report poor experiences of care.

4.2 National Reports

A number of national reports have been published related to the provision of care and services for patients with dementia. These include:

4.2.1 National Dementia Strategy – “Living well with Dementia: A National Dementia Strategy” (Department of

Health, 2009) This identifies improving dementia care and services as a key national priority. The strategic direction is defined through 3 broad themes:

- Raising awareness and understanding Increasing public and professional awareness and understanding of dementia will lead to individuals receiving

timely diagnosis and care, promote the prevention of dementia, and reduce stigma, social exclusion and discrimination.

- Early diagnosis and support Early diagnosis and intervention can delay progression of symptoms, help the person remain in their own

home and generally improve quality of life for themselves and carers. - Living well with dementia The care and support received by those with dementia, and their carers, needs to be sensitive to their needs

and maximise independence, dignity and empathy.

The National Strategy cites a number of deficits relating to care of patients with dementia in general hospitals which should be addressed to improve outcomes and form the basis of the Trust strategy.

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4.2.2 National Audit of Dementia Care (Royal College of Psychiatrists, 2013)

The National Audit of Dementia (general hospitals) was established in 2008. The first round of audit was carried out in 2010/2011 and a second round took place between April and October 2012. Each hospital was asked to complete:

o a hospital organisational checklist to audit service structures, policies, key staff and care processes o a retrospective audit of 40 sets of patient records against a checklist of standards

The audits provided the opportunity to examine the quality of care received by people with dementia in general hospitals. It also allowed Trusts to track their progress with meeting the standards as well as benchmarking performance against other Trusts. This Trust participated in both rounds of the National Audit.

4.2.3 The Right Care: A Call to Action on Improving the Care of People with Dementia in Acute Hospitals (Department of

Health 2012) In 2012 Chief Executives were invited to answer the Call to Action and pledge their organisation’s commitment to becoming dementia-friendly and this commitment was entered into by the Trust.

4.2.4 Dementia – Friendly Hospital Charter (Dementia Action Alliance, 2015)

The Charter is the second phase of the Right Care initiative. It provides high level principles of what a dementia-friendly hospital should look like and recommended actions that hospitals can take to fulfil them. It therefore offers a framework to assist hospitals in their self-assessment against the dementia-friendly principles and assists them on achieving their Dementia Action Alliance action plan.

4.2.5 Care Quality Commission – Cracks in the Pathway 2014

During 2013-14 the Care Quality Commission carried out a review of the care of people living with dementia as they moved between care homes and hospitals. This review found more good care than poor care but that its quality varies greatly. The Care Quality Commission will use the findings from this report to set clear standards, assess hospitals and care homes against them and encourage services to improve where this is found necessary.

4.2.6 Fix Dementia Care: Hospitals (Alzheimer’s Society, 2016)

The document sets out recommendations for the NHS and health regulators to improve the experiences of people affected by dementia in hospitals. The Alzheimer’s Society will be campaigning to ensure they are implemented.

Recommendations include:

- All hospitals to publish an annual statement of dementia care - Monitor to use the annual dementia statement as part of its risk assessment framework to identify and take

action in hospitals where dementia care is inadequate - Care Quality Commission (CQC) to appoint a specialist dementia adviser and include dementia care indicators as

part of its Intelligent Monitoring work to improve regulation of dementia services in hospital

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5. LOCAL CONTEXT

5.1 Patient Population The Trust serves a population of 1.2million people with an estimated 192,000 people over the age of 65 years of age. Currently, 4741 people in our locality are registered as having dementia (East Riding 2885 people diagnosed with dementia, Hull 1856 people diagnosed with dementia). East Riding CCG and Hull CCG have diagnosis rates of 60% and 77% respectively7. Therefore the estimated number of people living with dementia in our locality is in excess of 7000 people.

5.2 Current Acute Hospital Service Provision

The care of patients with dementia is currently centered on 5 Specialist Elderly Care wards at Hull Royal Infirmary (Wards 8, 80, 9, 90 and the Elderly Assessment Unit). There is daily input 7 days a week from allied disciplines including Social Services and Therapies. There is daily input (Monday – Friday) to inpatient care by the old age psychiatry liaison service that specialises in older people’s mental health. Patients with dementia may also be cared for in other wards throughout the Trust such as surgical, general and specialist medical wards. The same SPACE principles illustrated in section 6 and Appendix A of this strategy demonstrate the adjustments that are made in caring for people with dementia in other wards. Patients suspected of having undiagnosed dementia are referred to the Humber NHS Foundation Trust’s Memory Service for confirmation of the diagnosis and ongoing treatment and support post discharge from hospital. Such referrals are made in accordance with the established dementia pathway and Behavioural and Psychological Symptoms of Dementia (BPSD) policy that the Trust has in place. The Trust’s staff undertake a key role in the recognition and initial assessment of suspected dementia and the prevention and management of distress in dementia. The Trust staff are supported in this process by the role undertaken by its Alzheimer’s Society Support Workers. In addition, patients with dementia that present with behaviour that challenges are referred to the inpatient old age liaison psychiatry team. We run an age and needs based service therefore all medical patients age 80 years and older are cared for on the specialist elderly care wards. Younger patients who present with older care needs including dementia may also be admitted to our specialist elderly care wards. The Trust has a designated Consultant Dementia Lead and there is a dedicated Lead Nurse (0.4 whole time equivalent) for the service.

5.3 National Audit of Dementia Care (Royal College of Psychiatrists, 2013) The National Audits of Dementia Care in General Hospitals in 2010 and 2012 reviewed 130 standards expected in the delivery of care for patients with dementia. Specifically, it used a “checklist approach” to assess the Trust’s performance against recognised standards of patient care relating to their admission, assessment, care planning/delivery and discharge. The 2010 audit highlighted a number of deficiencies in the provision of care for people with dementia in the Trust. In summary, the Trust achieved 42 of 130 standards (national average 43). Importantly, the Trust failed 31 standards for which “failure would result in a significant threat to patient safety, rights or dignity and/or would breach the law”. Appendix C sets out the key findings from the subsequent 2012 audit as it related to the Trust. It is clear that many of these issues continue to have a focus in this strategy.

5.4 The Right Care: A Call to Action on Improving the Care of People with Dementia in Acute Hospitals (Department of

Health 2012) In response to the Call to Action this Trust signed the National Dementia Declaration in January 2013, which embraces the idea of making communities better places in which to live for people with dementia, engaging with a cross-section of individuals, commercial, public and voluntary bodies. The emphasis locally is on working with people with dementia, their carers and communities to promote positive attitudes and enabling people to participate in everyday life, maintaining as much independence as possible.

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The Dementia Action Alliance continues to work towards raising dementia awareness across all sections of communities by promoting practical actions that businesses, services providers and community groups can do to make a difference.

5.5 Dementia: Commissioning for Quality and Innovation (CQUIN)

In 2012-13 the Dementia CQUIN was introduced. The key aim of the CQUIN framework is to secure improvements in quality of dementia services and better outcomes for patients, whilst also maintaining strong financial management. The areas the CQUIN has focused on are assessment and early identification of dementia, staff training, carer involvement and leadership within the Trust. To date the CQUIN has secured income of over £2million for the Trust since its introduction.

5.6 Care Quality Commission – Trust Inspections (CQC)

Following recent CQC inspections the Trust is responding robustly to the CQC recommendations regarding dementia care. Dementia care is now reported through the annual Trust Quality Accounts. A Quality Improvement Plan has been developed to agree milestones to deliver the CQC actions, the Quality Account priorities and the Patient Safety Pledges.

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6. APPROACH TO ACHIEVING TRANSFORMATIONAL CHANGE In response to the National audit findings referenced in 5.3 above, a process of transforming and improving the Trust’s Dementia services was commenced in 2013. The Trust has established a multi-disciplinary Dementia Programme Board to ensure the dementia challenge is addressed. The approach taken by the Dementia Programme Board to achieve the required transformational change and improve the care of people with dementia in general hospitals was to use the principles of the Royal College of Nursing SPACE methodology8. The five principles set out in the SPACE approach embrace the following:

Staff who are skilled and have time to care Partnership working with carers Assessment and early identification of dementia Care plans which are person centred and individualised Environments that are dementia friendly

Appendix A sets out the progress that has been made by the service over the two year period ending December 2015. It is structured under the five SPACE principles. The experience gained from working through this process has informed the aims and objectives of this Trust dementia strategy.

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7. STRATEGIC OBJECTIVES 2016-17 to 2018-19 Whilst recognising the good progress made in the last two years there is no room for complacency and as a consequence this strategy sets out some challenging but achievable objectives. These strategic objectives are summarised as follows:

Objective 1: To improve service governance and leadership capacity

Objective 2: To ensure effective assessment and the early identification of people with dementia

Objective 3: To improve general hospital care of people with dementia and delirium

Objective 4: To improve the hospital discharge process and patient transfer arrangements

Objective 5: To ensure we have an informed and effective workforce (dementia training) Objective 6: To create environments that are dementia friendly

Objective 7: To further develop partnership working

Objective 8: To be recognised as a service that innovates and is involved in research

Objective 9: To deliver personalised end of life care for people with dementia

Objective 10: To improve Outpatient Care for people with dementia and their carers

To achieve these objectives the service has identified a number of topic areas and identified a series of related actions to take these objectives forward. Appendix B sets out in detail the activities to be undertaken over the next three years. A yearly Action Plan, using the template set out in Appendix D and drawing out the specific actions set out in Appendix B, will be completed to produce the service’s annual development and transformation programme.

8. RESOURCE IMPLICATIONS This strategy does not at the present time seek to secure any significant additional revenue resource. It does, however, seek organisational support from the Trust Board, the Executive and Health Group endorsement of its strategy. It also would seek continued support from key corporate functions and members of the Dementia Programme Board to ensure the lead Consultant and Nurse are assisted in delivering the service vision. In completing the service’s Annual Work Programme the service will have a dialogue with departments and individuals to secure their input into the process of service improvement as set out for each year. Reference is made in the document to the development of a limited number of new posts being required. Such requirements will be subject to the production of a formal business case and submissions will be made through the Trust’s established business planning cycle. A similar approach will be taken in respect of the capital funding required for related environmental improvements. Efforts to attract and use donated funds will be a focus particularly in relation to creating dementia-friendly clinical environments.

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9. IMPLEMENTING THE TRUST’S DEMENTIA STRATEGY

Delivery of this strategy will be overseen by the Dementia Programme Board. The Dementia Programme Board will regularly review the annual work programmes to ensure progress is being made and where necessary it will, through the appropriate management structures, take appropriate measures to ensure the overall delivery of the identified actions.

10. MAKING PROGRESS AND REVIEW PROCESS

Each year, as part of its review and updating of this Strategy the Dementia Programme Board will issue an Annual Report for consideration by the Trust Board that will cover the following aspects:

Key Performance Indicators Success to date Areas for further action/improvement Barriers to change Recommendations

11. CONCLUSION

In summary, this Strategy provides a framework that will ensure a cohesive approach to the continued development of services that are relevant to and meet the needs of people with dementia when receiving care in the Trust’s hospitals. Effectively implemented it will move the organisation closer to the achievement of its ultimate vision: To provide safe, high quality, effective care for every person with dementia.

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APPENDICES

APPENDIX A

IMPROVING DEMENTIA CARE – KEY ACHIEVEMENTS 2013 TO 2015 1. Governance and Leadership

No Action Benefit 1.1 Establishment of Multi-disciplinary Dementia Programme

Board Multi-agency representation ensuring partnership working, effective information sharing and a key part of improving service provision

1.2 Appointment of Lead Clinician Provides leadership focus and is a catalyst for improvement in the dementia service

1.3 Appointment of Lead Nurse Provides leadership focus and is a catalyst for improvement in the dementia service

1.4 Dementia Champions appointed across the Trust Some 150 in place in the Trust who have been trained in the Butterfly scheme and also disseminate new ideas/innovations to their teams

1.5 Dementia Teacher/Trainer appointed Responsible for the implementation of the Butterfly scheme and support dementia training across the organisation

1.6 Dementia dashboard of key performance indicators developed

Allows the review of healthcare outcomes for patients with dementia in relation to effectiveness (length of stay, readmission rates) and safety (falls, pressure ulcer, mortality)

1.7 The Trust has committed itself to the Dementia Action Alliance, which includes publication of the Trust’s Dementia Action Plan

The Dementia Action Alliance is made up of over 100 organisations committed to transforming dementia care in the UK.

2. To ensure Effective Assessment and the Early Identification of patients with dementia and delirium 2.1 Trust wide dementia and delirium screening tool designed

and implemented for all patients admitted to the organisation

This has allowed staff to identify people with undiagnosed dementia and refer on to appropriate community services. Audit of this system clearly demonstrates service improvement.

2.2 Dementia Care Pathway developed Ensure best practice adhered to.

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IMPROVING DEMENTIA CARE – KEY ACHIEVEMENTS 2013 TO 2015 cont’d

3. Antipsychotic Prescription: Protocol and Practice No. Action Benefit 3.1 Joint working achieved a reduction in the use of

antipsychotic drug use. In collaboration with the liaison psychiatry team we have reduced our prescribing rates, as part of the national drive to reduce the use of antipsychotic drugs. The Trust now has one of the lowest antipsychotic prescribing rates in the region (regional audit)

3.2 Policy in place for the management of Behavioural and Psychological Symptoms of Dementia (BPSD)

Provide safe care of patients with dementia with behaviour that challenges. Support the non-pharmacological approach to the management of BPSD

3.3 Policy in place for the management of delirium Provide safe care of patients with delirium. Support the non-pharmacological approach to delirium.

4. Liaison Psychiatry Service 4.1 Consultant-led Liaison psychiatry team providing Monday-

Friday day support of patients and carers A daily service enables a speedy assessment and response to patients’ needs and provides advice to staff in a timely manner. Service provides coordination of care with partnership working with community mental health teams.

5. Hospital Discharge and Transfer 5.1 A discharge and transfer policy has been put in place within

the Trust Ensures that patients with dementia are only moved for reasons pertaining to their care, during the day and with information provided to carers

5.2 A web-based patient tracker tool established. This system ensures patients with dementia are cared for in the right place, by the right people, at the right time.

5.3 Patients with dementia are identified on the electronic CAYDER board via a butterfly symbol to assist patient placement.

This minimises the inappropriate transfer of patients with dementia when bed pressures occur.

5.4 Utilisation of a Carer Survey Helps to address the needs of carers for people with dementia, particularly related to discharge arrangements

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IMPROVING DEMENTIA CARE – KEY ACHIEVEMENTS 2013 TO 2015 cont’d

6. Information and Communication No Action Benefit 6.1 Butterfly Scheme embedded across all inpatient wards

across both hospital sites and outpatient settingsThis scheme allows the delivery of person-centred care for allpatients with dementia or delirium whilst in hospital.

6.2 In collaboration with the Hull Dementia Academy we have implemented Dementia Mapping on the Specialist Elderly Care wards and some of the surgical wards

This enables the service to understand the deficiencies in our services from a patient’s perspective and improve service delivery.

6.3 Working in partnership with East Riding Council to provide Digital Reminiscence Therapy (DRT).

Improve engagement with patients with dementia in the ward environment. DRT can reduce agitation in ward environments by promoting inclusion, interaction and familiarity

7. Staff Training 7.1 The Trust has developed a dementia training package that

consists of basic awareness training for all staff (on line +/- face to face) and optional modules aimed at staff with a special interest in elderly care and dementia.

Ensure adequately trained workforce to meet the needs of people with dementia.

7.2 A Trust Intranet site has been developed to provide resource training materials.

Provides easily accessible training resources and signposts staff to existing services and training materials

7.3 The Trust has hosted successful Dementia Awareness days These events that are ”open to all” create an excitement and raise awareness of the impact of dementia for carers, relatives, professionals and the general public. It also affords the opportunity to give the topic wider publicity and exposure.

8. Environments that are Dementia Friendly 8.1 Proposals for the creation of a Dementia Friendly

Environment on the 8th floor have been developed. Funding for an initial phase has been secured and work is to begin early in 2016.

Enhance the healing environment by making the acute wards familiar, calmer, safe and affording greater privacy and dignity.

8.2 Reminiscence artwork in communal and bedded areas across all elderly care wards

Enhance the healing environment and facilitate meaningful engagement and interaction between patients and staff.

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IMPROVING DEMENTIA CARE – KEY ACHIEVEMENTS 2013 TO 2015

9. Partnership and Innovation No Action Benefit

9.1 Since the formation of the Dementia Programme Board , the Trust is now represented at a number of local, regional and national committees and networks

Involvement in such systems ensures the service is in tune with and can influence the development of services for people with dementia and ensure local service provision continues to develop.

9.2 Introduction of Alzheimer’s Society Support Workers onto the elderly care wards (pilot project wards 8 + 80)

Support the patient and family through the hospital journey and provide continuity of care on discharge from hospital.

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APPENDIX B

STRATEGIC OBJECTIVES – ACTIVITIES TO INFORM ANNUAL WORK PROGRAMMES

Objective 1: To improve service governance and Leadership Capacity No Topic Action Date

1.1 Replacement appointment of a Full Time Dementia Lead Nurse

Progress and complete appointment process July 16

1.2

Contribute to Dementia Action Alliance (DAA) action planning and membership of DAA groups

Dementia Programme Board to actively contribute to updating of DAA Action plan and ensure effective participation in Local, Regional and National DAA groups

Annual

1.3 Ensure Dementia Champion / Link person in all clinical areas

Review, update and maintain current register of Trust Dementia Champions/Link persons

Sept 16

1.4 Production of Annual Statement of Dementia care Annual Statement of Dementia Care produced and presented to the Trust Board

AnnualMay 17

1.5 Development and implementation of the Dementia

Strategy Dementia Programme Board to regularly review performance made in relation to the implementation of actions set out in Dementia Strategy to ensure effectively performance managed.

Quarterly 2016-17

1.6 Establish dedicated Speech and Language therapy dementia lead position

Finalise business case and submit for consideration for funding

Sept 16

1.7 Establish dedicated Dietetic dementia lead position Produce business case for additional post and submit for consideration for funding

June 17

1.8 Adherence to policies for the management of delirium and the behavioural and psychological symptoms of dementia (BPSD)

Review adherence to policies and review effectiveness in use. Undertake formal review of policies within 3 years

Annual

2017/181.9

Human Resource Issues: Consideration of carer leave for staff caring for a person with dementia

Develop programme of work to ensure key staffing issues are explored and a clear understanding of actions that need to be addressed by the Trust. Communicate outcome of process to staff, as appropriate

March 17

Combat stigma towards employees affected by dementia Make reasonable adjustments to enable people affected by dementia to continue working

1.10 Ensure achievement of local CQUIN targets relevant to dementia care – See also Objective -7.1

Performance management arrangements in place to deliver CQUIN requirements. Quarterly updates to Dementia Programme Board

Quarterly 2016-17

1.11 Confirm Quality & Safety Manager with lead responsibility for dementia.

Finalise discussions within Health Group to confirm individual with lead responsibility

July 16

1.12 Trust Quality Accounts to reflect key areas for improvement

Ensure action taken to input dementia service improvements in Trust Quality Accounts

Annual

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Objective 2: To ensure effective assessment and the early identification of people with dementia No Topic Action Date2.1 Assessments of dementia, delirium and depression Ensure all patients over age 75 years and relevant

younger patients are also assessed. Audit to ensure >90% screening for all patients 75 years and over

Sept 17

2.2 Access to an old age psychiatry liaison service that specialises in older people’s mental health

Explore extent to which old age liaison service can be improved and more effectively integrated into service to deliver a 7 day service

Sept 17

2.3

Patient Centred Care – The Butterfly Scheme: Ensure scheme successfully implemented across the Trust Butterfly scheme to operate in Emergency Department – including AAU and EAU

Work to ensure the effective application of Butterfly Scheme; applied to all patients, opt-in opportunity, prior to admission and continued active membership of local steering group. Consider implications and practicalities of using the Butterfly scheme in the Emergency Department

Annual review

2017-18

Objective 3: To improve general hospital care of people with dementia and delirium No Topic Action Date

3.1 Ensure Dementia and Delirium care pathway is utilised in all clinical areas

Check pathway is being used in all clinical areas and undertake audit

March 17

3.2 Review of antipsychotic prescription use for patients with dementia and delirium

Audit of antipsychotic prescriptions and their impact on people with dementia and delirium

April 17

3.3 Ensure falls prevention package is in place to minimise both the number and impact of falls in people with dementia

Review incidence of falls involving dementia patients and share findings to minimise risk of falls. Reflect findings in Annual Report

August17

3.4 Ensure nutritional needs of people with dementia are met

Continue to develop use of dining companions and related initiatives e.g. pictorial menus. Review provision of communal dining for patients

June 17

Oct 163.5 Develop guidance around dysphagia (problems

swallowing) and communication difficulties Audit effectiveness and accessibility of patient information/guidance

2018-19

3.6 Ensure pain is appropriately assessed and managed Develop protocol for assessing and managing pain in patients with dementia

2018-19

3.7 Ensure adherence to guidance on mental capacity assessment and deprivation of liberty safeguards (DoLS).

Review and ensure appropriate training and ensure awareness of staff as to where they can seek help

Ongoing

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Objective 4: To improve the hospital discharge process and patient transfer arrangements No Topic Action Date4.1 Ensure discharge and transfer policy implemented for

people with dementia is working effectively Audit transfers of people with dementia, publish outcomes and introduce improvement cycle. Audit discharge timings of people with dementia

Oct 17

4.2 No patient with dementia is to be "outlied" at times of bed pressures

Review “outlier” performance Undertake a review of discharge and transfer policy and update as required

Annual

May 194.3 Ensure CAYDER (Virtual whiteboards) is used to assist

patient placement Develop an outline Butterfly Symbol for delirium patients for incorporation into CAYDER board system Report on use of CAYDER board for patients with dementia and their ward placement

May 17

May 174.4 Ensure the immediate discharge letter (IDL) states the

results of dementia assessment, treatment and referral on to relevant services

Work with Lorenzo and IT team to automate the input of screening on to the IDL and potentially the opt-in form to the Butterfly scheme

Sept 17

4.5

Continue to enhance and improve discharge planning and discharge arrangements Create a dedicated discharge coordinator post to elderly care wards to facilitate safe discharge communication to families and carers

Review performance and arrangements for the effective involvement of families and care homes in discharge arrangements (e.g. complaints, Pals etc.) Develop business case and submit for consideration for funding

Annually

July 19

Objective 5: To ensure the Trust has an informed and effective workforce (Dementia Training) No Topic Action Date5.1 All staff have undertaken appropriate dementia

training commensurate to their role Active monitoring of all staff training against established performance levels to ensure achievement

Annual

5.2 Dementia training included in all junior doctor induction

Active monitoring of all junior doctor training against established performance levels to ensure achievement

Annual

5.3 Ensure Dementia training is an integral part of the organisations training and development strategy

Work in collaboration with Education and development to ensure this is achieved and maintained

Annual

5.4 Dementia Awareness (tier 1) is a standard component of the organisation’s induction programme and is achieved within first 3 months of appointment

Work in collaboration with Education and development to ensure this is achieved and maintained

2018-19

5.5 Maintain blended learning opportunities that are easily accessible

Review Dementia training page on intranet up-to-date with options for on-line,/face-to-face/1 hour and half-day sessions

Annual

5.6 Training materials are validated, current and relevant Work in collaboration with the Dementia Academy and University of Hull to ensure consistent training approach and resource availability

Annual

5.7 Participate in local and regional high profile dementia events aimed at promoting excellence in dementia care

Participate in Health Expo Arrange a further “local” awareness event

July 16

2017-185.8 Create Physical dementia learning environments

(mock ward) to facilitate learning and dementia awareness

Creation of two exemplar dementia ward training environments to be created within the Trust’s education centres

2016-17

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Objective 5: To ensure the Trust has an informed and effective workforce (Dementia Training) (continued) No Topic Action Date5.9 Contracts with agency staff providers specify how

they will uphold the principles of the Dementia- Friendly Hospital Charter

Review current arrangements with Human Resources to ensure agency staff have Tier 1 dementia awareness training

2017-18

5.10 Ensure that locally trained student nurses are dementia-aware on qualification prior to becoming Trust employees and that Trust staff at all levels can access further and higher education opportunities.

University representative on Dementia Programme Board to review system in process and highlight any key issues/opportunities.

Annual

Objective 6: To create environments that are dementia friendly No Topic Action Date6.1 Estates strategy to incorporate dementia-friendly

design principles. Including – Signage, bathroom facilities, pictures/objects to assist with orientation, seating, communal spaces.

Development of a supplement to the Trust’s Estate Strategy to create a Whole-Trust Dementia Friendly environment. Establish a phased implementation programme and quantify year-on-year resource requirements

Sept 16

March 176.2 Estates to ensure contracts with contractors specify

how they will uphold the principles of the Dementia-Friendly Hospital Charter

Current arrangements to be reviewed to ensure appropriateness to projects that could impact on people with dementia and their carers

Sept 16

6.3 Create a Dementia friendly ward environment as an exemplar of dementia friendly environments

Complete phase 1 works on wards 8 and 80 Explore opportunities to secure funding for subsequent phases

April 16

June 16

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Objective 7: To further develop partnership working No Topic Action Date7.1 Implement John’s Campaign (supporting carers and

family members of people with dementia (all ages), to be welcomed by us according to the patient’s needs and not restricted by visiting hours)

Develop policy/statement approved by the Trust Board Implementation plan for John’s Campaign developed Amend dementia training to include John’s campaign Develop carer information leaflet Undertake a carer survey to ensure implemented and working

Sept 16June 16 June 16 June 16 July 16

7.2 Flexible visiting including overnight stays in line with the needs of the person with dementia

Quantify and develop plan for the creation of relative/carer overnight accommodation related to item 6.1 and 6.3 above Agree extended visiting arrangements for relatives/carers of people with dementia and roll-out across all wards

Sept 16

March 17

7.3 Enable carers and family to assist during protected meal times

Put in place arrangements to enable ward managers to make relatives and carers are aware of opportunity to assist

March 17

7.4 Ensure carer representation on Dementia Programme Board membership

Maintain and encourage active engagement cares/patients’ representatives

Ongoing

7.5 Survey carer experience of care Undertake survey across elderly medicine wards and make improvements based on findings

Annual

7.6 Specialist support: Alzheimer’s support workers to support the needs of patients with dementia and their carers

Evaluate impact/benefit of these posts and subject to findings decide on future requirements

Sept 17

7.7 Regular focus groups with people with dementia and their carers who have used services

Develop closer working relationships with local Dementia Involvement Groups ( Hull and East Riding

Ongoing

7.8 A complaints process accessible for people with dementia and their carers

Maintain and further develop links with Dementia Action Alliance, Alzheimer's Society and PALS team

Dec 17

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Objective 8: To be recognised as a service that innovates and is involved in research No Topic Action Date8.1 Maintain Key Performance Indicator (KPI) database

(e.g. mortality, length of stay) Routinely report variance in Key Performance Indicators to Dementia Programme Board and use to inform performance improvement

Bi-Monthly

8.2 Further develop online Dementia resources Review and update Trust intranet site and ensure relevant changes are made e.g. training, information leaflets, policies etc.

Annual

8.3 Availability of activity which offers engagement and stimulation e.g. reminiscence therapy, Twiddlemuffs, music, communal dining etc. Develop proposal for creation of recreational therapist posts

Continued development of activity programmes Creation of communal dining facilities see also item 6.3 Agree role of recreational therapist posts and produce a business case for ongoing funding consideration

Ongoing

Oct 16

8.4 Participation in the National Audit for Dementia Care Trust already registered and audit to complete in-year Oct 168.5 Establish a Quality Improvement Project (QIP)

portfolio for Dementia Create portfolio and encourage junior doctors to participate in process

2017-18

8.6 Dementia Care Mapping (DCM) used consistently across relevant wards

Evaluate response to dementia care mapping already undertaken to ensure wards have adapted care to outcome of mapping process.

Ongoing

8.7 Utilise the “live” dementia database to proactively manage the care of people with dementia

Ensure Liaison Team and Alzheimer’s support workers have access to the dementia database Use database to assist review of patients before complications of hospitalisation arise.

Nov 16 Nov 16

8.8 Collaborate with partners in researching dementia.

Establish more formal links with NHS Humber Research and Development Team Current project: The Continuing self: Dementia and the Spiritual Journey to be written up.

2017-18

Dec 16

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Objective 9: To deliver personalised end of life care for people with dementia No Topic Action Date9.1 Working in partnership with Care Homes. Develop guidance for those patients in final days of life

to avoid inappropriate acute admissions

2017-18

9.2 Ensure those inpatients in final days of life receive specialist palliative assessment and care

In conjunction with palliative care staff audit current arrangements and agree areas needing to be changed

2017-18

9.3 Advance Care Planning (ACP):

Ensure ACP is both encouraged and communicated to primary care Ensure DNACPR section of IDL is complete

2018-19

9.4 Maintain membership of Hull and East Riding of Yorkshire Dementia, Palliative and End of Life Care Working Group.

To ensure consistent local approach to improving end of life care

Annual

Objective 10: To improve outpatient care for people with dementia No Topic Action Date

10.1 Provision of improved outpatient facilities for patients with dementia

Dementia Programme Board to explore the opportunities to develop an outpatient service model that is “centred” on the patient, relatives and carers, rather than a hospital clinical model.

2018-19

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APPENDIX C

NATIONAL AUDIT OF DEMENTIA 2012

The following Table summarises the key findings from the above report as they related to the Hull Royal Infirmary:

SUMMARY OF KEY FINDINGSGovernance Progress

(see note 1 below)

A care pathway for patients with dementia only in the ”development stage”

App A-2.2

The Executive Board did not regularly review the number of inpatient falls and causes, involving patients with dementia

App B-1.4 App B 3.3

Assessments: The policy/guideline to ensure assessment of patients with dementia or cognitive

impairment are assessed for the presence of delirium only in the “development stage” App A-2.1

There is no policy/guideline stating that an assessment of mental state is carried out on all patients over the age of 65.

App B-2.1

Mental Health and Liaison Psychiatry: Access to Liaison Psychiatry is not available in the evenings or at weekends

App A-4.1 App B-2.2

No reasons recorded in case notes for administration in hospital of antipsychotic drugs, for a range of specified conditions.

App A-3.1

Hospital Discharge and Transfers: No issues identified -

Information and Communication: No system in place across the hospital to ensure staff are aware of person’s dementia or

condition and how it affects them App A-6.1

No system in place across the hospital that ensures staff from other areas are aware of the person’s dementia or condition when accessing other treatments

No formal system in place for gathering information pertinent to caring for a patient with dementia.

Staff Training:

No training and knowledge framework/strategy that identifies the necessary skill development in working with and caring for people with dementia. This related to the need for dementia awareness training to be included in staff induction generally and dementia awareness training to doctors, nurses and healthcare assistants.

App A-7.1App B-5.1-5.10

. Note 1 – The references in the progress column link the findings highlighted in the audit with actions already undertaken (Appendix A) or to activities that remain to be fully addressed (Appendix B)

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APPENDIX D

Dementia Strategy: Annual Work Programme Objective: Year: No Action Lead Date Key Performance Indicator Comment

Note: The Annual Work Programme will be completed in February/March each year to identify the activities to be undertaken during the next financial year.

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REFERENCES

1. Cracks in the Pathway – Care Quality Commission 2014 2. Hull and east Yorkshire Hospitals: Dementia Services Progress Report – July 2013 3. Estimated prevalence derived by NHS England from Delphi 2007 and subject to review in the light of Dementia UK update, second edition, November 2014. 4. Department of Health, 2015: The Prime Ministers challenge on dementia 2020 5. Care Quality Commission, Care Update, Care Quality Commission. March 2013. 6. National Dementia Strategy – “Living well with Dementia: A National Dementia Strategy” (Department of Health, 2009) 7. Yorkshire and the Humber Strategic Clinical Networks data. Nov 2015. http://www.yhscn.nhs.uk/media/PDFs/mhdn/Dementia/Dementia%20Diagnosis/2015 _11%20Dementia%20Diagnosis%20Summary.pdf 8. Royal College of Nursing SPACE methodology

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