The main drivers Compassion - Compassion is the emotion that one feels in response to the suffering of others that motivates a desire to help Dignity - Moral, ethical, legal, and political discussions use the concept of dignity to express the idea that a being has an innate right to be valued and to receive ethical treatment Respect - a feeling of deep admiration for someone or something elicited by their abilities, qualities, or achievement. due regard for the feelings, wishes, or rights of others

The reports that showed this was lacking: The Counting the Cost report (2010) -Nurses not recognising or understanding dementia; -Lack of person-centred care; -Not being helped to eat and drink; -Lack of opportunity for social interaction; -Not as much involvement in decision-making as wished for -The person with dementia being treated with a lack of dignity and respect. The Royal Free Long Stay Audit (2011) -41.8% of delayed discharge patients developed an acute medical condition after being approved for discharge -19% of patients died. The National Dementia Strategy (2009) -identified the need to improve the discharge process from the Hospital setting, stating ‘there is often a lack of co-ordination between hospitals and care providers at the point of discharge;’ (DH, 2009).

How My Discharge addressed: Compassion - Dignity - Respect  Patients would be facilitated to make and influencing decisions for their own care  What matters to the patient would remain priority  Predicting where it might go wrong and planning ahead  Promotion of positive risk-taking  Considered approach to the persons ongoing needs

Original proposal A supported 48 hour discharge if required – including – –Home assessment –Start/ restart a provisional package of care (this can be covered by our PACE team for 5 days if there is a delay) Referral to rehabilitation unit if required See each patient an hour before discharge. Travel with patients home from hospital. Pick up basic supplies for the patient. Re-settle the patient and hand over to carer or family. Based between HSEP wards (8 West and 9 North) Flexible approach

Proposed outcome measures Number of referrals to the service Length of stay for patients Readmissions within 30 days. Re-attendances to A&E Patient and carer feedback

Which patients were appropriate? Have a diagnosis/ suspected diagnosis of dementia? Have they been admitted from their own home? Does the patient or their family want them to return home? Is there concerned about how they might manage at home because of their dementia? Is permanent placement being considered because of their dementia?

The main differences: Pro-active case management model, facilitating safe, sustainable and timely discharges for those with confirmed or suspected dementia Bespoke, personalised service in partnership with patients and their carers Thorough in-patient assessment of needs and implementation of therapy plan Signposts/ co- ordination of developing community infrastructure for on-going care Follow-up input/management as required

100 patients seen through the project

Significant outcomes Average length of stay reduction by 2.6 days per person 85% patients discharged home – 94% directly, 6% via rehab/ respite 26% reduction in re-attendances to A&E in addition to unexpected benefit of readmission avoidance through intervention in A&E 34% patients at risk of permanent placement discharged home with My Discharge support

Most important outcome… 100% positive carers feedback of carers acknowledging the effectiveness of the personalised approach to My Discharge “At last we’ve found someone who appreciates what we do and wants to help us as a family – I know I can call you anytime – it means so much just to have a phone number” “Thank you so much for hearing me and listening to me” “If Mum could thank you herself I’m sure she’d give you a big hug” “Lovely and caring; the utmost sincerity” “Lovely and caring; the utmost sincerity”

Our learning: Sustainability Skills gap noticeable between staff A case managed approach is key to managing complexity of physical and social issues in this population Essential to bridge the gap between acute and community settings Empowering carers to manage their loved ones in a supportive and proactive way Robust data collection needed Regular feedback to inform change Keep Compassion - Dignity – Respect as the focus

Moving forward We are now a permanent service! The team has expanded We are bridging the skills gap We are developing a dementia pathway Compassion - Dignity – Respect remain the focus

If you want to know more: Becky Lambert Dementia Lead, Royal Free London NHS foundation trust bleep 4045 Danielle Wilde Dementia Specialist Occupational Therapist Dementia Lead, Royal Free London NHS foundation trust.

Compassion, dignity and respect in practice #THFCompassion 15 What do I want to know more about? What are the implications of this for my / our work?