Welcome and Setting the Scene 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?

1960/70s (De)Institutionalization 1980s Community Care Before we launch into this - lets just take a moment to reflect? Why are we here? Why today? A contested area of care? Understanding where we have come from to know where we want to get to? -1960s Asylums 1960/70s (De)Institutionalization 1980s Community Care 2000s Care closer to home 2014 Health and Social care integration Service model – the care model reflects that???? Parallels with LD? The Dementia Strategy – Individuals with rights, rather than patients with problems. – strengths based. What is the care model for specialist dementia care at the moment? Does it reflect that aspiration? Recognition by MH Nursing leads that current provision, expectations, model of care and treatment does not reflect this aspiration De-institutionalisation Asylum-based care was the main model of psychiatric care for people with a mental illness until the 1960s when a combination of advances in psychiatry and drug treatment, greater emphasis on human rights, and advances in social science and philosophy including labelling and institutionalisation theory, combined to start the de-institutionalisation movement.

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

Financial Year Ending 31st March NHS Scotland Inpatient Facilities by NHS Board and Specialty: Psychiatry of Old age ISD Scotland September 2013 Indicator Financial Year Ending 31st March   2004 2005 2006 2007 2008 2009 2010 2011 2012 2013(2) Average Available Staffed Beds 3,545 3,299 3,207 3,100 2,965 2,823 2,645 2,484 2,355 2,222 % Occupancy 82.1 80.2 78.8 78.4 75.8 73.6 74.6 74.7 75.5 75.4 Mean Stay (Days) per Episode 158.8 150.3 144.7 149.5 144.3 141.7 140.0 138.3 134.4 136.2 Throughput 1.9 2.0 2.1

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 Scotland’s National Dementia Strategy: 2013-16 15

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?

Experiences and outcomes – considering the wider picture Approaches and interactions outside these care settings – e.g. within mainstream care homes Admissions and referrals – understanding how and why The purpose of the settings – the focus of care, the outcomes Cross sectoral initiatives – end of life care Therapeutic and environmental factors – social and physical – the therapeutic milieu

‘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 ?New Paradigm ?Old Paradigm 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 Treatment and Cure focus Single clinical speciality Separate - Mental Health/Geriatric specialists Clinical milieu Traditional staffing Professional care Secondary 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

Shining a light…challenges… Acknowledging and validating a complex and highly skilled area of practice Integrating national programmes and Initiatives - mainstreaming Education and Training – attractive career choice Improvement, research and development – developing data Raising expectations – National Dementia Standards and Charter of Rights

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 The importance of sharing successes and celebrating good practice Good practice examples across Scotland – what services and practitioners have already been doing:

(89% ‘very satisfied’, 9% ‘fairly satisfied’) 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)