1. 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

2. 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?

3. 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?

4. The history?

5. 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.

6. Why are we here today?
Dementia dialogue events – 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’

7. The settings?

8. 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

9. 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

11. 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

12. 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

13. Why is It important now?

14. 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

15. Scotland’s Dementia Strategies 2010-2016
Scotland’s National Dementia Strategy: 15

16. Mental Welfare Commission for Scotland – Dignity and Respect: Dementia continuing care visits report (2014)

17. 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

18. The priorities?

19. 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

20. ‘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

21. 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

22. 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

23. 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

24. 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

25. 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,

26. 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:

27. (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)