The Fife Dementia Strategy: 2010 – 2020 - The Knowledge Network

is referred on to a more appropriate service. There are concerns over these
inconsistent approaches and the impact they have on the service users.
In order to ensure equality in access as well as efficient referral practices, all
intermediate care services in Fife must review their referral criteria, ensuring
all relevant service providers are aware of the criteria and why the criteria
exist in the form they do. Where necessary intermediate care services should
re-develop their criteria, ensuring they are clear and implemented consistently
across the service. This will include criteria for use by people with cognitive
impairments such as with people with dementia, and in instances where it is
decided a person will not benefit from the service they will be referred to a
more appropriate service such as a specialist team (see Section 4.10.2). The
review process has already begun, with Fife Council working in partnership
with NHS Fife and the Mental Health Collaborative, and with Integrated
Response Teams (generalist intermediate care services) to identify ways of
improved working with people with dementia. Intermediate care services will
be included in the development of the dementia patient pathway as described
in section 4.2.1.
If it is the case that intermediate care services are being provided for people
with dementia then the services need to be structured in an appropriate way
which supports the individual needs of someone with confusion/memory loss.
As many services are currently not targeted at this group providers may not
have received the appropriate level of training. The report on generalist
intermediate care services drew attention to this point: “It was highlighted that
the training needs of staff should be considered to ensure team members
were appropriately trained in working with people affected with dementia.” 45
In order to ensure the people with dementia are receiving an intermediate
care service which meets their needs, all generalist intermediate care staff
working with adults and older people must receive dementia specific training.
4.8.2 Develop specialist mental health intermediate care services which
are available across Fife and have clear, consistent and well
communicated referral criteria.
The options for an older person when they cease (temporarily or permanently)
to be able to live independently at home are often limited due to the speed of
onset of this scenario and a lack of flexibility and responsiveness in current
care services. In many cases the default action for this situation is for an
individual to be admitted to an acute hospital.
As discussed in section 4.11, acute hospitals are a particularly challenging
and stressful environment for people with cognitive or communication
impairments such as those present in many patients with dementia. In general
people with dementia in hospital in general have worse outcomes in terms of
length of stay, institutionalisation and mortality 46 .
45 Gilmour M, Valentine J & McLaren G (2008).
46 Royal College of Psychiatrists (2005). Who Cares Wins: Improving the outcome for older
people admitted to the general hospital. RCPsych, London.
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