RCHT Dementia Care Policy - the Royal Cornwall Hospitals Trust ...

RCHT Dementia Care Policy
V1.0
April 2012

Table of Contents
1. Introduction...................................................................................................................3
2. Purpose of this Policy ...................................................................................................3
3. Scope ...........................................................................................................................3
4. Definitions / Glossary....................................................................................................3
5. Ownership and Responsibilities....................................................................................3
6. Standards and Practice ................................................................................................5
7. Dissemination and Implementation...............................................................................7
8. Monitoring compliance and effectiveness .....................................................................7
9. Updating and Review....................................................................................................8
10. Equality and Diversity................................................................................................8
STRATEGIC POLICY CONTEXT ......................................................................................10
Appendix 3. Governance Information ................................................................................18
Appendix 4.Initial Equality Impact Assessment Screening Form .......................................20
RCHT Dementia Policy
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1. Introduction
1.1. Dementia and the challenges of mild cognitive impairment will touch the vast
majority of our services directly or indirectly. Nationally the impact is recognised and
anticipated to grow as the demographic changes across our society witness a
significant growth in the older age population. The Trust Board has approved a local
hospital-wide dementia strategy (Appendix 2, December 2010) which sets this
context nationally and presents the local challenge to us all. This policy exists to
translate that strategy into practical means to benefit the population with dementia
and mild cognitive impairment using our services today and into the future.
2. Purpose of this Policy
2.1. The purpose of this policy is to ensure the Trust meets strategic and clinical
best practice standards in delivering its ambition to provide excellent dementia care
services.
3. Scope
3.1. This policy applies to all Trust staff who are directly or indirectly involved in the
care of people with dementia or cognitive impairment, their carers and families.
4. Definitions / Glossary
4.1. Dementia: The term 'dementia' is used to describe the symptoms that occur
when the brain is affected by specific diseases and conditions. These include
Alzheimer's disease, vascular dementia, dementia with Lewy bodies and
sometimes as a result of a stroke.
4.2. Mild cognitive impairment (MCI): is a relatively recent term, used to describe
people who have some problems with their memory but do not actually have
dementia. It is a descriptive term rather than a specific medical condition or disease.
It describes memory loss apparent to the individual, and those around them.
4.3. In the context of this polciy ‘Dementia’ from now on will include MCI, unless
seperation is warrented. (Definitions taken from Alzheimer’s Society Fact Sheet 400
and 470)
5. Ownership and Responsibilities
5.1. The Chief Executive and wider Trust Board have key roles and responsibilities to
ensure the Trust meets requirements set out by statutory and regulatory authorities
(for example: the Department of Health, Commissioners and the Care Quality
Commission). These responsibilities are delegated to an Executive Lead with
supportive structure to ensure and assure standards and expectations are met. These
are described below.
5.2. Role of the Executive Lead
The Executive Director for Nursing, Midwifery and Allied Health Professional is the
nominated Executive Lead and will be responsible for ensuring structures and
processes are in place to assure delivery of the Dementia Strategy. The Executive
Lead will report to Trust Board on progress as required.
5.3. Role of the RCHT Dementia Action Group Members
The Action Group is made up of three distinct participative groups: subject specialist,
divisional representatives and importantly service users, carers and representatives
of people with dementia.
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Subject specialist: bring expertise of the subject, from clinical, managerial and
commissioning perspectives
Divisional representative: are fundamental to ensure work flows from the
action group to clinical teams and that a feedback mechanism is established
back to the action group
Service users, carers and representatives of people with dementia: bring
reality to the action group of the patient group the action group serves
The Action Group is responsible for delivering the clinical and corporate
requirements linked to the ‘Dementia Strategy’, the ownership of a local
improvement plan, which is updated and monitored bi-monthly, is key assurance
measure of progressive quality improvements for this patient group. This Group
reports bi-monthly to the RCHT Governance Committee.
5.4. Role of the RCHT Governance Committee
The RCHT Governance Committee will hold to account the work and actions of the
RCHT Dementia Care Action Group. It will receive and scrutinise progress in
delivering the local improvement plan on behalf of the Trust Board.
5.5. Role of the RCHT Dementia Link Workers (DLWs)
A RCHT Dementia Link Worker Networks exists to enable clinical champions in each
clinical area to audit, monitor and progress practices changes with the aim to improve
the care of people with dementia, their carers and families. DLWs are empowered to
deliver the ambition of the organisation to provide excellent care for such people
across its whole service. Their role responsibilities are set out in appendix 3, this role
has Trust Board endorsement.
5.6. Role of Divisional Management Teams
Divisional Management Teams (Divisional Director, Divisional General Manager and
Divisional Nurse) are responsible for ensuring their divisional representative and local
network of DLWs are pulling together driving up the standards of care. Effective
mechanism for communication and disseminator of information to all clinical teams
must be assured.
5.7. Role of Ward and Department Sisters and Charge Nurses (and other
Departmental Leads / Managers)
Line managers are responsible for identifying and supporting their local DLW in
driving through changes and to ensure effective communication channels exist to the
divisional representative encouraging dissemination of information and actions
across the wider health care team.
5.8. Role of Individual Staff
All staff members are responsible to ensure they comply with Trust policy regarding
the care of people with dementia (including MCI (see Definitions)). They must meet
requirements set out regarding learning and development for their level of
involvement with people with dementia and should ensure they know who their local
dementia link worker or divisional representative is to enable communication and
sharing of information.
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6. Standards and Practice
6.1. Hospital Standards of Dementia Care
8. Appropriate
training and
workforce
development
1. Respect,
dignity and
appropriate care
2. Agreed
assessment,
admission and
discharge
processes with a
needs specific
care plan
5. Nutrition and
hydration needs
are well met
7. Ensure quality
of care at the end
of life
3. Access to a
specialist older
people’s s mental
health liaison
service
4. A dementia
friendly hospital
environment;
minimising
moves
6. Promote the
contribution of
volunteers
Established at the end of 2010 the Southwest Region launched eight standards for
general hospital to meet to demonstrate delivery of the National Dementia Strategy
and NICE guidance. These are:
Respect, dignity and appropriate care
Agreed assessment admission and discharge processes with a needs
specific care plan
Access to a specialist older peoples mental health liaison service
A dementia friendly hospital environment minimising moves
Nutrition and hydration needs are well met
Promote the contribution of volunteers
Ensure quality of care at the end of life
And overarching all these is: Appropriate training and workforce development
6.2. The standards call for specific requirements to be set out in policy, they are:
6.2.1. Vulnerable people with dementia or delirium should not be moved
between wards between the hours of 8pm and 8am unless required for
specifically justified care or treatment, due to the detrimental; effect it can have
upon the individual (moves at mealtimes and medication times should also be
avoided where possible). Organisational performance is tracked using the
Dementia Care Key Performance Indicators (KPIs), DATIX incident reports are
encouraged so rational behind such moves can be explored and reported.
6.2.2. In line with the Standards it is good practice to identify through
hospital systems patient with dementia. plans to have this information available
on PAS and in their health records is progressing. Currently all patient with
dementia or MCI should be ‘flagged’ on the interactive SWiftPlus boards with
the ‘forget-me-knot’ symbol.
6.2.3. Carer involvement is essential throughout the hospital journey of their
person. Information and support needs to be appropriately offered and
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ecorded. Materials to support carers are available and consideration of their
entitlement to an independent carers assessment must always be made.
6.2.4. To improve coding of patient who have a dementia diagnosis the Trust
promotes the notification of this through the use of the ‘Code:Dementia’ sticker
(CHA 2836). The eldercare team along with the Complex Care and Dementia
Psychiatric Liaison Service are primarily directed to leading sticker utilisation.
6.3. The Trust undertakes an annual self assessment against these standards and
develops an improvement / action plan that combines with its annual National Audit
performance results and its annual dementia patient and their carer survey results
into a comprehensive programme of work that the RCHT Dementia Care Action
Group has delegated responsibility to deliver.
6.4. The Trust has a number of work streams in place to deliver the ambitions of its
strategy, this policy and the standards set out within it. Underpinning these work
streams is clinical and practice guidance - essential to demonstrate and deliver
excellent care to this patient group, their carers and families.
6.5. Organisationally this is visually and practically presented in a ‘Map’, this
‘organisational map’ should guide staff to the appropriate information and guidance to
support care at key points on the patient journey through the acute care system and
when they interface with community services providers and partners.
6.6. The Organisational Dementia Care Map
Mental Capacity Act / Policy
Delirium
Pathway
Pre- /
Admission
Phase
Assessment
Phase
Acute Care
and
Management
Phase
Discharge
Planning
Phase
Dementia
Pathway
6.7. Pre-admission phase – This phase remains developmental and dependent of
intelligence sharing to support people admitted to hospital. For our elective pathway
patients, better information and communications can be prompted and started prior to
admission so care on admission can be tailored to meet their needs (e.g. making
available This is ME). Unscheduled or emergency admission pathway patients
require co-operation and often preparatory intervention from partners (e.g. care
homes) to prepare of such an admission. Currently the AMP (Assess Monitor and
Prevent) Document is being promoted in the community to enable early sharing of
information when people are admitted as an emergency to tour hospitals. Growing
use of shared technologies could aid better response to individual assessment of
needs in these unscheduled admissions.
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6.8. Assessment Phase – RCHT Guidelines have been developed to support
practice :
RCHT Guidelines for the Assessment and Management of Delirium
RCHT Guideline on the Assessment and Management of Pain in
Dementia and People with Sever Cognitive Impairment
6.9. Acute Care and Management Phase – RCHT Guidelines exist to support
practice :
RCHT Guidelines for the Assessment and Management of Delirium
RCHT Guideline on the Assessment and Management of Pain in
Dementia and People with Sever Cognitive Impairment
RCHT Guidelines for Palliative Care in Dementia
RCHT Dementia Care Plan (CHA 3009)
6.10. Discharge Planning Phase– RCHT guidelines exist to support practice:
RCHT Guidelines for Discharging a Person with Dementia
RCHT Guidelines for Palliative Care in Dementia
7. Dissemination and Implementation
7.1. This policy will be cascaded by the RCHT Dementia Care Action Group to
Divisional Representatives and to the RCHT Dementia Link Worker Network for
communicating and sharing at a local clinical level, making all resources available to
all relevant staff.
7.2. This policy’s implementation will be through the delivery of the improvement
plan for dementia care, championed by the Action Group. This promotes training
and educational opportunities and makes sure local recourses are available via
the dementia link worker network
8. Monitoring compliance and effectiveness
Element to be
monitored
Lead(s)
Tool
RCHT Dementia Policy
This policy underpins the Trust strategy and commitment to
improve the care of people with dementia in our services. National
and regional standards are established (reflected in this Policy and
Trust Strategy) and an improvement framework exist which
includes peer review to drive up standards.
The Trust Clinical Lead for Dementia Care takes responsibility for
monitoring (auditing) the Trust’s clinical performance in meeting the
Nationally set standards of care and service delivery for dementia
care.
The Trust Strategic Lead for Dementia Care take responsibility for
monitoring (auditing) the Trusts’ operational and strategic
performance against nationally and regionally set standards for
dementia care in general hospitals.
The Trust is committed to participating in the National Dementia
Care Audit, conducted by the Department of Health and facilitated
by the Royal College of Psychiatry. This template is Nationally
negotiated and published.
In addition, The Trust undertakes an annual self assessment based
on eight standards for dementia care in general hospitals and
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Frequency
Reporting
arrangements
Acting on
recommendations
and Lead(s)
Change in
practice and
lessons to be
shared
commissions an annual Dementia Patient and Carer Survey.
The Trust’s clinical care performance is benchmarked with National
results. These are published and reported, currently on an annual
basis.
Annually the Trust undertakes an annual assessment against eight
standards for dementia care in general hospitals
The Trust’s performance report, local response and improvement
plan are presented through the RCHT Dementia Care Action Group
to the and RCHT Governance Committee, who act on behalf on the
Trust Board to scrutinise and monitor improvement delivery.
Independent scrutiny of delivery is given from commissioners, and
a regional peer review processes.
The RCHT Dementia Care Action Group leads on service
improvement for dementia care in the organization. It is tasked to
deliver the improvement plan developed form audit and self
assessment against the hospital standards and signed off by
health, social care and voluntary sector partners. This has a
delivery timetable monitored by numerous groups and agencies.
Improvement and change in service delivery is documented in the
notes and minutes of the Action group, its sub groups and in the
evidence folders linked to the hospital standards.
9. Updating and Review
9.1. The policy will be kept under review by the authors and RCHT Dementia Care
Action Group in line with Trust strategic and operational developments and clinical
practice changes. The minimum review period will be in three years time in line with
Trust policy. Revision activity is recorded in the version control table at the beginning
of this document.
10. Equality and Diversity
10.1. This document complies with the Royal Cornwall Hospitals NHS
Trust service Equality and Diversity statement.
10.2. Royal Cornwall Hospitals NHS Trust is committed to a Policy of Equal
Opportunities in employment. The aim of this policy is to ensure that no job
applicant or employee receives less favourable treatment because of their race,
colour, nationality, ethnic or national origin, or on the grounds of their age,
gender, gender reassignment, marital status, domestic circumstances, disability,
HIV status, sexual orientation, religion, belief, political affiliation or trade union
membership, social or employment status or is disadvantaged by conditions or
requirements which are not justified by the job to be done. This policy concerns
all aspects of employment for existing staff and potential employees.
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11. Equality Impact Assessment
11.1. The Initial Equality Impact Assessment Screening Form is at Appendix 2.
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Appendix 1. RCHT Dementia Care Strategy
RCHT Dementia Care Strategy (v5.0)
Version 5.0 has had language and context updated to reflect more current development and service delivery.
However this document needs to be read in the context of the time it was written: pre- RCHT Dementia Policy and pre- South
West Dementia Care Standards for General Hospital which have gone a long way in progressing local developments around
dementia care in RCHT.
The RCHT Dementia Care Strategy sets out the Trust’s commitment to delivering objective
eight of the National Dementia Strategy and how it works with partners across Cornwall
and the Isles of Scilly to drive up the care standards for people with dementia and their
families and carers.
STRATEGIC POLICY CONTEXT
The National Dementia Strategy
This Strategy Document was launched in February 2009. Within the strategy there is a key
objective for all general hospitals:
Objective 8: Improved quality of care for people with dementia in general
hospitals.
Identifying leadership for dementia in general hospitals, defining the care
pathway for dementia there and the commissioning of specialist liaison older
people’s mental health teams to work in general hospitals.
The Strategy’s ambition is now embedded into two recent publications from the
Department of Health and form the National Institute for Healthcare and Clinical
Excellence. They reflect the national move to focus on quality standards and outcome
driven healthcare improvements. For example, patient related outcome measures
(PROMs) will play an increasingly important factor in measuring service quality.
This National level framework provides the fundamental focus for the Trust’s local strategy
and reference point to review other local strategies and some external reviews of our
services.
Alzheimer’s Society Report - Counting the Cost: Caring for people with dementia on
hospital wards
In 2009 this research report published a factual account of people with dementia and their
carers’ experiences of hospital care today. It quantifies that people with dementia over 65
years of age are currently using up to one quarter of hospital beds at any one time and
specifically that people with dementia stay far longer in hospital that other people for the
same procedure and that the longer they are in hospital the worse the effect on the
symptoms of dementia and the individuals physical health; discharge to a care home
becomes more likely and antipsychotic drugs are more likely to be used. Nine
recommendations are made and specific key messages to note, not covered in other
strategy papers, centre upon involving people with dementia and their families and carers
in their care to improve person-centred care and make sure processes are in place to
ensure people with dementia have enough to eat and drink.
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The NHS Confederation Report: Acute Awareness – Improving hospital care of
people with dementia
Published in June 2010 and focusing on improving outcomes, quality and efficiency, it
draws attention to the themes of: early patient identification of people with dementia in
hospital services; effective care pathways; training; the use of anti-psychotic drug;
nutrition; the care environment; effective discharge; leadership; liaison teams and
involvement of patient and carers.
The report concludes with a call for acute hospitals to re-think their services so efficiencies
can start and been sent through the delivery of: early identification of people with
dementia, leading to shorter stays and reduced hospital infections and on discharge
patients leaving with an appropriate care plan to help reduce the risk of readmission.
Therefore the hospital’s pathway interface at the point of admission and on discharge is
crucial to improving efficiencies as well as dementia care.
NHS Cornwall and Isles of Scilly Strategy
‘Improve care and support for people with dementia and their families’, section seven of
the local strategic plan for improving health in Cornwall and the Isles of Scilly 2008/09 to
2012/13:. It is recognised that the county has a comparatively high number of people with
dementia and low formal detection rates, which reinforces the demographic challenge
dementia holds for all health and social care services. The document presents a joint
commissioning plan, with Cornwall Council, that sets out fifteen immediate priorities. Five
are highlighted below as being significant to our Trust dementia strategy:
Improve public awareness of dementia
Implement specialist training for GPs, pharmacists and other health and social
care staff
Reduce the inappropriate use of antipsychotic medication as a means of
managing behaviour which challenges in all care settings
Improve the quality of dementia care in hospitals
Improve end of life care for people with dementia
This has been translated further into ‘Caring for People with Dementia and their Families -
A Plan for the Commissioning and Development of Services in Cornwall and the Isles of
Scilly’ and ten commissioning intentions are set out:
Planned increases in the level of recognition and diagnosis of dementia.
The development of care services for people with dementia and their carers as
part of an integrated service for Older People.
Agreed system of assessment in place across primary community and specialist
services.
Arrangements to achieve effective management and continuity of care and
support following diagnosis.
A fully funded Health and Social Care Education and Training Plan.
Assessment and alternative provision to secure more appropriate planned
hospital admission and entry into long term care.
Examination of options to provide crisis support through existing service or new
providers.
Arrangements for improved liaison services and support to cover transitions and
movements between care environments.
Common contract specifications to ensure appropriate standards, safeguards
and specialist support in care homes.
Raised standards for end of life care in line with national guidelines.
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Southwest Dementia Review
A review of all health and social care dementia services across Cornwall and the Isles of
Scilly was undertaken in 2009, which for objective 8 resulted in the following actions:
Objective
8
Observations
Areas for
Development
Action Owner Due Date
Improved
quality of
care for
people
with
dementia
in general
hospitals
Named lead
and work
stream in
place;
Reduction in
emergency
admissions
which has
been
significant
and
sustained;
Positive
findings in
acute trust
but query
about how
this links with
whole
system;
Lack of
information
about the
average
length of stay
and
readmission
rates for
people with
dementia.
Review
environmental
and design
aspects on
wards;
Determine
segments of
the Dementia
Care Pathway
to identify
specific
provider
contribution
and
collaboration.
Dementia Steering Group
to ensure delivery of
Workstream 7 –
Improving Dementia Care
in hospitals in local
programme.
1. Commission and
complete
environmental and
design review of all
general hospitals
(acute and
community hospitals)
to identify suitability
for people with
dementia and areas
for improvement.
2. Share lessons from
Cornwall Partnership
NHS Trust Enhancing
Healing Environment
Projects (Cove and
Garner wards) with
General Hospitals.
3. Encourage multiagency
collaboration
by establishing a
Dementia Provider
Forum and a
Managed Clinical
Network
Dementia
Steering
Group
This
action
plan
reflect the
state in
2009/10
that
influenced
at the time
the
developm
ent of the
RCHT
Dementia
Strategy
Cornwall Dementia Action Plan (February 2010)
The South West Dementia Partnership produced a paper outlining a regional review of
local action plans. This table was produced as a result of the review of Cornwall’s plans in
respect of objective eight:
Objective
8
Improved
quality of
care for
people
with
dementia
in general
hospitals
RCHT Dementia Policy
Strengths Weaknesses Possible ideas to
address
Named leads Lack of routine Dementia link
Care pathway information on workers.
in place
LOS/readmissions Environmental
Liaison service for people with improvements
Provider
dementia
on wards
forums Dementia
Clinical
awareness and
networks
training could be
Audits to
enhanced
increase Uncertainty on
knowledge how learning from
CQUINs linked Enhancing the
to mandatory Healing
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Future plans
Strengthening
dementia liaison
service
Setting CQUIN
for dementia
leads on wards
Workforce
development
plans
Up-date of e-
learning
New workbooks

training
Environment has
been evaluated
and disseminated
Challenges
around systematic
data collection
and cost models
South West Dementia Partnership General Hospital Standards Development: In
September 2010 a set of 10 draft standards for general hospitals in the South West
were published. This development plans to provide a commissioning framework to
assure high quality care across the sector. RCHT involvement in shaping these
standards is essential as they develop.
RCHT Our Plans 2010-2014
The Trust strategy commitment declares we ‘will focus particularly on the needs of patients
with (or suspected of having) dementia, in line with the National Dementia Strategy’.
2. STRATEGIC THEMES
Drawing for the current context of dementia care service provision (see above) the
following themes are presented as the Trust’s strategic direction.
2.1. Leadership
2.1.1. Engagement and Communication Strategy: The need to reach out to bring
the voice and experience of the patient and their family into the ongoing
development of services in the trust is essential. Representation and
meaningful involvement will be sought through the local Alzheimer’s Society to
inform an engagement strategy statement and plan. In addition the need to
inform and effectively disseminate information to the Trust workforce and wider
public is fundamental to delivering this strategy. Exploiting Trust
communication networks will be sought to inform a communication strategy
and plan.
2.1.2. ‘Dementia Care in General Hospital Action Group’: Executive, non-executive
and clinical champion leadership will support the delivery of this Trust Board
approved strategy. A new Action Group will be tasked to deliver this, with
membership made up of experts in the field of dementia care, patient and carer
representatives along with cross divisional representation. The Action Group
will report to the Divisional Quality Group on incremental progress in delivering
this strategy.
2.2. Cognitive Impairment Care Pathway
2.2.1. New pathway development: Current best practice embedded with in
numerous Trust policies and guidance will be consolidated into a ‘cognitive
impairment care pathway’, rather than a ‘dementia care pathway’ supporting
the focus on early detection and decision making, the care pathway will
promote the use of community based memory clinic services to facilitate
diagnosis and shift the focus from diagnosis whilst in hospital. It will also clarify
options for early discharge to supportive community services for ongoing care
and treatment of necessary. Guidance on medication use and limiting antipsychotic
medicine usage will be embedded in the pathway, which in turn will
be supported by the dementia educational framework (see 2.4.1).
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2.2.2. Review of clinical service provision: With nationally acknowledged
unacceptable variation in the quality of dementia care provided in general
wards (Alzheimer's Society, 2009) and recognising the future demographic
challenge dementia poses hospital services, a move from ‘dementia specialist’
and dedicated facilities and service models to a ‘generic service’ with access to
excellent dementia care throughout the hospital’s services, is the direction the
Trust is committed to move towards.
Therefore in line with the Trust’s five year strategy and the clinical site
development plan, the creation of more generalist facilities to support the
cognitive impairment care pathway, for example a frailty assessment and care
area within the ‘single front door’ developments to triage the needs of frail
individuals for hospital admission and support our care closer to home
commitment with health and social care partners. This area should also
provide safe and secure confusional assessment facilities, environmentally
equipped to support some of the more challenging presentations people with
delirium, which maybe alongside a diagnosed dementia, present with. In
addition the Trust is likely a require a facilitative team working with local clinical
teams to support this new direction.
2.3. Performance Monitoring and Management Framework
2.3.1. ‘RCHT Dementia Care Improvement Plan’: This Trust strategy will inform the
development of an ‘Improvement Plan’ to enable monitoring of progress with
ongoing refinement and delivery the strategic themes identified. This
Improvement Plan will inform Trust Board of progress and will be used to
assure commissioner and regulators of our continued commitment and
progress to improve hospital services for people with dementia and their
families.
2.3.2. Organisational performance data: There is a requirement to report to Trust
Board information about average length of stay and readmission rates for
people with dementia in its services. This will be co-ordinated through the
Dementia in General Hospital Action Group.
2.3.3. Care pathway performance data: Pathway monitoring that feeds back into
service improvement and organisation learning is a key objective for the
cognitive impairment pathway.
2.3.4. Liaison Service performance data: Monitoring and reporting to the Trust on
delivery against the commissioned service level agreement will enable cooperation
and partnership support to ensure effective person-centred service
delivery for people with dementia in our services.
2.4. Workforce Education and Practice Development
2.4.1. Education and Training Framework: A recommended framework of education
and training will be developed and promoted through the Trust’s new staff
training prospectus. Different levels of training and education will be made
available internally from the Trust’s core awareness programme embedded
into the induction programme, to e-learning programmes for clinical and nonclinical
staff in direct contact with people with dementia and further educational
opportunities internally and externally to the Trust to develop specialist skills
and knowledge in dementia care.
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2.4.2. Dementia Link Workers: The Trust is committed to developing and
supporting a network of clinically based Dementia Link Worker (DLW), to
interface with the already established Cornwall DLW Network. The DLW will be
receive specialist training and support and receive support materials and a
practical tool kit to help raise the standards of dementia care with colleagues in
their clinical care setting.
2.4.3. Person-centred care developments: Moving to a more generic base for the
care of people with dementia in hospital challenges the concept of person
centred care – promotion of the ‘life story pocket book’ is just the start of
getting the care experience right for each individual. Underpinned by the
education framework and network of DLW – person-centred care is our gal for
each patient in our care.
2.5. Clinical Environment Development Programme
2.5.1. ‘Dementia Care Friendly’ Framework for Estate Developments: The evidence
base for adaptations to the care environment to make a hospital stay more
therapeutic and meaningful and less stressful has been clearly set out. The
Trust will work with Estates teams to be built into future clinical site
developments for a ‘Dementia Care Friendly’ framework to enhance the care
environment for all patients.
2.6. Multi-Agency Collaboration
2.6.1. Complex Care and Dementia Psychiatric Liaison Service: This fundamental
specialist element of the service we offer people with dementia in the Trust and
is provided by the Cornwall Partnership Foundation Trust. Commissioned by
NHS Cornwall and the Isles of Scilly the commissioned has to work inside a
complex organisation to collaboration between partners are essential to an
enable effective and efficient response. The Action Group has agreed to
regularly review the service level agreement, operational plan and performance
to support this.
2.6.2. Social Services: Work to build strong relationships that will enable personcentred
care to be continued as the dementia pathway extends out of hospital
are required.
2.6.3. The Third Sector: Opportunities are available and need to be explored with
this sector as developments move forward.
3. SUMMARY
Delivering excellence in dementia care cannot be done in isolation. This strategy
focuses very clearly on making the acute hospital’s aspect of care for people with
dementia our priority, but we cannot fail to have open and honest relationships with
partners to move the vision of an integrated dementia service for Cornwall and the Isles
of Scilly forward. This strategy gives a clear direction, identified in six strategic themes,
underpinned by structure and the process, to realise the Trust’s ambition to deliver
excellence within the context of its higher strategic plan.
This Strategic Paper informed a yeas worth of progress in improving the care of people with dementia and has been
preceded by the now established South West Dementia Care Standards for General Hospitals.
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Appendix 2. Dementia Link Worker Role Description
Dementia Link Worker v2
All wards and departments where staff work with patients who have a dementia and staff
who work with relatives and carers who’s relative has a dementia will identify and support
Dementia Link Workers.
All staff that care for patients with a dementia should be appropriately trained and
therefore it is essential that protected time is given to maintain a knowledge base and to
fulfil the duties of this role; this should be negotiated with individual line managers as each
area will require different demands on their time.
It is essential that Dementia Link Workers are fully supported and empowered by
line managers to carry out these responsibilities.
Role Description
The Dementia Link Workers provide support within the organisation by:
Being a single point of contact for the ward team caring for patients with a
dementia, to cascade information from the Trust’s dementia care action group to
their own clinical area
Providing an essential link between practice areas across the Trust
Supporting staff to ensure that patients with a dementia are the focus for
consideration even when the primary intervention is with the carers
Being vital in supporting the Trust to execute its responsibilities to safeguard
patients with dementia.
Being aware of the named and designated leads for dementia care in the Trust and
know how to access them
Alerting the Ward Sister / Charge Nurse to any serious or significant incident or
concern relating to the welfare of a patient with dementia
Being proactive and informing the Ward Sister / Charge Nurse or Divisional Action
Group Representative of any gaps identified within the services in their area of work
relating to caring for patients with a dementia
Support the Trust’s dementia care monitoring programme through audits and
evaluations, and implementing actions from these findings
Responsibilities
The Dementia Link Workers will promote best practice in dementia care within their ward
areas by:
Acting as a resource for staff within their area on issues relating to dementia care
and best practice, keeping staff on their ward/department up to date about current
dementia issues
Supporting staff to deliver patient-centred dementia care
Signposting staff and carers to supporting services
Providing support and information to staff within their area to access appropriate
advice and assistance
Seeking advice, support and supervision from their divisional action group
representative or dementia care action group itself, if needed
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Ensuring systems and processes are in place on their wards to deliver the trust’s
safeguarding and mental capacity policies
Ensuring processes are in place to share information and findings with the Ward
Sister / Charge Nurse and ward staff information from ‘Dementia Link Worker
Meetings’.
Carryout monthly Key Performance Indicator (KPI) audits in their local area if
appropriate
If nominated by the Divisional Representative to attend any group, ensure that they
do so and actively participate in the event and give timely feedback and advise
Learning and Development
Dementia Link Workers will be supported and developed to fulfil their role expectations.
This includes induction for new link workers, provision of support materials to promote
excellence in care and a time commitment to attend local dementia multi-agency training
to maintain knowledge and skills.
The Dementia Link Worker will be expected to attend regular Dementia Link Worker
(DLW) Meetings:
Local RCHT DLW Development Sessions
County-Wide DLW Events
The meetings will provide an opportunity to share new developments in dementia care,
ensure systems are in place to enable safe and skilled practice, and to disseminate
lessons learned from case reviews. The meetings will provide a forum to discuss best
practice and share experiences relating to dementia.
The Dementia Link Worker will responsible for ensuring all new staff within their area of
responsibility has dementia addressed in their work place induction; Assist with the
delivery of training within their area; Act as a resource for staff requiring further training or
who have a particular interest in Dementia; and Identify any additional training needs
within their area of responsibility or for individual staff members.
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Appendix 3. Governance Information
Document Title
RCHT Dementia Care Policy
Date Issued/Approved: 7 th May 2012
Date Valid From: 7 th May 2012
Date for Review: 1 st May 2015
Directorate / Department responsible
(author/owner):
Contact details: 01872 252447
Dr Fiona Boyd, Consultant Geriatrician.
Frazer Underwood, Associate Director of
Nursing/Consultant Nurse for Older
Peoples Services
Brief summary of contents
The purpose of this policy is to ensure the
Trust meets strategic and clinical best
practice standards in delivering its ambition
to provide excellent dementia care services
Suggested Keywords:
Target Audience
Executive Director responsible for
Policy:
Date revised:
This document replaces (exact title of
previous version):
Approval route (names of
committees)/consultation:
Divisional Manager confirming
approval processes
Name and Post Title of additional
signatories
Signature of Executive Director giving
approval
Publication Location (refer to Policy
on Policies – Approvals and
Ratification):
Document Library Folder/Sub Folder
Dementia, Dementia Care, Stragegy
RCHT PCT CFT
Medical Director
New Document
RCHT Dementia Care Action Group and
associated partners
Frazer Underwood, Associate Director of
Nursing/Consultant Nurse for Older
Peoples Services
If none enter ‘Not Required’
{Original Copy Signed}
Internet & Intranet
Clinical / Dementia
Intranet Only
Links to key external standards CQC Outcomes: 1, 2, 4, 5, 6, 7, 9
Related Documents:
RCHT Mental Capacity Act, DOLS and
Safeguarding Policy
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Training Need Identified
RCHT Guidelines for Palliative Care in
Dementia
RCHT Guidelines for the Assessment and
Management of Delirium
RCHT Guideline on the Assessment and
Management of Pain in Dementia and
People with Sever Cognitive Impairment
RCHT Safeguarding Adults Policy
RCHT Adult Discharge and Transfer Policy
Yes
Version Control Table
Date
Versio
n No
21.6.2012 V1.0
Summary of Changes
New document incorporating Trust strategy
document and commitment to deliver
Southwest Hospital Standards for Dementia
Care
Changes Made by
(Name and Job Title)
Frazer Underwood –
Consultant
Nurse/Associate
Director of Nursing
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy on Document Production. It should not be altered in any way without the
express permission of the author or their Line Manager.
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Appendix 4.Initial Equality Impact Assessment Screening Form
Name of service, strategy, policy or project (hereafter referred to as policy) to be
assessed: RCHT Dementia Care Policy
Directorate and service area:
Is this a new or existing Procedure New
Name of individual completing
Telephone: 01872 255043
assessment: Frazer Underwood
1. Policy Aim* The purpose of this policy is to ensure the Trust meets
strategic and clinical best practice standards in delivering its
ambition to provide excellent dementia care services.
2. Policy Objectives* Improve and standardise care
3. Policy – intended
Outcomes*
4. How will you measure
the outcome
5. Who is intended to
benefit from the Policy
6a. Is consultation
required with the
workforce, equality
groups, local interest
groups etc. around this
policy
Improved patient and carer experience of dementia care in
hospital
Annual participation in the National Dementia Car Audit
Monitoring of the Standards of Dementia Care in General
Hospital (inc. peer review)
Patient, carers and staff
No
b. If yes, have these
groups been consulted
c. Please list any groups
who have been consulted
about this procedure.
*Please see Glossary
7. The Impact
Please complete the following table using ticks. You should refer to the EA guidance notes
for areas of possible impact and also the Glossary if needed.
Where you think that the policy could have a positive impact on any of the equality
group(s) like promoting equality and equal opportunities or improving relations
within equality groups, tick the ‘Positive impact’ box.
Where you think that the policy could have a negative impact on any of the equality
group(s) i.e. it could disadvantage them, tick the ‘Negative impact’ box.
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Where you think that the policy has no impact on any of the equality group(s) listed
below i.e. it has no effect currently on equality groups, tick the ‘No impact’ box.
Equality
Group
Positive
Impact
Negative
Impact
No
Impact
Age
Disability
Religion or
belief
Reasons for decision
Dementia is linked to a aging
population, so a proactive agenda
on improving dementia care will
have a positive impact on those
aged in society generally
Gender
Transgender
Pregnancy/
Maternity
Race
Sexual
Orientation
Marriage / Civil
Partnership
You will need to continue to a full Equality Impact Assessment if the following have
been highlighted:
A negative impact and
No consultation (this excludes any policies which have been identified as not
requiring consultation).
8. If there is no evidence that the policy
promotes equality, equal opportunities
or improved relations - could it be
adapted so that it does How
Full statement of commitment to policy of
equal opportunities is included in the policy
Please sign and date this form.
Keep one copy and send a copy to Matron, Equality, Diversity and Human Rights,
c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Chyvean
House, Penventinnie Lane, Truro, Cornwall, TR1 3LJ
A summary of the results will be published on the Trust’s web site.
Signed ________________________________________
Date _________________________________________
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