quality improvement dementia masterclass

QI Dementia MasterclassSupporting our staff to deliver great hospital care

Tuesday 24th March 2015

Welcome and IntroductionChris Dyer, Consultant GeriatricianRoyal United Hospital Bath

Dave Evans, QI Programme ManagerWest of England AHSN

NHS Foundation Trust

What can happen in hospital

Disorientation/ environment Lack of information Lack of understanding of the condition General not personalised care Not involving the carer 1 week average los increase

NHS Foundation Trust

The dementia working group

Chris Atkinson Alzheimer’s Society Stephany Bardzil Alzheimer’s Support Martin Kirkby Carer Jane Davies Matron for Dementia Care Sue Leathers Matron for Older People Donna Little Ward Manager Sharon Manhi Head of Quality Jon Willis Ward Manager Alice Rigby Senior Sister Theresa Hegarty Head of Patient Experience Roy Jones RICE Nigel Harris Designability

NHS Foundation Trust

What are we proud of?

Environmental change and funds

Dementia charter mark

7 day service for patients with dementia

1. Respect, dignity and

appropriate care

1. Respect, dignity and

appropriate care

5. Nutrition and hydration needs

are well met

5. Nutrition and hydration needs

are well met

7. Ensure quality of care at

the end of life

7. Ensure quality of care at

the end of life

6. Promote the contribution of

volunteers

6. Promote the contribution of

volunteers

4. A dementia friendly hospital

environment; minimising

moves

4. A dementia friendly hospital

environment; minimising

moves

2. Agreed assessment,

admission and discharge

processes with a needs specific

care plan

3. Access to a specialist older people’s mental

health liaison service

3. Access to a specialist older people’s mental

health liaison service

8. Appropriate training and workforce

development

8. Appropriate training and workforce

development

NHS Foundation Trust

Vision

to be a truly dementia friendly hospital by 2019:

The views of patients with dementia and their carers are sought consistently and valued

Personalised dementia care is always achieved

A Dementia team is established incorporating clinical leaders, trainers, researchers including dementia coordinators and mental health workers

A CLEAR STRATEGY TO SUPPORT STAFF IS ESSENTIAL

Dementia – The current and future challenges

Professor Dawn BrookerDirector of the Association for Dementia StudiesUniversity of Worcester

10

Hoping to cover

• The Association for Dementia Studies

• The challenge – numbers and lack of investment

• Drivers: Global, National, Local

Association for Dementia StudiesUniversity of Worcester

Association for Dementia Studies (est. 2009)Developing evidence-based practical ways to help people live

well with dementia

The ADS LINK Group

• The experience of people living with dementia and their families inform the work of ADS at all stages.

• ADS LINK group Sept 2014

University of Worcester Association for Dementia Studies

Care Fit for VIPS websitewww.carefitforvips.co.uk

Dementia Pledge

• Dementia currently affects over 800,000 people in the UK. (Dementia 2012 – Alzheimer's Society 2012)

• 824,000 people with dementia in the UK (Dementia 2010 – Alzheimer’s Research UK 2010)

Diagram from (Dementia 2012 – Alzheimer's Society 2012)

Age group 2006 2011 2026

30-64 200 200 200

65-69 300 400 400

70-74 600 700 900

75-79 1,100 1,200 2,000

80-84 1,700 1,800 3,000

85-plus 2,900 3,700 6,600

Totals 6,900 8,000 13,100

Worcestershire: Estimated age breakdown of citizens living with dementia Total Population approx 580,000

2009 -2015• National Dementia Strategy & PM Challenge • Dementia Action Alliance, Dementia Friends,

Dementia Friendly……..• National Audit of Dementia in Hospitals• Royal College of Nursing, Triangle of Care, SPACE• Enhancing the Healing Environment • Diagnosis, Antipsychotics• PM Challenge to 2020• WHO Ministerial Meeting and Call to Action

We are failing to meet the needs of people with dementia and their carers

More than half of all people with dementia

undiagnosed

Carers 20% more likely

to have mental health problems

One in three only leave the house once a week

Hospital costs three times higher than for other people

A third of those in care homes on

antipsychotics

A third come out of hospital

with reduced functional ability. Half of these people never recover.

WHO Ministerial Action on Defeating Dementia Call to action March 17th 2015Guiding principles• Empowering and engaging people living with dementia,

their caregivers and families, • Balancing prevention, risk reduction, care and cure so that

whilst efforts are directed towards finding effective treatments and practices and risk reduction interventions, continuous improvements are made on care for people living with dementia and support for their caregivers;

• Evidence-based approach and shared learning, open research and data sharing

• Human rights, gender & rehabilitation

WHO Ministerial Action on Defeating Dementia Call to action March 17th 2015

• Raising the priority at a global level • Strengthen capacity, leadership, governance and partnerships • Promoting understanding , public awareness and engagement, • Advancing prevention, risk reduction, diagnosis and treatment of dementia,

consistent with evidence • Facilitate technological and social innovations • Collective efforts in dementia research • Coordinated delivery of health and social care for people living with dementia,

including capacity building of the workforce, supporting mutual care taking across generations on an individual, family and society level, and strengthening support and services for their caregivers and families;

• A gender-sensitive approach • Strengthening international efforts to support plans and policies at all levels for

people living with dementia, in particular in low- and middle-income countries;

We have identified ten key objectives of dementia policy for countries to consider

Store

First symptoms appear

1

2

3

4

5

6

109

7

8

End of lifeEnd of life care for people with dementia presents specific challenges

Advanced dementiaGreater need for formal care services and specialised accommodation

Early dementiaLiving in the community and relying on informal care

Those who wish to care for friends and relatives are supported

People living with dementia can access safe and high quality social care services

People living with dementia die with dignity in the place of their choosing

People living with dementia live in safe and appropriate environments

Communities are safer for and more accepting of people with dementia

Dementia is diagnosed quickly once someone becomes concerned about symptoms

The risk of people developing dementia is minimised

Risk reduction

Diagnosis

Care is coordinated, proactive and delivered closer to home

Health services recognise and effectively manage people living with dementia

Progression of dementia

Care coordination and the role of technology

The potential of technology to support dementia care is realised

GAP: By delivering skilled care we can

• Support the PERSON to live with their dementia

• Prevent excess disability, distress and harm

• End inappropriate antipsychotics

• End physical restraint

University of Worcester Association for Dementia Studies

PM challenge to 2020• Risk Reduction• Equality for timely access to diagnosis (6 weeks from referral)• Named GP to coordinate care • Every person has meaningful post diagnostic care • All NHS staff receive training appropriate to their role. • 3 million Dementia Friends & Dementia Friendly

Communities • Dementia Friendly Businesses & Public sector - local Dementia

Action Alliances • Dementia research funding doubled by 2025, international

dementia institute and increased investment to build research capacity

Dementia Friendly Hospital….DAA

Staffing : trained and a positive attitude, appropriate staffing levelsPartnership: patients, families, community, admission & discharge.Assessment: Comprehensive, physical, emotional and socialCare Plan: personalised, pain assess, nutrition, risk & safetyEnvironment: signage, toilets, EHE tools

Plus leadership, management, governance, HR and quality

Thank you for listening!

Professor Dawn BrookerUniversity of Worcester, UKAssociation for Dementia Studiesd.brooker@worc.ac.uk

http://www.worcester.ac.uk/dementia

Photos copyright Cathy Greenblat, cathy@LoveLossAndLaughter.com

Photographs of people living with dementia taking part in The Enriched Opportunities Programme

www.carefitforvips.co.uk

© The Association for Dementia Studies

Health Education England’s Dementia Programme Project Update

Sue ManserDementia Education Project LeadHESW and HEE

www.hee.nhs.uk

To ensure that all Healthcare Staff involved in the care of people affected by dementia have the necessary skills, knowledge and attitudes to provide the best quality care in the roles and settings where they work.

Dementia Education and Training Project Aim

www.hee.nhs.uk

2014 Mandate – Six Dementia Objectives 1 Tier 1 training provided to an additional 250,000

NHS staff2 Dementia education to be included in all

undergraduate curricula 3 All newly qualified healthcare staff to have

received Tier 1 Training4 Training to be available to support staff to diagnose

early symptoms of dementia5 Develop Tier 2 training provision6 Ensure relevant tools and training are available for

all staff

Project objectives

www.hee.nhs.uk

HEE Dementia Programme Board and Project Team

• Prof Lisa Bayliss-Pratt, Director of Nursing, HEE • Paul Holmes, Director, South HEE and Dementia Education

Project SRO• Pat Saunders, Senior Education and Policy Officer, HEE• David Sallah, Clinical Lead – Mental Health Workforce• Sue Manser, Dementia Education Project Lead, HESW• Nick Jupp. Programme Manager and Dementia Education

Lead, HESW• Mauretta Belton-Simmons, Dementia Education Data Analyst,

HESW• Moira White, Dementia Education Project Support Officer,

HESW• Tricia Ellis, Head of Knowledge Management and eLearning

and Dementia Project Support, LETB Leads, HESW

• See http://hee.nhs.uk/work-programmes/dementia-awareness-training

for more details

www.hee.nhs.uk

Dementia Training Definitions

Tier 1 Awareness raising, in terms of knowledge, skills and attitudes for all those working in health and care;

Tier 2 Knowledge, skills and attitudes for roles that have regular contact with people living with dementia

Tier 3 Enhancing the knowledge, skills and attitudes for key staff (experts) working with people living with dementia designed to support them to play leadership roles.

www.hee.nhs.uk

Dementia Education and Training Project Key Achievements – March 2015

• Over 400,000 NHS staff have completed Tier 1 Dementia Awareness Training ( Q3)

• A National Dementia Core Knowledge and Skills Framework has been developed by HEE and Skills for Health

• There are a wide range of tools, resources and training available in all aspects of dementia at each of the three tiers

www.hee.nhs.uk

Dementia Core Knowledge and Skills Framework - Subjects

Dementia Awareness

Dementia identification, assessment and diagnosis

Dementia risk reduction and prevention

Person –centered dementia care

Commmunication, Interaction and behaviour in dementia care

Health and well being in dementia care

Pharmacological interventions in dementia care

Living well with dementia and promoting independence

Families and carers as partners in dementia care

Equality, diversity and inclusion in dementia care

Law, ethics and safeguarding in dementia care

End of Life in dementia care

Research and service improvement in dementia care

Leadership in transforming dementia care

www.hee.nhs.uk

Tier 1 – Dementia Awareness Training

• E-Learning for Healthcare ‘ Introduction to Dementia’ course – open access

http://www.e-lfh.org.uk/projects/dementia/open-access-sessions/

• This course is also available to NHS staff via the Electronic Staff Record system.

• Social Care Institute for Excellence Open Dementia Programme which is free to access

http://www.scie.org.uk/publications/elearning/dementia/index.asp

• Barbara’s Story - DVD and Training Resources - Free on request

www.hee.nhs.uk

Tier 2 – Dementia Training

• Barbara’s Story ( Asian, African Carribean; and Social Care Films and Resources under development )

• Dementia Education And Learning Through Simulation (DEALTS)

• House of Memories

• Inside Out of Mind – Theatre and Post Show Workshops

• ‘In House’ blended learning - good practice on HESW Webpages

www.hee.nhs.uk

Tier 3 – Dementia Training

• Higher Education for Dementia Network – course directory

• http://www.dementiauk.org/assets/files/what_we_do/networks/hedn/HEDN%20Course%202015_Final.pdf

• Last updated Feb 2015

www.hee.nhs.uk

Identifying National Dementia Education and Training

Priorities 2015 -16

Prime Ministers Dementia Challenge 2020

HEE Mandate 2015

www.hee.nhs.uk

Next Steps • Roll out tier 1 awareness training to all NHS Staff• Assurance that Dementia Awareness is in HEI curricula• Launch and implementation of the Dementia Core Knowledge and

Skills Framework • Closer integration with Social care training • Follow up of sub projects funded through 2014-15 dementia

project budget• Increase awareness of cultural / diversity issues • All staff to be aware of and able to signpost people to ‘ join

dementia research’ • Gather evidence about what works in dementia education and

training (to inform future smarter education)• Work with other care and dementia organisations to promote

resources available for training informal carers

www.hee.nhs.uk

Results of Dementia Education and Training Project

• Massive increase in the number of NHS staff who have undertaken dementia awareness training

• Increase in learning opportunities available at all three tiers• Increase in expertise in LETBs to support dementia education and

training • Development of working partnerships across health and social care

networks; across clinical and education providers, with charitable bodies and other key stakeholders

• Production of a wide range of resources that are available to support health and care staff and people affected by dementia

Enhancing the healing environment

Sarah WallerProgramme DirectorThe King’s Fund

People with dementia are likely to:

• Be confused and agitated in unfamiliar environments

• Become distracted when faced with competing information e.g. signs and notices

• Not to be able to see things if they are the same colour as the background e.g. handrails

• Resist walking on shiny floors as they may appear wet and think shadows may represent a change in level

• Want to walk

Hospitals common issues of:

• Poor signage and lack of way-finding cues• Poor use of colour and contrast• Unhelpful lighting – glare and pooling• Shiny floors• Clutter and distractions• Stark, unwelcoming spaces off long featureless corridors• No personalisation of space• Under-use of gardens and outside spaces

Developing supportive design for people with dementiaOverarching design principles

Evaluation of the Enhancing the Healing Environment Dementia Programme

Used routinely collected hospital data 6 months pre and post the environmental transformation on

FallsIncidents of violence and aggressionStaff sickness and absence

ToInvestigate impact within and across sitesHighlight areas amenable to further research

Mean numbers of incidents of violence and aggression

pre 1 pre 2 pre 3 pre 4 pre 5 pre 6 post 1 post 2 post 3 post 4 post 5 post 60

1

2

3

4

5

6

7

8

Mean nos of incidents of V&A (n=10)

Months

Mea

n no

s of

inci

dent

s

Dementia Friendly Environments

What has made most difference? Staff• Education

- understanding of dementia- impact of the environment- what makes good design

leading to changes in attitudes and behaviours

• Environment - clear sight lines and removal of distractions - improved lighting, flooring and signage - use of colour, aids to wayfinding and orientation

(including artworks)- familiar spaces, furniture and sanitary ware- social spaces and age appropriate activities

Resources Via the King’s Fund or Association of Dementia Studies web sites • King’s Fund publication – Developing supportive design

for people with dementia • King’s Fund assessment tools

Go and look at exemplar schemes

Expected this month from the Department of Health • Evaluation of the dementia friendly capital programme• Health Building Note dementia friendly environments

www.worcester.ac.uk/dementia

www.kingsfund.org.uk/dementia

Developing Dementia Leadership Skills

Professor Dawn Brooker

Drawing on experience…

• Royal Wolverhampton NHS Hospitals Trust development of the Dementia Care Bundle

• West Midlands and South Central network• Facilitated 12 x in-depth bespoke Action

Learning Sets for Hospital Dementia Leads• Evaluated the 2014 RCN Dementia

Hospitals leadership programme

University of Worcester Association for Dementia Studies

HELPING TO CHANGE • Recognise that the lack of knowledge and confidence,

even at senior levels, is serious• Help the whole organisation be clear on what good

looks like – shared vision from Trust Board, Clinical depts, non-clinical services, managers, shift leaders, HCA’s

• Get care right for the most vulnerable people with dementia then you’ll get it right for everyone

• The more people identify with the patients they care for, the less us and them, the more they want to learn.

REFLECTIONS ON PEOPLE WHO ARE DEMENTIA LEADS

• This is an experienced and intelligent work-force.• Need to equip staff to make good decisions, not to

think there is an instruction to follow.• Aim to support staff to operate with clarity, creativity,

and resilience and rather than with insecurity and doubt.

• Recognise changing the culture of care is about people’s hearts and minds. This is a people service; tools need to be well cared for, staff need to feel valued for a job well done.

Dementia Leadership Programme: fit for the journey

• Senior staff MDT bands 6 and above

• Organisational Influence • Skilled delivery for

people living with dementia & families

• Increased confidence and competence to lead others and find solutions

Dementia Leadership Action Learning Sets

• 6 -9 days in total• Delivered in 2-day blocks to up to

25 staff over a three to four month period by 2 expert tutors & guest lecturers

• Evidence based practice • Project work individual and group

University of Worcester Association for Dementia Studies

Three Core Elements of the Dementia leadership programme

PERSON CENTRED CHANGE TOOLS

CHANGING MINDS: KNOWLEDGE & SKILLS

CHANGING HEARTS:ATTITUDES & COMPASSION

Leaders work with each others and seek partners to

implement better solutions

Start the education programme with the Leaders of an organisation.

Agents of change: Tools for change

• Policy and strategy• The dementia journey• Theoretical underpinning• Kotter’s 8 steps• RCN SPACE, triangle of

care• Action planning• Care fit for VIPS

www.carefitforvips.co.uk • Project work on-going• Reflective practice• Learning and

development

• VIPS poster

Changing Minds:Knowledge & Skills

• Enriched model of dementia care• Neurological impairment &

capacity• Rare forms of dementia • Diagnosis • Communication & family context• Life story & knowing the person• Health, delirium & co-

morbidities• Pharmacology• Distress behaviours• Safeguarding, Risk & vulnerability • Cultural competence• End of life care• Who can help – expert panel

Changing Hearts: Attitudes and compassion

• Person centred team management

• Inspiring the vision• Sit and See Tool• Eradicating malignant social

psychology• Positive person work in all

interactions• Learning from experts by

experience• Friends, family, activity…..

University of Worcester Association for Dementia Studies

Conference on

leadership in dementia care

• September & December 2013: Overview of key developments in dementia care, the leadership challenge and importance of skilled workforce

6 Actio

n Learning Sets

• October 2013 – March 2014: six x 6-day ALS (delivered in 2-day blocks) for 134 staff working in the geographical areas of South, Central & West, North & East

• Focusing on Improving Diagnosis; Working with families as partners in care; Embedding positive practice and compassion

Conference

to repor

t back on

work and

agree next steps

• April 2014; Final conference to review progress with key partners and to consolidate learning across the Trust

Dementia Leadership Programme overview example

Innovative projects

Dementia friendly bays

in A&E

Training and education

programmes

Patient passports for personalised

care

Family carers

feedback workshops Carers

passport

Facilitated activity room for

patients with dementia

Reduction of ward

moves

Pain assessment tool for patients with

dementia Bay nursing and dining for

patients with dementia

Your Trust working together?ALS build a powerful alliance

to support the change

Increases the sphere of influence

Working to a shared vision?

YOU

Thank you for listening!

Professor Dawn BrookerUniversity of Worcester Association for Dementia Studiesd.brooker@worc.ac.uk

http://www.worc.ac.uk/discover/association-for-dementia-studies.html

Photographs of people living with dementia taking part in ExtraCare Charitable Trust Enriched Opportunities Programme

Dr Kotter’s 8 Steps to leading change

http://www.kotterinternational.com/our-principles/changesteps/changesteps

Identify the urgency and recognise the interconnectedness of actions

Leadership and top-level commitment to implementing excellence in dementia Within

the hospitalPatients Families

CliniciansLiaisonSupport services

Volunteers CateringEstates

informatics

C

O

M

P

O

S

I

T

E

Specialist ward

Volunteers Outreach

Staff development

Care Bundle

Local Health and Social Care

Commissioners, Local Authority, Primary Care, Community Hospitals, Private and third sector providers of services

Dementia friendly physical environment

Integrated dementia pathway from admission to discharge

Bowlby and attachment theory into practice

• 1940 First theoretical paper

• 1950 WHO paper endorsing Bowlby’s position regarding children needing a continuous “mother” figure

How long until change becomes institutionalised?

• 1949 my 3-year old brother spends 5 weeks in hospital with no contact at all with his mum

• 1967 Aged 8, I spend 3 days in hospital for a tonsillectomy – my mum visits 3 times

• 1995 my 5 week old baby spends 5 days in hospital – I sleep on the floor next to his cot

• 2005 my 10 year old has an appendectomy – I have a bed next to him and a family sitting room

Person Centred Approaches to people living with

dementia1992 Tom Kitwood:

Towards a theory of personhood in dementia care

2006 NICE –SCIE guidelines on dementia care UK Govt recommend person centred care

Using the same timescale we should have institutionalised person centred care for people with dementia by

2057University of Worcester Association

for Dementia Studies

A training development by Gloucestershire Dementia Training and Education team

Tina KukstasSenior Nurse Practitioner- Organic/MCA& DoLS2gether

Gloucestershire Dementia Training

& Education StrategyDementia Education Team:

Mary Keating

Sue Keane

Rachel Peake

Dementia Leadership Programme: Lead: Mary Keating

Workshop One• The Grey Matters

• Models for Improvement using the PDSA cycle

• The impact on staff of supporting people to live well with dementia

• Action plan presentation• Action Plan presentations

Workshop Two• Leadership in the

Community• Assessing using the

enriched model framework• Developing skills to coach

teams to self sustain in problem solving

• Developing specialist dementia services

• Where Next

04/15/2023 09:46:59 AM 72

:

Workshop Lead: Tina Kukstas

The impact on staff of supporting people to live well with dementia

The psychological needs of staff who are caring / supporting people with dementia

04/15/2023 09:46:59 AM 74

‘There is a close connection between the personhood of clients and that of the staff’

(Tom Kitwood 1997 p 109)

Dementia Reconsidered

What does the workshop aim to do?

Support managers and leaders who are in positions where they are working with formal care workers to:

• Consider what stressors the brain is subjected to when providing person centred care

• Consider what support staff might need in the context of providing person centred care

75

What is covered: Presentation Outline

Recap:

What are the changes in the brain caused by dementia

Consider:• What the changes are in the brain caused by supporting

people with dementia• How these changes effect a care worker’s psychological

needs• How care workers can be supported to meet their

psychological needs

76

References used:

• Elizabeth Milwain, Journal of dementia care September/October 2010 (Vol 18 no5)

• Steve Peters The Chimp Paradox (2012) • Tom Kitwood: Dementia Reconsidered1997

04/15/2023 09:46:59 AM 77

Key Messages• Working with people with dementia puts enormous

demands on the frontal lobe of the brain• The frontal lobe is essential for managing the amygdala• If the energy in the frontal lobe is used up it will shut

down.• Its not possible to continue with person centred support

without the frontal lobe working well

78

What are the challenges for leadership

Carers supporting people with dementia

Strong emotions

triggered for the carer

High demand on the frontal lobe ‘Human’ to manage emotions

Emotional labour

exhausted

Little energy left for Person Centred

Care

79

Key Message re Training

• Consistent person centred information programmed into the storage system through education and training will enable staff to respond in a person centred way automatically.

• This also requires a culture within an organisation which challenges language and attitudes that are not person centred

04/15/2023 09:46:59 AM 80

The Frontal lobe (human) : Keeps the amygdala (chimp) in check

• When the amagdala (chimp) becomes activated: work is needed by the orbitofrontal cortex (human) to dampen it down

• This is an ongoing and active process• When this fails a person will lose their ability manage

strong emotions: anger /frustration

Chimp/Human : Steve Peters

04/15/2023 09:46:59 AM 81

Energy Hungry

The frontal area of the brain is ‘energy hungry’ (Millwain, 2013). • Using the analogy of a mobile phone, the brain utilises energy

at a fast rate and only has a certain ‘battery life’ before shutting down: when the resource available is used up, the brain will not work effectively until ‘re-charged’.

• A mobile phone will need to be connected to a power source, the frontal lobe of the brain will need to rest.

82

Encouraging leaders to consider how they support staff:• Providing structured support in the form of regular

supervision for staff.• Enabling staff to vocalise potentially strong feelings in a

safe environment.

•Offer opportunities to reward expert practice

•Provide dementia training opportunities for the staff to embed key ‘autopilot’ messages to inform the culture of the home.

•Provide positive feedback to staff regularly.

04/15/2023 09:46:59 AM 83

04/15/2023 09:46:59 AM 84

‘There is a close connection between the personhood of clients and that of the staff’

(Tom Kitwood 1997 p 109)

Dementia Reconsidered

Questions?

04/15/2023 09:46:59 AM 85

Coffee Break

A Patient/Carer Story

Lyn Juffernholz Carer/patient representative

Developing our people – updates from the front lineDave Evans Quality Improvement Programme ManagerWest of England AHSN

Great Western Hospital , Swindon

1. Does your organisation already have a dementia training strategy in place?

Yes – Full training for all staff according to Health Education England tier 1 and tier 2 requirements.

2. What are you most proud of?

Our first dementia friendly ward (Jupiter Ward) refurbished according to the principles of the King’s Fund, Enhancing the Healing Environment work (opened November 2014).

OWLS pilot project – Outpatient Liaison and Welcome Service designed to support individuals with dementia and their carers when using our outpatient services.

Our advanced dementia training opportunities for staff including the SCOPE course (Specialist Care of Older Persons’ Essentials) which includes training in pain management, delirium, appropriate environments, challenging behaviour and end of life care for people with dementia; as well as our Closer Support training programme which provides staff with the appropriate skills to offer 1:1 support for patients with dementia who have special needs.

Great Western Hospital , Swindon (continued)

3. What areas require more attention?

A comprehensive dementia pathway encompassing both acute and community settings.Improving advanced care planning and end of life care for individuals with dementia.

4. What resource is currently dedicated to training for dementia care?

Dementia lead for training who coordinates the development, implementation and evaluation of dementia training.

Gloucestershire Hospitals NHS Foundation Trust

1. Does your organisation already have a dementia training strategy in place? Yes. A one day Dementia care face to face training day is part of the training programme for new Band 2 staff, a ½ day for new Band 5 staff. A Dementia care ½ day is part of the training programme for Unscheduled care Team. Trust bespoke Dementia e-learning level 1 for all staff( 5020) .Trust bespoke level 2(3145) Dementia care training for all patient facing staff. Trust bespoke Delirium e-learning for clinical teams( 2005) A Multi-professional one day Dementia Care training day is offered to all Trust staff. Trust Dementia Champion annual training and development programme. 7 Trust Lecturer Practitioners, a Practitioner with a lead for Mental Health and Dementia Care. Trust bespoke 2 day training programme for HCA’s who undertake one to one observational care ‘’specialing’’

Gloucestershire Hospitals NHS Foundation Trust (continued)

2. What are you most proud of?

- Trust resources support the care team in delivering good care- this aids the training plan - Our Trust Dementia Carers /Relatives survey - results are used to underpin training and to give an insight into ’’what does good Dementia care look like in our Trust ‘’ - Dementia Champions - role, website and team resource folder - Leadership and staff engagement, partnership working( County wide) - Health Education England training reporting Quarterly – TIER 1 training reporting( level 2 Trust e-learning)

3. What areas require more attention? - Strengthening application of the Mental Capacity Act in practice – our Trust wide action plan 2015 is in place

4. What resource is currently dedicated to training for dementia care? - The training plan as stated above and Clinical staff to support delivery of the staff training programme

North Bristol Trust

1. Does your organisation already have a dementia training strategy in place? Yes2. What are you most proud of? Compliance with both level 1 and 2 trainingMultiple types of training available with level 3 training about to be started through a series of modulesChampions conferences/ forums to keep them interested and informed

3. What areas require more attention?

Always trying to make the training as real as possible and relevant to target audience, this means that the trainers (all of us) need to have a very broad background so as to provide real life examples and be able to talk around the subject

4. What resource is currently dedicated to training for dementia care?Full time substantive post dementia trainer. Dementia nurse and medical leads also provide training formally and informally on a weekly basis, from all levels from medical student through consultants at Mandatory training, local GPs and Chief exec team, student nurses to Director of Nursing.

North Somerset Community Partnership

1. Does your organisation already have a dementia training strategy in place? Yes2. What are you most proud of?• Achieving the training CQUIN over 95% of staff having dementia awareness and over 50%

having dementia next steps (2014/15)• Undertaking and accessing Joint training with AWP Mental Health Day

3. What areas require more attention?• End of life and Dementia• Delirium• Behaviours that challenge – communication and dementia

4. What resource is currently dedicated to training for dementia care?• E-learning • Intranet webpage with direct resources to good website• 1 day per week Band 6 dementia trainer• Dementia Lead Band 7 - 3 days per week

Sirona

1. Does your organisation already have a dementia training strategy in place? Not sure that it does2. What are you most proud of?

The commitment of the teams and the enthusiasm for wanting to learn more to care for people with Dementia.Dementia Challenge fund has helped the Telehealth team and design ability to create some interesting and clever gadgets to help people with memory problems.

3. What areas require more attention?

We have a strategy in place, and have recently looked at an implementation plan. We have formed a strategy group and plan to have Dementia Champions in place very soon. We are also looking into the possibility of working towards accreditation of the residential homes.

4. What resource is currently dedicated to training for dementia care?We have a named lead in the Learning and Development team, who was responsible for basic awareness raising and for training and development of the teams in our residential units.

Bristol Community Health.

1. Does your organisation already have a dementia training strategy in place? (Yes, training matrix)2. What are you most proud of?Level 2 training engages our BCH specialist clinicians and partner organisations such as the Alzheimer's Society and The Carers Support Centre. The training aims to give practical advice and information to enable our clinicians to better support people who have dementia and their carers.Establishing Dementia Champions in each service/team has helped distribute leadership in Dementia Care and enabled case finding and assessment for people who have signs and symptoms of Dementia.Our Dementia Lead is a member of the Dementia HIT (Bristol Partners), and joint lead for the education work stream.

3. What areas require more attention? We are developing understanding and ability of staff to undertake an assessment of mental capacity. We have worked with our UWE colleagues to identify Dementia education at Level 3

4. What resource is currently dedicated to training for dementia care? 1.0 wte Safeguarding and Dementia Lead, with support from 1.0 wte Clinical Lead Nurse.

2gether NHS Foundation Trust

1. Does your organisation already have a dementia training strategy in place?

Yes, with annual review of target/objectives that is delivered against a 3 year strategy. This flexible approach has been key to ensuring that the training strategy is linked to dementia strategy priorities

2. What are you most proud of?

Joint commissioning and clinical leadership that has developed a partnership, county wide approach to improving dementia care through training & education

Consistent high quality delivery from the Dementia Education Nurse team Dementia Training & Education Strategy’s model of DLW & Leads Includes End of Life and Safeguarding strategies – MCA&DoLS Community Dementia Links and growing community networks using a strengths based

approach Intergenerational Dementia Project & BME links Commitment to dementia training and education has been maintained and developed since

2007 when it was introduced in care homes as a POPPS initiative.

2gether NHS Foundation Trust (continued)

3. What areas require more attention?

Sustaining workforce knowledge & skills training already deliveredPrevention – in widest sense; public health and crisisEvidence of improved outcomes for people living with dementia (in terms of the strategy or as a result of the training products or as a result of the roles)Links with higher education

4. What resource is currently dedicated to training for dementia care?

£125,000 from CCG recurring£80,000 from GCC (bid for annually and reduced from original match funding arrangement)

1. Does your organisation already have a dementia training strategy in place? Yes

Key Training Programme for HCA/NA staff leading to Dementia Certificate (Old NVQ now CQF)Dementia Care Pathway for Training and development for all relevant staffFour Dementia specific E-learning courses for all staffFour Dementia specific Face-to-face training days for all staff

2. What are you most proud of?

Begun to embrace Dementia Care Mapping within the trust having trained at least one member of staff within our Older adults Inpatients units across the trust. Forget me not centre, Swindon’s younger onset dementia service. Lynda Hughes, Occupational Therapist won the South West leadership award for her work in developing the centre.

3. What areas require more attention?

The appointment of a new consultant nurse for dementia care will allow us to further develop the current training and development needs for staff. This will look at further utilising and developing DCM within the trust for staff aspiring to becoming ‘mappers’ and those already qualified. Development of dementia specific clinical networks, dementia focussed clinical supervision ‘master classes’ for staff also. Development of clinical network for Dementia.

4. What resource is currently dedicated to training for dementia care?

Ongoing programme within Staff Training programmeCare home Liaison Teams offer training to domiciliary care providers and care home staff.

Joint Dementia Research

Ali HodgesClinical Studies Officer / NIHR CRN WE Join DementiaAvon and Wiltshire Mental Health Partnership

Lunch

A Quality Improvement Approach

Dave EvansQuality Improvement Programme ManagerWest of England AHSN

Driver Diagram

Driver Diagram

Driver Diagram

Driver Diagram for Dementia Training Strategy

Working together to develop solutions:Session 1

Workshop Exercise 1

4 groups to each consider:

1. The primary Drivers - are they correct?

2. The proposed measures – what would you change?

3. Feedback

Working together to develop solutions:Session 2

Workshop Exercise 2

4 groups to each consider 1 of the primary drivers to:

1. Develop some secondary drivers (actions to achieve the primary drivers) – and write them on the Driver diagrams

2. Feedback

SPACE Principles

1. Staff who are skilled and have time to care2. Partnerships working with carers3. Assessments and early identification4. Care that is individualised5. Environments that are dementia friendly

Review and Next Steps

1. Review and Next Steps

2. Evaluation

THANK YOU