Thursday, 16 April 2015

How can the NHS improve dementia care

How the NHS can improve care for dementia patients
Treating people with dementia costs the health service £4.3bn a year, the illness currently affects more than 800,000 people


David Cameron gave a commitment that all NHS staff will be required to undergo training in dementia.

There are over 800,000 people living with dementia in the UK and numbers are expected to double within 30 years. Yet, despite the push for better dementia care, education and training in dementia for healthcare professionals remains patchy.

This gap in training is caused by a fixation on a “hospital only” model, instead of addressing the shift towards community care, according to the Dementia today and tomorrow report (pdf) for the Alzheimer’s Society. The document, published in February, calls for targeted initiatives so that appropriate education and training is provided for all staff across the NHS and social care.

Jeremy Hughes, chief executive of the Alzheimer’s Society, describes three tiers in dementia training. The base level is having better awareness for everyone in the NHS. To this end, the society has been working with the health service on a customised version of its Dementia Friends public awareness programme. 


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He commends Barbara’s Story, a film produced by Guy’s and St Thomas’ NHS foundation trust. The 33 minute “soap opera”, already viewed by more than 12,500 NHS staff, is seen from the perspective of a patient with dementia and reveals her bewildering, confusing and sometimes frightening experiences of the healthcare system.

“It’s incredibly powerful,” says Hughes. “It’s a wonderful example of how you can convey the message to staff in a very poignant but not patronising way. And Guy’s has been making it available for other NHS trusts around the country to use.”

Meanwhile a joint initiative by Unison and the Open University is delivering dementia awareness workshops aimed at all levels of staff. The workshops are typically initiated by a Unison rep who works with the employer to organise the venue and publicity. An Open University tutor is funded by Unison to lead sessions, which include presentations, film clips, printed resources and group discussions.

Helga Pile is a national officer in Unison’s health group. She says the Queen Elizabeth hospital in King’s Lynn has delivered several of the workshops, following a Care Quality Commission inspection which identified problems in dementia care at the hospital. “The workshops have been very well received and lots of members say that they really want something like this,” she says. 

Hughes is confident that the base level of training is improving; likewise the top level training for geriatricians and others who have direct clinical expertise in dementia. The difficulty is the middle level where staff have clinical engagement with patients with dementia, but are not specialists.

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“These are people like the consultant working with somebody who may be in hospital because of orthopaedics, or an infection, but who also has dementia; or it’s the GP who has a patient who has dementia alongside other comorbidities,” he says.

In February prime minister David Cameron gave a commitment that all NHS staff – some 1.3 million people ranging from porters to surgeons – will be required to undergo training in dementia. The response has be mixed, however.

Royal College of Surgeons council member Scarlett McNally cautions: “While this initiative will raise awareness about dementia, any new NHS training package will need to be carefully planned and tested, as a ‘one size fits all’ package may not offer value to staff with very varied experiences.”

There are concerns too at the exclusion of 1.6 million social care staff who are increasingly expected to deliver services for people with dementia with little, or no, training.

Pile sees this as the elephant in the room: “When we talk to our members they describe how distressing it is when you haven’t got any experience or knowledge about dementia to try and go into people’s homes and not understanding why they might be behaving or responding as they do.”

Another issue is that there will be no extra money. “Local authorities have had 40% cuts to their budgets and they’re going to say they could not possibly deliver, or expect their providers to deliver this, without additional funding,” says Pile.


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Hughes says: “Our view is that it’s not a problem with the care home managers, but that commissioners are strapped for cash and aren’t giving sufficient fee levels to allow care home operators to provide training courses, and give people the time off for the training they need.”

He argues for separate funding, aside from the individual commission fee per patient, to help care home and domiciliary care operators to train staff in dementia.

Suzanne Rastrick is NHS England’s chief allied health professions officer. She thinks commissioners – local authorities or clinical commissioning groups – should include dementia training in their contracts. “For the provider it would be about demonstrating that they offer a quality service, and for the workforce it’s about giving them confidence in dealing with people with dementia.”

The Department of Health has given NHS organisations until 2018 to up their dementia training game. How optimistic is Hughes that this will be achieved? Hard facts will win through in the end, he believes. Indeed the Alzheimer’s Society’s latest Dementia UK update shows that the total annual cost of dementia is £26.3bn, with the NHS picking up £4.3bn and social care £10.3bn.

“People are increasingly recognising that it’s a false economy to have fully trained staff who don’t know enough about dementia and then patients who are admitted to hospital unnecessarily because the care home staff don’t understand what to do,” Hughes says.



Until the Government fully accepts that dementia, is a group of illnesses and not just one, we will never get anywhere.

For some reason Mr Cameron thinks that, there is only one form of Dementia, and therefore, if you have been trained in it, you know it all there is to know

Just how wrong can he be?

It is well documented that there are over 120 variations of this illness, so is he in all honesty, expecting all staff to be fully trained, in every aspect of the illness. 

Where will the time and money come from, to train all of these staff, or us he expecting the staff to train in their own time. 

This is one illness where one size does not fit all. 

We are all individuals, with individual problems and symptoms.

The NHS is now stretched and many trained staff are leaving, because of the added stress and pressure from this government.  

Many feel that they have been pushed to the limit, and by adding this, he is going to cause extra work and strain on the workforce

   

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