Quality and Excellence in Specialist Dementia Care (QESDC): baseline one-off self-assessment tool and reporting arrangements

NHS Boards undertook a one-off baseline self-assessment of current practices in all specialist dementia care settings to meet the needs of Commitment 11 and address the issues raised in the Mental Welfare Commission report 'Dignity and Respect: dementia continuing care visits'. This report summarises those self-assessment returns to identify common areas of practice.

Outcome 9. Workforce planning and development

People with dementia are cared for by staff who are knowledgeable, competent and accountable for the care they deliver. A clinical and care governance framework is in place to underpin the quality improvement agenda and safeguard high standards of care. Staff are aware of relevant legislation, national standards and key strategies that support this framework. People with dementia have access to high-quality general medical care.

The Promoting Excellence Framework provides the infrastructure against which staff knowledge and competency levels are assessed and supported. The boards are using the framework to ensure all grades of staff have the appropriate competences to match their level of involvement with people with dementia and their carers, with education opportunities ranging from induction training, through ward-based and in-service activities, to postgraduate study.

All NHS Forth Valley staff, including junior doctors, nurses, allied health professionals and hotel-service staff, are provided with basic training in dementia and delirium that includes the board's Butterfly Scheme (an opt-in scheme for the support of people with dementia). A workforce plan for Promoting Excellence is being developed, with a pilot programme of dementia education at Dementia Informed Practice Level being rolled out to over 500 staff. In addition, the Values-based Reflective Practice approach to caring for people who have dementia has now been introduced to training days.

The intention in Clisham Ward in NHS Western Isles is to address Promoting Excellence through practice education facilitators' priority training days. The proposed programme will allow for all registered staff to be trained to Dementia Skilled Practice Level, with Enhanced and Expertise-level education being driven by staff in the ward.

All appropriate staff in NHS Grampian undergo a training programme aimed at delivering the Promoting Excellence Framework. New staff are required to undertake Informed Level training as part of their induction and a plan is in place to enable local nursing students to also complete this level as part of their programmes. Training is embedded in induction programmes and the Knowledge and Skills Framework (KSF) through e-KSF appraisal. A high percentage of healthcare support workers have completed the Best Practice in Dementia course, supported by ward-based facilitators trained at Stirling University. Other staff groups are actively involved in professional development activity through processes such as e-KSF, forums, workshops, in-house training delivered by experienced staff and postgraduate study.

Supervision options are discussed at staff meetings and staff are encouraged to make use of them. NHS Grampian has recently refreshed its policy on clinical supervision and a steering group has been tasked with liaising with the Clinical Effectiveness Team to discuss the feasibility of undertaking an online survey and audit of personal objectives relating to clinical supervision, to be undertaken during 2015.

The e-KSF also features strongly in training initiatives in NHS Lothian, where staff members' personal development plans are mapped to the Promoting Excellence Framework to ensure all are evidencing their competences at the appropriate level. This also helps to ensure staff have clear guidelines on the expectations of working with people with dementia.

An analysis of dementia-specific training in the board suggested, however, that the training had been pitched at a lower level than would be expected for staff working in wards whose primary role was providing care for people with dementia: it was at Skilled, rather than Enhanced, Level. The aim now is to look at developing a pan-Lothian programme to provide training at appropriate levels. While staff induction programmes in the board do not currently feature dementia awareness, such sessions do form part of the newly qualified practitioner programme.

All NHS boards are now mandated by the Scottish Government to use the suite of tools provided by the Nursing & Midwifery Workforce & Workload Planning Programme (NMWWPP) to plan and deploy their nursing establishments. An example of this in action is provided by NHS Lanarkshire's mental health service, which has undertaken two inpatient workforce planning exercises in line with the triangulation approach advocated by the NMWWPP.

The NMWWPP commissioned a national run of the Mental Health Nursing Workforce Planning Tool across all mental health wards in 2014. NHS Lanarkshire submitted data to the Scottish Government as part of this process and local analysis and senior professional judgement has been applied to develop a proposed future resourcing model, building on previous improvements in skill-mix and numbers in inpatient wards for people with dementia in the board area. Nursing establishments will in future reflect the complex care needs of patients in these wards and will support increases in therapeutic activities, assessment and individualised patient care.


Email: Ian Roxburgh

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