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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 2. Person-centred care

Ensure that all care is person-centred and that care is developed with the involvement of the person with dementia, their family and their carer, if appropriate.

The "Getting to Know Me" documentation and wider approaches to life-story work are being used commonly across boards. All specialist dementia wards in NHS Forth Valley, for instance, use person-centred assessment and care planning processes that include the use of "Getting to Know Me" documentation, which encourages family and carer participation in completing the documents with patients and ensures patients' views and wishes are at the heart of care-planning. More in-depth processes for life-story work are currently being considered for patients in specialist dementia wards.

In NHS Borders, life histories are well underway in one of its two facilities for people with dementia. These are completed by the patient's named nurse with input from carers and significant others, which can prove challenging at times: skilled interventions are required to support carers in what can be an emotional experience. Person-centred care plans continue to be developed in both wards areas, with "This is Me" documentation being completed for each patient in the second unit.

All units in NHS Grampian aim to have life-story work initiated within the first week of admission, using the "Getting to Know Me" booklet as a starting point. The Mental Welfare Commission commented in September 2014 that: "Life stories were completed for all patients on the wards. Some of these documents contained a large amount of information which could be used to guide care and management of patients. This reflected the efforts of staff to develop knowledge about the patients in their care."

Examples of the wide range of person-centred approaches being adopted in boards include:

  • all patients in units in NHS Grampian having a therapeutic activity care plan with information derived from the patient (where possible), family/carers and life-story work
  • two dedicated activities nurses in the ward in NHS Western Isles to ensure that appropriate activities are provided for each patient
  • the use of nursing assessments in NHS Ayrshire & Arran undertaken in partnership with the patient and family/carer (if appropriate and possible) to provide a systematic and consistent approach to ensuring safe and effective multidisciplinary care-planning from initial assessment to discharge
  • the establishment of a multidisciplinary steering group in NHS Lanarkshire with representation from social work and voluntary agencies that links into the board's wider commitments under the Scottish Government's Person-centred Health and Care Programme
  • a review of nursing care plans in NHS Forth Valley to ensure they incorporate person-centred care principles
  • continuous review of the quality of person-centred care in NHS Lanarkshire through methods such as the Scottish Recovery Indicator 2 and ongoing action plans, ward-based clinical governance groups, record-keeping audits and dementia care-mapping.

Training also plays a big part in boards' approaches to promoting person-centred care. In NHS Lanarkshire, for instance, all staff working in the board's admission wards for patients with dementia and associated care homes are in the process of taking training to ensure they are working at the Enhanced Dementia Practice or Expertise in Dementia Practice Level of the Promoting Excellence Framework,[5] regardless of profession or banding. A focus on a person-centred approach to care is considered fundamental to current and future training. And NHS Greater Glasgow & Clyde has undertaken awareness-raising education and training as appropriate on key policy, standards, guidance and recommendations on dementia.

The importance of spiritual, cultural and religious preferences and people's individual value systems in providing significant information for the development of person-centred care planning seems to be recognised. Person-centred care plans in NHS Lothian demonstrate that staff are fully aware of people's spiritual and religious needs and that the views and wishes of people with dementia are taken into account in care-planning. In NHS Forth Valley, values-based care planning is being rolled out across the board area. The principles of person-centred care using the five "must-dos" are being implemented in older people's services, with a strong focus on "who matters to me", "what matters to me" and engaging with carers and families.

NHS Forth Valley is also the first Scottish board to take part in the Macmilllan Values-based Standard Programme, which defines eight moments that patients and staff say matter most to them. The moments are grounded in dignity and respect and embrace behaviours that encourage patients' involvement in decisions on their own care. While primarily developed for people with cancer, the board is currently piloting the programme in specific areas, including a community hospital ward that provides care for patients with dementia.

Contact

Email: Ian Roxburgh

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