Royal College of Psychiatrists

The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the United Kingdom. The Royal College of Psychiatrists is committed to improving the understanding of psychiatry and mental health. We want there to be a greater understanding of the interaction between mental and physical health and the social and cultural context in which people live. We are at the forefront in setting and achieving the highest standards through education, training and research. We lead the way in developing excellence and promoting best practice in mental health services. We promote research and publish the results in our world-class psychiatric journals.

Updated:
10 February 2016
Location:
National
Sectors:
Membership Organisations

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

Faculty of Psychiatry of Old Age, of Royal College of Psychiatrists, since its inception as a Section in 1978 and Faculty in 1988, has been a forerunner in maintaining standards of service for mental health service for older people and improving education and training of doctors in training. The Faculty takes primary responsibility within the College for formulating policies on psychiatric services to older people and giving advice to other bodies (including the Department of Health) on matters pertaining to the mental health of older people.

The College seeks advice on matters of public interest from its consumer group represented by Alzheimer's society, AgeUK, Mind, Users (patients) and Carers. Faculty always acted as an advocate for older people through its links with Department of Health, Parliament and public media. Few examples are presentation in the Parliament on Age discrimination, representation to NICE against its Technical appraisal of anti dementia drugs, delivering to evidence to various parliamentary committees, expert evidence to Department of Health's consultations etc. Faculty also strongly supports the Fair Deal and anti Stigma campaign (RCPsych). 

Old Age Psychiatrists are mainly responsible in the diagnosis and medical treatment of people with dementia, as well as leading Community Mental Health Teams, and providing inpatient services for people with behaviours that challenge.  We make sure that highest quality standards are maintained in doing so and support others to deliver better quality care. We also can help to diagnose dementia early and advice on post diagnostic services through accreditation of Memory clinics. We are committed to improve standards of care through involvement in general hospitals, through old age hospital liaison services, in care homes, and Primary Care, not only in terms of assessment and management of people with dementia in these settings, but also in our liaison, training and support role to other professionals working there.

It also contributes fully to the College's other activities in maintaining training standards, research, public education and other areas. It has strong ties with other similar organisations and Royal colleges. In particular, The Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI) aims to raise the standard of care that people with emotional or mental health needs receive by helping providers, users and commissioners of services assess and increase the quality of care they provide. More than 90% of mental health services in the UK participate in the work of the CCQI.

Several CCQI projects work on improving care for older people and people with dementia:

AIMS is a standards-based accreditation service designed to improve the quality of care in psychiatric wards, and has dedicated standards for older people’s wards.  For more information: aims@rcpsych.ac.uk

 Memory Services National Accreditation Programme (MSNAP) is a standards-based accreditation programme designed to improve the quality of care received by people with memory problems/dementia (specifically focusing on the process around the assessment and diagnosis of memory problems/dementia). msnap@rcpsych.ac.uk

 Psychiatric Liaison Accreditation Network (PLAN) works with services to assure and improve the quality of psychiatric liaison in hospital settings, from referral systems, to meeting emergency and routine mental health needs.  plan@rcpsych.ac.uk

 The Enabling Environments Award is a quality mark given to those who can demonstrate they are achieving an outstanding level of best practice in creating and sustaining a positive and effective social environment. EEmail@rcpsych.ac.uk

The Quality Mark for Elder-Friendly Hospital Wards is a subscription-based quality-improvement programme for individual hospital wards in the acute setting. The process focuses on the quality of essential care provided for people over the age of 65 admitted to hospital.  qualitymark@rcpsych.ac.uk.

The National Audit of Dementia is working with hospitals providing general acute inpatient services to measure criteria relating to care delivery which are known to impact on people with dementia admitted to hospital.  nad@rcpsych.ac.uk

Together with partner organisations e.g. British Geriatric Society, Royal College of Physicians, Royal College of General Practitioners, Nursing and Midwifery Council, Alzheimer's Society/Alzheimer's Scotland etc. we will raise awareness of the importance of symptoms of dementia, and advocate for rights of people with. Working with GPs and other commissioners we will encourage early diagnosis and care and referral to specialist services.  We will fully involve the person with dementia and their carer in the decision making process.  We will become closely involved with governmental committees and seek to improve funding for clinical services and research at national and local levels.

 

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

We recognise the development of a curriculum for dementia training (our core curriculum for medical training has been accepted by PMETB).  We will ensure that psychiatrists are trained in dealing with all aspects of dementia and train them in team working and team building to ensure the best possible care is delivered.  We are committed to involve our Consumer group with representatives from voluntary organisations, users and carers in developing this curriculum and examinations. At individual level it is important to eradicate stigma of dementia and other mental illnesses. It is also equally significant to work with other psychiatrists and physicians to remove stigma of dementia and old age in medical profession and also to raise their expertise to diagnose and treat dementia. We are aware of bottlenecks in the pathway of treatment of a person with dementia throughout the course of their illness. We highlight the growing elderly population, increase in people with dementia and significant lack of funding to meet their demands for treatment, care and support, compared to general adult psychiatry and other medical specialities.

Member contacts

www.rcpsych.ac.uk/‎

2. Actions

  • Identify and promote examples

    Identify and promote examples of good service delivery across the UK. 

    Status:
    Implementation

    2012 - Third Quarter Update

    Nothing to report

    2012 - Second Quarter Update

    Nothing to report

    2012 - First Quarter Update

    Progress: Members are encouraged to highlight and promote good service delivery and this discussed in the Executive committee and consumer forum Working Group set up of Old Age Faculty Executive Members Poster organised for residential meeting in March to encourage reporting of examples of good service delivery.

  • Reduction of age discrimination

    Continue to work on the reduction of age discrimination which is particularly marked in the field of mental health.

    Status:
    Delivery

    2012 - Third Quarter Update

    Nothing to report

    2012 - Second Quarter Update

    Nothing to report 

    2012 - First Quarter Update

    Progress: Contribution to policy making through meetings of the Executive Council of the Royal College of Psychiatrists.

  • Development of a national research agenda

    Contribute to the development of a national research agenda incorporating longitudinal studies of ageing, improved recruitment of research participants, and evaluation of secondary prevention strategies for people with current dementia, improved recognition and management of behavioural and psychological symptoms, improved research in care homes and promoting a research culture amongst non-specialist workforce

    Status:
    Implementation

    2012 - Third Quarter Update

    Nothing to report 

    2012 - Second Quarter Update

    Nothing to report 

    2012 - First Quarter Update

    Progress: Contact made with Directors of DeNDRoN, Scottish Dementia Clinical Research Network and equivalent networks in Wales and Northern Ireland.

  • Support and evaluate progress

    Support and evaluate progress on the English and Scottish Dementia Strategies and help refine future service developments as a consequence

    Status:
    Implementation

    2012 - Third Quarter Update

    Nothing to report 

    2012 - Second Quarter Update

    Nothing to report 

    2012 - First Quarter Update

    Progress: we are attempting to identify areas of new practice. This is achieved by the Faculty and by the College Divisions through out England (ongoing)

  • Support our members

    Support our members in delivering the National Dementia Strategy, the NICE Guideline on Dementia and the NICE Quality Standards to improve standards of care

    Status:
    Implementation

    2012 - Third Quarter Update

    Nothing to report

    2012 - Second Quarter Update

    Nothing to report 

    2012 - First Quarter Update

    Ongoing

  • Formal personal links

    Set up formal personal links with other professional organisations to ensure coherence of service planning and the planning of educational and training programmes

    Status:
    Implementation

    2012 - Third Quarter Update

    Nothing to report 

    2012 - Second Quarter Update

    Nothing to report 

    2012 - First Quarter Update

    Progress: Meeting with Chief Executive of Alzheimer Society and AlzheimerScotland. Meeting with Alistair Burns, National Clinical Director

  • College report on Psychiatric Services for Black and Minority Ethnic Older People

    Work to promote the recommendations of our College report on Psychiatric Services for Black and Minority Ethnic Older People

    Status:
    Delivery

    2012 - Third Quarter Update

    Nothing to report 

    2012 - Second Quarter Update

    Nothing to report 

    2012 - First Quarter Update

    Progress: Meeting with Chief Executive of Alzheimer Society and Alzheimer Scotland. Meeting with Alistair Burns, National Clinical Director

  • Consumer Forum

    Expand the role of our well established Consumer Forum to ensure more widespread input of the views of people with dementia and carers particularly into training programmes.

    Status:
    Implementation

    2012 - Third Quarter Update

    Nothing to report 

    2012 - Second Quarter Update

    Nothing to report 

    2012 - First Quarter Update

    Nothing to report

  • Improve quality standards

    To improve quality standards of Memory clinics through national accreditation service and dementia wards through AIMS accreditation service.

    Status:
    Implementation

    2012 - Third Quarter

    Nothing to report

    2012 - Second Quarter

    Nothing to report

    2012 - First Quarter

    Progress: Meeting on the 16 July to discuss UK wide remit of this group.

    A training curriculum in Old age psychiatry was approved by PMETB and Consumer forum has agreed to participate and offer help in the training of Psychiatric trainees

    MSNAP Report received on the 16 February.

    A National Dementia audit is planned in General Hospitals by RCPsych to identify deficiencies in current service and promote good practice. Pilot is completed and full report is expected in Summer 2011.

  • NAD E-bulletin - Sharing practice to improve care for people with dementia

    Identify and promote examples of good service delivery across the UK.

    Status:
    Completed

    2015 - First Quarter Update

    At the College Centre for Quality Improvement (CCQI), the National Audit of Dementia (NAD) produced a one off e-bulletin at the end of the second round of audit. The purpose of the e-bulletin was to follow up on hospital action plans to share good practice and innovative ideas.

    NAD contacted more hospitals in 2015 who were keen to share further articles as well as update us on the progress and positive changes that have taken place, to ensure that improvements are made to the care provided to people with dementia. The e-bulletin for 2015 is available at: www.nationalauditofdementia.org.uk

  • National Audit of Dementia (NAD) - Third round of audit

    To measure criteria relating to care delivery, which are known to impact on people with dementia admitted to hospital. Criteria include policies and governance in the hospital that recognise and support the needs of people with dementia, elements of comprehensive assessment, involvement of carers, discharge planning, and identified changes to support needs during admission. NAD have been awarded a three year contract (2015 - 2017) to manage the third round of the audit, commissioned by Healthcare Quality Improvement Partnership (HQIP) and funded by NHS England and the Welsh Government.

    Status:
    Being implemented

    2015 - Second Quarter Update

    We are currently developing the methodology, standards and tools for the pilot phase and feasibility study. We hope to share and test the newly developed tools with participating sites before the third quarter. Sharing and testing the tools enables the audit to identify the necessary amendments required before data collection commences. For more information on the development of the methodology and audit tools, please see the NAD action plan on ‘audit standards, sampling and development of tools’.

    2015 - First Quarter Update

    The NAD pilot phase is currently in process and it aims to test the changes (structure and methodology) made to the main audit. A parallel pilot called the feasibility study is also underway and the aim of the feasibility study is to examine the inclusion of community hospitals in the main audit.

    Recruitment - Ten acute hospitals have been recruited for the pilot phase and five community hospitals have been recruited for the feasibility study, across England and Wales. Hospitals were recruited based on their size and location to ensure that feedback is gathered on different types of organisations and catchment areas.

    Registration for the main audit is now open and eligible sites across England and Wales can complete an online registration form to participate in the main audit and feasibility pilot.   

  • NAD3 (pilot phase) - Audit standards, sampling and development of tools

    For the third round of NAD new tools and methods of identifying the sample will be developed. During piloting, feedback will be gathered from hospitals to ensure that they produce good quality data when implemented in the main audit in 2016. The pilot phase will aim to:

    1. Reduce the burden of data entry by shortening the case note audit tool and simplifying online data entry

    2. Develop an organisational checklist with more emphasis on actions taken

    3. Develop a carer survey for carers of people with dementia, focusing on quality of communication and perceived care standards

    4. Develop a staff survey with a focus on staff's experience of training and support.

    Status:
    Being implemented

    2015 - Second Quarter Update

    Sampling methodology – The sampling methodology for the pilot study is currently in development. Since previous rounds of audit have highlighted inconsistencies in ICD10 coding for dementia diagnoses, the pilot phase will trial use of the National Dementia CQUIN in addition to ICD10 codes to help generate a larger and more consistent sample. Using a two stage sampling process will allow for comparability with samples identified in previous rounds of audit.

    Audit tools – As a result of the standards review, the case note audit has been simplified and shortened and we are currently in the process of finalising the content for both the case note audit and the organisational checklist.  

    Staff and community site workshops are currently being carried out to aid the development of the staff survey and feedback from the workshops is being collated to help develop methods of distribution for the carer survey.

    2015 - First Quarter Update

    Audit standards – The first draft of the audit standards for the third round of NAD has been produced.  To maintain comparison with previous rounds of NAD, standards which remain from the previous rounds have undergone minimal changes to allow for comparability. Standards which have been excluded from this round have been removed due to data quality issues or because they have been replaced by more up-to-date information. 

  • NAD3 (pilot phase and feasibility study) - Data collection, analysis and reporting

    Shortly before data collection commences, the newly developed tools will be available to the participating pilot sites. Data collection for both the pilot phase and feasibility study is expected to begin in August and conclude in November 2015. Data collected from the pilot phase and feasibility study will not be made publically available or published. Each participating site will receive a local report at the end of pilot/study period. The commissioner of the audit (HQIP) will be sent an overall report containing results from the pilot/study as well as possible next steps.

    Status:
    Planning

    2015 - Second Quarter Update

    Content to be finalised

    2015 - First Quarter Update

    Date collection scheduled and confirmed with pilot sites