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St George’s Healthcare NHS Trust

With nearly 8000 dedicated staff caring for patients around the clock, we are the largest healthcare provider in southwest London. Our main site, St. George's Hospital in Tooting - one of the country's principle teaching hospitals - is shared with St. George's, University of London, which trains medical students and carries out advanced medical research. St. George's Hospital also hosts the St. George's, University of London and Kingston University Faculty of Health and Social Care Sciences, which is responsible for training a wide range of healthcare professionals from across the region. As well as acute hospital services, we provide a wide variety of specialist care and a full range of community services to patients of all ages following integration with Community Services Wandsworth in 2010. St. George's Healthcare serves a populations of 1.3 million across southwest London. A large number of services also cover significant populations from Surrey and Sussex, totalling around 3.5 million people.

13 May 2014
Health, Hospitals and Hospital Trusts
Local Alliances:
Merton Dementia Action Alliance

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?

St George’s Healthcare NHS Trust is committed to offering the highest standard of care to all our service users, including those with dementia and their carers. With regard to in-patient episodes, we must ensure that:

  • We identify dementia and delirium appropriately.
  • Our patients are cared for by the right number of appropriately trained staff.
  • Our policies and practices maintain patient safety at all times, enhance a stay in hospital and do not cause distress.
  • We involve carers as much as possible in the healing process in hospital and in discharge planning.
  • We work collaboratively with social care providers to ensure that patients have a timely discharge from hospital to a safe environment.
  • We seek feedback from patients and carers so that we can continuously improve the quality of our services.

To drive these objectives forward we established a dementia strategy group in 2011, chaired by the dementia clinical lead, with multi-professional and multi-agency representation.

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

  • There is a risk that time and energy are diverted towards those aspects of care that are financially incentivised. Thus, we must ensure that we don’t just focus on dementia CQUINs but take a broader look at how to make our services more dementia friendly.
  • As one of the largest acute trusts in the country, rolling out dementia training to several thousand employees requires a dedicated training programme and we must ensure that this is adequately resourced.
  • We do not have complete control over admissions e.g. A&E attendances, or discharges which depend on input from social care providers.

2. Actions

  • The environment in which care is given

    • We will review the physical environment of the hospital and look to integrate dementia friendly features into the redesign of our elderly care wards.
    • We will study our local results and the national recommendations from the 2012 National Audit of Dementia in order to further improve processes of care for patients with dementia and their carers.
    • We will continue to grow our research activity in dementia so that our patients can benefit from the latest advances in diagnosis and treatment.
    • We will continue to develop specialist services for patients with dementia and other cognitive disorders, consistent with our role as a regional neuroscience centre.

    2013 - Fourth Quarter Update

    New member

  • The knowledge, skills and attitudes of the workforce

    • We held a dementia study half day in January 2013 attended by 50 professionals from St George’s Healthcare NHS Trust and partner agencies including Wandsworth social services, the local Alzheimer’s Society and mental health trust.  We aim to repeat this in 2014 and on a yearly basis thereafter.
    • We will develop web-based dementia awareness training for all staff groups at corporate induction and deliver this for existing staff on a three yearly basis.
    • We have an action plan to deliver enhanced dementia training to doctors, nurses and allied health professionals who work in areas of the Trust where there are significant numbers of older patients.
    • By adopting the Butterfly scheme we recruited 45 dementia Butterfly champions across the organization.  During 2013/14 we will recruit further champions.
    Delivery, Planning

    2013 - Fourth Quarter Update

    New member

  • The ability to identify and assess cognitive impairment

    • We have introduced a mandatory dementia and delirium assessment for all patients aged 75+ who are admitted to hospital as an emergency.  We audit compliance with this on a monthly basis. 
    • We screen all elective surgery patients age 75+ for cognitive impairment at pre-admission assessment. 
    • We have adopted the Butterfly scheme for in-patients with dementia and will be working to embed it on all wards during 2013/14.
    Delivery, Implementation

    2013 - Fourth Quarter Update

    New member

  • The ability to support people with dementia to be discharged back home

    • We have a Trust policy on discharge planning which includes assessment of personal needs, methods of communication, home circumstances, normal functional levels, care network and carer needs. Compliance with this is audited regularly.
    • We are contributing to a Wandsworth dementia services directory that will be available to all service users and their carers.
    • We have four community wards made up of a multidisciplinary team including community matron, advanced nurse practitioner and a GP. The community wards are particularly appropriate for people with dementia as their aims include reducing the risk of repeat hospital admission and caring for people with complex health and social care needs.  We will work to ensure that they are actively involved in the discharge process and help accelerate this as appropriate.

    2013 - Fourth Quarter Update

    New member

  • The use of a person-centred care plan which involves families and carers

    • We have worked collaboratively with Wandsworth social services to develop a dementia passport.  We will remind staff to make full use of this document in care planning, to issue passports to patients who don’t have one and to assist patients and carers in filling them out prior to discharge or following a diagnosis of a dementia in an out-patient setting.
    • During 2013/14 we will start regularly collecting feedback from family carers of in-patients with dementia on the quality of care we offer.

    2013 - Fourth Quarter Update

    New member