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South Tees Hospitals NHS Foundation Trust

South Tees Hospitals NHS Foundation Trust is the largest hospital trust in the Tees Valley serving the people of Middlesbrough, Redcar and Cleveland, Hambleton and Richmondshire and beyond.

Updated:
8 October 2015
Location:
North East
Sectors:
Communication, Finance, Pharmaceutical, Health, Care, Hospitals and Hospital Trusts, Research Sector, Transport Sector

1. Action Plan

1. The National Dementia Declaration lists a number of outcomes that we 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? 

This action plan represents our formal commitment and ambition to improve care, outcomes and services for patients with dementia, their families and carers. We believe passionately that our patients are central to everything that we do, and this philosophy underpins our plans to improve dementia services. However, we cannot achieve sustainable change in isolation. We are committed to working with our local and national partners, and to share our experiences of delivering large scale change. We recognise that our biggest resource is the commitment and passion of our staff and we will work creatively with them to engage and embed service improvements that transform care for patients with dementia. 

Our key actions: 

  • Our workforce will be skilled and effective, able to care for patients with dementia effectively and compassionately.
  • We will develop pathways of care and patient-centred care plans for all acute admissions until discharge or end of life.
  • Our environments of care will support and engage people with dementia when in our hospitals.
  • We will work collaboratively with our community and social care partners to identify and assess cognitive impairment, ensure rapid discharge and continued effective care.

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

The clinical and organisational changes we propose are interdependent and complex. Our main challenges will include: 

  • Ensuring dementia is seen by all as a key priority.
  • Changing the culture across the organisation to one where patients and their life stories are central to the care-planning process and delivery.
  • Engaging local partners to work collaboratively to achieve change
  • Releasing staff to undertake dementia training
  • Resourcing environmental changes and dementia-related services in the current funding climate
  • Meaningfully evaluating and measuring our success
  • Empowering patients and carers to give us honest feedback and making that meaningful to staff. 

2. Actions

  • Dementia programme board

    A dementia programme board has been initiated and includes representatives from South Tees Hospitals NHS Foundation Trust and local partners and commissioners. This programme board will act as a strategic overseeing group.

    Status:

    First Quarter

    In progress

    Second Quarter

    In progress

  • Dementia project manager

    A dementia project manager has been appointed for 12 months (September 2012) with the primary aim of co-ordinating and overseeing the development of a South Tees Foundation Trust Dementia Strategy in line with the Prime Minister Challenge, Counting Cost report, the DAA Call to Action and CQUIN’s.

    Status:

    First Quarter 

    In progress

    Second Quarter 

    In progress

  • Process for assessment

    A clear process for assessment, referral and diagnosis for patient over 75 has been agreed through local partnership working, and this will launch October 2012 to meet the CQUIN.

    Status:

    First Quarter

    In progress 

    Second Quarter

    In progress

  • Process for assessment

    A clear process for assessment, referral and diagnosis for patient over 75 has been agreed through local partnership working, and this will launch October 2012 to meet the CQUIN.

    Status:

    First Quarter

    In progress 

    Second Quarter

    In progress

  • Dementia project

    The dementia project has been successfully aligned to the NHS change model and this will underpin all aspects of the strategy and compliment other strategic projects currently being undertaken by South Tees as part of QIPP programme such as the transforming community services project.

    Status:

    First Quarter

    In progress

    Second Quarter 

    In progress

  • Six work streams

    Six work streams have been established and each has a nominated lead with proven leadership skills. The work streams will utilise existing service improvement methodology to implement, deliver and measure clinical changes and service improvements. Membership of each work stream is reflective of the complexity and interdependence of effective evidence based best practice for patients with dementia in acute care.

    The work streams are:

    • Skilled and effective workforce, 
    • Assessment / early diagnosis and care planning 
    • Safeguarding 
    • Partnership working 
    • Environments of care 
    • Information 

    The work streams have been aligned to the five commitments contained within the Call to Action and demonstrate the Trust’s willingness to become dementia friendly by 2013. 

    South Tees will undertake the self assessment tool produced to complement the Call to Action and this will act as a gap analysis and inform actions/ interventions that will form the majority of the work to be commissioned and delivered by the work streams. 

    Status:

    First Quarter 

    In progress 

    Second Quarter 

    In progress

  • Work streams leads

    The work streams leads will report progress to the strategic programme board.

    Status:

    First Quarter

    In progress 

    Second Quarter 

    In progress

  • Establish a web-based forum

    We intend to establish a web-based forum for professionals and for patients and carers using social media as the platform.

    Status:

    First Quarter

    In progress 

    Second Quarter 

    In progress

  • Establish and foster relationships

    We will establish and foster relationships between all relevant local partner organisations such as GP’s, commissioners, clinicians and case managers, social care, volunteers and carers to engage them within the service improvements and clinical changes process.

    Status:

    First Quarter

    In progress 

    Second Quarter

    In progress

  • Partnership with our local Mental Health Trust

    We will produce in partnership with our local Mental Health Trust patients’ and carer information that is relevant, concise and sign posts local sources of help and support.

    Status:

    First Quarter 

    In progress 

    Second Quarter

    In progress

  • Work streams to produce business cases

    Work streams will be encouraged to produce business cases for environmental improvements that can be submitted to the board / management group for consideration.

    Status:

    First Quarter

    In progress 

    Second Quarter 

    In progress