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London North West Healthcare NHS Trust

London North West Healthcare NHS Trust manages Northwick Park and St Mark’s hospitals in Harrow, Central Middlesex Hospital in Park Royal and Ealing Hospital. We care for more than half a million people living across Brent, Harrow and Ealing as well as patients from all over the country and internationally at St Mark’s, our specialist hospital for bowel diseases. This makes us one of the biggest and busiest NHS trusts in the capital. We employ more than 4,300 doctors, nurses, therapists, scientists and other health professionals as well as administrative and support staff who, together care for over 134,300 people who are admitted to the Trust each year. In 2013/14, 48,426 patients over the age of 65 were admitted to the Trust. We are aware that across Brent and Harrow, around 5000 people will have dementia and just thirty to forty percent will have received a formal diagnosis. Improving the knowledge, skills and quality of care provided for people with dementia and their close relatives is a priority for London North West Healthcare NHS Trust.

Updated:
20 January 2015
Location:
London
Sectors:
Hospitals and Hospital Trusts

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?

Delivering care for people with dementia and their close relatives involves working in a way which is in keeping with London North West Healthcare NHS Trust's organisational values, aims and objectives.  A multidisciplinary Dementia Working Group at the Trust determines which projects are prioritised, how they are implemented and evaluated. The nature of these projects reflect the Trust's role in working to provide high-quality services for people with dementia and its intention, in the longer term, to be regarded as a centre for excellence in caring for people with dementia, with knowledge and experience that can be shared with similar organisations locally and nationally. Key aspects of the Trust's role in achieving the seven outcomes prioritised by the Dementia Action Alliance include: - Ensuring that Trust services for people with dementia and their close relatives are underpinned by the principles of Person Centred Care as described by Kitwood (1997) and that this approach to understanding and supporting people with dementia informs the full care pathway. - Ensuring that up-to-date information shapes the care received by people with dementia and their close relatives in the Trust and that this is shared with families and other organisations in preparation for discharge from hospital. Also, to ensure that information on issues relating to dementia is available in a range of formats for all to use, and that people with dementia and their close relatives are directed to resources that reflect their current psychological and practical needs. - Recognition of the importance of using and contributing to research which improves the way in which staff understand and support people with dementia and their close relatives in an acute care setting. With this in mind, the Trust have begun to develop links with the National Association for Dementia Studies at the University of Worcester and with local training courses for a range of professions to encourage regular small-scale research and audits to be undertaken on the care of people with dementia and their close relatives within the Trust.

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

The Dementia Working Group has identified a number of challenges to delivering the seven outcomes prioritised by the Dementia Action Alliance. The challenges within the Trust are: - To create and sustain cultural change so that individuals, professions and wards all have a shared understanding of dementia and how to best support people with dementia and their close relatives during their time in hospital. - To implement a training programme that ensures general awareness of dementia for all and a more developed knowledge of the theory and practice of supporting people with dementia for clinical staff across the Trust. Related to this, ensuring that managers recognise the need for selected staff on each ward (dementia advocates) to have dedicated time to train colleagues and to allow all members of staff across the Trust the time to use regular experts by experience sessions if needed. - To routinely and systematically monitor how the Trust performs in terms of its ability to achieve Dementia Action Alliance actions and other key targets and to ensure that the everyday experiences of people with dementia and their close relatives is a significant part of this work. To ensure that where areas for improvement are identified these are addressed promptly and robustly. The challenges beyond the Trust are: - To ensure that a fully integrated dementia care pathway is developed which incorporates social care, health, independent and voluntary services. - To ensure that local commissioners are aware of current work being undertaken in the Trust with people with dementia and their close relatives and that the Trust develops relationships with these organisations so that such work can be further developed. - Associated with this, ensuring that time is set aside to build links with local and national voluntary organisations, academic institutions, strategic networks to facilitate the routine application and contribution to the evidence base for understanding and supporting people with dementia and their close relatives in acute settings.

Member website

www.lnwh.nhs.uk

2. Actions

  • A Trust dementia pathway will be developed.

    A Trust Dementia Care Pathway will be developed with other local organisations to ensure that people with suspected and diagnosed dementia are recognised at the earliest opportunity and that all aspects of care received in hospital through to discharge or end of life care takes into account individual strengths, difficulties, preferences and needs.

    Status:
    Being implemented

    2014 - Fourth Quarter Update

    Work on the Trust Dementia Care Pathway is ongoing.

  • A graded programme of staff training will be developed and implemented.

    A graded programme of staff training will be developed, implemented and evaluated so that all employees of the Trust are confident in their knowledge, skills and competencies around dementia.  Central to this training will be the principles of person centred care and this will include dementia awareness training for all staff, and further intermediate training as appropriate, the latter co-facilitated with selected  ‘dementia advocates’ from each ward in the Trust.

    Status:
    Being implemented

    2014 - Fourth Quarter Update

    Work on a graded programme of staff training and its evaluation is ongoing.

  • The Trust will develop an up-to-date resource of information and support about dementia.

    The Trust will develop an up-to-date resource of information and support about dementia that can be accessed by staff, people with dementia and their close relatives in a variety of formats.  This will include regular support sessions where staff in the Trust experienced in working with people with dementia will use a formulation-led approach to support colleagues to better understand and work with people with suspected or diagnosed dementia and a quarterly e-letter with updates on best practice in working with people with dementia accessed via the Trust intranet.  It is intended that this action will be supported through close working with local resources e.g. branches of the Alzheimer’s Society.

    Status:
    Being implemented

    2014 - Fourth Quarter Update

    Work on the development of an up-to-date resource of information and support about dementia is ongoing.

  • The Trust will develop a governance framework to systematically assess outcomes for people with dementia.

    The Trust will develop a governance framework to systematically assess outcomes for people with dementia with a view to reporting findings to the Trust Board.  This will include factors including length of stay, discharge destination, readmissions, use of antipsychotics with people with dementia, feedback from a service-user forum and so on.

    Status:
    Being implemented

    2014 - Fourth Quarter Update

    Work towards developing a governance framework to systematically assess outcomes for people with dementia with a view to reporting findings to the Trust Board is ongoing.