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Royal Free London NHS Foundation Trust

We were the first to provide care free of charge and the only London hospital to stay open during the 19th-century cholera epidemics. In the 21st century, we continue to lead improvements in healthcare, from targeted cancer therapies to new kinds of surgery. We offer an exceptionally wide range of local and specialist services, including cancer, plastic surgery, vascular, haemophilia and infectious diseases and are proud to have some of the best clinical outcomes in the country. A regional centre for kidney and liver diseases and a major transplantation centre, we see around 700,000 patients a year from all over the world. We are a campus of UCL Medical School and conduct important medical research. We also train doctors, nurses, midwives and many other clinical and non-clinical professionals. We helped to set up the academic health science centre, UCLPartners.

Updated:
9 November 2015
Location:
London
Sectors:
Medical, Health, Hospitals and Hospital Trusts, Care
Local Alliances:
Camden 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?

Integrated care is a core theme of our strategy and to this end we are committed to developing integrated care services in partnership with community providers to ensure a seemless service for patients with dementia.  We have developed a community based multidisciplinary team for frail older people including those with dementia to ensure they receive a comprehensive assessment of their health and social needs and a care plan to ensure that appropriate care is delivered. 

We have commissioned a psychiatric liaison service which operates 24 hours per day 365 days per year and ensures expert advice on patients in hospital with dementia.  We have also developed a new Cognitive Impairment Diagnostic Service which offers both early accurate diagnosis of dementia as well as assessment and treatment of other physical conditions which contribute to frailty.

In recognition that approximately 25% of acute medical patients admitted to hospital suffer with a degree of cognitive impairment, we have rolled out a training programme on dementia across the Trust for doctors, nurses and allied health professionals.

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

There are number of competing priorities for the Trust in terms of both finance and time and it will be a challenge for dementia champions to ensure that dementia remains a high priority.

A combination of increased service demand, increased patient expectations and financial constraints will increasingly challenge our ability to deliver high quality services for patients with dementia.

People with dementia require a range of services across health and social care which cross organisational boundaries each with their own budget, line management, policies and operating procedures.  This militates against patients with dementia receiving the care they need and it will be a challenge to break down such barriers to produce a timely effective and efficient service.

With over 10,000 staff over 3 hospital sites, it is a big challenge to provide the required level of training and support to ensure all our staff are aware of and can respond to the needs of people with dementia.

Our hospital building is going through refurbishment and we are working hard to ensure any changes made are in line with Enhanced Healing Environment principals.  There are many local changes that can be made, however these often take time.

2. Actions

  • Appointment Dementia specialist team to work with Trust Dementia Lead

    Appoint dementia specialist posts to work alongside the Trust Dementia Lead in promoting dementia awareness and delivering a dementia friendly hospital.

    Status:
    Completed

    2015 - First Quarter Update

    The trust now has a number of dementia specialist posts including:

    - Clinical Dementia Lead

    - Dementia Lead AHP

    - Dementia specialist Occupational Therapist

    - Dementia Skills Facilitator

    - Dementia specialist Therapy Assistant

    2014 - First Quarter Update

    Appoint dementia specialist posts to work alongside the Trust Dementia Lead in promoting dementia awareness and delivering a dementia friendly hospital.

    Update - First Quarter

    Recruitment of a dementia lead was completed - Becky Lambert who was previously the dementia specialist Occupational Therapist at the trust has been in post since January 2014.

    She will work along side Dan Lee - Trust dementia lead in implementing dementia initiatives throughout the trust

  • Extension of Cognitive Impairment Diagnostic Service

    Extend the Cognitive Impairment Diagnostic Service so that it is available to more patients who would benefit from it.

    Status:
    Planning

    Update - First Quarter

    Publicity of the service has resulted in an increase of referrals.  Voulnteers have been recruited to assist with the running of the clinic and support patients and families who attend.

  • Dementia training program for staff

    Devise and deliver a dementia training program for medical, nursing and allied health professional staff.

    Status:
    Being implemented

    2015 - First Quarter Update

    To date 62% staff in the trust have recieved at least tier 1 level training.  There is a robust training plan in place for the year which includes:

    - Dementia awarness

    - Dementia Friends sessions

    - Dementia Study Day

    - Making specialling special

    - Department/ ward specific bespoke training

     

    Update - First Quarter

    Dementia awareness is now included in the trust induction fo all new staff recruited to the trust.  A trust wide dementia traiing programme is in place offering Core and Advanced training days covering skills from communication, nutrition and hydration to end of life care and complex case management.  Both the core and advanced days are offered every month. The training days run alongside bespoke training for each ward and department as requested and provide an opportunity for interactive and reflective learning.

  • Continue to improve the ward environment

    Continue to improve the ward environment such that wards become more dementia friendly.

    Status:
    Implementation

    2015 - First Quarter Update

    Funding approval has been granted for a refurbishment of Larch ward on the Barnet hospital site.

    Funding apporval has been granted for cosmetic changes on the health services for older people's wards at the Royal Free site

    Dementia friendly environmental changes are being prioritised along side the A&E and outpatient refurbishments planned for 2015

    2014 - Third Quarter Update

    Calender clocks and orientation boards are now in place on the Health Services for Elderly people's wards

    Update - First Quarter

    Grants have been applied for to develop the ward environment including information boards for carers, interactive pictures for patients and orientation boards and clocks.

  • Dementia friendly environments in A & E

    Build in dementia friendly design to the new A/E  refurbishment.

    Status:
    Planning

    Update - First Quarter

    On-going plans being made for the redevelopment

  • Seek funding for more complimentary therapy

    Seek funding to extend the complimentary therapy for patients in hospital with dementia such that massage is available to all those who would benefit from it.

    Status:
    Delivery

    Update - First Quarter

    Initial funding secured for the service and ongoing fundraising throughout the hospital being carried out to enable it to continue. The profiel of this service has been raised and there has been an increase in referals for patients who have dementia

  • My Discharge - model for discharging patients with dementia

    From April 2013 A pro-active case management, Dementia Specialist Occupational Therapist led, model for discharging patients with dementia. Bespoke, personalized service in partnership with the patient, their carer and health, social and voluntary organisations, to discharge patients in a safe dignified way and prevent their readmission through case management.  This service brings together eight partner organisations in an innovative single pathway. My Discharge has attracted an award from The Health Foundation for the 1 year pilot phase

    Status:
    Delivered

    2014 - Third Quarter Update

    significan results were achieved through the project including:

    - reduction of lenght of stay for people with dementia by 2.6 days

    - reduction of reattendances to A&E by 26%

    - 34% patients seen through the project were at risk of transfer to permanent placement and were instead supported home

    - 100% positive carers feedback

    My Discharge Project has been made into a permanent service with full funding of the dementia specialist Occupational Therapist.  Funding was also granted for a dementia specialist therapy assistant to support with service implementation.

    Update - First Quarter

    My Discharge Project has been working to provide a pro-active case management model of care, facilitating safe, sustainable and timely discharges for those with confirmed or suspected dementia is offers:

    Bespoke, personalised service in partnership with patients and their carersSignpost/ co-ordination of developing community infrastructure for on-going careFlexible follow-up input/management from In-patient post discharge home as required

    Through the initial 9 month period, using a comparison group of 100 patients with dementia from the previous year, the project has shown:

    An impact on length of stay by 2.6 days. 85% of patients through the project (101) were discharged home(94% directly, 6%via respite/rehab).Reduced re-attendance to A&E by 26%Assisted 34% of patients who were at risk of permanent placement to return home.

    Following the conclusion of the Health Foundation SHINE award funding, there is currently a business case being developed to apply for permanent funding for this project with the aim to continue to implement and develop this service further.

  • Support for families and carers

    An important part of dementia care for us is the support available for carers and families.  The action is to develop a support structure which ensure carers and families feel supported and informed.

    Status:
    Implementation

    2015 - First Quarter Update

    An online survey is now available for carers of people with dementia, to enable more frequent feedback.

    2014 - Second Quarter Update

    Carers support sessions are now offered on the wards for family and carers to discuss with the dementia lead any issues or concerns regarding their loved one. A questionnaire has been developed for carers to reflect on their perception of dementia care in the hospital and assist in ongoing development of dementia services in the trust.

    Information boards for leaflets and key contacts have been purchased.

    An important part of dementia care for us is the support available for carers and families.  The action is to develop a support structure which ensure carers and families feel supported and informed.