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Mid Essex Hospital Services NHS Trust

Mid Essex Hospital Services NHS Trust provides a comprehensive range of acute and community based services. It also hosts regional plastics, head and neck and upper gastrointestinal (upper GI) surgical services and a supra-regional burns service to a population of 9.8 million. The Trust, based in the heart of Essex, employs over 3,800 staff and provides services from five sites in and around Chelmsford, Maldon and Braintree. The main site is Broomfield Hospital in Chelmsford which has been redeveloped as part of a £148m Private Finance Initiative (PFI). The Trust enjoys a strong clinical reputation and provides a wide range of services including A&E, emergency medicine and surgery, elective surgery in most specialties, and maternity and paediatric services.

Updated:
26 January 2015
Location:
East of England
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?       

The Trust’s role in delivering better health outcomes for people with dementia and their carers includes:

  • Having a dementia friendly physical environment
  • Ensuring a good experience for patients and their carers
  • Ensuring seamless transfer of care, internally and between health settings
  • Raising awareness of dementia.

The Trust has implemented a number of changes to ensure it fulfils the DAA outcomes.  For example:

  • Establishment of a dedicated dementia multidisciplinary team
  • On-going improvements to the ward environments and outdoor space
  • Implementation of the Butterfly scheme
  • Identification of dementia champions and link nurses
  • Development of close working relationships with key organisations; for example, the North Essex Partnership Foundation Trust
  • Development of joint  policies and pathways to ensure transfer of care and clinical practice is consistent across organisations
  • Dementia awareness training for both clinical and non-clinical staff
  • Implementation of the FAIR (find, assess, investigate, refer) assessment.

Further actions to be undertaken include: 

  • On-going changes to the hospital environment to enhance and improve the experience for both people with dementia and their carers
  • Improve and embed training and awareness of staff to ensure they are appropriately skilled to care for patients with dementia
  • Improved support and signposting to agencies for carers of patients with dementia.

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

The Trust’s footprint includes a PFI wing as well as older, retained estate; both have different physical designs and present different challenges in caring for people with dementia.

The Trust recognises the need to make physical changes to both the PFI and retained estate.  The challenge is making these changes in the current financial climate; however, the Trust proposes that phase one will include making simple changes to its physical environment, which will enhance the calm and healing environment – for example, clear, coloured signage and painting walls a distinctive colour to distinguish from the wall.

The Trust’s other key challenges to delivering the outcomes above will be:

  • Identifying and sustaining the necessary resources to deliver the continuous training programme
  • Ensuring staff have capacity to complete different levels of training
  • Embedding new practices, raising awareness and cultural change around dementia care.

2. Actions

  • Change physical environments

    Change internal and external physical environments on piloted wards to create calm, healing and therapeutic space

    Status:
    Implementation

    2014 - Fourth Quarter Update

    Work on phase one is still in the final stages. Appropriate signage for toilets and individualised paintings for each bed space are currently being sourced. Funding for recommended curtains is being explored.

    Work on the dementia friendly garden has now commenced. The works were commenced on 15thNovember  with ‘The First Dig’ launch day, the day was attended by members of staff and a large workforce of volunteers from The 41 Club, The Round Table, Writtle College, League of Friends and other local organisations. The work on the garden was officially opened by The Major of Chelmsford and the MEHT’s Chairman.

    2014 - Third Quarter Update

    Phase One of the plans to change the physical environment is now in the final stages as we are awaiting two essential changes such as plain bed curtain replacement (to avoid visual mis-perceptions and distress) and individualised local paintings for each bed space (to promote reminiscence and support patients to recognise their own bed space).  Staff have repeatedly commented about the significantly positive impact this is having for patients with dementia.  Early feedback suggests that the single change that has impacted patients the most is the improved lighting.

    The Dementia MDT and interested parties have now selected a ‘winning’ design for the Sensory Gardens and members from the local ‘41 Club’ are working tirelessly to ensure the essential design can be implemented within the budget generously donated from hospital charities including The Friends at Broomfield Hospital.  The local ’41 Club’ have also agreed to undertake all the work on a voluntary basis commencing in November with a view to opening the gardens in the spring.

    2014 - Second Quarter Update

    Works to complete Phase One of the MEHT proposed plans to change the physical environment on the two care of the elderly wards are now underway.  It is expected that that the refurbishment of both wards will be achieved by the end of August 2014.

    The Senior Occupational Therapist who has been the lead for this project has based the design on clinical knowledge gained from attending the “King’s Fund – Designing Care Environments for People with Dementia”.  This includes coloured coded bays, coloured coded bathroom doors and individualised paintings to aid orientation, coloured toilet seats for contrast and identification, appropriate signage and improved lighting.

    MEHT recognises the importance of patients with dementia being able to access safe and therapeutic outdoor space.  Planning for Phase Two (Sensory Gardens) are underway.  The Senior Occupational Therapist (Project lead) has engaged with the local specialist college which support s careers focused on the ‘Green Industries’ and asked students to design the gardens based on a remit of clinically evidenced requirements.

    The selection of the design is planned for the end of July with work anticipated to commence shortly after.  The Project Lead has involved local charities, specialist nursing, estates, the patient council and members from the executive board to make the final selection.

    2014 - First Quarter Update

    The project has now been split into three phases, phase one has been agreed by the trust executive board and is due to commence imminently. Phase one has focused on coloured coded bays, coloured coded bathroom doors and individualised paintings to aid orientation, coloured toilet seats for contrast and identifcation, appropriate signage and improved lighting.

    A member of the elderly assessment team has attended The King’s Fund Designing Care Environments for People with Dementia course at the end of January, this will shape the plans for phase two which will focus on day rooms and outside space, will now commence.

    2013 - Second Quarter Update

    The Trust has now secured funding to enable changes to the hospital environment.  These will focus upon the care of the elderly wards including plans to ensure patients have secure access to outside space; coloured identification of each bay to promote orientation; provision of occupation and stimulation resources; specialised clocks and contrasting toilet seats.

  • Expand the criteria of the dementia MDT

    Expand the criteria of the dementia MDT to engage different directorates to attend and raise the profile for people with dementia

    Status:
    Delivery

    2014 - Fourth Quarter Update

    Dementia Connections kindly attended The Dementia MDT in December and explained how their service could support patients with dementia on discharge from hospital. They have also now been invited to become a member of the MDT and have offered to visit the care of the elderly wards to increase staff awareness of available community services.

    Further clinical case reviews have occurred lead by Physiotherapy / Occupational Therapy and nursing staff. Dietetics and medical lead clinical case reviews have been scheduled for early 2015.

    2014 - Third Quarter Update

    Clinical Case Reviews continue to be led by different members of the multi-disciplinary team with the Dietetics department leading their first review in October.  This will then be followed by a medical led review.

    2014 - Second Quarter Update

    The Dementia MDT continues to encourage staff from all disciplines from across the organisation to present a case for review.  Clinical Case Reviews have been presented by Speech and Language Therapy, Occupational Therapy, Nursing and Pharmacy.  A medical led review expected soon.  Learning from these reviews is being put in to practice and culture change is occurring as a result.

    2014 - First Quarter Update

    The Dementia MDT has now commenced monthly clinical case reviews, which have involved representatives from all disciplines, different wards and departments presenting a recent case which highlights examples of areas of good practice and discuss areas for advice and support. Both areas of good practice and areas for learning have been disseminated throughout the trust by ward managers and the newly established dementia champions. Staff that have attended and presented at the MDT have found it a positive experience.

    2013 - Second Quarter Update

    The Dementia MDT has focused upon devising a strategy for implementing key objectives from national and local initiatives to improve the care and experience of people with dementia and their carers.  The executive board have given full support to this action plan.

    The Dementia MDT will be expanded next month to include clinical case review.  This will involve a representative from different wards and departments presenting a recent situation where they would like to highlight examples of good practice or discuss a situation where they would like advice and support.  Both areas of good practice and areas for learning will then be disseminated throughout the Trust.

     

     

  • Dementia care training

    Deliver our agreed dementia care training programme

    Status:
    Delivery

    2014 - Fourth Quarter Update

    The training programme continues to be well implemented at all levels. Many staff have requested to attend the level 3 course following feedback from colleagues and witnessing positive changes in practice.

    Dates for the ‘Virtual Dementia Tour’ have now been released for staff to book on

    2014 - Third Quarter Update

    The training programme continues to be well-attended and evaluated and changing practice on wards to improve the patient experience.

     

    From October the Level 3 training will now incorporate the ‘Virtual Dementia Tour’ to reinforce key learning. 

     

    The Trust recognises the potentially huge importance of providing Level 3 training for as many doctors as possible but particularly Clinical Directors and clinical leads and is exploring methods of extending this training to capture this group of staff.

     

    2014 - Second Quarter Update

    The Trust is continuing to implement three levels of dementia training which is well-attended and well-evaluated.  Over 1000 staff accessed this training in 2013/2014 and over 100 staff have completed the three day dementia champion course.

     

    The Trust is now providing this training to the community to ensure partnership working and a seamless transition of care across organisations.

     

    The Trust is planning to incorporate the ‘Virtual Dementia Tour’ into Level 3 training.  This training is designed to simulate the experience of people with dementia in hospital.  Five staff are now booked onto facilitators training to enable them to deliver this across the organisation.

     

    This year the Trust has made a commitment to ensure at least 25% of nursing and allied health professionals receive Level 2 training on general adult wards and 75% of nursing and allied health professionals receive Level 2 training on care of the elderly wards.

    2014 - First Quarter Update

    We have identified that access to level one training for all staff via the online method was at times challenging for a number of staff therefore a level one training booklet specific to our trust's needs has been devised and introduced as an alternative option. This has been well received.

    Level one training has now been indentified as a mandatory requirement for all trust staff.

    2013 - Second Quarter Update

    A three level training programme has been devised and is currently being implemented for all staff throughout the Trust.

    All Heads of Departments (clinical and non-clinical) are currently undertaking Level 1 training and ensuring basic dementia awareness within their teams.

    Level 2 training is being encouraged for all clinical staff whilst the Level 3 course (3 day course based on the Bradford Dementia Group) is being accessed by all levels of senior nursing staff.  These courses are running monthly and have been extremely well evaluated with experienced staff describing how it has transformed their practice.  Training includes a session from an independent organisation (Action for Family Carers) to ensure staff are equipped to support carers.  Candidates are asked to demonstrate how the training has changed their practice and practice within their department.

     The Trust is also encouraging e-learning using the SCIE Dementia Gateway which staff report to find extremely beneficial.

     All doctors new to the Trust in August 2013 received Dementia Awareness information and have access to an online dementia training module.  Plans are being made to include Dementia Awareness training in the Trust Doctors Induction Programme.

     

  • Use assessment tools

    Measure patient and carer experience through meaningful assessment tools

    Status:
    Implementation

    2014 - Fourth Quarter Update

    Braxted ward have now completed their training on ‘QUIS’ (Quality of Interactions Schedule, Dean, Proudfoot & Lindesay, 1993) and are now completing these on a monthly basis.

    Both Braxted and Baddow wards are completing individual ward dementia action plans to monitor porgress made following QUIS assessment outcomes and Abbey pain scale audits.

    Abbey pain score audits are now being completed by the pain team on all wards across the trust.

    2014 - Third Quarter Update

    Baddow ward (one of two care of the elderly wards) are now assessing the patient experience for people with dementia on a monthly basis and have formulated an action plan to change practice as a result of lessons learnt from this.  Braxted ward (also a care of the elderly ward) is completing training to complete the assessments this month and will then be replicating this model as from November.

    Ward staff are continuing to offer patients and their relatives Trust Dementia Packs which includes: ‘This Is Me’ (to understand life history and understand likes/dislikes to enable individualised care planning), Information and Signposting leaflet as well as the Carer’s Questionnaire with envelope for anonymity. 

    A recent ward audit (“Effective Pain Management for People with Cognitive Impairment”) demonstrated that staff had successfully initiated the correct use of the Abbey Pain Assessment Scale and consequently the majority of patients with or without cognitive impairment were pain-free.

    The ward were able to demonstrate they had adopted best practice and this has been successfully embedded following a third audit.  This audit was completed two months later (unannounced) where all patients with dementia cognitive impairment pain had been assessed appropriately and there was no evidence of uncontrolled pain.

    2014 - Second Quarter Update

    The Trust is still working towards implementing on the Care of the Elderly wards a ‘QUIS’ (Quality of Interactions Schedule, Dean, Proudfoot & Lindesay, 1993) assessment tool.  The aim is that this will be conducted monthly and an action plan compiled accordingly and then presented to the Dementia MDT. 

    The Trust has increased the returns from the Carer’s Questionnaire significantly since all patients and their relatives are provided with a ‘dementia pack’.  This pack includes; ‘This Is Me’ (to understand life history and understand likes/dislikes to enable individualised care planning), Information and Signposting leaflet as well as the Carer’s Questionnaire with envelope for anonymity.

    We understand that there is concern that people with dementia are less likely to have their pain assessed accurately and therefore receive less analgesia.  All staff have been made aware that use of an adapted tool (Abbey Pain Assessment scale) is necessary and should be used at least four times daily.  The Trust have now commenced an audit of wards to ensure appropriate use of this tool accompanied by intensive education provided jointly by the dementia/pain team.

    2014 - First Quarter Update

    The ‘QUIS’ (Quality of Interactions Schedule, Dean, Proudfoot & Lindesay, 1993) assessments that have been completed on one of the care of the elderly wards have revealed high standards of care delivery but highlighted a need to provide more occupation and stimulation. Action is being taken to address this, including an individualised meaningful activity plan and we are in the process of developing a dementia volunteer project which will assist with the delivery of this. This is now going to be piloted within the care of the elderly wards.

    The QUIS assessment will now be completed on the second care of the elderly ward and will engage more staff in both the assessment process and devising plans to improve care as appropriate.

    2013 - Second Quarter Update

    The Dementia Specialist and a Senior Nurse have accessed training to enable them to implement the ‘QUIS’ (Quality of Interactions Schedule, Dean, Proudfoot & Lindesay, 1993) assessment tool.  This assessment tool will be piloted over the next few months on the two care of the elderly wards and the emergency assessment unit to gain a meaningful insight into the experience of people with dementia.  The wards will then be responsible for devising action plans to improve care as appropriate.

    The Trust is committed to providing safe, high quality care to people admitted to hospital with dementia. Involving carers and taking their expert knowledge into account is recognised as essential to the provision of personalised care to patients with dementia. With this in mind we have developed a questionnaire to seek the views of persons acting as carers for people diagnosed with dementia admitted toBroomfieldHospital. By looking at the responses, we aim to identify what we do well and where we need to improve.

     

  • Develop services

    Work with external agencies, patients and carers to ensure services develop to meet the needs of patients and carers.

    Status:
    Implementation

    2014 - Fourth Quarter Update

    The Department of Health visited MEHT on the 4th, 5th, 8th& 9thof December. The purpose of the visit was to explore how the patient journey for people with dementia can be improved across the organisation.  The following pathways were explored during the visits:

    Delayed dischargesCrisis in community resulting in avoidable admissionsThe experience of people with dementia in the emergency department

    A relative of a patient with dementia shared his story of his father’s experience with the trust board and this was also shared with the Dementia MDT. Key learning points from this were identified and disseminated across the trust.

    Dementia Connections kindly attended The Dementia MDT in December and explained how their service could support patients with dementia on discharge from hospital. They have also now been invited to become a member of the MDT and have offered to visit the care of the elderly wards to increase staff awareness of available community services.

    2014 - Third Quarter Update

    The Trust has taken part in the Department of Health’s ‘Connecting with patients and people who use services programme’.  One of the areas specifically focussed on how dementia care is delivered.  As a result of the combined knowledge of and insights from the dementia care team, the Trust have been invited to join a multi-organisation work stream to set up another Connecting experience that would provide Department of Health staff with a person’s journey through the system.  This would be based upon a person with dementia based in Mid Essex to explore ways of improving pathways across organisations and ultimately improve the patient experience.

     

    The Trust has also accessed 20 spaces on a local educational and networking workshop called ‘Whose Shoes’.  This was funded by a carer whose father had dementia and was aimed at improving the experience for patients in the future and was a very valuable way of gaining a greater understanding of the patient’s and carer’s perspective.  The Executive Board also invited the relative to the public meeting so the Trust can shape care and services accordingly.

     

    Ward managers are being asked to raise any learning from Carer’s Questionnaires at their team meetings and explore mechanisms of improving care as a result.

     

    The Trust hosted a Voluntary and Community Sector Showcase event, held on 11th September which included stands from local support organisations specific to those with dementia (Dementia Adventure, Alzheimer’s Society and Age UK amongst others) as well as a range of other appropriate support including Action for Family Carers, Chelmsford Community Transport, Dengie Project Trust and Braintree and Chelmsford Crossroads Care.

     

    The event was open to staff, patients and visitors to learn more about services accessible in the community.  Following this event the general public were invited and welcomed to the AGM where the Trust where the Elderly Assessment team spoke to a wide cross-section of individuals to update on Trust progress with dementia care and to signpost to other organisations as appropriate.

     

     

     

    2014 - Second Quarter Update

    The Trust is now providing this training to the community staff to ensure partnership working and a seamless transition of care across organisations.

     

    We are currently engaging with stakeholders to work towards establishment of a North Essex Dementia Action Alliance.

     

    2014 - First Quarter Update

    It is a requirement of the CQUIN (2013-14) to signpost carers to relevant advice and support and they receive relevant information to support them.  The trust (in conjunction with Action for Family Carers) has developed a leaflet to provide this information for relatives/carers of people with dementia but also included information for people with dementia in line with the requirements of the National Dementia Strategy, National Audit of Dementia and NICE guidance.  The Trust has the agreement from the local Alzheimer’s Society to provide copies of their ‘The Dementia Guide’ to all patients and relatives as required.  These are anticipated to be available from February 2014.

    The Dementia MDT has established positive and effective working relationships with the local mental health Trust.  Dementia Specialist at North Essex Partnership Foundation Trust attends our fortnightly Dementia MDT. 

    The Hospital Link Worker from Action for Family Carers regularly attends the Dementia MDT and provides invaluable input.

    The Trust has been well supported by 'The Friends at Broomfield Hospital' (local independent charity) who have funded luxury toiletry bags for patients who are admitted with dementia and who do not have essential items.

    2013 - Second Quarter Update

    The Mid Essex Clinical Commissioning Group fund a service commissioned from Action Fro Family Carers which is a carers support charity affiliated to the Carers Trust nationally.  A minimum of 50% of referrals from the Trust to this service relate to patients and their carers either with a formal diagnosis of dementia or presenting with significant long term cognitive impairment.

    The DementiaSupportManager from the local Alzheimer’s Society has agreed to attend the regular Dementia MDT by invite.

    The Trust have developed a pathway with the local mental health hospital to enable patients with dementia who require an X-Ray to have direct access to radiology avoiding the need to attend the Emergency Department which can be extremely distressing.