Dementia Strategy 2013-16 Proposition Paper

The Scottish Government: February 2013
The official paper can be accessed here: http://www.scotland.gov.uk/Topics/Health/Services/Mental-Health/Dementia/DSPropositionPaper2013-16

(text in BOLD as per official paper)

Introduction

  1. This paper sets out our proposals for the key themes and priorities that should underpin Scotland’s second National Dementia Strategy.
  2. The paper reflects the strong consensus we heard from the recent Dementia Dialogue process:
  • that we should consolidate and build upon the work taken forward since 2010;
  • that we should identify areas where extra support and leverage is needed to support service transformation; and
  •  that we should capitalise on new opportunities, for example through The Life Changes Trust.

Progress

  • This government made dementia a national priority in 2007, set a national target on improving diagnosis rates in 2008 and published an initial 3-year national strategy in 2010, underpinned by a rights-based approach to care, treatment and support. Our work over the last 3 years has been based on strong collaboration in developing and implementing the strategy in a coordinated way.
  • In 2011 we published the Standards of Care for Dementia in Scotland as well as the Promoting Excellence framework which supports the health and social services workforce to meet the standards.
  • The 3-year diagnosis target was achieved nationally and The UK Alzheimer Society’s second annual dementia map – published in January 2013 – shows that, up to March 2012, in Scotland around 64% of those with dementia were being diagnosed (contrasted with around 44% in England, 38% in Wales and 63% in Northern Ireland), using the Dementia UK prevalence model.
  • From April 2013, we introduce a HEAT target which guarantees that everyone newly diagnosed with dementia will be entitled to at least a year’s worth of post-diagnostic support, coordinated by a named link worker.
  • Since 2011 the Chief Nursing Officer has led an improvement programme with NHS Boards on the care of older people in hospitals. Alzheimer Scotland Dementia Nurse Consultants have been appointed to Boards across Scotland and 300 Dementia Champions will be in place by March.

Challenges

  • We need to do more to help services promote and deliver the high quality, compassionate, non-discriminatory care that people have the right to expect on every occasion.
  • While we have an improvement framework and capacity and capability in place we need to take more action to help lever and sustain change in services. This is necessary not only because of the need to improve outcomes and people’s experience of services but also because of the need to redesign services to support the increasing number of people with dementia.
  • We need to help local planning partners redesign care pathways to deliver better and more cost-effective care, including providing a range of improvement support and learning resources, such as the analysis of the resourcing of dementia services across Midlothian CHP.

Approach

  • We propose continuing our consensus-based, partnership approach to taking forward this work up to 2016, with the views and experience of people with dementia and their families and carers at the centre of our work.
  • The actions will be ambitious and measurable and we will focus attention on areas of dementia care where we can make the biggest impact. As in the first strategy, our aim is to make real improvements for people in the here and now in parallel with work to shape and drive the ongoing transformation of care for older people.

Themes

  • Continuing to focus on promoting and supporting early, accurate diagnosis of dementia.
  • Supporting a significant improvement in the quality and consistency of post-diagnostic support.
  • Engaging and involving people with dementia and their families and carers as equal partners in care throughout the journey of the illness.
  • Supporting people to live a good quality of life at home for as long as possible, as they move from self- management to needing more intensive community-based support.
  • Ensuring people get safe, appropriate and dignified care in hospital and in care homes on every occasion
  • Nurturing dementia-enabled and dementia-friendly local communities.

Priorities

  • Sustaining and improving further diagnosis rates, which may include developing an approach around routine testing.
  • Supporting the implementation of the post-diagnostic HEAT target.
  • Testing an approach to providing intensive support, based on Alzheimer Scotland’s 8 Pillars model, which is centred on a care coordinator role.
  • Implementing a Promoting Excellence training plan for the next 3 years, to embed, build on and extend the skills and competencies of staff across health and social services including the housing sector – and including increasing access to psychological therapies.
  • Developing an innovative digital platform for dementia, which could help inform and empower people with the illness and their families in being equal partners in care.
  • Implementing a package of improvement measures for dementia care in hospitals, which will involve maximising the impact of the Alzheimer Scotland Nurse Consultants and the Dementia Champions; and ensuring that people with dementia and their families are treated with dignity and respect as equal partners in care.
  • Assessing the need for improvement activity specifically around care homes, including staff training and supporting the implementation of the HEAT post-diagnostic target for people diagnosed in those settings.
  • Implementing a national commitment on the prescribing of psychoactive medications, as part of ensuring that such medication is used only where there is no appropriate alternative.
  • Publishing an initial report on implementation of the dementia standards; taking forward work to align them with the National Care Standards as part of their review process; and linking with further work to integrate inspections of services.
  • Working to embed outcomes for people with dementia in the outcomes framework which will support implementation of the integration of health and social care.
  • Working with The Life Changes Trust as they administer grants from this year for initiatives to benefit people with dementia and their families and carers, including initiatives around dementia-enabled and dementia-friendly communities, peer support and befriending, to ensure that this activity complements and supports the new HEAT target.
  • Continuing to support research through funding The Scottish Dementia Clinical Research Network and supporting the work of the new Scottish Dementia Research Consortium in its objective to bring together the range of dementia research interests in Scotland and maximise the impact of and funding opportunities for research capacity here.
  • Looking at the need for national action around linkages with other chronic conditions; and the need for national action around early onset dementia.
  • Exploring further opportunities to link with health improvement activity focussing on reducing the risk of developing dementia and enhancing the physical health and quality of life of people living with the illness.

Support

  1. Developing a National Improvement Programme for Dementia, drawing on the blend of improvement support skills in The Joint Improvement Team and The Scottish Government Quality and Efficiency Support Team utilised in the Dementia Demonstrator and post-diagnostic test sites work, with a number of key improvement objectives:-
  • Testing the Alzheimer Scotland 8 Pillars model for community-based support in 3 or 4 pilots, looking at different environments (urban; rural; island), but also within different hosting arrangements – primary care, local government, and including one integrated service.
  • Supporting delivery of the Post-Diagnostic HEAT target from April.
  • Testing initiatives around community capacity/coproduction and around primary care engagement
  1. Publishing the dementia benchmarking framework to enable services to compare performance around key indicators of improvement.

Next Steps

• This paper will form the basis of work by an expert group which will meet between March and May to finalise the strategy; and it will also be sent out to participants in the Dementia Dialogue for further comment.

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