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New tool to ‘promote outstanding dementia care’ in NHS

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Consultant nurses and nurse specialists should be leading the way in dementia care, according to a tool designed to help NHS healthcare providers to deliver an “outstanding” service to their most vulnerable patients.

There should also be enhanced training for dementia champions and link nurses, and nursing staff generally should have the “right knowledge and skills” to meet the needs of those with dementia.

In addition, buy in from trust nursing leaders was key to ensuring the best possible dementia care, stated the Dementia Assessment and Improvement Framework.

The framework, launched this week by NHS Improvement’s nursing directorate, comes in the form of a checklist, consisting of eight core standards that trusts should strive to meet.

  1. Diagnosis
  2. Person-centred care
  3. Patient and carer information and support
  4. Involvement and co-design
  5. Workforce education and training
  6. Leadership
  7. Environment
  8. Nutrition and hydration

The document stated it was designed to support “organisational leaders”, such as senior sisters and charge nurses, to provide “outstanding” care in acute, community or mental health settings.

The regulator told Nursing Times that the idea was also that directors of nursing should use the checklist to evaluate the care on offer in their organisation and make any necessary improvements.

The framework, which covers areas such as person-centred care, information for patients, and staff training, has been sent to all trusts in England.

The tool was designed by Antonia Lynch, NHS Improvement’s out-going nursing fellow and deputy chief nurse at the Great Western Hospitals NHS Foundation Trust.

It draws on national policy, guidance and best practice from organisations that have achieved an “outstanding” rating from the Care Quality Commission, as well as the views of patients and carers.

One of the eight standards focuses on leadership and highlights the important role of senior nurses in ensuring high quality dementia care across their organisations, as observed by CQC inspectors.

“Leadership at trusts rated ‘outstanding’ and ‘good’ was provided by consultants, consultant nurses and clinical nurse specialists,” stated the framework document.

It also highlighted the impact that nursing directors could have, stating: “The inspectors noted visible executive leadership by the chief nurse at two trusts and this had a positive impact on the culture of the organisation generally.”

However, it noted that leadership was “rarely mentioned” in CQC reports on trusts rated “requires improvement” or “inadequate”. Such trusts tended to rely on less senior link nurses and dementia champions to promote good dementia care, it said.

Trusts rated “inadequate” had a “much lower prevalence of consultant nurses and dementia specialist nurses than in outstanding and good rated trusts”, highlighted the document.

Meanwhile, the new checklist stated that organisations should have an up-to-date dementia strategy and that staff should understand their role in achieving its aims.

Consultants, consultant nurses and nurse specialists should be leading the way in dementia care, it said. For example, it noted that one trust had a hospital-wide Macmillan dementia nurse consultant.

“This tool brings together the evidence and expert research from charities, government and health organisations”

Ruth May

At a ward level, there should be enhanced training and development for dementia champions and link nurses, and they should be able to demonstrate how they were improving care standards.

When it comes to staff training more generally, the framework told trusts they must ensure the workforce had “the right knowledge and skills to meet the needs of people living with dementia”.

Staff should understand the behavioural and psychological symptoms of dementia, manifestations of pain and delirium and its relationship dementia.

As well as ensuring clinical staff are clued up on dementia, trust dementia strategies should ensure all non-clinical staff such as receptionists, those working in shops and cafes, and volunteers were trained to care for people with dementia.

Trusts should also encourage as many people as possible sign up to the Alzheimer’s Society’s “dementia friends” initiative in order to promote a dementia-friendly service at all levels. However, the document stressed that this should “not replace training”.

In addition, trusts should offer dementia training to professionals outside of their organisation such as care home staff and workers from other public services.

The checklist also covers diagnosis, nutrition and hydration, the care environment, information on offer to patients and carers and the involvement of patients in their care and in designing services.

For example, one outstanding-rated trust involved people with dementia in redesigning its emergency department.

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Ruth May

Dr Ruth May, executive director of nursing at NHS Improvement, said getting dementia right was “crucial” as it affected the lives of so many people with numbers predicted to rise.

“In the past few years, extensive work has been carried out across the country to understand the impact of dementia and how can we improve the way we care for those diagnosed with it,” she said.

“This tool brings together the evidence and expert research from charities, government and health organisations to provide a comprehensive framework to help deliver change to patients with dementia,” noted Dr May.

She added: “We understand there is a long way to go to meet the growing pressures, but by setting the scene for what outstanding care looks like in the NHS, we can better work together to deliver positive and lasting change.”

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