Healthcare professionals’ own assessments of how dementia-friendly their settings are reveal “alarming” variations across England, experts say.
The PLACE (Patient-Led Assessment of the Care Environment) scores focus on the environment in care homes and hospitals, including how well they protect patients’ dignity, the food and catering, and general maintenance.
“It is vital dementia-friendly facilities, such as clear signage and handrails, are in place consistently across the country”
For the first time the assessments, which cover both NHS and independent sector premises and are carried out voluntarily by settings, include scores for how well services cater for people with dementia.
In particular, the evaluations looked at flooring, decor and signage, plus facilities like seating and handrails that can make all the difference to the frail and confused.
Scores were compiled for organisations as a whole as well as individual sites. The national average dementia score across all sites was just under 75% with 1,333 individual assessments carried out this year.
However, there was wide variation in scores with some locations awarding themselves scores below 50%, while others recorded full marks scores of 100%.
The Alzheimer’ Society said the ratings showed many hospitals and care settings were not properly set up to look after dementia patients.
“Despite the rising numbers of people with dementia, these figures reveal that many hospitals and care settings are still not adequately equipped to meet their needs and there is alarming regional variation,” said the charity’s head of policy George McNamara.
“It is vital dementia-friendly facilities, such as clear signage and handrails, are in place consistently across the country so that people with the condition can be cared for appropriately,” he said.
“While we recognise the important part that the environment plays in supporting patient care, we also place great emphasis on the care itself”
Yeovil District Hospital FT
The organisation that recorded the lowest score was Yeovil District Hospital Foundation Trust on 42.31%, followed by County Durham and Darlington Foundation Trust on 47.88% and Kingston Hospital Foundation Trust on 47.89%.
Yeovil said its score reflected the “tough approach” it was taking to improve dementia care and an attention to detail that may make it fare worse than others with a less stringent stance.
The trust said its self-assessment was done by specialist staff, including its dementia nurse consultant, alongside a patient group.
“To ensure such assessments add value and learning to our hospital, it is vital we take a tough approach and identify all opportunities for improvement, no matter how small, even if this results in an adverse score when compared to other organisations,” said a spokeswoman.
“This ensures we have the information we need to make appropriate, well-evidenced changes to our building, which make a real difference to patients,” she added.
She said the trust had since launched a “top to bottom review” of the entire hospital and had installed new signage, changed the colour of wards and created quiet areas as a result.
“While we recognise the important part that the environment plays in supporting patient care, we also place great emphasis on the care itself,” said the spokeswoman.
“We have recently launched several initiatives specifically aimed at patients with dementia, such as live music on our wards, our ‘Special Sundays’ project and our dementia-friendly garden, all of which have received national funding and support,” she said.
“Patients with dementia and their carers will also help us to identify further opportunity for improvements through a new survey recently launched by our specialist dementia team,” she noted.
Duncan Burton, director of nursing and patient experience at Kingston, said the trust was committed to improving dementia care as one of its “top priorities” and the scores highlighted areas in which it could do better.
He said: “Since the survey took place we are installing analogue clocks on the wards, improved our group activities bay that runs regular sessions patients with dementia, and we are currently trialling the impact of different colour crockery.”
“Improving the care of patients with dementia, and their carers is one of the Trusts top priorities”
He added: “Unfortunately Kingston Hospital was not one of the trusts that benefited from national funding made available two years ago to facilitate improvements to environments of care.”
Noel Scanlon, executive director of nursing at Durham and Darlington, said: “This is the first time the PLACE assessments have included scoring on dementia and it sits alongside other areas of care and treatment including food, cleanliness and privacy and dignity in which we score very highly.
“We are a large organisation with multiple sites and although we have areas where we have done a lot work to make our areas more dementia friendly – in particular our elderly care wards on our main sites – and our outpatient departments, which at Darlington is used as a national exemplar of best practice, we are at the beginning of a journey,” he said.
“We recognise that we have more work to do to make sure all our hospitals and ward areas are less confusing and disorientating for people living with dementia,” he added.
“Although we have areas where we have done a lot work to make our areas more dementia friendly… we are at the beginning of a journey”
The only organisation to record a 100% score overall was Locala Community Partnerships, an independent community interest company providing community health services in Kirklees and surrounding areas.
It was followed by South London and Maudsley NHS Foundation Trust on 98.41% and South West Yorkshire Partnership NHS Foundation Trust on 98.28%.
The individual site with the lowest score was The Robertson Centre mental health facility run by Worcestershire Health and Care NHS Trust, which gave itself just 40.26%.
A spokesman for the Worcestershire trust said: “The overall view was that despite the fact the centre doesn’t directly provide services for patients with dementia, more work was required to ensure the environment was dementia-friendly.
“We have made a number of improvements since the inspection including ensuring signage in and around the ward was more suitable,” he said.
The 2015 PLACE scores, which are now in their third year, have been published in a report by the Health and Social Care Information Centre.
They also cover food and hydration, cleanliness, privacy, dignity and respect, and the condition, appearance and maintenance of buildings.
While the national average scores for sites were similar to last year, they appear to show a slight dip in several areas.
The average score for cleanliness had improved slightly from 97.25% in 2014 to 97.57% this year.
However, the average food and hydration score had dropped from 88.79% in 2014 to 88.49% this year.
Meanwhile, the score for privacy, dignity and respect was down from 87.73% to 86.03% this time round.
The condition of premises was also down slightly at 90.11%, compared to 91.97% in 2014.