Living with dementia magazine March 2011

The Society's Putting Care Right campaign is aimed at improving quality of care for people with dementia in all settings. Here, Luke Bishop reports on the progress made following stage two of the campaign, which focused on improving dementia care in hospital.

Up to one-quarter of all hospital beds are used by people with dementia aged over 65. Yet, according to Alzheimer's Society's Counting the cost report released in 2009, some hospitals systematically continue to fail people with dementia.

The report, which was compiled following consultation with people with dementia, their carers and health professionals, identified great room for improvement in the nation's hospital wards in the form of nine key recommendations. These included empowering nurses with specialist training and reducing the average amount of time people with dementia stay in hospital by a week, which could save the NHS over £80 million per year.

Since the release of Counting the cost, Alzheimer's Society staff and volunteers have been busy working alongside clinical staff at many NHS trusts to try to implement its suggestions. Some hospital trusts, including Ipswich and Northumbria, have been proactive in taking on board our recommendations.

A summary of the recommendations

• Hospitals need to recognise that dementia is a growing, costly problem.

• The number of people with dementia cared for in hospitals needs to be reduced to avoid inappropriate admission to acute care.

• A senior clinician in hospitals should be in place to lead on improving the quality of care for people with dementia.

• Specialist older people's mental health teams should be commissioned to improve the care of people with dementia in hospitals.

• Dementia care training needs to be provided for the acute care workforce.

• The use of antipsychotic drugs needs to be reduced.

• People with dementia and family and friends should be involved in care decisions.

• Hospital staff must ensure that people with dementia have enough to eat and drink.

• The approach to care for people with dementia needs to be changed to one of dignity and respect.

Learning from mistakes in Ipswich

When Richard Warnock's wife, Pam, went to Ipswich Hospital on two occasions in 2009, he found the visits anything but straightforward. Due to a combination of lack of awareness about dementia and of Pam's personal needs in particular, Richard encountered many difficulties.

Pam, 70, is in the later stages of vascular dementia. Richard, 68, says,

'Pam didn't have a very good experience at first because the staff, both nurses and doctors, didn't seem to know how to deal with dementia.

'There was no point telling Pam things that she didn't understand. When she went to A&E a nurse was trying to fix pads on her for an ECG (electrocardiogram). I explained that Pam would just peel them off but they didn't seem to understand that is what someone with dementia might do.

'On another occasion, a doctor was trying to give Pam instructions, saying 'Turn this way,' but she didn't understand what to do. Luckily, I was there to explain all these things to them, but what happens to someone who hasn't got anybody who can be there for them?'

As a result of these frustrating experiences, Richard joined the local Alzheimer's Society campaigns group, which was working alongside the hospital trust to implement the report's recommendations

Using the experiences of people such as Richard, staff at Ipswich hospital have worked hard over the last year to deliver better care for dementia patients. A programme of ongoing training in dementia care is now given to all nurses, occupational therapists and healthcare assistants, as well as anyone who has regular contact with patients.

For Julie Sadler, Head of Patient Experience at Ipswich Hospital, improving the quality of care for people with dementia has been a priority. She says,

'Within our complex care wards about 75 per cent of patients at any time have dementia. It may not be the reason they are in hospital, but it is certainly something we need to be aware of.

'My interest is in how we can treat people better and improve the environment for people with dementia. We started by giving extra training to staff because we were very aware that we weren't providing this as much as we should be.'

Sharing expertise

A complex care team from Suffolk Mental Health Trust has been working alongside hospital staff for the past 18 months. The team works with carers, patients and nurses and uses its expertise to help improve overall quality of care.

It has supported staff training, helped to raise awareness of issues around delirium and dementia, undertaken follow up calls following discharge, and helped staff respond appropriately to patients who are unsettled or aggressive.

Since January 2010, the team has handled more than 600 referrals.

In addition, a Dementia Champion has been appointed with responsibility for ensuring people are well looked after, that their needs are met and they are discharged at an appropriate time.

Julie says, 

'When patients come into hospital it is a strange environment and this can have a negative effect on them when they return home. We are trying to make sure that patients aren't further disabled by their experiences in hospital.'

The hospital is also preparing to launch a major project entitled Enhancing the healing environment. This will include refurbishing a hospital ward to make it dementia-friendly, using guidance from Alzheimer's Society's Guide to the Dementia Care Environment and the University of Stirling.

The hospital has also been working with Suffolk museums and introduced memory boxes to wards to stimulate patients' memories in the hope they will aid relaxation and communication.

Northumbria

Training staff in dementia care is equally high on the agenda at Northumbria NHS Trust. Money granted by NHS North East has been invested into a two-day training programme for staff.

Andrew Teodorczuk, Consultant Liaison Psychiatrist at the trust, says,

'Part of the training has involved us learning from carers and patients, particularly about person-centred care. We have trained a wide range of people including porters, doctors and managers.'

As an extra aid to training, a film featuring interviews with people with dementia and their carers has been produced by the trust.

Sadie Bills, 68, who has Alzheimer's disease, features in the film talking about her dementia. Sadie says, 

'If doing this video is going to help people with dementia I am glad to do it because we need as many people told about it as possible.'

Andrew says that the focus on training staff about dementia has already had a noticeable impact. He says,

'It has certainly been very successful in addressing some of the attitudes that had been identified as the main barrier to good care for people with dementia.'

Listening to carers

Carers such as Barbara Dow have had a great deal of input in developing a training programme. When her husband Alastair went into hospital five years ago, Barbara experienced a number of problems, including staff failing to recognise that Alastair was in pain. Since his death in hospital, Barbara has campaigned hard for improvements and given talks to nurses and medical students about her experiences and what can be learned from them.

She says, 

'I really feel very strongly that there needs to be more training for nurses. Carers and staff need to work together because the carers build up a wealth of very important information about the person which will help in providing good care.

'For the past five years I have really been pushing for change because my husband deserved better treatment. But rather than confronting people, I wanted to help change attitudes and I'm pleased there has been such willingness at Northumbria to listen to patients and carers.'

The hospital has also acted on the recommendation in Counting the cost to ensure people with dementia have enough to eat and drink. Brightly-coloured cups are now being used to encourage patients to keep hydrated.

Lynne Harrison, Liaison Nurse for Old Age Psychiatry, says,

'We had to help people with dementia drink more and enable them to recognise what is sitting on the table in front of them. Research has shown that recognition of coloured cups has led to 84 per cent more fluid intake.

'Nurses have told us they are filling the cups up three times as much, as the patients are drinking much more.'

To find out more about improvements being made in hospitals and read our Counting the cost report, visit alzheimers.org.uk/countingthecost

This is me

Alzheimer's Society's has a leaflet called This is me for people with dementia who are going into hospital. It provides a snapshot of the person with dementia, giving information about them as an individual, such as needs, preferences, likes and dislikes. You can download it or place an order with Xcalibre on 01628 529240.