November is now upon and as 2016 rapidly approaches, what does it mean for you, Christmas parties, family gatherings, good food and friends and time for reflection but also a time for planning and looking forward to the future.
2016 also heralds the launch of Scotland’s third Dementia Strategy, which will include themes supporting advanced, palliative and end of life dementia care for people with dementia.
Throughout November and December (2015) a National Dementia Dialogue consultation process gets under way, how this will look and what it will mean for the people of Scotland is in your hands.
With free dialogue events being held across Scotland.
Is there a need for a further strategy I hear you ask?. Although dementia can occur in any age group, much of the research in relation to the prevalence of dementia suggests that the incidence increases with age (Jorm et al 1998, Corrada Et Al 2010.)
As a result of which dementia has become a worldwide priority in relation to economics and service provision due to the overall growth in the numbers of people over the age of 65 years.
At a macro level, Kinsella Et. Al (2001) suggested that ” the world’s population aged 65 and over are growing at approximately 800,000 people per month” with these figures in mind, it is understandable why in the future there is an expected explosion in the numbers of people with dementia.
In relation, at a micro level the prevalence of people with dementia in Scotland has been estimated by Alzheimer Scotland (2014) as currently 88,000 with an expectation that the numbers will double in the next 25 years. With these estimated projections, it is clear to see in relation to the economic burden of care why dementia has become a public health priority for the Scottish Government.
The graph in figure 1 highlights the current economic cost for dementia care, in relation to cancer, heart disease and stroke.
As the population grows and ages, the economic burden of dementia is expected to rise significantly. According to The King’s Fund, the total annual spending on dementia is projected to reach £35 billion in 2026.
So how have we responded ?
Our Journey So Far
I would argue that as with similar health strategies, the dementia strategies are live documents that influence, shape the direction of future care. On the other hand, if this is the image that strategies conjures up in your mind.
I would ask you to take a moment and reflect on the impact that Strategies 1 and 2 have had on both clinical practice and outcomes for people with dementia across NHS Ayrshire and Arran.
Alongside strategy 1 Scotland’s Standards of Care (2011) highlighted the rights of people with dementia to receive a diagnosis. So how have we done?
In 2010 ISD Scotland indicated that diagnostic rates across Scotland were relatively low, which saw a dementia diagnostic HEAT target of 61% being set.
Within NHS Ayrshire & Arran in 2010 the diagnostic rate was around 43%, not good I hear you say.
In response NHS Ayrshire and Arran adopted improvement measures which saw diagnostic rates not only meet the HEAT target of 61% but exceed to 63% by 2012.
Earlier this year, I was extremely fortunate in being in the position of attending 25th Alzheimer Europe Conference in Ljubljana, where I spent some time discussing diagnostic rates and barriers with colleagues from across Europe.
I was struck by the correlation of lower diagnostic rates in countries without dementia strategies in place. In comparison both nationally and globally, Scotland continues to have higher diagnostic rates, with the number of people being diagnosed with dementia around 25% higher (relative to population size) in Scotland than in England(.Sep 15).
NHS Ayrshire & Arran have now adopted the 4AT dementia/delirium screening tool as standard practice on admission for people >65yr. Although this is not a diagnostic tool it is indicative of the need for further assessment and has been incorporated into patient admission documentation.
This was based on an 8 Pillar Model of care developed by Alzheimer Scotland,
Subsequently all people in Scotland who are diagnosed with dementia now have the offer of a minimum of 1 years post diagnostic support.
Carer Support and Education
The Dementia Standards (2011) and the subsequent Dementia Strategy 2, 10 Dementia Care Actions in Hospital also identified the need to have carers both formal and informal who were well supported and educated in relation to dementia.
In response to which the Scottish Government and Alzheimer Scotland in conjunction with local health boards funded the Alzheimer Scotland Dementia Nurse Consultant Posts in each health board.
As a result of which, I have now been in post within NHS Ayrshire & Arran since 2012, with a remit of developing policy into practice, practice improvement, support and education.
Simultaneously the Dementia Champions course was developed and delivered through The University of West of Scotland and funded by NHS Education for Scotland. Of which we are now on cohort 6, with over 500 champions across Scotland and 37 champions in NHS Ayrshire & Arran with a further 7 about to graduate.
Care action 2 highlighted the need for health boards to develop their workforce in line with Promoting Excellence (2011). Since 2011 NHS Ayrshire & Arran have supported an internal dementia education programme at all 4 levels of care (informed, skilled, enhanced & expert). With numbers of people trained at levels appropriate to their role now exceeding 7,000.
Care action 8 – Work in equal partners with families, friends and carers saw NHS Ayrshire & Arran embark on the #youcanmakeadifference campaign with Tommy Whitelaw from Dementia Cares Voices.
With talks being hosted across sites throughout 2014, this resulted in over 250 staff personal pledges to improve care, and saw the development of our pledge trees which can be seen in both University Hospitals Crosshouse and Ayr dining rooms.
Care Action 6
Highlights the need to develop safe and therapeutic environments for people with dementia. August 2013 saw the official opening of the Forget-me-not Garden at Marchburn Ward in East Ayrshire Community Hospital , under the watchful eye of Senior Charge Nurse Lainey McLeod.
The garden allows patients to spend time outdoors, while keeping them safe. The garden is designed to stimulate the senses, whilst allowing patients to smell, touch and see a wide variety of plants and flowers.
This was identified by The Mental Welfare Commission in the Dignity and Respect: dementia continuing care visit report (2014) as an area of excellent practice.
This is only a snap shot of the dementia care improvement work taking place throughout NHS Ayrshire & Arran. Has there been improvement since 2010 ?, absolutely, but, can I honestly say that we have got it right for every person every time ? At this stage I don’t think we are quite there yet, but we are striving for that ultimate goal and I for one as Dementia Nurse Consultant feel privileged working alongside colleagues who are committed to improving care for people with dementia throughout Ayrshire & Arran.
So I ask you once again is there a need for a 3rd Dementia Strategy ?
Absolutely, let us drive the direction of dementia care in Scotland by having your say on the road that this will take by logging in here to attend a free dialogue event to have your voice heard.
This week’s blog was by @janicemcalister (Janice McAlister), Alzheimer Scotland Dementia Nurse Consultant, NHS Ayrshire & Arran