The North Lanarkshire Dementia Demonstrator Site (NLDDS) started in April 2011. It aims for whole system redesign of the dementia pathway. Our objective is for support to be provided in an integrated way across sectors and services, for people with dementia, their families and carers, using change initiatives showing better outcomes for more people using the same or less resource. People with dementia, at any stage, can easily become socially isolated and excluded. The NLDDS aims to support people within their community boosting both their health and their social inclusion.
PLANNING / · a clear rationale, defined processes and focus on stakeholder needs· contributes to organisation’s goals and addresses current or emerging challenges
In June 2010, Scotland’s National Dementia Strategy was formally launched in Coatbridge, North Lanarkshire. One of eight specific actions identified to address the key challenges detailed in the strategy was a government commitment to provide ‘integrated support for change’. The mechanism to achieve this commitment was to develop three dementia demonstrator sites involving health and care partnerships in discrete NHS Board/Local Authority areas. NHS Lanarkshire (NHSL) and North Lanarkshire Council (NLC) were successful in a joint bid to the Scottish Government to become a demonstrator site and the North Lanarkshire Dementia Demonstrator Site (NLDDS) formally started in April 2011. The NLDDS aims to explore the impact of whole system redesign, in terms of the dementia pathway. The objective is to develop an approach that enables change support to be provided in an integrated way across sectors and services, tracking the quality and economic impacts of change. In broad terms, testing out change initiatives which show better outcomes for more people using the same or less resource.
The NLDDS is co-ordinated by a project group consisting of representatives from the partner agencies and the Joint Improvement Team and a carer representative. The project group reports to the North Lanarkshire Health and Care Partnership through the Older People’s Partnership Board. Following extensive consultation with a variety of local stakeholders, including a locality based mapping exercise, the work of the NLDDS has been focussed on change initiatives at different points on the dementia pathway:
Early Intervention through:
Dementia Capable Communities – aim to launch the first Scottish dementia friendly town (Motherwell)
Making Life Easier – promote the take up of equipment and adaptations through the website
Carer Support though:
Development of the GP website – to include more information on dementia and the support available
Dementia Cafés – promote the use of the three locality based cafes
General Hospital Developments – support a wide range of initiatives as part of the change programme in the acute sector
Post Diagnosis Support Project
Drawing on Alzheimer’s Scotland’s ‘5 Pillars of Support’ – piloting a model of support in Wishaw
Integrated Day Services outreach service – to provide support and assistance for people with dementia with the aim of avoiding unnecessary admissions to acute care in hospital
Palliative and end of life care – working to produce an integrated care pathway for people with dementia
The NLDDS is making a major contribution to the health and wellbeing theme of the council’s corporate plan, which states that we are “committed to providing our residents with the best opportunities to improve their health and wellbeing and access appropriate housing. The health and wellbeing of our residents is influenced by a number of factors including lifestyle choices, life circumstances and inequalities.” It directly contributes to the measure that we have “excellent health and care services that are timely, effective and centred around individuals”, developing communities that support and enable people with dementia and their families and carers in a localised environment. This is equally applicable to the Single Outcome Agreement (SOA) statement that our “aim is for people in North Lanarkshire to have a healthy life as well as a long life”. The SOA references the mental health action plan ‘Towards a mental flourishing Lanarkshire’ and the NLDDS is clearly directed towards the stated outcome of linking people with support within the community in its aim of promoting a culture whereby the whole community is aware and supportive of issues surrounding dementia.
DELIVERING / · implemented in all relevant areas and across all the required stakeholders· carried out in a structured and logical way , using robust and sustainable methods
Early Intervention
Dementia Capable Communities – this partnership initiative is adopting a community asset building approach to link with key agencies in the Motherwell town centre area to enhance and develop the awareness and resilience of the local community in providing a supportive environment for people living with dementia, their families and carers, in its broadest sense. Through this initiative it is intended to assist local businesses and services to develop their responses to people living with dementia in the community both in terms of environment and staff approaches.
Making Life Easier – this joint service provided through North Lanarkshire Council’s website provides people with information on a wide range of health matters and advice on managing everyday activities independently and safely, including matching people to particular pieces of equipment from the Integrated Equipment and Adaptations Service, to assist with living at home. Input from the NLDDS has ensured this initiative is accessible and relevant for people living with dementia, their families and carers with a prominent ‘memory icon’ portal. The software in place enables data to be collected on the numbers of people accessing the site and the nature and progress of their enquiry.
Carer Support
We are looking to develop the GP website to incorporate more information on dementia and supports available in Lanarkshire which can be passed on to people via NHSL’s Library Service. Previously, progress on this initiative has been measured but the commitment remains to enhance current information provision to support people to maintain their caring role.
Dementia Cafés – three locality based dementia cafés are operating in Motherwell, Airdrie and Cumbernauld. The cafés aim to provide information, education and advice on a variety of topics for people worried about their memory, living with dementia, their carers and their families. The cafés also provide a forum for peer support, widely recognised as a key element of post diagnosis interventions.
General Hospital Developments
A number of change initiatives in the acute sector have been implemented, supported by the Improving Care Dementia Group, Alzheimer Scotland Dementia Nurse Consultant and the NLDDS:
o Raising awareness of acute general hospital staff re potential of assistive technology
o Nine Dementia Champions across NHSL to support the drive to improve standards of care for people living with dementia in acute hospital settings.
o Development work in relation to a Delirium Care Pathway for use in A&E Departments and Emergency Care Units
o Environmental changes to specific wards in Monklands Hospital to become ‘dementia friendly’.
o Ensuring upgrades to ward environments include consideration of ‘dementia friendly’ components.
o Dementia awareness training for staff and volunteers.
o Charge Nurse training on delirium and dementia with associated action plan to cascade to junior staff.
o Strengthening links with the University of West of Scotland, University of Stirling and Alzheimer Scotland to embed educational programmes within the workforce in line with the Promoting Excellence framework.
Post Diagnosis Support Project – drawing on Alzheimer’s Scotland’s ‘5 Pillars of Support’, the NLDDS is piloting a model of support for people who have just been diagnosed with dementia in the Wishaw locality. A member of staff from NHSL, NLC or Alzheimer Scotland is being identified to act as a consistent support presence for at least the first year after diagnosis ensuring the person is sufficiently informed and supported throughout this period.
Integrated Day Services outreach service – NLDDS has started an integrated day service outreach model to ensure people who have complex needs, associated with dementia, receive the appropriate level of support irrespective of their ability or willingness to attend the building based service in Wishaw. The aim is to provide support and assistance for people living with dementia and their carers at home to avoid or delay the need for long term, institutional forms of care and to provide timely and appropriate advice on health and behavioural matters relating to dementia in order to assist in the avoidance of unnecessary admissions to acute general hospital settings. The outreach service also provides practical advice for carers to assist them in continuing their caring role.
Palliative and end of life care – early work has commenced to produce an Integrated Care Pathway (ICP) for Palliative Care in Dementia. The intention is to build an ICP that connects the Dementia ICP with current Palliative Care Pathways. In line with the Promoting Excellence framework, staff from the partner agencies are being released to take part in Alzheimer Scotland training on Palliative Care in Dementia with a view to cascading the learning throughout the appropriate services.
INNOVATION + LEADING PRACTICE / · Demonstrates leading practice, and is capable of replication elsewhere· Achieves genuine innovation or new ways of working
As one of the three Dementia Demonstrator Sites in Scotland, the NLDDS is leading the way in exploring a holistic, inclusive approach to support for people with dementia, their carers and families, that enables change support to be provided in an integrated way across sectors and services, tracking the quality and economic impacts of change. The stated intention of the Scottish Government is that the work of these sites should then be broadened out and good practice replicated throughout Scotland. The approaches described here have the aim of exploring new solutions to an ever increasing issue. In broad terms, the NLDDS – along with the other demonstrator sites – is testing out change initiatives that will show better outcomes for more people using the same or less resource. One of the stated aims and intended outcomes is that this should be a replicable approach, with the facility to be rolled out more widely throughout the country.
So one of our main imperatives is to share the learning from the three sites widely across Scotland. In this regard the NLDDS is participating in the following:
o Lanarkshire Dementia Strategy Implementation Group
o Three site learning events – share learning with the other demonstrator sites
o National learning events – national promotion of the work of the demonstrator sites
o Dementia Managed Knowledge Network – web based NHS site with specific pages for each demonstrator site.
RESULTS + IMPACT / · a convincing mix of customer and internal performance measures· demonstrates how better outcomes are being achieved
· a full range of relevant results– either already achieved or with potential to deliver over time
Early intervention through:
Dementia Capable Communities - individual stories of people’s current experience have been gathered which will be revisited prior to the end of the NLDDS to evaluate impact. It is acknowledged that this is a longer term task, which outlives the term of the NLDDS, whose success is dependant largely on cultural shift. With this in mind, sustainability is being built in through active collaboration with Alzheimer Scotland and the Voice of Experience Forum.
Making Life Easier – as a web based programme, we are able to collate statistics on the numbers of people accessing the site and the nature and progress of their enquiry.
Carer Support though:
Development of the GP website – again, following implementation, we will be able to collate statistics on the usefulness of this site.
Dementia Cafés – In total, around 100 people are attending the monthly sessions – a combination of new and returning attendees. Initial findings suggest an increase in referrals to locality memory services since the inception of this model of support. All three cafes are providing six monthly evaluation updates. A fuller evaluation report in summer 2013 will be carried out with a view to rolling out the model to the remaining three localities in North Lanarkshire.
General Hospital Developments – agreement on an evaluation process is currently under discussion.
Post Diagnosis Support Project - anticipated individual outcomes as a result of post diagnosis support would be improved quality of life and sustained independence within the context of strong family and community support. A key aspect of this approach will be the development of a detailed, holistic and person centred support plan in partnership with the person living with dementia, their families and support networks which will cover the range of issues in relation to information, practical, legal and emotional support. The plan will enable the person to be at the centre of their care as the illness progresses and to be a key resource to be accessed by professionals in all care settings. In terms of service benefits, there is strong evidence that making improvements in and directing resources to an earlier phase of care will also contribute to savings in areas such as unplanned hospital admissions and entry to long term residential care environments.
Integrated Day Services outreach service – The service has been in operation since January 2012. 20 people have received support in the period to end of June 2012; the majority being people whose condition has deteriorated to the extent that attendance at IDS is no longer appropriate or beneficial. Direct support to the person and their family in the form of practical advice and coping strategies to manage the condition has played a significant part, along with other supports, in maintaining the person at home longer than might otherwise be the case. The Talking Points outcome based evaluation method is being used on an individual basis as the project progresses. Initial findings show high degrees of satisfaction with the service in terms of ameliorating the impact of dementia on the life of the carer and their relationship with the person living with dementia. In addition, constructive criticisms have enabled associated services to modify their approach in some circumstances to take account of the views of people caring for someone with dementia and adopt a more person centred approach.