APPENDIX 2
NHS Bournemouth and Poole and NHS Dorset Cluster
Dorset Healthcare University NHS Foundation Trust
TRANSFORMING MENTAL HEALTH SERVICES FOR OLDER PEOPLE IN BOURNEMOUTH, POOLE AND DORSET
Response to issues raised through the stakeholder engagement process
- INTRODUCTION
1.1. The PCT Cluster and Dorset Healthcare University NHS Foundation Trust have welcomed the comments made by stakeholders throughout the engagement process
1.2. Events held with service users, carers and the voluntary sector have been positive and constructive and have highlighted a range of issues which have scope to make improvements beyond this project, particularly in the area of carer support and development.
1.3. The responses in this paper take the consolidated responses of all the work that was undertaken to gather feedback on the specific areas highlighted in the process.
1.4. Although evidently from different perspectives, the concerns expressed about the proposed service changes by the various stakeholder groups tended to focus on similar issues.
2. REPONSES TO KEY ISSUES
Moving people away from hospital care and providing intensive community support
Issues raised
2.1. Many people saw benefits in early access to community-based care but were concerned about continuity of care (for example between dementia services and their GP or acute hospitals, and the availability of care outside normal working hours) and the personalisation of services (i.e. the ability to address effectively their specific social and cultural needs as well as the clinical condition
Response
2.2. The PCT Cluster has established a support programme for general practices to raise awareness about dementia, the importance of early diagnosis and the availability of services for people with dementia and their carers. GP localities have been asked to identify dementia champions to maintain the profile of dementia within practices and provide a reference point for information and advice. In addition the PCT Cluster and Local Authorities have commissioned a range of community support services for people with dementia and their carers, including a network of Memory Advisers, extended day services and access to information/advice
2.3. The local acute hospitals have participated in a peer review of care across the South West for people with dementia. This identified good practice in Royal Bournemouth Hospital and Poole Hospital but also highlighted the need for improvement in identifying people with a diagnosis of dementia and managing their care appropriately. The PCT Cluster has developed improved monitoring of these issues through the contract management process and an incentive scheme to further encourage better support for people with dementia who need to be in hospital because of other illnesses. This includes better preparation for discharge from hospital care, involving appropriate liaison with the Intermediate Care Service for Dementia.
2.4. The Intermediate Care Service for Dementia has been expanded to accommodate the possibility of being required to meet increased social care need. Although in the course of planning the clinical coverage has been increased to 12 hours every day, this is not a 24 hour clinical service. However, the Intermediate Care Service for Dementia will be able to deploy resources to provide planned carer support outside normal working hours in some cases if this would enable the service user to continue to be cared for at home. Even so, it may not be possible to maintain support at home for some people, especially where there is no carer supporting the individual. For these people admission to a dementia care bed may continue to be the best option.
2.5. To provide continuity of care if a response from the Intermediate Care Service for Dementia is needed the case management responsibility will remain with the Community Mental Health Team, liaising with the Intermediate Care Service for Dementia and the Inpatient service (where the consultant psychiatrists will be working across both services). It should be noted from the assessment work undertaken locally that by far the majority of people admitted to dementia beds were admitted from care homes. The number of people requiring support in their own home is likely to be quite low, but the Intermediate Care Service for Dementia will have the flexibility to mobilise enhanced social care input if necessary. It may not always be possible to ensure support from the same staff but where possible an extension of existing care will be provided.
2.6. When Dorset HealthCare University NHS Foundation Trust undertook engagement sessions with carers of people who are currently using inpatient dementia beds it was requested that staff who currently work within the service continue to do so. The Trust were able to assure carers that roles within the new service will be ‘ring-fenced’ for those who currently work within the service, ensuring continuity of care.
Single specialist inpatient facility at Alderney Hospital
Issues raised
2.7. There was no opposition to the idea of a single specialist inpatient site at Alderney Hospital. However most people, with the exception of current users and carers of Alderney and Kings Park hospitals, highlighted the need for facilities to be accessible by public transport and to have sufficient parking for visitors on site. The new unit should be able to provide advice and information to carers about dementia and be a source of guidance on challenges resulting from progression of the condition. Some people suggested it would be a good opportunity and important to create a new image of specialist dementia care far removed from the old fashioned hospital environment.
2.8. When Dorset HealthCare University Foundation Trust undertook engagement sessions with carers of people who currently use inpatient services there was support for the proposals and consensus that had the new Intermediate Care Service for Dementia been available for their relatives it would have much improved their experience.
2.9. The carers who attended the engagement workshops suggested the new unit should have large open corridors and be well lit. The Trust were able to share information about the proposed plans, which include the suggestions made and were well supported by those who attended
Response
2.10. It was noted that by placing services on one site will inevitably mean a longer journey for some people, which would be the case wherever the unit was sited. It was noted that Alderney Hospital has better public transport access than King’s Park Hospital, with a bus stop adjacent to the entrance only a short walk from the proposed unit. Previous developments on the Alderney site have encountered preservation orders on trees restricting potential development so it may not be possible to extend parking facilities to any significant degree, however the provider will be considering options to support visitors to the site
2.11. In response to the carers feedback that any new unit should be able to provide advice and information to carers about dementia, it is proposed that the new site at Alderney Hospital will become a centre of excellence in dementia care and will provide a base for the Intermediate Care Service for Dementia well as inpatient facilities.
2.12. The facilities at Alderney will be considerably upgraded and remodelled using the latest guidance and research to establish a “dementia friendly” environment, with the appropriate use of colour, light and themed areas which is known to be important in the therapeutic process. The Trust will work closely with staff, patients and carers to create new names and branding for the service to reflect the changes made.
2.13. Each ward and the day services will have identified carer leads who will meet monthly to update and monitor action plans based on input from carers. Ongoing engagement will be important and the provider will ensure that there is easy access to make comments and that carers are supported in this. Access to information and advice will be a more prominent feature of the service and the new Dorset HealthCare University NHS Foundation Trust website already has a specific information page for carers with details of available support. The new Recovery Education Centre will be developing courses for carers, developed by carers and piloted by them.
Information
Issues raised
2.14. There is a lot of information available about dementia but the sources are varied and, especially for carers and people recently diagnosed with dementia, not obvious or easily accessible. Many people thought that on diagnosis there was a need for a comprehensive information pack containing basic details about the condition and what to expect. There should also be information about (for example) access to benefits, home adaptations and peer support, as well as clinical information about the condition and its management. Many people felt that their GP surgery was a good place to get this information, although access through the internet and from support organisations was also valued.
Response
2.15. The PCT Cluster is considering the development of an up to date information resource to help people with dementia and their carers to understand the condition and the help that is available to support them through the care pathway. Memory Advisers are seen as an important resource, linking with GP surgeries and the Memory Assessment Service to ensure that people newly-diagnosed with the condition are helped to understand the implications and options associated with the diagnosis. The PCT Cluster is looking to establish a wider network of Memory Advisers so that there is better coverage across the county. Dorset Healthcare University NHS Foundation Trust is extending the involvement of carers in designing and running education courses for carers and developing useful information packs.
Additional services
Issues raised
2.16. The overwhelming response from carers was for more respite care, but also for more befriending and networking opportunities. Some people suggested that more challenging and mentally stimulating day care activities would be beneficial, and that the needs of men with dementia could perhaps be addressed in men-only activities
2.17. In addition, third sector organisations felt that awareness raising and training about the issues facing people with dementia should be offered more widely to include staff in acute hospitals, community services, private nursing and residential homes, and voluntary organisations. This would help to ensure the best possible care and support for people with dementia and their carers.
Response
2.18. All the statutory organisations acknowledge the key role played by the carers of people with dementia. Much of the development associated with improving care for people with dementia more generally, following the guidance contained in the Dementia Strategy, is aimed at supporting carers.
2.19. Dorset County Council is piloting increased availability of respite care via block contracts with selected nursing homes and the Borough of Poole already has a service available at a dementia specialist care home, and home based respite with a range of other support services for carers such as social activities, newsletter, emergency card, befriending services. All three Local Authorities commission day care services and many are run by voluntary organisations. The PCT Cluster and Dorset Healthcare University NHS Foundation Trust are developing better access to information to support carers, and through the Recovery Education Centre will be involving carers in designing and running courses.
2.20. Dorset Health Care University NHS Foundation Trust has been running a pilot service providing in-reach to care homes. This is valued by the care homes where it has been available and the new Intermediate Care Service for Dementia will incorporate an extended care homes in-reach element as a core part of the service. Many people likely to benefit from the service rather than a hospital admission will be resident in care homes. The service will be structured to enable urgent in-reach care to be provided, and this can be supplemented by input provided by care home staff supported by the service.
2.21. The PCT Cluster and Dorset Healthcare University NHS Foundation Trust are following up assessment of other areas (eg. York and Devon) where approaches have been introduced to establish a greater awareness of dementia, reducing the stigma that can be associated with the condition and leading to a more supportive environment for people with dementia and their carers.
3. CONCLUSION
3.1. The feedback from service users, carers and the voluntary sector has been extremely useful in developing these services. The PCT Cluster is at an early stage of commissioning services for older people’s mental health and sees the ongoing engagement of users and carers as essential to ensure that service design and development has users and carers at its heart.
3.2. Ongoing engagement to gather feedback and patient experience will be essential for the ongoing monitoring of the service developments.