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19. Dementia

RCN Northern Branch

(MFD) That this meeting of Congress discusses "Do people with dementia get a fair deal when admitted to hospital?"



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Debate report

The proposer, Andrew Thompson from the Northern Branch, Northern Ireland posed Congress a question in his opening speech, “Do people with dementia get a fair deal when admitted to hospital?” He spoke of a lack of awareness and of resources, and said that care was not of a consistently high standard.

In an emotive debate, many members spoke of their own personal and professional experiences. Such was the interest in this item that Stuart McKenzie, Chair of Congress, made the decision, with members in the hall, to extend the debate.

Evan Keir, Dumfries and Galloway Branch stated there was still an “abundance of stigma” and he went on to say that we need a culture change; “if you work with adults, you work with dementia.”

The debate saw procedural items raised – one to change it from a matter for discussion to a resolution (passed), and others regarding the wording of the item.

Angela McGarry, Yorkshire Branch said many of her patients have dementia and she commended the many positive initiatives and practices in place to care for patients.  

Members spoke of the need to understand the individual and see the person not just dementia, while others commented on staff shortages, and the lack of resources and time, affecting the level of care that can be given. One member stated that “it’s a failure across the board, not just acute or social care.”

Katie Davies, Manchester Central Branch said it was “important to look at this holistically, it’s about community and home care too”.

Andrew Thompson closed the debate with a call to action to combine resources, share expertise and “do something to improve this rapidly changing situation.”

Resolution passed with 2 against and 4 abstentions.

Background

The number of people in the UK with dementia is increasing and presents a significant and urgent challenge to health and social care, both in terms of the number of people affected and the associated cost. There are approximately 850,000 people with dementia in the UK, and approximately one in six people over the age of 80 has a form of dementia. While dementia is predominantly a condition of later life, there are over 40,000 people under the age of 65 in the UK with the illness. (Alzheimer’s Society, 2016)

People with dementia and their carers (family members and friends) have the same human rights as every other citizen. This includes the right to a proper diagnosis, and access to information and support from a range of informed, skilled professionals who are able to provide individualised care. In 2012, the Department of Health launched the Prime Minister’s Challenge on Dementia 2020, which set out a vision “to create a society by 2020 where every person with dementia, and their carers and families, (…) receive high quality, compassionate care from diagnosis through to end of life care.” (Department of Health, 2015)

The Royal College of Nursing (RCN) has been instrumental in supporting acute trusts to improve dementia care and implemented a well-evaluated practice improvement programme, which was completed in 2014. The programme was based on the RCN SPACE dementia principles. (Evans et al., 2015) A similar version is now being piloted in care homes across the UK.

In Scotland, the Government completed a three-year strategy in 2015 to improve dementia care in hospitals through standards, leadership, and staff support and training. This included two positively evaluated initiatives in NHS territorial boards: Alzheimer Scotland Dementia Nurse Consultants and Dementia Champions. Healthcare Improvement Scotland’s improvement work and inspections of care for older people in acute hospitals also include a specific focus on dementia and cognitive impairment. However, in the Scottish Government’s 2015 National Dementia Dialogue, stakeholders noted a need for improvement in care in acute settings. Following this Dialogue, the Government has published its high-level proposal for the third National Dementia Strategy, 2016-2019. (Scottish Government, 2015)

In Northern Ireland, the Department of Health, Social Services and Public Safety (DHSSPS) launched a strategy for dementia in 2011. It estimates that there are 19,000 people currently living with dementia in Northern Ireland, noting that 56% of acute hospital beds are occupied by people aged 65 and over and up to 40% of these people have dementia. The strategy sets out specific measures to enhance the care of people with dementia in acute hospitals. A key element is the need to ensure that dementia among patients in acute hospitals is appropriately diagnosed and then accounted for in the patient’s care plan. (DHSSPS, 2011)

Dementia is a major public health issue in Wales. In 2014, there were an estimated 43,477 people in Wales living with dementia, and that number is expected to increase to more than 55,000 by 2021. In April 2015, the Welsh Government announced funding of £1 million as part of a strategy for dementia in Wales. The plans include a new target for health boards to improve the dementia diagnosis rate to at least 50% by 2016. There will be funding for 32 new primary care support workers, who will provide face-to-face support, information and advice on accessing the right care and services for people diagnosed with dementia. (Public Health Wales, 2015)

References and further reading

Department of Health, Social Services and Public Safety (2011) Improving dementia services in Northern Ireland: a regional strategy. Belfast: DHSSPC Available at: www.dhsspsni.gov.uk/sites/default/files/publications/dhssps/improving-dementia-services-2011.pdf (Accessed 16/05/16) 

Evans, S.; Brooker, D.; Thompson, R.; Bryan, J.; Milosevic, S.; Bruce, M.; and Carter, C. (2015) Introduction to the transforming dementia care in hospital series. Nursing Older People, 27 (6), p18-24 

Public Health Wales (2015) New dementia targets and staff unveiled by the Welsh Government Cardiff: Public Health Wales Available at: www.wales.nhs.uk/sitesplus/888/news/37020 (Accessed 16/05/16) 

Scottish Government (2016) Proposal for Scotland’s National Dementia Strategy 2016-19 Edinburgh: Scottish Government. Available at: www.gov.scot/Resource/0049/00497716.pdf (Accessed 16/05/16) 

Welsh Government (2015) New dementia targets and staff unveiled by the Welsh Government Cardiff: Welsh Government Available at: gov.wales/newsroom/healthandsocialcare/2015/150402dementia/?lang=en (Accessed 16/05/16) 

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