RCHT Dementia Care Policy V1.0

RCHT Dementia Care Policy V1.0 April 2012

Table of Contents 1. Introduction...3 2. Purpose of this Policy...3 3. Scope...3 4. Definitions / Glossary...3 5. Ownership and Responsibilities...3 6. Standards and Practice...5 7. Dissemination and Implementation...7 8. Monitoring compliance and effectiveness...7 9. Updating and Review...8 10. Equality and Diversity...8 STRATEGIC POLICY CONTEXT...10 Appendix 3. Governance Information...18 Appendix 4.Initial Equality Impact Assessment Screening Form...20 Page 2 of 21

1. Introduction 1.1. Dementia and the challenges of mild cognitive impairment will touch the vast majority of our services directly or indirectly. Nationally the impact is recognised and anticipated to grow as the demographic changes across our society witness a significant growth in the older age population. The Trust Board has approved a local hospital-wide dementia strategy (Appendix 2, December 2010) which sets this context nationally and presents the local challenge to us all. This policy exists to translate that strategy into practical means to benefit the population with dementia and mild cognitive impairment using our services today and into the future. 2. Purpose of this Policy 2.1. The purpose of this policy is to ensure the Trust meets strategic and clinical best practice standards in delivering its ambition to provide excellent dementia care services. 3. Scope 3.1. This policy applies to all Trust staff who are directly or indirectly involved in the care of people with dementia or cognitive impairment, their carers and families. 4. Definitions / Glossary 4.1. Dementia: The term 'dementia' is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions. These include Alzheimer's disease, vascular dementia, dementia with Lewy bodies and sometimes as a result of a stroke. 4.2. Mild cognitive impairment (MCI): is a relatively recent term, used to describe people who have some problems with their memory but do not actually have dementia. It is a descriptive term rather than a specific medical condition or disease. It describes memory loss apparent to the individual, and those around them. 4.3. In the context of this polciy Dementia from now on will include MCI, unless seperation is warrented. (Definitions taken from Alzheimer s Society Fact Sheet 400 and 470) 5. Ownership and Responsibilities 5.1. The Chief Executive and wider Trust Board have key roles and responsibilities to ensure the Trust meets requirements set out by statutory and regulatory authorities (for example: the Department of Health, Commissioners and the Care Quality Commission). These responsibilities are delegated to an Executive Lead with supportive structure to ensure and assure standards and expectations are met. These are described below. 5.2. Role of the Executive Lead The Executive Director for Nursing, Midwifery and Allied Health Professional is the nominated Executive Lead and will be responsible for ensuring structures and processes are in place to assure delivery of the Dementia Strategy. The Executive Lead will report to Trust Board on progress as required. 5.3. Role of the RCHT Dementia Action Group Members The Action Group is made up of three distinct participative groups: subject specialist, divisional representatives and importantly service users, carers and representatives of people with dementia. Page 3 of 21

Subject specialist: bring expertise of the subject, from clinical, managerial and commissioning perspectives Divisional representative: are fundamental to ensure work flows from the action group to clinical teams and that a feedback mechanism is established back to the action group Service users, carers and representatives of people with dementia: bring reality to the action group of the patient group the action group serves The Action Group is responsible for delivering the clinical and corporate requirements linked to the Dementia Strategy, the ownership of a local improvement plan, which is updated and monitored bi-monthly, is key assurance measure of progressive quality improvements for this patient group. This Group reports bi-monthly to the RCHT Governance Committee. 5.4. Role of the RCHT Governance Committee The RCHT Governance Committee will hold to account the work and actions of the RCHT Dementia Care Action Group. It will receive and scrutinise progress in delivering the local improvement plan on behalf of the Trust Board. 5.5. Role of the RCHT Dementia Link Workers (DLWs) A RCHT Dementia Link Worker Networks exists to enable clinical champions in each clinical area to audit, monitor and progress practices changes with the aim to improve the care of people with dementia, their carers and families. DLWs are empowered to deliver the ambition of the organisation to provide excellent care for such people across its whole service. Their role responsibilities are set out in appendix 3, this role has Trust Board endorsement. 5.6. Role of Divisional Management Teams Divisional Management Teams (Divisional Director, Divisional General Manager and Divisional Nurse) are responsible for ensuring their divisional representative and local network of DLWs are pulling together driving up the standards of care. Effective mechanism for communication and disseminator of information to all clinical teams must be assured. 5.7. Role of Ward and Department Sisters and Charge Nurses (and other Departmental Leads / Managers) Line managers are responsible for identifying and supporting their local DLW in driving through changes and to ensure effective communication channels exist to the divisional representative encouraging dissemination of information and actions across the wider health care team. 5.8. Role of Individual Staff All staff members are responsible to ensure they comply with Trust policy regarding the care of people with dementia (including MCI (see Definitions)). They must meet requirements set out regarding learning and development for their level of involvement with people with dementia and should ensure they know who their local dementia link worker or divisional representative is to enable communication and sharing of information. Page 4 of 21

6. Standards and Practice 6.1. Hospital Standards of Dementia Care 8. Appropriate training and workforce development 1. Respect, dignity and appropriate care 2. Agreed assessment, admission and discharge processes with a needs specific care plan 5. Nutrition and hydration needs are well met 7. Ensure quality of care at the end of life 3. Access to a specialist older people s s mental health liaison service 4. A dementia friendly hospital environment; minimising moves 6. Promote the contribution of volunteers Established at the end of 2010 the Southwest Region launched eight standards for general hospital to meet to demonstrate delivery of the National Dementia Strategy and NICE guidance. These are: Respect, dignity and appropriate care Agreed assessment admission and discharge processes with a needs specific care plan Access to a specialist older peoples mental health liaison service A dementia friendly hospital environment minimising moves Nutrition and hydration needs are well met Promote the contribution of volunteers Ensure quality of care at the end of life And overarching all these is: Appropriate training and workforce development 6.2. The standards call for specific requirements to be set out in policy, they are: 6.2.1. Vulnerable people with dementia or delirium should not be moved between wards between the hours of 8pm and 8am unless required for specifically justified care or treatment, due to the detrimental; effect it can have upon the individual (moves at mealtimes and medication times should also be avoided where possible). Organisational performance is tracked using the Dementia Care Key Performance Indicators (KPIs), DATIX incident reports are encouraged so rational behind such moves can be explored and reported. 6.2.2. In line with the Standards it is good practice to identify through hospital systems patient with dementia. plans to have this information available on PAS and in their health records is progressing. Currently all patient with dementia or MCI should be flagged on the interactive SWiftPlus boards with the forget-me-knot symbol. 6.2.3. Carer involvement is essential throughout the hospital journey of their person. Information and support needs to be appropriately offered and Page 5 of 21

recorded. Materials to support carers are available and consideration of their entitlement to an independent carers assessment must always be made. 6.2.4. To improve coding of patient who have a dementia diagnosis the Trust promotes the notification of this through the use of the Code:Dementia sticker (CHA 2836). The eldercare team along with the Complex Care and Dementia Psychiatric Liaison Service are primarily directed to leading sticker utilisation. 6.3. The Trust undertakes an annual self assessment against these standards and develops an improvement / action plan that combines with its annual National Audit performance results and its annual dementia patient and their carer survey results into a comprehensive programme of work that the RCHT Dementia Care Action Group has delegated responsibility to deliver. 6.4. The Trust has a number of work streams in place to deliver the ambitions of its strategy, this policy and the standards set out within it. Underpinning these work streams is clinical and practice guidance - essential to demonstrate and deliver excellent care to this patient group, their carers and families. 6.5. Organisationally this is visually and practically presented in a Map, this organisational map should guide staff to the appropriate information and guidance to support care at key points on the patient journey through the acute care system and when they interface with community services providers and partners. 6.6. The Organisational Dementia Care Map Mental Capacity Act / Policy Delirium Pathway Pre- / Admission Phase Assessment Phase Acute Care and Management Phase Discharge Planning Phase Dementia Pathway 6.7. Pre-admission phase This phase remains developmental and dependent of intelligence sharing to support people admitted to hospital. For our elective pathway patients, better information and communications can be prompted and started prior to admission so care on admission can be tailored to meet their needs (e.g. making available This is ME). Unscheduled or emergency admission pathway patients require co-operation and often preparatory intervention from partners (e.g. care homes) to prepare of such an admission. Currently the AMP (Assess Monitor and Prevent) Document is being promoted in the community to enable early sharing of information when people are admitted as an emergency to tour hospitals. Growing use of shared technologies could aid better response to individual assessment of needs in these unscheduled admissions. Page 6 of 21

6.8. Assessment Phase RCHT Guidelines have been developed to support practice : RCHT Guidelines for the Assessment and Management of Delirium RCHT Guideline on the Assessment and Management of Pain in Dementia and People with Sever Cognitive Impairment 6.9. Acute Care and Management Phase RCHT Guidelines exist to support practice : RCHT Guidelines for the Assessment and Management of Delirium RCHT Guideline on the Assessment and Management of Pain in Dementia and People with Sever Cognitive Impairment RCHT Guidelines for Palliative Care in Dementia RCHT Dementia Care Plan (CHA 3009) 6.10. Discharge Planning Phase RCHT guidelines exist to support practice: RCHT Guidelines for Discharging a Person with Dementia RCHT Guidelines for Palliative Care in Dementia 7. Dissemination and Implementation 7.1. This policy will be cascaded by the RCHT Dementia Care Action Group to Divisional Representatives and to the RCHT Dementia Link Worker Network for communicating and sharing at a local clinical level, making all resources available to all relevant staff. 7.2. This policy s implementation will be through the delivery of the improvement plan for dementia care, championed by the Action Group. This promotes training and educational opportunities and makes sure local recourses are available via the dementia link worker network 8. Monitoring compliance and effectiveness Element to be monitored Lead(s) Tool This policy underpins the Trust strategy and commitment to improve the care of people with dementia in our services. National and regional standards are established (reflected in this Policy and Trust Strategy) and an improvement framework exist which includes peer review to drive up standards. The Trust Clinical Lead for Dementia Care takes responsibility for monitoring (auditing) the Trust s clinical performance in meeting the Nationally set standards of care and service delivery for dementia care. The Trust Strategic Lead for Dementia Care take responsibility for monitoring (auditing) the Trusts operational and strategic performance against nationally and regionally set standards for dementia care in general hospitals. The Trust is committed to participating in the National Dementia Care Audit, conducted by the Department of Health and facilitated by the Royal College of Psychiatry. This template is Nationally negotiated and published. In addition, The Trust undertakes an annual self assessment based on eight standards for dementia care in general hospitals and Page 7 of 21

Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared commissions an annual Dementia Patient and Carer Survey. The Trust s clinical care performance is benchmarked with National results. These are published and reported, currently on an annual basis. Annually the Trust undertakes an annual assessment against eight standards for dementia care in general hospitals The Trust s performance report, local response and improvement plan are presented through the RCHT Dementia Care Action Group to the and RCHT Governance Committee, who act on behalf on the Trust Board to scrutinise and monitor improvement delivery. Independent scrutiny of delivery is given from commissioners, and a regional peer review processes. The RCHT Dementia Care Action Group leads on service improvement for dementia care in the organization. It is tasked to deliver the improvement plan developed form audit and self assessment against the hospital standards and signed off by health, social care and voluntary sector partners. This has a delivery timetable monitored by numerous groups and agencies. Improvement and change in service delivery is documented in the notes and minutes of the Action group, its sub groups and in the evidence folders linked to the hospital standards. 9. Updating and Review 9.1. The policy will be kept under review by the authors and RCHT Dementia Care Action Group in line with Trust strategic and operational developments and clinical practice changes. The minimum review period will be in three years time in line with Trust policy. Revision activity is recorded in the version control table at the beginning of this document. 10. Equality and Diversity 10.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement. 10.2. Royal Cornwall Hospitals NHS Trust is committed to a Policy of Equal Opportunities in employment. The aim of this policy is to ensure that no job applicant or employee receives less favourable treatment because of their race, colour, nationality, ethnic or national origin, or on the grounds of their age, gender, gender reassignment, marital status, domestic circumstances, disability, HIV status, sexual orientation, religion, belief, political affiliation or trade union membership, social or employment status or is disadvantaged by conditions or requirements which are not justified by the job to be done. This policy concerns all aspects of employment for existing staff and potential employees. Page 8 of 21

11. Equality Impact Assessment 11.1. The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 9 of 21

Appendix 1. RCHT Dementia Care Strategy RCHT Dementia Care Strategy (v5.0) Version 5.0 has had language and context updated to reflect more current development and service delivery. However this document needs to be read in the context of the time it was written: pre- and pre- South West Dementia Care Standards for General Hospital which have gone a long way in progressing local developments around dementia care in RCHT. The RCHT Dementia Care Strategy sets out the Trust s commitment to delivering objective eight of the National Dementia Strategy and how it works with partners across Cornwall and the Isles of Scilly to drive up the care standards for people with dementia and their families and carers. STRATEGIC POLICY CONTEXT The National Dementia Strategy This Strategy Document was launched in February 2009. Within the strategy there is a key objective for all general hospitals: Objective 8: Improved quality of care for people with dementia in general hospitals. Identifying leadership for dementia in general hospitals, defining the care pathway for dementia there and the commissioning of specialist liaison older people s mental health teams to work in general hospitals. The Strategy s ambition is now embedded into two recent publications from the Department of Health and form the National Institute for Healthcare and Clinical Excellence. They reflect the national move to focus on quality standards and outcome driven healthcare improvements. For example, patient related outcome measures (PROMs) will play an increasingly important factor in measuring service quality. This National level framework provides the fundamental focus for the Trust s local strategy and reference point to review other local strategies and some external reviews of our services. Alzheimer s Society Report - Counting the Cost: Caring for people with dementia on hospital wards In 2009 this research report published a factual account of people with dementia and their carers experiences of hospital care today. It quantifies that people with dementia over 65 years of age are currently using up to one quarter of hospital beds at any one time and specifically that people with dementia stay far longer in hospital that other people for the same procedure and that the longer they are in hospital the worse the effect on the symptoms of dementia and the individuals physical health; discharge to a care home becomes more likely and antipsychotic drugs are more likely to be used. Nine recommendations are made and specific key messages to note, not covered in other strategy papers, centre upon involving people with dementia and their families and carers in their care to improve person-centred care and make sure processes are in place to ensure people with dementia have enough to eat and drink. Page 10 of 21

The NHS Confederation Report: Acute Awareness Improving hospital care of people with dementia Published in June 2010 and focusing on improving outcomes, quality and efficiency, it draws attention to the themes of: early patient identification of people with dementia in hospital services; effective care pathways; training; the use of anti-psychotic drug; nutrition; the care environment; effective discharge; leadership; liaison teams and involvement of patient and carers. The report concludes with a call for acute hospitals to re-think their services so efficiencies can start and been sent through the delivery of: early identification of people with dementia, leading to shorter stays and reduced hospital infections and on discharge patients leaving with an appropriate care plan to help reduce the risk of readmission. Therefore the hospital s pathway interface at the point of admission and on discharge is crucial to improving efficiencies as well as dementia care. NHS Cornwall and Isles of Scilly Strategy Improve care and support for people with dementia and their families, section seven of the local strategic plan for improving health in Cornwall and the Isles of Scilly 2008/09 to 2012/13:. It is recognised that the county has a comparatively high number of people with dementia and low formal detection rates, which reinforces the demographic challenge dementia holds for all health and social care services. The document presents a joint commissioning plan, with Cornwall Council, that sets out fifteen immediate priorities. Five are highlighted below as being significant to our Trust dementia strategy: Improve public awareness of dementia Implement specialist training for GPs, pharmacists and other health and social care staff Reduce the inappropriate use of antipsychotic medication as a means of managing behaviour which challenges in all care settings Improve the quality of dementia care in hospitals Improve end of life care for people with dementia This has been translated further into Caring for People with Dementia and their Families - A Plan for the Commissioning and Development of Services in Cornwall and the Isles of Scilly and ten commissioning intentions are set out: Planned increases in the level of recognition and diagnosis of dementia. The development of care services for people with dementia and their carers as part of an integrated service for Older People. Agreed system of assessment in place across primary community and specialist services. Arrangements to achieve effective management and continuity of care and support following diagnosis. A fully funded Health and Social Care Education and Training Plan. Assessment and alternative provision to secure more appropriate planned hospital admission and entry into long term care. Examination of options to provide crisis support through existing service or new providers. Arrangements for improved liaison services and support to cover transitions and movements between care environments. Common contract specifications to ensure appropriate standards, safeguards and specialist support in care homes. Raised standards for end of life care in line with national guidelines. Page 11 of 21

Southwest Dementia Review A review of all health and social care dementia services across Cornwall and the Isles of Scilly was undertaken in 2009, which for objective 8 resulted in the following actions: Objective 8 Observations Areas for Development Action Owner Due Date Improved quality of care for people with dementia in general hospitals Named lead and work stream in place; Reduction in emergency admissions which has been significant and sustained; Positive findings in acute trust but query about how this links with whole system; Lack of information about the average length of stay and readmission rates for people with dementia. Review environmental and design aspects on wards; Determine segments of the Dementia Care Pathway to identify specific provider contribution and collaboration. Dementia Steering Group to ensure delivery of Workstream 7 Improving Dementia Care in hospitals in local programme. 1. Commission and complete environmental and design review of all general hospitals (acute and community hospitals) to identify suitability for people with dementia and areas for improvement. 2. Share lessons from Cornwall Partnership NHS Trust Enhancing Healing Environment Projects (Cove and Garner wards) with General Hospitals. 3. Encourage multiagency collaboration by establishing a Dementia Provider Forum and a Managed Clinical Network Dementia Steering Group This action plan reflect the state in 2009/10 that influenced at the time the developm ent of the RCHT Dementia Strategy Cornwall Dementia Action Plan (February 2010) The South West Dementia Partnership produced a paper outlining a regional review of local action plans. This table was produced as a result of the review of Cornwall s plans in respect of objective eight: Objective 8 Improved quality of care for people with dementia in general hospitals Strengths Weaknesses Possible ideas to address Named leads Lack of routine Dementia link Care pathway information on workers. in place LOS/readmissions Environmental Liaison service for people with improvements Provider dementia on wards forums Dementia Clinical awareness and networks training could be Audits to enhanced increase Uncertainty on knowledge how learning from CQUINs linked Enhancing the to mandatory Healing Page 12 of 21 Future plans Strengthening dementia liaison service Setting CQUIN for dementia leads on wards Workforce development plans Up-date of e- learning New workbooks

training Environment has been evaluated and disseminated Challenges around systematic data collection and cost models South West Dementia Partnership General Hospital Standards Development: In September 2010 a set of 10 draft standards for general hospitals in the South West were published. This development plans to provide a commissioning framework to assure high quality care across the sector. RCHT involvement in shaping these standards is essential as they develop. RCHT Our Plans 2010-2014 The Trust strategy commitment declares we will focus particularly on the needs of patients with (or suspected of having) dementia, in line with the National Dementia Strategy. 2. STRATEGIC THEMES Drawing for the current context of dementia care service provision (see above) the following themes are presented as the Trust s strategic direction. 2.1. Leadership 2.1.1. Engagement and Communication Strategy: The need to reach out to bring the voice and experience of the patient and their family into the ongoing development of services in the trust is essential. Representation and meaningful involvement will be sought through the local Alzheimer s Society to inform an engagement strategy statement and plan. In addition the need to inform and effectively disseminate information to the Trust workforce and wider public is fundamental to delivering this strategy. Exploiting Trust communication networks will be sought to inform a communication strategy and plan. 2.1.2. Dementia Care in General Hospital Action Group : Executive, non-executive and clinical champion leadership will support the delivery of this Trust Board approved strategy. A new Action Group will be tasked to deliver this, with membership made up of experts in the field of dementia care, patient and carer representatives along with cross divisional representation. The Action Group will report to the Divisional Quality Group on incremental progress in delivering this strategy. 2.2. Cognitive Impairment Care Pathway 2.2.1. New pathway development: Current best practice embedded with in numerous Trust policies and guidance will be consolidated into a cognitive impairment care pathway, rather than a dementia care pathway supporting the focus on early detection and decision making, the care pathway will promote the use of community based memory clinic services to facilitate diagnosis and shift the focus from diagnosis whilst in hospital. It will also clarify options for early discharge to supportive community services for ongoing care and treatment of necessary. Guidance on medication use and limiting antipsychotic medicine usage will be embedded in the pathway, which in turn will be supported by the dementia educational framework (see 2.4.1). Page 13 of 21

2.2.2. Review of clinical service provision: With nationally acknowledged unacceptable variation in the quality of dementia care provided in general wards (Alzheimer's Society, 2009) and recognising the future demographic challenge dementia poses hospital services, a move from dementia specialist and dedicated facilities and service models to a generic service with access to excellent dementia care throughout the hospital s services, is the direction the Trust is committed to move towards. Therefore in line with the Trust s five year strategy and the clinical site development plan, the creation of more generalist facilities to support the cognitive impairment care pathway, for example a frailty assessment and care area within the single front door developments to triage the needs of frail individuals for hospital admission and support our care closer to home commitment with health and social care partners. This area should also provide safe and secure confusional assessment facilities, environmentally equipped to support some of the more challenging presentations people with delirium, which maybe alongside a diagnosed dementia, present with. In addition the Trust is likely a require a facilitative team working with local clinical teams to support this new direction. 2.3. Performance Monitoring and Management Framework 2.3.1. RCHT Dementia Care Improvement Plan : This Trust strategy will inform the development of an Improvement Plan to enable monitoring of progress with ongoing refinement and delivery the strategic themes identified. This Improvement Plan will inform Trust Board of progress and will be used to assure commissioner and regulators of our continued commitment and progress to improve hospital services for people with dementia and their families. 2.3.2. Organisational performance data: There is a requirement to report to Trust Board information about average length of stay and readmission rates for people with dementia in its services. This will be co-ordinated through the Dementia in General Hospital Action Group. 2.3.3. Care pathway performance data: Pathway monitoring that feeds back into service improvement and organisation learning is a key objective for the cognitive impairment pathway. 2.3.4. Liaison Service performance data: Monitoring and reporting to the Trust on delivery against the commissioned service level agreement will enable cooperation and partnership support to ensure effective person-centred service delivery for people with dementia in our services. 2.4. Workforce Education and Practice Development 2.4.1. Education and Training Framework: A recommended framework of education and training will be developed and promoted through the Trust s new staff training prospectus. Different levels of training and education will be made available internally from the Trust s core awareness programme embedded into the induction programme, to e-learning programmes for clinical and nonclinical staff in direct contact with people with dementia and further educational opportunities internally and externally to the Trust to develop specialist skills and knowledge in dementia care. Page 14 of 21

2.4.2. Dementia Link Workers: The Trust is committed to developing and supporting a network of clinically based Dementia Link Worker (DLW), to interface with the already established Cornwall DLW Network. The DLW will be receive specialist training and support and receive support materials and a practical tool kit to help raise the standards of dementia care with colleagues in their clinical care setting. 2.4.3. Person-centred care developments: Moving to a more generic base for the care of people with dementia in hospital challenges the concept of person centred care promotion of the life story pocket book is just the start of getting the care experience right for each individual. Underpinned by the education framework and network of DLW person-centred care is our gal for each patient in our care. 2.5. Clinical Environment Development Programme 2.5.1. Dementia Care Friendly Framework for Estate Developments: The evidence base for adaptations to the care environment to make a hospital stay more therapeutic and meaningful and less stressful has been clearly set out. The Trust will work with Estates teams to be built into future clinical site developments for a Dementia Care Friendly framework to enhance the care environment for all patients. 2.6. Multi-Agency Collaboration 2.6.1. Complex Care and Dementia Psychiatric Liaison Service: This fundamental specialist element of the service we offer people with dementia in the Trust and is provided by the Cornwall Partnership Foundation Trust. Commissioned by NHS Cornwall and the Isles of Scilly the commissioned has to work inside a complex organisation to collaboration between partners are essential to an enable effective and efficient response. The Action Group has agreed to regularly review the service level agreement, operational plan and performance to support this. 2.6.2. Social Services: Work to build strong relationships that will enable personcentred care to be continued as the dementia pathway extends out of hospital are required. 2.6.3. The Third Sector: Opportunities are available and need to be explored with this sector as developments move forward. 3. SUMMARY Delivering excellence in dementia care cannot be done in isolation. This strategy focuses very clearly on making the acute hospital s aspect of care for people with dementia our priority, but we cannot fail to have open and honest relationships with partners to move the vision of an integrated dementia service for Cornwall and the Isles of Scilly forward. This strategy gives a clear direction, identified in six strategic themes, underpinned by structure and the process, to realise the Trust s ambition to deliver excellence within the context of its higher strategic plan. This Strategic Paper informed a yeas worth of progress in improving the care of people with dementia and has been preceded by the now established South West Dementia Care Standards for General Hospitals. Page 15 of 21

Appendix 2. Dementia Link Worker Role Description Dementia Link Worker v2 All wards and departments where staff work with patients who have a dementia and staff who work with relatives and carers who s relative has a dementia will identify and support Dementia Link Workers. All staff that care for patients with a dementia should be appropriately trained and therefore it is essential that protected time is given to maintain a knowledge base and to fulfil the duties of this role; this should be negotiated with individual line managers as each area will require different demands on their time. It is essential that Dementia Link Workers are fully supported and empowered by line managers to carry out these responsibilities. Role Description The Dementia Link Workers provide support within the organisation by: Being a single point of contact for the ward team caring for patients with a dementia, to cascade information from the Trust s dementia care action group to their own clinical area Providing an essential link between practice areas across the Trust Supporting staff to ensure that patients with a dementia are the focus for consideration even when the primary intervention is with the carers Being vital in supporting the Trust to execute its responsibilities to safeguard patients with dementia. Being aware of the named and designated leads for dementia care in the Trust and know how to access them Alerting the Ward Sister / Charge Nurse to any serious or significant incident or concern relating to the welfare of a patient with dementia Being proactive and informing the Ward Sister / Charge Nurse or Divisional Action Group Representative of any gaps identified within the services in their area of work relating to caring for patients with a dementia Support the Trust s dementia care monitoring programme through audits and evaluations, and implementing actions from these findings Responsibilities The Dementia Link Workers will promote best practice in dementia care within their ward areas by: Acting as a resource for staff within their area on issues relating to dementia care and best practice, keeping staff on their ward/department up to date about current dementia issues Supporting staff to deliver patient-centred dementia care Signposting staff and carers to supporting services Providing support and information to staff within their area to access appropriate advice and assistance Seeking advice, support and supervision from their divisional action group representative or dementia care action group itself, if needed Page 16 of 21

Ensuring systems and processes are in place on their wards to deliver the trust s safeguarding and mental capacity policies Ensuring processes are in place to share information and findings with the Ward Sister / Charge Nurse and ward staff information from Dementia Link Worker Meetings. Carryout monthly Key Performance Indicator (KPI) audits in their local area if appropriate If nominated by the Divisional Representative to attend any group, ensure that they do so and actively participate in the event and give timely feedback and advise Learning and Development Dementia Link Workers will be supported and developed to fulfil their role expectations. This includes induction for new link workers, provision of support materials to promote excellence in care and a time commitment to attend local dementia multi-agency training to maintain knowledge and skills. The Dementia Link Worker will be expected to attend regular Dementia Link Worker (DLW) Meetings: Local RCHT DLW Development Sessions County-Wide DLW Events The meetings will provide an opportunity to share new developments in dementia care, ensure systems are in place to enable safe and skilled practice, and to disseminate lessons learned from case reviews. The meetings will provide a forum to discuss best practice and share experiences relating to dementia. The Dementia Link Worker will responsible for ensuring all new staff within their area of responsibility has dementia addressed in their work place induction; Assist with the delivery of training within their area; Act as a resource for staff requiring further training or who have a particular interest in Dementia; and Identify any additional training needs within their area of responsibility or for individual staff members. Page 17 of 21

Appendix 3. Governance Information Document Title RCHT Dementia Care Policy Date Issued/Approved: 7 th May 2012 Date Valid From: 7 th May 2012 Date for Review: 1 st May 2015 Directorate / Department responsible (author/owner): Contact details: 01872 252447 Dr Fiona Boyd, Consultant Geriatrician. Frazer Underwood, Associate Director of Nursing/Consultant Nurse for Older Peoples Services Brief summary of contents The purpose of this policy is to ensure the Trust meets strategic and clinical best practice standards in delivering its ambition to provide excellent dementia care services Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Dementia, Dementia Care, Stragegy RCHT PCT CFT Medical Director New Document RCHT Dementia Care Action Group and associated partners Frazer Underwood, Associate Director of Nursing/Consultant Nurse for Older Peoples Services If none enter Not Required {Original Copy Signed} Internet & Intranet Clinical / Dementia Intranet Only Links to key external standards CQC Outcomes: 1, 2, 4, 5, 6, 7, 9 Related Documents: RCHT Mental Capacity Act, DOLS and Safeguarding Policy Page 18 of 21

Training Need Identified? RCHT Guidelines for Palliative Care in Dementia RCHT Guidelines for the Assessment and Management of Delirium RCHT Guideline on the Assessment and Management of Pain in Dementia and People with Sever Cognitive Impairment RCHT Safeguarding Adults Policy RCHT Adult Discharge and Transfer Policy Yes Version Control Table Date Versio n No 21.6.2012 V1.0 Summary of Changes New document incorporating Trust strategy document and commitment to deliver Southwest Hospital Standards for Dementia Care Changes Made by (Name and Job Title) Frazer Underwood Consultant Nurse/Associate Director of Nursing All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 19 of 21

Appendix 4.Initial Equality Impact Assessment Screening Form Name of service, strategy, policy or project (hereafter referred to as policy) to be assessed: RCHT Dementia Care Policy Directorate and service area: Is this a new or existing Procedure? New Name of individual completing Telephone: 01872 255043 assessment: Frazer Underwood 1. Policy Aim* The purpose of this policy is to ensure the Trust meets strategic and clinical best practice standards in delivering its ambition to provide excellent dementia care services. 2. Policy Objectives* Improve and standardise care 3. Policy intended Outcomes* 4. How will you measure the outcome? 5. Who is intended to benefit from the Policy? 6a. Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? Improved patient and carer experience of dementia care in hospital Annual participation in the National Dementia Car Audit Monitoring of the Standards of Dementia Care in General Hospital (inc. peer review) Patient, carers and staff No b. If yes, have these groups been consulted? c. Please list any groups who have been consulted about this procedure. *Please see Glossary 7. The Impact Please complete the following table using ticks. You should refer to the EA guidance notes for areas of possible impact and also the Glossary if needed. Where you think that the policy could have a positive impact on any of the equality group(s) like promoting equality and equal opportunities or improving relations within equality groups, tick the Positive impact box. Where you think that the policy could have a negative impact on any of the equality group(s) i.e. it could disadvantage them, tick the Negative impact box. Page 20 of 21

Where you think that the policy has no impact on any of the equality group(s) listed below i.e. it has no effect currently on equality groups, tick the No impact box. Equality Group Positive Impact Negative Impact No Impact Age Disability Religion or belief Reasons for decision Dementia is linked to a aging population, so a proactive agenda on improving dementia care will have a positive impact on those aged in society generally Gender Transgender Pregnancy/ Maternity Race Sexual Orientation Marriage / Civil Partnership You will need to continue to a full Equality Impact Assessment if the following have been highlighted: A negative impact and No consultation (this excludes any policies which have been identified as not requiring consultation). 8. If there is no evidence that the policy promotes equality, equal opportunities or improved relations - could it be adapted so that it does? How? Full statement of commitment to policy of equal opportunities is included in the policy Please sign and date this form. Keep one copy and send a copy to Matron, Equality, Diversity and Human Rights, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Chyvean House, Penventinnie Lane, Truro, Cornwall, TR1 3LJ A summary of the results will be published on the Trust s web site. Signed Date Page 21 of 21