7. High quality hospital care and alternatives to hospital care for people with dementia, including pathways to ensure appropriate and timely and discharge
The length of stay of for people in North Bristol Trust has reduced in the past two years but the length of stay for people with dementia is twice that of people of the same age who do not have dementia.
Most people admitted to the South Gloucestershire Clinical Commissioning Group’s beds in Laurel Ward, Callington Road Hospital stay for months not days. Their health often deteriorates before they can be discharged, and other people are denied access to assessment.
North Bristol Trust has a dementia team of: clinical lead, dementia matron and a dementia trainer. The trust is working towards improving the admission for people with dementia, by providing meaningful activity programmes and a better environment, developing the care pathway for people with cognitive impairment or dementia.
Hospital is not the right place to make a diagnosis of dementia so GPs are informed when the inpatient team thinks there may be a problem with cognition. All members of staff (clinical and nonclinical) receive training in dementia. There is a cognitive care bundle which should allow personal care plans to be in place for each person.
North Bristol Trust and the Alzheimer’s Society have established a Memory Café at Southmead Hospital that has been of great support to people living with dementia and carers.
We have specialist learning difficulties hospital liaison nurses at Southmead Hospital to support people with learning difficulties and dementia.
Work has started to define operational standards consistent with the Choice Directive for Laurel Ward at Callington Road Hospital. A priority for 2016.
Avon and Wiltshire Partnership improved the physical environment on Laurel Ward, Callington Road in 2015.
Laurel Ward at Callington Road Hospital should be supported to undertake a further streamlining of existing processes in order to reduce delays and minimise risks associated with protracted lengths of stay (Expanding Options report recommendation no 14).
Consider any potential value in co-locating adult social work practitioners within inpatient units (Expanding Options report recommendation no 15).
Share the learning from initiatives in the acute sector and Avon and Wiltshire Partnership, where appropriate, and apply to relevant parts of each organisation (Expanding Options report, recommendation no 16).
Laurel Ward at Callington Road Hospital should clarify and widely publicise its admission criteria and explore how its staff team can be creatively deployed to support safer discharge (Expanding Options report, recommendation no 17).
Commissioners should explore the feasibility of a ‘Discharge to Assess’ model and possible associated step down facility for people with dementia (Expanding Options report recommendation no 18).
Commissioners should develop, with partner agencies, appropriate guidance for the implementation of the Choice Directive (Expanding Options report, recommendation no 20).
We are investigating the Discharge to Assess process to ensure that people with learning difficulties have the same access to this service. Considering whether there is a need to commission specialist beds in the future. recommendation no 10).