When the Alzheimer’s Society delivered its petition to Downing Street this month, I commented to its CEO, Kate Lee, that I’m seeing a widening of the gap between the hospitals which are building and increasing their dementia care leadership teams and those where even nominated Dementia Leads are constantly struggling to get the time to cover that role, in some cases being redeployed onto the wards to cover staffing shortages; she replied that she couldn’t agree more.
Hospital dementia care needs leadership! If you’re aiming to deliver anything more than basic identification (which is simply admin, not care!), you have a whole workforce to inspire, educate, support and then educate again, regularly checking whether the level of insight and care delivery needs topping up as staff move, leave, arrive or simply need a refresher. You need time with your dementia champions to share best practice, listen to and address any difficulties they’re facing and guide them in leading their teams. You need time to visit the wards regularly, not only to deliver interventions, but to absorb the atmosphere and get a sense of whether patients with dementia feel at ease or anxious and whether staff are confident in their dementia care delivery. You need time to liaise with family carers, who can so often provide that fantastic idea or nuggets of insight that make all the difference and inspire further improvements in care.
What I’ve observed over the years is that when a really good Dementia Lead is given the chance to embrace the role and make a difference, their organisation suddenly realises that getting dementia care right actually makes savings for them – not just in care costs, when length of stay is kept to a minimum instead of being extended through inappropriate care, but also in fewer complaints and fewer so-called “aggressive incidents” (which are generally, in the case of dementia, not “aggressive” at all!). Once the organisation recognises that upturn, suddenly there’s funding for additional staff to assist and work alongside the Dementia Lead. Time and time again, I’ve seen really good Dementia Leads who have been given the time to actually lead, reporting to me that they’ve been allocated a couple of senior nurses to add to their team, or they’re recruiting for a team of activity coordinators, or they’re building an Enhanced Care team – or sometimes all of those.
I know with absolute certainty where the very best levels of hospital dementia care can be found – and there are many where the quality of dementia care is absolutely superb – but I also know that in some places disillusioned Dementia Leads remain frustrated that they can’t get the opportunity to do anything more than firefight; for them, dementia care development is out of the question. It’s wrong that hospital dementia care provision should vary so hugely according to catchment area; all these years down the line since hospital dementia care was first highlighted as needing attention, all hospitals should be achieving that same level of excellence in their provision. Yes, the pandemic set things back, but the difference I’m seeing is that whilst those who were previously excellent have worked to regain those levels of care delivery, too many have found that their dementia care leadership role has lost its spotlight and their line managers have failed to give them the support they need in order to pull things back.
Family carers are right to expect excellent dementia care in hospital and should always press for contact with the hospital’s Dementia Lead if anything isn’t right and a dementia champion hasn’t been able to sort it out. Only by making it clear that carers now know what can be achieved – and know that other hospitals are achieving it – can Dementia Leads evidence to those holding the purse strings that people with dementia need and deserve more support.
My measure of success? If a family carer feels able to go home, confident in the care provided, knowing that the team will liaise if their advice is wanted, the dementia care is where it needs to be. I warmly applaud the fabulous dementia care teams who are achieving that.