Plan

Partnership working | Outcomes | Care settings | Training |
Direct payments | Innovation | Sustainability | Incentives | Risk

Partnership working

Are you working in partnership across sectors and are there arrangements for joint commissioning and integrated approaches? What are the workforce implications emerging from these approaches?

  • Integrated and partnership approaches
    The best arrangements will be made when health and social care organisations work together to develop their workforce and there is co-ordination across local systems.
    Health and wellbeing boards are due to be established from 2013 and running in shadow form from 2012. The main purpose of the board will be to join up commissioning across the NHS, public health, social care and other services. The joint strategic needs assessment (JSNA) will be an integral part of the health and wellbeing boards.
    Strategic workforce planning needs to be underpinned by meaningful clinical engagement and include appropriate voluntary sector organisations and the views of people living with dementia and carers.
  • NHS Confederation. (2011) ‘The joint strategic needs assessment’ briefing paper
    http://www.nhsconfed.org/Publications/briefings/Pages/joint-strategic-needs-assessment.aspx
  • Joint Commissioning Framework for Dementia
    The National Dementia Strategy joint commissioning framework provides best practice guidance for commissioning dementia services. It includes a Joint Strategic Needs Assessment template, summary of NICE and SCIE evidence for dementia services, commissioning levers against each of the strategy’s objectives and a summary of South East Coastal SHA dementia metrics.
    http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_100835
  • National Institute for Health and Clinical Excellence – Dementia Quality Standard
    The quality standard for dementia requires that dementia services should be commissioned from and coordinated across all relevant agencies encompassing the whole dementia care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with dementia.
    http://www.nice.org.uk/media/7EF/3F/DementiaQualityStandard.pdf

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Outcomes

Are you taking an outcomes based approach to commissioning dementia services?

Possible outcomes of a dementia workforce strategy could be:

  • To develop a confident and competent workforce to meet both current and future demand for the needs of people with dementia
  • To deliver a systematic and consistent multi-agency pathway
  • To achieve core workforce knowledge and competencies
  • To ensure learning is embedded into practice across all sectors to improve the quality of person centred dementia care

Dementia standards
Within the South West region dementia standards have been set around improving care for people with dementia while in hospital and also a quality mark for care homes has been developed. Both could help inform workforce strategic planning and commissioning.

Dementia Quality Mark for Care Homes – discussion paper
http://www.southwestdementiapartnership.org.uk/wp-content/uploads/dementia_quality_mark.pdf
The home should apply monitoring and dependency tools to ensure that there are sufficient staff available to meet the psychological and social needs as well physical care needs.
All staff, including non-care staff must receive dementia awareness training. In particular they must be able to understand the importance of appreciating the perspective of the person with dementia.
The home must have a written dementia training plan to enable care staff must have training and development opportunities in line with the qualifications and credits framework. (In the longer term care homes should ensure that 50% care staff on duty achieve level 2, dementia care).
The care home should identify and establish a trained dementia LINK worker who can provide a resource to other staff.

Alzheimers Society Home from home – A report highlighting opportunities for improving standards of dementia care in care homes
http://alzheimers.org.uk/site/scripts/download_info.php?fileID=270

Improving care for people with dementia or mild cognitive impairment while in hospital
The 8 Hospital Standards
1. People with dementia are assured respect, dignity and appropriate care
2. Agreed assessment, admission and discharge processes are in place, with care plans specific to meet the individual needs of people with dementia and their carer/s.
3. People with dementia or suspected cognitive impairment who are admitted to hospital, and their carers/families have access to a specialist mental health liaison service.
4. The hospital and ward environment is dementia-friendly, minimising the number of ward and unit moves within the hospital setting and between hospitals.
5. The nutrition and hydration needs of people with dementia are well met.
6. The hospital and wards promote the contribution of volunteers to the well-being of people with dementia in hospital
7. The hospital and wards ensure quality of care at the end of life.
8. Appropriate training and workforce development are in place to promote and enhance the care of people with dementia in general and community hospitals, and their carers/families.
http://www.southwestdementiapartnership.org.uk/wp-content/uploads/hospital-standards-v020.doc

Common core principles for supporting people with dementia: a guide to training the social care and health workforce
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_127442

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Care settings

Are you clear around what is needed in terms of necessary actions to meet the defined outcomes across dementia care pathways within different settings?

  • Identification of workforce (including informal carers)
    Many people will help people with dementia within the communities usually beginning with the family, friends and carers and they need support and information. With approximately 750,000 people with dementia currently, the number involved in caring for and supporting people with dementia is likely to be between around 1 million 2.
    Within the health and social care sector many workers will assist people with dementia to varying degrees. Examples include:

    • Primary and community care – GP’s, Practice nurses, social workers, care co-ordinators, allied health professions.
    • Personal assistants
    • Domiciliary Care
    • General and community hospitals – clinical and ancillary staff including those providing clinical support eg nursing assistants, health care assistants, clinical administration, clerical staff, porters etc
    • Mental health hospitals – Older People’s Mental Health Liaison teams
    • Intermediate Care
    • Reablement services
    • Care Homes
    • Palliative Care – Admiral Nurses, Marie Curie Nurses, Community Mental Health staff, Commissioners – commissioning staff in health and social care and related services (housing etc)
  • Considering the different functions within different settings
    The South West Dementia Partnership website has examples of new ways of working in dementia across a range of different settings with information on different functions by the workforce and what has been achieved.
    http://www.southwestdementiapartnership.org.uk/workforce-development/innovation/
  • Healthcare for London – Dementia Services Guide
    This guide includes an integrated care pathway, a general hospital care pathway and information on developing memory services with actions needed to be taken across the pathway and the competencies needed to support this.
    http://www.londonhp.nhs.uk/wp-content/uploads/2011/03/Dementia-Services-Guide.pdf
  • Counting the cost: caring for people with dementia on hospital wards
    http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=1199
  • All-Party Parliamentary Group on Dementia (2009) Prepared to care. Challenging the dementia skills gap
    The All-Party Parliamentary Group on Dementia (APPG) published its inquiry into the dementia care skills of care home staff and staff supporting people with dementia in their own homes
    http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=829
  • Alzheimers Society Home from home – A report highlighting opportunities for improving standards of dementia care in care homes
    http://alzheimers.org.uk/site/scripts/download_info.php?fileID=270

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Training

Do your service contracts specify the minimum competencies and educational training and development requirements in dementia care?

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Direct payments

For those individuals and families directly purchasing care (privately, using direct payments or personal budgets), is there information, advice and support arrangements in place to inform them about the competencies they should expect to meet particular needs in different settings?

  • Promoting self-directed support for people living with dementia: overcoming the challenges.
    This article considers the use of self-directed supported in West Sussex for older people with dementia. It is examined in the context of empowerment to have greater control over the support that people need. The views presented are derived from interviews with social care staff and people living with dementia. A number of challenges were highlighted in making self-directed support a reality for those with dementia.
    http://www.scie-socialcareonline.org.uk/profile.asp?guid=31138279-87e6-4950-984d-8408c42079f8
  • Common core principles to support self care
    The ‘Common Core Principles to Support Self Care’ are intended to be a resource for reflection, challenge and practice change. Their purpose is to enable organisations and all those who work in health and social care, whether as commissioners, service providers or educators, to make personalised services, enablement and early intervention to promote independence a reality.
    http://www.skillsforcare.org.uk/publications/publications_c.aspx
  • Commissioning for personalisation – from the fringes to mainstream (2010)
    http://www.cipfa.org.uk/pmpa/publications/download/Commissioning_for_personalization_-_from_the_fringes_to_the_mainstream.pdf
  • A new model for care and support: sharing lives and taking charge.
    This paper aims to look at lesser-known approaches to working with older people suggesting that they lie on a continuum of support services, which stretches from traditional, paid-by-the-hour, professional/client transactions at one end, to unboundaried, unpaid family care at the other. The paper looks at Shared Lives, ASA Lincolnshire’s At Home Day Resource for people with dementia, Homeshare, KeyRing and micro-enterprises. Through combining the value of real relationships with more formal support approaches, better outcomes can be achieved at lower costs.
    http://www.scie-socialcareonline.org.uk/profile.asp?guid=d526345a-d585-4c9d-acbe-5992be57d1c7

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Innovation

Have you considered new roles and ways of working within dementia services which may improve outcomes?

  • New ways of working in dementia
    The South West Dementia Partnership has information on a range of examples of new ways of working in dementia and innovative approaches.
    http://www.southwestdementiapartnership.org.uk/workforce-development/innovation/
  • Apprenticeships
    Apprenticeships and Advanced Apprenticeships are vocational qualifications taken after the age of 16 by those wishing to work in Health and Social Care. These industry-recognised qualifications allow young people and adults to become qualified workers in Health and Social Care. Apprentices are employed and, on average, spend 4 days learning on the job and 1 day off the job.
    http://www.apprenticeships.org.uk/Types-of-Apprenticeships/Health-Public-Services-and-Care/Health-and-Social-Care.aspx
    The new generation of National Apprenticeships programmes have been in place since 1995 and have been regularly updated to take into account the changing skills needs of employers. They have been used by businesses to attract people from a wide talent pool into jobs and to train and retain them. Until now, they followed a Blueprint to make sure that all frameworks in England and Wales were designed to the same consistent specification.
    From the 6th April 2011, all frameworks must meet the new Specifications for Apprenticeships for England (SASE) and for Wales (SASW) which replaces the Blueprint.
  • SASE framework and funding
    http://www.skillsforcare.org.uk/qualifications_and_training/apprenticeships/16+providerinfo.aspx
  • Apprenticeship Frameworks Online is the repository for Apprenticeship frameworks that meet the national standards for England and Wales. The Health and Social Care framework is the sole apprenticeship framework for people employed in delivering adult social care in England. This framework is also suitable for some workers in the health sector.
    In social care this framework provides a suitable way to meet the development and qualification needs of a variety of roles and job titles, including care workers, community, support and outreach workers, personal assistance, domiciliary care workers, supervisors and senior care workers. The apprenticeship framework is inclusive of emerging roles in adult social care. As well as being suitable for existing staff, this framework gives apprentices extensive opportunities to gain employment in the social care sector as well as in some health care roles. In the health sector, this framework is suitable for healthcare assistants or clinical support workers.
    http://www.apprenticeshipframeworksonline.semta.org.uk/
  • A new model for care and support: sharing lives and taking charge.
    This paper aims to look at lesser-known approaches to working with older people suggesting that they lie on a continuum of support services, which stretches from traditional, paid-by-the-hour, professional/client transactions at one end, to unboundaried, unpaid family care at the other. The paper looks at Shared Lives, ASA Lincolnshire’s At Home Day Resource for people with dementia, Homeshare, KeyRing and micro-enterprises. Through combining the value of real relationships with more formal support approaches, better outcomes can be achieved at lower costs.
    http://www.scie-socialcareonline.org.uk/profile.asp?guid=d526345a-d585-4c9d-acbe-5992be57d1c7

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Sustainability

How can you be assured that there is sustainable capacity and capability in the workforce of the dementia care providers you commission to deliver the required outcomes, and assure quality and safety and in future?

Workforce size and growth
It is estimated that the total size of the health and social care workforce working with people with dementia is in the order of 2.75 million staff.3 However it is worth noting that whilst statistics relating to the Hospital and Community Health Services are well established, those for social care have been established for a relatively shorter time and rely on voluntary returns.

Diversity of the workforce
One of the key challenges to consider is the diversity of the workforce and the wide range of differing needs in terms of skills development, ranging from dementia awareness through to detailed specialist knowledge.

Dementia crosses traditional sector boundaries with individuals passing between health care and social care service provision. Each sector has very different structures, professions, cultures, languages and service funding arrangements which can bring challenges for workforce and skills development.

According to Sector Skills Council changes to the makeup of the population and workforce, especially in terms of age, will probably pose challenges for many organisations. Furthermore the NHS has one of oldest age profiles, with few employees under 25 and a relatively high proportion over 50. Within the social care workforce there is a relatively high turnover, particularly within the domiciliary care area of around 22%.4

In terms of growth, the Skills for Care workforce simulation model projects a paid social care workforce required by 2025 of between 2 – 2.5 million workers 5.

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Incentives

What incentives are you using to encourage improvements to the dementia workforce and higher quality services?

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Risk

Is there a realistic timescale planned with a risk analysis to establish risks to delivery related to capacity and capability in workforce, and mitigation of these risks?

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