Quality and Excellence in Specialist Dementia Care (QESDC): baseline one-off self-assessment tool and reporting arrangements

Outcome 10. Leadership

People with dementia are cared for by staff who are led and supported by effective managers/leadership at every level (from line manager to executive team and NHS board members). The NHS board is able to demonstrate that there is strong leadership from the board downwards throughout the whole organisation. The management structure of the NHS board can be clearly articulated and evidence is available to show it is being put into practice at ward level, to the benefit of people with dementia.

Some boards provide evidence of dementia awareness at the highest levels of leadership in the organisation. The Chief Executive of NHS Dumfries & Galloway, for instance, has taken training as a Dementia Champion; dementia features as a performance objective of the Executive Nurse Director of NHS Tayside; the Chief Nurse and Older People's Clinical Services Development Manager are the senior sponsors for the Commitment 11 programme for NHS Lothian; and the Director of Nursing of NHS Western Isles chairs the board's Dementia Steering Group.

Senior NHS board directors in all boards carry out leadership walk-rounds as part of the Scottish Patient Safety Programme - mental health units have been included in this walk-round in NHS Ayrshire & Arran since the outset of the programme. Senior management in NHS Grampian regularly participate in "Back to the Floor" exercises, guided by the Associate Director of Nursing for Mental Health and Learning Disabilities.

At clinical leadership level, the role of senior charge nurses (SCNs) is central. SCNs in NHS Forth Valley are directed and supported to deliver the highest quality of care and professional practice under the auspices of Leading Better Care. The board has developed a framework dedicated to the four national agreed components of the SCN role and ensures that SCNs are non-case-holding to enable them to carry out the leadership elements.

A nurse-sensitive Balanced Scorecard has been in place in the board since 2008 to ensure a consistent focus on improvement. The process is owned by the SCNs and is tested, monitored and reported to patients, carers, peers and senior management.

SCNs in NHS Ayrshire & Arran are responsible for undertaking regular and planned audits using an agreed quality assurance tool. The aim is to give assurance to the board that all wards and departments are meeting required standards of patient care. Audit criteria include the availability of appropriate care plans that support the delivery of person-centred care, staff being observed to demonstrate caring, safe and respectful interactions with patients and carers, and actions being taken to respond to "You said, we did …" exercises. The Clinical Nurse Manager for inpatient areas has worked with the Clinical Improvement Unit to develop and complete an audit in the elderly mental health wards that looked at environment, staff/patient interactions and record-keeping.

Work is underway in NHS Fife to clarify leadership responsibilities and roles and create a structure of strategic oversight and governance for a series of dementia-related workstreams, including initiatives focused on achieving Commitments 10 and 11 from Scotland's Dementia Strategy and the national post-diagnostic HEAT target. Work on Commitment 11 has been adopted as a workstream priority, with monthly updates being provided to the Mental Health Strategic Management Team. In NHS Lothian, QESDC meetings have been set up monthly; the group includes all of the nurses participating in the Commitment 11 "Train the trainer" programme who represent NHS Lothian.