National dementia strategy: 2017-2020

2. Where we are now

Progress and achievements 2013-2016

It is ten years since this Government made dementia a national priority for Scotland. In that time we believe significant progress has been made. This includes progress in diagnosis rates, post-diagnostic support, and in improving the experience of people with dementia and that of their families and carers in hospital and other settings. Our work over the last three years has been based on strong collaboration in developing and implementing the strategy in a coordinated way. Achievements include:

1. developing a greater understanding of the composition of people diagnosed with dementia through our recent research report, Estimated and Projected Diagnosis Rates for Dementia in Scotland 2014-2020. ^[2] This shows that many people are diagnosed with dementia later in life and often live with other significant and life-limiting chronic conditions

2. introducing the guarantee that everyone newly diagnosed with dementia will be entitled to at least a year's worth of post-diagnostic support, coordinated by a named Link Worker

3. continuing the Promoting Excellence workforce skills and development programme, including the development of a large suite of accessible educational resources, which has been used by tens of thousands of staff across health and social services, and provision of a breadth of training programmes provided. ^[3] Promoting Excellence has also been embedded in pre-registration nursing programmes

4. embracing the principle of personalised dementia care in acute and specialist NHS dementia care settings

5. successfully completing the project to test and independently evaluate Alzheimer Scotland's 8 Pillars Model for intensive, home-based support

6. commissioning the International Consortium for Health Outcomes Measurement ( ICHOM) to develop global outcomes for measuring and reporting on outcomes for people with dementia

7. coordinating the three-year Second EU Joint Action on Dementia - Act on Dementia. Launched in March 2016, this work seeks to ensure collaboration among participating EU institutions to review good practice and ensure successful uptake of evidence-based approaches.

Policy and strategic context

There are a number of related policies that underpin and reinforce our vision and strategy to improve the care and support for people with dementia and their carers. These include:

1. Health and Social Care Delivery Plan

This plans sets out our programme to further enhance health and social care services so that the people of Scotland can live longer, healthier lives at home or in a homely setting, and to ensure we have a health and social care system that:

• is integrated
• focuses on prevention, anticipation and supported self-management
• will make outpatient treatment the norm, where hospital treatment is required and cannot be provided in a community setting
• focuses on care being provided to the highest standards of quality and safety, whatever the setting, with the person at the centre of all decisions
• ensures people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

2. Integration of Health and Social Care and Primary Care Transformation

Health and social care integration and primary care transformation are significantly changing community services and providing opportunities to better support people, including those with dementia, in their homes and communities. The new Integration Authorities must plan and deliver well-coordinated care that is timely and appropriate to people's needs. An important aspect of this will be ensuring that people's care needs are better anticipated so that fewer people are inappropriately admitted to hospital or long-term care.

3. National Clinical Strategy

The National Clinical Strategy sets out a framework for developing health services in Scotland for the next 10-20 years. At its heart is a fundamental change in the respective work of acute and hospital services, greater emphasis on primary and community care, and a focus on realistic medicine.

4. Carers Strategy and Act

The Carers (Scotland) Act 2016 will commence in April 2018 and aims to ensure that 'people who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing'. ^[4] The provisions in the Act include:

• a duty on local authorities to provide support to carers based on the carer's identified needs, which meet the local eligibility criteria;
• a specific Adult Carer Support Plan and Young Carer Statement to identify each carer's needs and personal outcomes
• a requirement for each local authority to have its own information and advice service for carers.

5. Self-Directed Support

The aim of the Social Care (Self-directed Support) (Scotland) Act 2013 is to allow people, carers and families to make informed choices about what their social care support is and how it is provided. It aims to empower people to be equal partners in their care, to support decisions and to participate in education, work and social life. This includes people accessing social care for support with dementia. The actions in the Self-directed Support Strategy 2010-2020, Implementation Plan 2016-2018 should help to ensure that Integration Authorities provide more creative and flexible support. ^[5]

6. Palliative and End of Life Care Strategic Framework

This framework outlines the key actions to be taken that will allow everyone in Scotland to receive services that respond to their individual palliative and end of life care needs, regardless of setting or diagnosis. This is consistent with, and highly supportive of, our vision of improving care and support for people with dementia and their carers. ^[6]

7. Housing strategy

Age, Home and Community: A Strategy For Housing For Scotland's Older People: 2012 - 21 recognises the important role of housing support in enabling people to live safely and independently at home for as long as possible. ^[7] A review of the first five years of strategy will be published shortly and will consider progress on the design of housing and support for those diagnosed with dementia. A new strategy will follow later in the summer.

Considerable progress has already been made through these policy developments and through the implementation of the commitments in our second dementia strategy. However, we know there is more to do. We acknowledge our partners' concern that we must ensure that the transformation made in the way we view, understand and support people living with dementia is not lost amid the financial challenges and pressures facing all local areas at present. In the discussions with stakeholders during our National Dementia Dialogue and other events, a number of priorities emerged. These are presented below as outcomes.

Key Outcomes

The key outcomes we want to see are:

• more people have increased say and control over their dementia diagnosis and are diagnosed early enough that they can take as full a part as possible in their own care planning
• more people get earlier access to good quality, person-centred post-diagnostic support in a way that meets their needs and circumstances
• more people with dementia are enabled to live well and safely at home or in a homely setting for as long as they and their family wish
• more people get timely access to good quality palliative and end of life care
• during the process of diagnosis and through all parts of the care journey, the critical input of family carers is encouraged and facilitated, and carers' own needs are recognised and addressed
• people with dementia's right to good quality, dignified, safe and therapeutic treatment, care and support is recognised and facilitated equally in all care settings - at home, in care homes or in acute or specialist NHS facilities
• there are more dementia-friendly and dementia-enabled communities, organisations, institutions and initiatives.