Transforming specialist dementia hospital care: independent report

Footnotes

^a Chaired by Professor Graham Jackson and attended by representatives from Scottish Government, NHS Health Boards and Royal College of Psychiatrists

^b Brodaty et al (2003) "Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery" Medical Journal of Australia https://www.mja.com.au/journal/2003/178/5/behavioural-and-psychological-symptoms-dementia-seven-tiered-model-service

^c This is based on an estimated 560 people with dementia who require care and treatment in a specialist dementia unit.

^d Continuing to live at home or in a care home

^e This includes family carers, care homes, care at home service and day care

^f Alzheimer Scotland (2015) "Advanced dementia practice model: understanding and transforming advanced dementia and end-of-life care" https://www.alzscot.org/campaigning/advanced_dementia_model

^g Mental Welfare Commission (2014) "Dignity and respect: dementia continuing care visits" http://www.mwcscot.org.uk/media/191892/dignity_and_respect_-_final_approved.pdf

^h Chaired by Professor Graham Jackson and attended by representatives from Scottish Government, NHS Health Boards and Royal College of Psychiatrists

ⁱ Review took place between April 2015 and March 2016 and included Ayrshire and Arran, Dumfries and Galloway, Fife, Forth Valley, Grampian, Greater Glasgow and Clyde, Lanarkshire, Lothian, Scottish Borders and Tayside.

^k The first National Dementia Strategy was published in 2010, with subsequent updates published in 2013 and 2017

^l "Charter of Rights for People with Dementia and their Carers in Scotland" (2009) https://www.alzscot.org/assets/0000/2678/Charter_of_Rights.pdf

^m NHS Education for Scotland and Scottish Social Services Council (2011) "Promoting Excellence Framework" http://www.gov.scot/Resource/Doc/350174/0117211.pdf

ⁿ Commitment 11: "We will set out plans for extending the work on quality of care in general hospitals to other hospitals and NHS settings."

^o Mental Health (Care and Treatment) (Scotland) Act 2003 and updated provisions in Mental Health (Scotland) Act 2015.

^p Nuffield Council on Bioethics (2009) "Dementia ethical issues" http://nuffieldbioethics.org/wp-content/uploads/2014/07/Dementia-report-Oct-09.pdf

^q Continuing to live at home or in a care home

^r Brodaty et al (2003) "Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery" Medical Journal of Australia https://www.mja.com.au/journal/2003/178/5/behavioural-and-psychological-symptoms-dementia-seven-tiered-model-service

^s Scottish Government audit of NHS Boards for National Dementia Strategy Commitment 11 Working Group

^t 1,160 long stay beds and 3,235 in units other than long stay https://www.isdscotland.org/Health-Topics/Hospital-Care/Beds/

^u A full report on the review is provided in Appendix 1

^v Inspections that took place during 2016 and 2017

^w Mental Health (Care and Treatment) (Scotland) Act 2003 and Adults with Incapacity (Scotland) Act 2000

^x To provide specialist support to care homes and people with dementia who continue to live at home.

^y There was general consensus throughout the review that between 60% to 80% of these beds are not required and that the care of this client group could be met within alternative care environments ( Appendix 1).

^z Outlined in Section 2.3

^aa Scottish Government audit of NHS Boards for National Dementia Strategy Commitment 11 Working Group

^bb There is an estimated 90,000 people with dementia in Scotland in 2017 – 560 is 0.6 percent of this total.

^cc Brodaty et al (2003) "Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery" Medical Journal of Australia https://www.mja.com.au/journal/2003/178/5/behavioural-and-psychological-symptoms-dementia-seven-tiered-model-service

^dd Based on average cost of inpatient bed per week for geriatric psychiatry ISD (2016) "Speciality group costs: inpatients in long-stay specialities National Statistics release"

^ee This is based on the overall estimated number of people with dementia in Scotland and the proportional breakdown across each NHS Board according to population age and size.

^ff A breakdown by NHS Board is provided in Appendix 2

^gg This includes family carers, care homes, care at home service and day care

^hh Scottish Government (2015) "Hospital based complex clinical care http://www.sehd.scot.nhs.uk/dl/DL(2015)11.pdf

ⁱⁱ James (2011) "Understanding behaviour in dementia that challenges" Jessica Kingsley Publisher London

^jj University of Bradford "Dementia care mapping" https://www.bradford.ac.uk/health/dementia/dementia-care-mapping/

^kk "Charter of Rights for People with Dementia and their Carers in Scotland" (2009) https://www.alzscot.org/assets/0000/2678/Charter_of_Rights.pdf

^ll Informed, skilled, enhanced and expertise levels.

^mm Staff are most likely to be working with people at the "Living well with increasing help and support" and "End-of-life and dying well" phase of illness.

ⁿⁿ This is based on an estimated 560 people with dementia who require care and treatment in a specialist dementia unit.

^oo This estimate was put forward as part of the roundtable discussion – the review by the Alzheimer Scotland National Dementia Nurse Consultant found this to be much higher in practice.

^pp Scottish Government (2015) Guidance on NHS complex clinical care http://www.sehd.scot.nhs.uk/dl/DL(2015)11.pdf

^qq The term unit is used throughout the findings section to describe the range of environments where assessment, transition and specialist dementia care is delivered.