Transforming specialist dementia hospital care: independent report

5. Conclusion and recommendations

There is an urgent need for extensive improvement of specialist dementia hospital provision in Scotland. This specialist area of practice has been overlooked for too long. There is a lack of the multi-disciplinary specialist care and treatment required and there are environments that are not conducive to person-centred care. Most people in specialist dementia hospital environments can be more appropriately cared for in community settings.

A decommissioning and re-design process would enable the development and roll-out of centres of excellence that would provide the small proportion of people with highly complex psychological needs the care and treatment they need. It would also allow resources to be transferred to the community so that care homes and those providing day- to-day care can receive specialist support and people with dementia are not admitted to hospital, unless it is essential to their clinical care needs. This would provide an efficient re- commissioning of current resources and tackle inappropriate admissions and unnecessarily lengthy stays in hospital.

Recommendations:

• That specialist NHS dementia care is modernised, providing high quality, human rights- based care, specifically for individuals who cannot be cared for in the community.
• Integration Joint Boards develop a transition plan and a local engagement strategy with their partners, including NHS Boards and people living with dementia, for any necessary de-commissioning process and re-investment in specialist dementia units and to develop further community capacity in health and social care services.
• That the Scottish Dementia Working Group and National Dementia Carers Action Network provide the representative groups for this local engagement.
• Integration Joint Boards and NHS Boards assess the proportion of people with dementia that can be safely transitioned to more appropriate community settings.
• The Alzheimer Scotland National Dementia Nurse Consultant provides expert guidance at both a national and local level.
• Integration Joint Boards and NHS Boards build strong and strategic local engagement on:
  • Any necessary de-commissioning and re-directing of resources to the development of specialist dementia hospital units and
  • building further community health and social care services.
• NHS National Procurement to commission the design of a blueprint for a specialist dementia unit that can be implemented by each NHS Board.
• There should be no financial detriment for families as part of the decommissioning process, with the financial cost of the care and treatment of the person with dementia being transitioned to the community continuing to be met by the NHS Board.
• The legal status of patients being transitioned to the community is reviewed and the appropriate legal documentation put in place.
• The creation of modern specialist dementia units that will provide centres of excellence to treat the small number of people with dementia who have a clinical need to be in hospital.
  The estimated 45 ^[nn] specialist dementia units required across Scotland will provide a highly skilled practice area and make it an attractive specialism for ambitious and talented practitioners to deliver highly skilled therapeutic interventions.
  Promoting Excellence Framework the foundation for evidence based care for all practitioners. Leaders and senior practitioners ensuring that everyone working within the unit are trained at the appropriate level to ensure a high quality therapeutic approach.
  They will be underpinned and supported by the Charter of Rights for People with Dementia and their Carers in Scotland, the Promoting Excellence Framework and the Standards of Care for Dementia in Scotland.
• The timeframe for this process will extend beyond the end-point of Scotland's 2017- 2020 National Dementia Strategy