See the transcript from Andrea's presentation below.
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Our expectation around dementia care is that it has to be person centred and person centred means including the family and carers as well. It needs to take into account the physical and the mental wellbeing of the individual. We absolutely understand that people will move between services but we’ve got to do more to improve the experience of those people and we’re expecting services to keep up to date with good practice.
So we took a thematic approach to this last year by looking at the experience of people living with dementia as they moved from care home to hospital and back to care home. We identified in the state of care report in the previous year that actually people living with dementia stayed longer in hospital, they were much more likely to be admitted to hospital and they had deteriorated when they had gone back to the care home. So there were a lot of issues that we felt that we needed to explore.
We found more good care than bad care, but what we did find is that across all of the services that we looked at in 90 per cent of those services there was something that wasn’t quite right, which means if you extrapolate that outwards that actually people living with dementia are very likely to come across some aspect of poor care at some point in their journey between services and that’s the variation that we’ve got to tackle and that we’ve got to address.
We particularly identified that it was transitions between services and it’s the whole issue of information exchange that was really very, very poor. So in care homes, for example, there were some services that had done a fantastic job in actually doing the little ‘this is me’ books or the life story or whatever it is that actually gives people an understanding of the individual. They either didn’t go with the person to the hospital or when they did go with the person to the hospital the hospital lost them, and so simple things like what it is that somebody needs to be supported to do when they need to eat or drink that information wasn’t shared. So is it any wonder that when somebody comes back from the hospital to the care home they’ve deteriorated physically because their nutritional and hydration needs have not been met?
In nearly a third of care homes, but actually well over half of hospitals, we found aspects of variable or poor care regarding how a person’s needs were assessed and if they’re not doing the assessment right how can the follow on care actually be effective or responsive to the needs of that individual? That assessment is absolutely critical.
We also found again in about a third of care homes but just shy of half of hospitals that, in terms of planning and the delivery of care, again there was variation and there was poor practice and particularly in seeing the whole person, not thinking through the whole emotional and social needs. But there is some good practice. There are some things that people are doing, people are responsive, they are caring, they are actually effective in meeting the needs of the people who are using their services and throughout our report we highlighted quotes from people who are using the services, their carers and families but also from staff that highlighted some of the good things that are happening which I think we can build on, but we also highlighted some of the things that we needed to do as the regulator to support all of that.
We absolutely need to make sure that when we find poor care we take action. We will be appointing a new national specialist advisor for dementia care to provide support and advice across all of our teams. What’s really important is that our judgements about what good looks like needs to be consistent, robust and reliable. It’s no good for us to be basing our judgment on the individual opinions of our inspectors. They need to make sure that they’re making those judgments on the basis of the most up to date evidence and understanding of what good and outstanding should be.
A lot of people who are living with dementia are not able to express and articulate to us what it is that’s happening and how they feel about it, particularly if they’re in the very advanced stages, but actually blending into the background, sitting, watching, observing carefully what’s happening you would be astonished to see what it is that people will continue to do even if there’s an inspector in the room and either it’s because they don’t know it’s the wrong or the right thing to do or they don’t care and, whichever way it is, we need to be finding it out and so our observational tool is very important for us.
I would encourage you to go on our website, look at our outstanding reports. This was our first outstanding care home, the Prince of Wales House in Ipswich, and this quote I think bears repeating, ‘we didn’t think we were outstanding and perhaps that’s why we were. I think it’s because we see every single person that comes through our doors as an individual, it is our privilege to support them to live their last years of their life with as much happiness, love and security as we can possibly give them’. If that doesn’t inspire all of us to go out there and do the best that we can do for people living with dementia I don’t know what does.
Thank you very much for listening. You can follow me on Twitter at @Crouchendtiger7 if you like. Thank you.