Dementia care in hospitals: Findings from National Audit of Dementia interim report

Embargoed until 16 December 2010

A report into the care received by nearly 8,000 patients with dementia in 206 hospitals in England and Wales has revealed that few hospitals provide mandatory training for their staff in awareness of dementia, that many patients with dementia are not having assessments of their mental health or state of nutrition and that there are serious delays for patients referred to in-hospital psychiatry liaison services.

Findings of the clinical audit – commissioned by the Healthcare Quality Improvement Partnership and conducted by a project team at The Royal College of Psychiatrists’ Centre for Quality Improvement – are also surprising in the current financial climate. The National Audit Office reported in 2007 that each hospital could save an average £6 million a year by correctly identifying dementia patients, providing more appropriate and timely care, thus reducing length of stay and improving health outcomes.

SELECTED KEY FINDINGS FROM THE NATIONAL AUDIT OF DEMENTIA INTERIM REPORT:

• 95% of hospitals do not have mandatory training in dementia awareness for all staff whose work is likely to bring them into contact with patients with dementia.
• About one-third of patients did not have a nutritional assessment recorded during their admission.
• Fewer than one-half  of patients received a formal mental status test upon admission to hospital.
• One-third  of patients referred to in-hospital psychiatry liaison services not seen within 96 hours.
• Fewer than one in ten hospital executive boards regularly review readmission data for patients with dementia and only one in five regularly review information on delayed patient transfers.

Professor Peter Crome – Chair of the report’s Steering Committee, Professor of Geriatric Medicine at Keele University and Consultant Geriatrician at North Staffordshire NHS Trust – said: "Yet again a report has found marked deficiencies in the care of older people with dementia in general hospitals. There is still reluctance by clinicians and managers to accept that the care of this most vulnerable group of patients is a core function of acute hospitals. This must change. Assessing and treating dementia patients properly and supporting their carers will not only improve the patients health and quality of life  but will also result in shortened hospital stays and reduce both NHS and social care costs."

750,000 people in the UK have dementia and up to one in four hospital beds are occupied by an older person who has dementia (see ‘key facts on dementia in the UK’ below). The Interim Report from the first annual National Audit of Dementia examined the care provided by 206 hospitals across England and Wales to 7,934 patients, discharged from hospital between 1 September 2009 and 28 February 2010.

The audit Steering Group for the clinical audit includes representatives from the Royal College of Psychiatrists, the Royal College of Nursing, the Royal College of Physicians, the Royal College of General Practitioners, the British Geriatrics Society and the Alzheimer’s Society. The full report is set to publish in December 2011.

The audit had two strands. Firstly, the hospitals involved were asked about their policies, care processes and procedures that affect the care of people with dementia.  Secondly, the casenotes of people with a diagnosis of dementia were examined for evidence of compliance with key practice standards. Key facts from both strands are listed below.

KEY FINDINGS FROM THE SURVEY OF 206 HOSPITALS:

• Only 30% of hospitals have formal system for gathering pertinent personal information to caring for person with dementia
• Just 8% of hospital executive boards regularly review readmission data for patients with dementia
• 20%  of hospital executive boards regularly review information collected on delayed transfers of people with dementia
• 70% of hospitals do not have a review process for discharge procedures for people with dementia
• 69% of hospitals were not able to identify people with dementia within reported information on in-hospital falls and their causes
• 84% of hospitals said all staff working with people with dementia and older adults had training in protection of vulnerable adults
• 77% of hospitals do not have a training strategy identifying key skills for working with people with dementia
• 95% of hospitals do not have mandatory training in dementia awareness for all staff
• Just 19% of hospitals had a system to ensure ward staff were aware that a person had dementia and how it affected them, and that necessary information was imparted to other staff with whom the person came into contact

KEY FINDINGS FROM THE REVIEW OF CASENOTES OF 7,934 PATIENTS:

• Just 41% of patients received a standard mental status test during admission to hospital
• While 90% of participating hospitals provided access to a liaison psychiatry service who can help provide diagnosis, review of care and medication and appropriate discharge planning, just 40% of those referred were seen within 48 hours and 36% had not been seen after 96 hours
• While rates of provision of support from hospitals for carers of those with dementia were reasonably high, casenotes results showed that 26% of hospitals did not carry out assessments of the carer’s current needs in advance of discharge
• Although it was policy in 96% of the hospitals that all patients with dementia have an assessment made of their nutritional status, the audit of casenotes found that this did not happen for 30% of the patients in the national sample.

KEY FACTS ON DEMENTIA IN THE UK:

• Up to one in four hospital beds at any one time is occupied by a person over the age of 65 who has dementia (source: Counting the Cost, Alzheimer’s Society, 2009).
• About 750,000 people in the UK have dementia (16,000 of these people are under 65).
• One in 14 people over 65 years of age and one in six people over 80 has a form of dementia (see Alzheimer’s Society position statement, updated January 2010).
• Counting the Cost found that people with dementia stay longer in hospital than others who go in for the same procedure. The longer people with dementia are in hospital, the worse the effect on the symptoms of dementia and the individual's physical health.

Note to editors:

The Royal College of Psychiatrists’ Centre for Quality Improvement manages an extensive programme of national clinical audits, clinical services accreditation and national quality improvement networks that involve nearly all mental health services in England and Wales. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact of clinical audit in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The programme comprises 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The audit is managed by the Royal College of Psychiatrists’ Centre for Quality Improvement, working in close partnership with professional and service user representatives. The collaborators in this project are the professional bodies for five of the main disciplines involved in providing dementia services, and one of the main voluntary sector providers of supports and services: • The Royal College of Psychiatrists • The British Geriatrics Society • The Royal College of Nursing • The Royal College of Physicians • The Royal College of General Practitioners • The Alzheimer’s Society www.rcpsych.ac.uk/quality.aspx