full report of the National Audit of Dementia has identified a
need for significant improvements in hospital ward environments,
staff training and the overall approach to care delivery for
patients with dementia.
Although the majority of wards meet basic
safety requirements, the audit shows that many had not addressed
simple measures that could lessen the distress caused to dementia
patients by an unfamiliar and confusing hospital environment.
The audit also reveals deficiencies in staff
training. Less than a third of staff said that their training and
development in dementia care was sufficient. Observations of care
carried out for the audit found that care is often delivered in an
impersonal manner, by staff who did not fully understand the needs
of patients. This resulted in staff not greeting or talking to
patients during care, explaining what they were doing or offering
choice. Sometimes, staff were seen failing to respond to patient’s
requests for help.
The audit was commissioned by the Healthcare
Quality Improvement Partnership (HQIP) and carried out by the Royal
College of Psychiatrists’ Centre for Quality Improvement in
partnership with other organisations. The main audit looked at data
collected from 210 hospitals across England and Wales. Ward level
data was collected from a sample of 145 wards across 55 hospitals.
This included 2,211 staff questionnaires, and 105 observations of
care on the ward, carried out by hospital staff.
Key findings from the report include:
- Only 6% of hospitals had a
care pathway in place for people with dementia – although 44% had
one in development at the time of the audit.
- Only 32% of staff said that
their training and development in dementia care was sufficient. One
staff member surveyed said: “I have never had any training related
to caring with patients with dementia or Alzheimer’s. As staff have
not had training, I feel that these patients do not receive the
specialised attention that they deserve, or understanding and time
from staff.” Interim audit findings released last year showed that
only 5% of hospitals had mandatory awareness training for their
- 50% of staff felt they had
not received sufficient training in communication skills specific
to people with dementia, and 54% felt they had not received
sufficient training in dealing with challenging or aggressive
- Very few wards demonstrated
a culture which was “person-centred” – this is one which treats the
person with dementia as an individual and takes their perspective
into account in a supportive environment.
- 59% of wards reported that
personal items (such as family photographs or cards) were not
situated where the patient could see them for reassurance.
- Only 15% of wards used colour
schemes to help patients with dementia find their way around the
ward. Only 38% of wards said that signs in the ward were large,
bold and distinctive.
The report makes a series of recommendations
to help address the problems, including:
- All staff should be provided
with basic training in dementia awareness, and a specified
proportion of ward staff should receive higher level training.
- Assessment of staffing
levels must take account of the additional support needs of people
- A Senior Clinical Lead for
dementia should be in place in each hospital with designated time
in their job role to develop, implement and review the dementia
pathway. These clinicians should identify Dementia Champions in
each department in the hospital and at ward level.
- Ward managers should make
sure that staff can involve people with dementia and their carers
in discussions on care, treatment and discharge.
- Systems for guidance,
supervision and support should be in place for staff caring for
people with dementia.
- Health departments in
England and Wales should provide guidance on dementia-friendly ward
design. These should be incorporated as standard into all
refurbishments and new-builds.
- Simple and effective
improvements to the environment should be carried out in all wards
admitting older people, including orientation aids such as colour
schemes and personalising bed areas.
Hospitals have begun work locally to address
problems after receiving local reports from the audit team earlier
in the year. Many have submitted action plans detailing key actions
for improvement, including:
- Awareness training for staff
- Identifying Dementia
Champions (25 hospitals)
- Development or review of the
care pathway (36 hospitals)
- Improving involvement of
carers (18 hospitals)
Staff on audited wards are working on actions
to improve the experience of care, including making sure that staff
understand the preferences and needs of the people with dementia
they see, encouraging positive communication and conversation, and
making sure that leadership from champions and role models is in
place to support front-line staff.
Professor Peter Crome, Chair of the National
Audit of Dementia Steering Group, said: “This report provides
further concrete evidence that the care of patients with dementia
in hospital is in need of a radical shake-up. We have a provided a
number of recommendations that if implemented will enable patients
and their families to have confidence in their hospital treatment.
It is good to see that several hospitals have responded to the
results of the interim findings with programmes of quality
improvement. Hopefully real change will be seen in the results of
the next national audit, which is due to be published in June
Dr Kevin Stewart, Clinical Director of the
Royal College of Physicians’ Clinical Effectiveness and Evaluation
Unit, said: “We have a lot of work to do to make sure that patients
with dementia get the best possible care in hospital. They
deserve no less, and we are delighted that the NHS in England has
made the care of this group one of its top priorities. The
Royal College of Physicians will work with clinicians, health
service managers, the Department of Health and the wider NHS to
ensure that we bring standards across the country up to the best
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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.
Note to editors:
The Healthcare Quality Improvement Partnership 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.