National Audit of Dementia fourth round report published

Press release
10 July 2019

The National Audit of Dementia (care in general hospitals) has published its fourth national report based on data received from 195 acute general hospitals in England and Wales. 

NAD looks at the quality of care received by people with dementia in general hospitals.  The audit was carried out by the College Centre for Quality Improvement (CCQI) and commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England and the Welsh Government.

The report details improvements since the Round 3 audit report in 2017, including: 

  • 96% hospitals signed up to John's Campaign, advocating the right for people with dementia to be supported by family carers when in hospital
  • Only 10% staff said that they had not received dementia training at the hospital, compared with 17% in Round 3
  • 51% carers said that staff were well informed and understood the needs of people with dementia (up from 47%)
  • 66% staff felt encouraged to accommodate individual needs of people with dementia (up from 61%)

Priorities for improvement

These include:

Delirium: 58% of notes of people with dementia admitted to hospital showed that an initial assessment for delirium had taken place on or during admission.  People with dementia are at increased risk of developing delirium during an admission which results in worsened health outcomes.

Using information about the person to provide better care: 61% of casenotes showed that some personal information had been collected.  However, this often excluded information about any factors that might case distress to the person with dementia or that might help them if they did become distressed.  For people with dementia, an admission to hospital can increase disorientation and confusion.  Staff can provide better care if they have access to information about what causes distress, as well as preferences and care needs.

Training records: 89% of 13407 staff surveyed said that they had received some dementia training.  However, this could not be compared across hospitals as only half of the hospitals kept consistent records on staff training. This is important information to evaluate training strategies and outcomes for patient care.

Trust Boards reviewing inpatient outcomes for people with dementia:  Trust Boards examining outcomes for their patients did not always review data on people for dementia. The proportion of people with dementia could be identified by 64% Trust Boards looking at inpatient falls, 40% Boards reviewing delayed discharges, and 37% Boards reviewing readmissions.

Overall, results show slight (although many significant) improvements from those reported in Round 3 (2017).  The audit’s expert Steering Group recommends that Trusts work to implement these recommendations by World Alzheimer’s Day 2020 (21 September) and should also:

  • Publish progress made on implementing dementia recommendations in an annual Trust statement on dementia care
  • Include other dementia friendly hospital initiatives, such as self-assessment based on the National Dementia Action Alliance 2018 Charter.

The full report, local reports and map of hospital scores can be found on our main NAD site.


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