Nurse-led dementia service - Hampshire Partnership NHS Foundation Trust

ADOPTION/CULTURE

WHAT IS THE ISSUE?

Recovery is now a dominant theme underpinning service development in a number of sectors of mental health care in the UK. According to a new report, Recovery for Action (2009), The Mental Health Foundation and Strategic Network for Mental Health says recovery needs to be embedded in all mental health services.  In recent years, there has been much focus on developing recovery focused services, both in terms of service development and academic work, for people with mental health problems, other than dementia.  This project aims to evaluate whether people with dementia can benefit from recovery focused approaches and thus to ensure their inclusion. Particularly given the provisions of the Mental Capacity Act 2005, it seems essential the recovery approach should be applied to people with dementia as it has the potential to make significant improvements to the quality of life of a very venerable group of people.

WHAT IS THE INNOVATION?

This pioneering project will develop, deliver and evaluate a nurse-led, recovery focussed service for people with dementia, in an in-patient unit at the Becton Centre in the New Forest. Nurses have been empowered to use their therapeutic skills in communication and facilitation to enable service users to move through their acute illness and re-establish hope and meaning in their lives. It is fundamental to the principles of Recovery Focused service that partnership, led by the service user, is key. The model of project delivery will, wholly necessarily, draw on the philosophy of inclusivity and models of Self Directed Support.

This is the first such project to test a hypothesis that a recovery approach is applicable for people with dementia. Dementia care and the improved quality and productivity in this area are key pieces of the Mental Health programme. This is a truly innovative proposal challenging the long held tradition of medically led in-patient services with specialist mental health services.

WHAT IS THE BENEFIT?

For patients/staff/service

• Enhanced service user and carer engagement.
• Harness and maximisation of the use of strengths and desires of people with dementia and their carers.
• Improved service user / carer satisfaction.
• Improved level of compassion and empathy in staff.
• Improved staff perception of well being and performance working ‘with’ people rather than ‘on’ people.
• Working in a recovery focussed way will ensure people with dementia are afforded equity through achieveing empowerment and engagement as do people with mental health problems and other long term conditions.

Increased quality and productivity

• Improved cost efficacy of in-patient service delivery by exploring new ways of working and skill mix.
• Medical staff cost saving.
• Reduction in length of hospital stay.
• Reduction in drug spend.
• Reduction in discharge to care homes with saving to heath and social care economy.

Spread and sustainability

• Contribution to dementia literature.
• Easily replicated elsewhere with improved quality of service at lower cost – proactive spread required.
• Use of  this work to inform the Trust, and wider organisations in delivering against the National Dementia Strategy for England.
• Ambassador for developing the model of service in other specialist wards across the Trust.
• Presentation of findings to colleagues in the SHA and beyond.

Projected savings

• Project year cost neutral.
• Post Project Annually 1WTE staff grade medical (£68,000), 0.2WTE Consultant Psychiatrist (£20,000), drug spend 10% (£1400) – 0.4WTE Project Nurse (£19,600) = £69,800.
• Hampshire Partnership NHS FT (across eight dementia in-patient units) £558,400.
• South Central Strategic Health Authority (across 4 MH Trusts) £2,233,000.
• Saved bed days may influence ability to reduce bed numbers.