Request for proposal: Action plan to improve care for...

Request for proposal: Action plan to improve care for people with dementia in hospital

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Policy EstatesHR / Workforce CommissioningManagement IM & TPlanning / FinanceClinical Social Care / Partnership Working

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Commissioning Packs are tools to help commissioners improve the quality of services and minimise unwarranted variation in service delivery. Each Pack provides a tailored set of guidance, templates, tools and information to assist commissioners in commissioning services from existing providers or for use in new procurements.

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21 Jul 2011PCT CEs, SHA CEs, Local Authority CEs, Directors of Adult SSs, GPs

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www.dh.gov.uk

16035

Best Practice Guidance

For Recipient's Use

Dementia Commissioning Pack

LS2 7UE0113 25 46359

Gill AylingQuarry HouseLeeds

The Dementia Commissioning Pack

Handbook

Procurement templates and guidance

1. Early diagnosis 2. Care at home / care home 3. Care in hospital Commissioning Framework & Assessment Tool Commissioning Framework & Assessment Tool

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Contents

A. Introduction 2 A.1 Request for proposal 2 B. The case for change 3 B.1 National and local context 3 B.2 Commissioning context 4 C. Request for proposal instructions 5 C.1 Commissioning authority 5 C.2 Timeline 5 D. Response template 6 D.1 Organisation’s details 6 D.2 Leadership, governance and project resources 7 D.3 Action plan 10 D.4 Outcomes 11 D.5 Training needs analysis 16 D.6 Training delivery 17 D.7 Training targets 18 D.8 Awareness raising and communications strategy 19 D.9 Sustainability 20 D.10 Reporting requirements 21

A. Introduction A.1 Request for proposal

This is a request for a proposal to improve care for people with dementia in hospital. Upon satisfactory review of the proposal, and subject to agreed outcomes being met, commissioners will consent to a payment of [£0k] per annum to fund the work of a nominated Executive Board member and an implementation team that will mobilise the resources of the NHS trust in order to deliver improved dementia care in hospital.

Improving dementia care cannot be a staff training issue on its own; it requires a commitment to a new way of working across the whole organisation, as well as integration with other care organisations. The proposal should therefore include:

1. a commitment to providing leadership and resources at Board level and senior clinician level

2. an analysis of dementia training needs and how they will be addressed

3. identification of organisational priorities to improve dementia care, and a description of how they will be addressed.

The delivery model should be regarded as similar to that used for infection control, and responses should outline:

• project governance arrangements

• organisational development objectives

• the evidence base for a local training requirement

• delivery arrangements for meeting the training requirement

• reporting arrangements

• how the work will be sustained.

B. The case for change

B.1 National and local context

People with cognitive impairment occupy more than a quarter of hospital beds at any one time. While there are examples of excellent local action to recognise and address the challenges of dementia, there are also instances of substandard and even neglectful care.

People with dementia who are admitted to hospital with a medical problem often stay longer than people without dementia who are admitted for the same condition. The longer they stay in hospital, the worse the effect on the symptoms of dementia and well-being and the more likely a discharge to a care home.

As well as having an effect on the person with dementia, an increased length of stay places financial pressure on the National Health Service, as indeed does a high rate of unplanned readmission.

The Department of Health’s 2009 National Dementia Strategy notes the importance of identifying a senior clinician to take the lead in improving the quality of dementia care and in developing an explicit care pathway for the management of people with dementia, as well as the importance of effective basic training and continuous professional and vocational training.1 However, better dementia care in the general hospital should also include:

• a mental health liaison service to support the delivery of better care for people with dementia

• better cross-organisational and inter-organisational working to improve discharge planning

• consideration of the needs of carers and their involvement as partners in care

• improvement in the physical layout and signage in hospitals to address the needs of people with dementia.

1 Department of Health (2009), Living Well with Dementia: A National Dementia Strategy. London: TSO.

B.2 Commissioning context

Tackling inappropriate lengths of stay and substandard care of patients in hospital through improved training and organisational change should deliver:

• an increase in the number of patients and carers who have a positive experience of hospital care, with fewer complaints

• a reduction in serious and untoward incidents associated with, or experienced by, patients with dementia

• efficiency gains and cost savings to the NHS, including reduced lengths of stay and lower rates of unplanned readmission

• a reduction in the number of patients discharged from hospital direct to care homes as a new place of residence

• a reduction in staff stress and an increase in job satisfaction.

C. Request for proposal instructions C.1 Commissioning authority

Name of commissioning authority

Address

Name of lead contact

Contact details

C.2 Timeline

Issue request for proposal

Deadline for queries

Deadline for receipt of proposal

Decision on award

Contract start

D. Response template D.1 Organisation’s details

Please complete the details of the organisation that is submitting the proposal and the name of the person who is responsible for submitting the proposal.

Name of tendering organisation

Name of lead contact

Job title

Address

Telephone

Email address

D.2 Leadership, governance and project resources

Effective leadership, commitment and resources are required to implement and sustain organisational changes aimed at improving dementia care. As part of the organisation’s application, please provide details of the people who will be responsible for delivery of the project.

Executive Board member2

Name

Job title

Weekly time commitment [x] days

Description of responsibility To provide leadership on the implementation of organisational changes to improve care for patients with dementia

Deliverables Agreed action plan priorities

Quarterly report to the Board on progress against action plan

Clinical Lead3

2 This may be, for example, the director of nursing, the medical director, the director of finance or the director of performance.

Name

Job title


Description of responsibility To lead on the delivery of the action plan, including training

Clinical input into the design and implementation of the action plan

Management of the Delivery Lead

Deliverables Monthly report to Executive Board member on progress

Quarterly progress report to clinical commissioning group

3 This could be a consultant geriatrician or nurse consultant.

Delivery Lead

Name

Job title


Description of responsibility To ensure that the action plan is implemented on time and within budget

Liaison and management of other resources involved in the delivery of the action plan

Deliverables Monthly report on progress against implementation and benefits

realisation plan

D.3 Action plan

Please provide details of the four priority areas that your organisation will be focusing on to provide better care for dementia patients. One of the priority areas should be dementia training for hospital staff. The organisation should explain in the next section what analysis has been carried out to identify training priorities in the hospital. Examples of some of the other priorities that an organisation may wish to consider include: • a hospital mental health liaison service (a separate service specification is available) • environmental improvements (including improved layout and signage/dementia ‘sign-off’ for environmental or building changes)

• improving the recording of co-morbid dementia in coding and clinical systems

• better cross-system working (including work with other care organisations for discharge planning)

• addressing the needs of carers in hospital (for example, flexible visiting hours during meal times, overnight stays)

• involving carers as partners in decision making and discharge planning

• dedicated ward champions

• development and implementation of dementia-friendly care pathways and protocols that are specific to mental health.

D.4 Outcomes

Please describe the outcomes that the action plan will help deliver. No. Outcome Related NICE

Quality Standard NHS Outcomes Framework

1 2 3 4

Priority 1: Dementia training for hospital staff

Actions for delivering priority Responsibility Date Action 1 (Outline any specific action you are going to take to address the weaknesses identified in the priority area)

Action 2 Action 3

Priority 2:


Action 2 Action 3

Priority 3:


Action 2 Action 3

Priority 4:


Action 2 Action 3

D.5 Training needs analysis

Please describe what analysis has been carried out to identify the priority groups and themes in the hospital that need to be tackled by training. This should include staff to be trained, how training might be delivered to best meet the needs of the trainee group(s), the content of the training (competences) and the levels at which the training should be delivered. In order to inform the needs analysis, organisations may wish to refer to the scoping study report and to the report on existing training and education provision to support the implementation of the National Dementia Strategy,4 common core principles for supporting people with dementia5 and also a recent report by the Alzheimer’s Society on dementia care in hospital wards.6 Useful information may also be available from the National Audit of Dementia.7 Attention should be paid to the question of how to change attitudes and develop skills, as well as how to improve knowledge throughout the hospital.

4 Department of Health, Skills for Care and Skills for Health (2010), Working to Support the Implementation of the National Dementia Strategy Project: Mapping existing accredited education/training and gap analysis report; Department of Health, Skills for Care and Skills for Health (2010), Working to Support the Implementation of the National Dementia Strategy Project: Scoping study report. London: Department of Health, Skills for Care, Skills for Health. 5 Department of Health, Skills for Care and Skills for Health (2011), Common Core Principles for Supporting People with Dementia. Leeds and Bristol: Skills for Care and Skills for Health. 6 Alzheimer’s Society (2009), Counting the Cost: Caring for people with dementia on hospital wards. London: Alzheimer’s Society. 7 See: www.rcpsych.ac.uk/quality/quality,accreditationaudit/nationalauditofdementia1.aspx

D.6 Training delivery

The response should describe how training will be delivered and by whom, including people with dementia and their carers. The response should include the issue of how dementia training will be integrated into standard induction training for all staff and the approach to ‘winning hearts and minds’, in order to persuade staff of the importance of attending dementia training. The proposal should also include a description of how attendance at dementia training might be optimised, together with the dates by which the training targets (next section) will be achieved.

D.7 Training targets

The response should include a description of departments that will receive dementia training, together with a description of groups of staff to be trained and the numbers who will be trained to either a basic standard or an advanced standard. An advanced standard may be considered to be Qualifications and Credit Framework level 4 and above.8 Reference may be made to learning beyond registration degree modules, if relevant.

Department/grade Basic Advanced Name of department Staff to be trained, e.g. :

Nursing staff Healthcare assistants Nursing assistants Senior nursing grades Consultants Other doctors Allied health professionals Porters Catering staff Receptionists Cleaning staff

8 Department of Health, Skills for Care and Skills for Health (2010), Working to Support the Implementation of the National Dementia Strategy Project: Mapping existing accredited education/training and gap analysis report; Department of Health, Skills for Care and Skills for Health (2010), Working to Support the Implementation of the National Dementia Strategy Project: Scoping study report. London: Department of Health, Skills for Care, Skills for Health.

D.8 Awareness raising and communications strategy

The response should include the issue of how dementia awareness-raising activity will be delivered, and should also explain the approach and content of a strategy for communications about the project to improve dementia care.

D.9 Sustainability

The response should include a description of arrangements that will be put in place to ensure that improvements can be sustained once the project comes to an end.

D.10 Reporting requirements

The organisation should outline the kind of report that will be provided to the clinical commissioning group as a measure of progress against the action plan. This should include a description of key milestone dates and a key outcome measure for each priority area in the action plan.

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