Commissioned by - RCPsych

Commissioned by:

Many thanks to Hwyl for permission to use the cover artwork. Hwyl is an art project run by Dementia Matters in Powys (DMiP) and Arts Alive Wales based at the Brecon War Memorial Hospital. The project focuses on working with elderly patients on hospital wards, with their families, carers, the ward staff and artists on a weekly basis. With thanks to Rhiannon Davies (DMiP) and Tessa Waite (Arts Alive Wales). This audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP). The report is produced and published by the Royal College of Psychiatrists’ Centre for Quality Improvement. © Healthcare Quality Improvement Partnership Ltd. (HQIP) 2017

Authors This report was prepared by the NAD Project Team. Content is advised and approved by all members of the Steering Group. Please see full details of the Steering Group members and the Project Team below.

Steering Group Professor Peter Crome, Honorary Professor, UCL, Emeritus Professor, Keele University (Chair)

Professor Dawn Brooker, Director, University of Worcester Association for Dementia

Dr Amanda Buttery, Innovation Fellow Dementia, South London Academic Health Science Network

Angela Connelly, Carer Representative

Dr Oliver Corrado, Consultant Geriatrician and Leeds Teaching Hospitals' 'Dementia Champion’ (NAD

Clinical Lead)

Dr Duncan Forsyth, Consultant Geriatrician, Cambridge University Hospitals/ British Geriatrics Society

Dawne Garrett, Professional Lead for Older People and Dementia Care, Royal College of Nursing

Nicci Gerrard, Carer Representative, John’s Campaign

Professor Rowan Harwood, Professor of Geriatric Medicine, Nottingham University Hospitals

Janet Husk, Programme Manager, Healthcare of Older People, Clinical Effectiveness and Evaluation

Unit (CEEU), Royal College of Physicians

Kelly Kaye, Partnership Manager, Dementia Action Alliance

David McKinlay, Programme Manager, Healthcare Quality Improvement Partnership

Dr Wendy Neil, Consultant Psychiatrist, Faculty of Old Age Psychiatry, Royal College of Psychiatrists

Sean Page, Consultant Nurse – Dementia, Wrexham Maelor Hospital

Sue Pierlejewski, Carer Representative

Dr Imran Rafi, Chair of Clinical Innovation and Research, Royal College of General Practitioners

Léa Renoux, Senior Health Influencing Manager (Policy), Age UK

Dr Kevin Stewart, Clinical Director, Clinical Effectiveness and Evaluation Unit (CEEU), Royal College of

Physicians

Beth Swanson, Lead Nurse, The James Cook University Hospital (Nurse Consultant to the audit)

Gavin Terry, Policy Manager, Alzheimer's Society

Dr Daphne Wallace, Living with Dementia Group

Kirsten Windfuhr, Associate Director, Healthcare Quality Improvement Partnership

The National Audit of Dementia Project Team

Professor Mike Crawford, Director of the Royal College of Psychiatrists’ Centre for Quality

Improvement

Dr Alan Quirk, Senior Programme Manager (Research and Audit)

Chloë Hood, Programme Manager

Chloë Snowdon, Deputy Programme Manager

Sarah Keane, Project Worker

Simone Jayakumar, Project Worker

Vicky Cartwright, Project Administrator

Holly Robinson, Deputy Programme Manager (from 2015 to February 2016)

Rahena Khatun, Project Administrator (from 2015 to June 2016)

National Audit of Dementia Round 3 ● Wales | 1

Acknowledgements We would like to thank all members of hospital staff and carers of people with dementia who completed a staff or carer questionnaire during this round of the audit. Thanks also to Kelly Kaye at Dementia Action Alliance, Alzheimer’s Society Talking Point and Bethan Davies and Sarah Beardon of Imperial College, London. Huge thanks to staff at all of the feasibility and pilot study sites for their part in testing the tools and commenting on necessary amendments for audit proper. Special thanks to the audit leads: Louise Ayres, St Peter’s Ward, Hemel Hempstead Hospital, Hertfordshire Community NHS Trust Maggie Bean, Macmillan Wolds Unit, Bridlington and District Hospital, Humber NHS Foundation Trust Wendy Blank, Dartmouth and Kingswear Community Hospital, Torbay and Devon NHS Foundation Trust Joanne Burden, Withernsea Community Hospital, Humber NHS Foundation Trust Jacqui Bussin, St Helens Hospital, St Helens and Knowsley Hospitals NHS Trust Liz Champion, Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust Debra Dawson, Dawlish Community Hospital, Torbay and Devon NHS Foundation Trust Fiona Durham, Castleberg Hospital, Airedale NHS Foundation Trust Chris Dyer, Royal United Hospital Bath, Royal United Hospitals Bath NHS Foundation Trust Andrew Fletcher and Judith Gibson, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust Theresa Frang, Amersham Community Hospital, Buckinghamshire Healthcare NHS Trust Jenny Friend, Blyth Community Hospital, Northumbria Healthcare NHS Foundation Trust Lucy Frost, Zachary Merton Hospital and Uckfield Community Hospital, Sussex Community NHS

Foundation Trust Carla Howgate and Sue Johnson, Southport & Formby District General Hospital, Southport and Ormskirk

Hospital NHS Trust Nina Jalota and Teresa Keegal, Teddington Memorial Hospital, Hounslow and Richmond Community

Healthcare NHS Trust Claire Jones, East Riding Community Hospital, Humber NHS Foundation Trust Vicki Leah, University College Hospital, University College London Hospitals NHS Foundation Trust Chooi Lee, Kingston Hospital, Kingston Hospital NHS Foundation Trust Peter McCann, Chorley and South Ribble Hospital, Lancashire Teaching Hospitals NHS Foundation Trust Anya Pinhorn, Ystradgynlais Community Hospital, Powys Teaching Health Board Evelyn Prodger, Crawley Hospital, Sussex Community NHS Foundation Trust Sharon Savigar, Liskeard Community Hospital, Cornwall Partnership NHS Foundation Trust Roger Simpson, Ilkeston Community Hospital, Derbyshire Community Health Services NHS Foundation

Trust Inderpal Singh, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board Claire Smith, Lings Bar Hospital, Nottinghamshire Healthcare NHS Foundation Trust Beth Swanson, South Tees Hospitals NHS Foundation Trust Andrew Thomas, Bridgnorth Community Hospital and Whitchurch Community Hospital, Shropshire

Community Health NHS Trust Teresa Walls, Bluebird Lodge, Suffolk Community Healthcare, Ipswich Hospital NHS Trust Gill Withington, Warminster Hospital, Savernake Community Hospital and Chippenham Community

Hospital, Wiltshire Health and Care Sue Yorwerth and Anthony White, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board Lesley Young, Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust We would also like to thank all consultants and members of the Steering Group and our Chair, Peter Crome.


Table of Contents

Introduction .................................................................................................................................................................................................. 5

Mean average scores across England and Wales .......................................................................................................................... 9

Wales scores ............................................................................................................................................................................................... 10

Key findings in local and national reporting .................................................................................................................................. 11

Key findings from the National Report .................................................................................................................................. 11

Key findings and Wales ................................................................................................................................................................ 12

Audit Themes ............................................................................................................................................................................................. 22

Assessment ....................................................................................................................................................................................... 23

Information and Communication ............................................................................................................................................ 26

Staffing and Training .................................................................................................................................................................... 32

Nutrition ............................................................................................................................................................................................. 36

Discharge ........................................................................................................................................................................................... 40

Governance ....................................................................................................................................................................................... 46

Carer expectations and recommendations .................................................................................................................................... 54

Carer expectations from the National Report .................................................................................................................... 55

Full list of recommendations from the National Report ................................................................................................ 57

Appendices ................................................................................................................................................................................................. 61

Introduction to the appendices .......................................................................................................................................................... 62

Appendix A: Organisational checklist data ..................................................................................................................................... 63

Appendix B: Patient demographics ................................................................................................................................................... 80

Appendix C: Casenote audit data ....................................................................................................................................................... 89

Appendix D: Carer demographics ................................................................................................................................................... 100

Appendix E: Carer questionnaire data ........................................................................................................................................... 102

Appendix F: Staff demographics ..................................................................................................................................................... 107

Appendix G: Staff questionnaire data ........................................................................................................................................... 109

List of web resources ............................................................................................................................................................................ 118


List of Figures and Tables

Figures

Figure 1: Percentage of patients who had an initial screening for delirium, a clinical assessment for delirium folowing the screening and symptoms of delirium summarised for discharge .............................................................. 12

Figure 2: Results from the ‘mini audit’, showing the percentage of patients checked who had a personal information document present ........................................................................................................................................................... 13

Figure 3: Percentage of casenotes where information about the person with dementia had been collected .. 14

Figure 4: Carers’ perspective on how well informed staff were about the needs of the person with dementia 15

Figure 5: Staff perspective on the availability of personal information to help them care for/ support people with dementia ............................................................................................................................................................................................ 15

Figure 6: Staff perspective on meeting the nutritional needs of patients with dementia ......................................... 16

Figure 7: Staff perspective on access to finger foods for people with dementia .......................................................... 17

Figure 8: Staff perspective on access to snacks for people with dementia ..................................................................... 17

Figure 9: Staff view of training provided by their current hospital ..................................................................................... 18

Figure 10: Staff perspective on support available from specialist dementia services during office hours ......... 19

Figure 11: Staff perspective on support available from specialist dementia services out of hours ....................... 19

Figure 12: Carer perspective on whether the person with dementia was treated with respect .............................. 20

Figure 13: Carer view of support provided to them by the hospital .................................................................................. 21

Figure 14: Carer overall view of patient care provided by the hospital ............................................................................ 21

Tables

Table 1: Explanation of how data tables are presented in audit theme chapters ........................................................... 8

Table 2: Range of scores in the national sample, broken down by quartile .................................................................... 10

Table 3: Wales’s scores and rankings .............................................................................................................................................. 10

Table 4: Assessment score for Wales .............................................................................................................................................. 23

Table 5: Information and communication scores for Wales .................................................................................................. 26

Table 6: Nutrition score for Wales .................................................................................................................................................... 36

Table 7: Discharge score for Wales .................................................................................................................................................. 40

Table 8: Governance score for Wales .............................................................................................................................................. 46


Introduction

Reporting for Wales and Regions in England

This report contains a full presentation of the results for Wales for the third round of the National Audit of Dementia, alongside the national results from all participating hospitals. The Round 2 results for Wales are also shown where applicable. The data are presented in four ways in this report: Themed scores derived from the four audit tools Key messages and recommendations from this round’s National Report A full breakdown of data for Wales by audit theme A full breakdown of data for all of the English regions and Wales by audit tool.

Background to the audit

The National Audit of Dementia (care in general hospitals) examines aspects of care received by people with dementia in general hospitals in England and Wales. The audit is commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England and the Welsh Government, as part of the National Clinical Audit Programme. The audit is managed by the Royal College of Psychiatrists in partnership with: Royal College of Nursing Royal College of Physicians British Geriatrics Society Alzheimer’s Society Dementia Action Alliance Age UK John’s Campaign.

Data collection There have been two previous rounds of the National Audit of Dementia, reporting in 2011 and 2013. Round 2 of the audit showed that while significant progress in the care provided to people with dementia had taken place, some aspects of care still needed to evolve. The Round 2 report recommended collecting feedback from the carers of people with dementia and staff who provide care, to gain a better understanding of important aspects of care, such as communication and understanding individual needs. Round 3 of the National Audit of Dementia collected data between April and November 2016. The audit was open to all general acute hospitals in England and Wales providing acute services on more than one ward which admit adults over the age of 65. One hundred and ninety-nine hospitals in England and Wales (98% of eligible hospitals) took part in this round of audit. A list of participating hospitals is on our website.


http://www.rcpsych.ac.uk/workinpsychiatry/qualityimprovement/nationalclinicalaudits/dementia/nationalauditofdementia.aspx

Participating hospitals were asked to complete four elements for the audit: A hospital level organisational checklist A retrospective casenote audit with a target of a minimum of 50 sets of patient notes A survey of carer experience of quality of care A staff questionnaire on providing care and support to people with dementia.

In total, the audit received 199 organisational checklists, 10047 casenote submissions, 14416 staff questionnaires and 4664 carer questionnaires.

Audit standards The standards for the National Audit of Dementia have been derived from national and professional guidance, including NICE Quality Standards, the Dementia Friendly Hospitals Charter and reports from the Alzheimer’s Society, Age Concern and Royal Colleges. The standards have been compiled with their sources and the questions used to measure them, and can be found on the audit website.

How to use this report

Scoring in Round 3 of audit For the first time for the National Audit of Dementia, we present hospital level scores. The scoring system allows easy comparison between hospitals on the different themes of the audit. There are seven scores, each relating to an audit theme, plus a score for the carer overall rating of care. There was insufficient data available to produce a score for the staffing and training theme. The full method for the scoring can be found on the audit website. On pages 9 and 10 you will find the national mean averages, the scores for your hospital and the range of scores for each theme. To receive a full set of scores, hospitals were required to provide one complete organisational checklist, more than 19 casenotes, 20 or more eligible staff questionnaires and 10 or more carer questionnaires. Hospitals with fewer than the required number, have not received a score for that theme. Scores are derived from separate data sources and therefore should be viewed independently. For example, a hospital’s score for Assessment should only be compared to other Assessment scores, rather than the other scores for the same hospital. A hospital’s highest score may not reflect its area of greatest achievement, if it is a theme in which all hospitals have scored highly.

Case adjustment The impact of gender, age and ethnicity on scores were examined. The differences between the unadjusted and adjusted hospital scores were very small and there were no meaningful adjustments to be made. Therefore, all scores have been left in an unadjusted format.




Data breakdown by audit theme Audit standards are measured across the audit tools. Therefore, data submitted are presented thematically, with data from different tools presented together. The themes are:

1. Assessment

Data from the casenote audit. This looks at whether people with dementia admitted to

hospital have received a comprehensive assessment, and how well each element of

assessment is carried out.

2. Information and communication

Data from the organisational checklist, casenote audit, staff and carer questionnaires. This

looks at communication systems in use in the hospital, evidence of their use in casenotes and

presents feedback from carers and staff about the quality of communication.

3. Staffing and training

Data from the organisational checklist, staff questionnaire and carer questionnaire. This looks

at staffing provision, the extent of training delivery in hospitals and presents feedback from

staff on training quality.

4. Nutrition

Data from the organisational checklist and staff questionnaire. This looks at whether hospitals

have services that provide for the needs of people with dementia and presents feedback from

staff on service quality.

5. Discharge and hospital transfer

Data from the organisational checklist and casenote audit. This looks at the extent of planning

for discharge from hospital for people with dementia and whether they and their carers are

adequately informed.

6. Governance

Data from the organisational checklist, staff questionnaire and carer questionnaire. This looks

at the involvement of hospital leads and the Executive Board in leading, planning and

monitoring care, review of the environment and carer engagement.


Data tables in audit theme chapters Table 1: Explanation of how data tables are presented in audit theme chapters

When comparing Round 2 data with Round 3 data, please be aware that differences in sample sizes and slight wording changes to some questions, can affect results in both rounds. Comparison of the data should be made with caution. Quality Assurance visits Quality assurance visits were carried out to five randomly selected sites, and items checked across ten casenotes submitted, also randomly selected. It appears that there may be some variation in the ways in which sites are carrying out and recording some assessments and discharge planning. This may also affect results. No adjustments were made to data following the quality assurance visits.

Data breakdown by audit tool Data has also been presented by audit tool. This can be found in the separate Appendices document. The result for all of the English regions and Wales are provided here to allow for easy comparison – though differing sample sizes should be noted as this may impact results. Inter-rater reliability Inter-rater reliability analysis was carried out for the casenote audit and full results are on the audit website. Any items with an inter-rater agreement of less than 0.5 have been highlighted in the casenote audit, Appendix C (Appendices in a separate document).

Std no. [Type]

Question number, tool and text

National audit Round 3:

% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

Standard reference and type. Standards document

can be found on the audit website.

Audit tool that

item appears in and

question number.

Question wording

as in tool.

The national audit refers to all hospitals

from England and Wales that

participated in Round 3 of the audit.

Data for Wales from Round 3.

If the same question or a similar question was asked in Round 2, we

have provided the Round 2 data, for comparison. Therefore, the carer and staff questionnaires are not represented in this

column.

We have provided the percentage ‘yes’ response (unless otherwise indicated) and the numerator/ denominator. The denominator will change throughout the report, depending on whether questions

were routed (not asked in some instances), ‘N/A’ responses chosen (these have been excluded from the analyses), or if staff and carers

did not respond to a question.






Mean average scores across England and Wales The scores presented below are the national mean averages from the 7 scoring themes, based on data submitted by 199 hospitals in England and Wales. A table with scores for each of the participating hospitals can be found in the National Report on the audit website.



Wales scores Below are the scores derived from the data submitted by all of the participating hospitals in Wales and the range of scores for each of the scoring items. The scores are derived from separate data sources and should be viewed independently. For more information, please see page 6.

Table 2: Range of scores in the national sample, broken down by quartile

Score Highest scores - - - - - - - - - - - - - - - - - - - - - - - Lowest Scores

Governance 100% - 84.4% 81.3% - 65.6% 62.5% - 50% 48.4% - 12.5%

Nutrition 100% 95% - 87.5% 82.5% - 73.8% 68.8% - 36.3%

Discharge 98.5% - 85.2% 84.6% - 75.3% 75.2% - 63.6% 63.2% - 22%

Assessment 99.1% - 88.9% 88.6% - 85.4% 85.2% - 79.9% 79.7% - 48.7%

Staff rating of information & communication

82.7% - 68.5% 68.4% - 64.8% 64.7% - 61.6% 61.5% - 48.1%

Carer rating of information & communication

89.3% - 71.7% 71.5% - 63.4% 63.1% - 57.3% 57.2% - 22.2%

Carer rating of patient care 93.3% - 77.9% 77.8% - 72.4% 72.3% - 66.1% 64.7% - 21.7%

Table 3: Average scores for Wales (17 hospitals)

Scoring Average score for

Wales Range of scores for

Wales

Governance 46.5 12.9 - 87.1

Nutrition 78.7 37.5 - 100

Discharge 66.9 47.9 - 84.9

Assessment 78.2 60.4 - 90.4

Staff rating of information & communication 59.9 52.2 - 70.4

Carer rating of information & communication 71.0 65 - 79.2

Carer rating of patient care 77.8 62.5 - 89.3


Key findings in local and national reporting The National Report for this round of audit contained five key messages derived from the national data set. These are shown below.

For local reporting, we have included graphical representations of data related to the key findings to allow for comparison between Wales and the national results. These can be found starting on page 12.

Key findings from the National Report

Delirium recording requires improvement In more than half of casenotes of people with dementia, there was no recording of an initial screen or check for symptoms of delirium. Inconsistency in what is recorded and communicated may affect clinical care and thereby increase a person with dementia’s risk to developing delirium.

Personal information to support better care must be accessible A ward spot check carried out during the audit looked for the document with key personal information about care needs and communication that should be completed for people with dementia, and found that only half of these patients had one in place. Forty percent of staff said that they could not access this information most of the time, and under half of carers said definitely, staff were well informed.

Services must meet the nutritional needs of people with dementia Catering services should be able to provide for the needs of people with dementia, who may not be able to eat full meals at regular times and need finger food meal alternatives and snacks available at any time to ensure they are nourished. Less than 75% of staff said that they could obtain finger foods or snacks between meals for these patients. Twenty-four percent of staff thought people with dementia had nutritional needs met sometimes, or were not met.

Championing dementia means supporting staff To support staff to deliver better care, nearly all hospitals have created dementia champions at ward level. Just under 70% of carers gave a high rating to care overall. Staff said they needed more support, especially out of hours when less than a quarter of staff said they could access specialist support for dementia always or most of the time.

Involve the person with dementia in decision making Where a change in residence after discharge (e.g. from their own home to a care home) was proposed, just over one third of patients did not have their consent to begin this process recorded, or evidence that a best interests decision making process had taken place, in the case that they lacked capacity.


Key findings and Wales

This section of the report presents some of the data and recommendations associated with the key findings. Some additional questions from the carer questionnaire are also included. Each figure shows the national mean average results next to the data for Wales to allow for easy comparison. All percentages have been rounded up to a whole number which means some results may calculate to just under or over 100%. The national averages include data collected from 199 hospitals across England and Wales.

The exact sample sizes for both the national sample and the sample for Wales are presented in the figure titles.

Delirium

Figure 1 shows the percentage of patients receiving an initial and full clinical assessment for delirium, alongside the percentage of patients who had symptoms of delirium summarised (where applicable) for discharge. All of this data is taken from the casenote audit.

Please note that initial delirium assessment is an item with lower than average inter-rater reliability (full results can be found on the audit website). Therefore, your results may relate to inconsistency in the recording of this assessment which may point to a need to agree local procedures to ensure that this important information is consistently recorded and shared.

Figure 1: Percentage of patients who had: an initial screening for delirium, for the national sample (n=10047) and Wales (n=832); a clinical assessment for delirium following the screening, for the national sample (n=2603) and Wales (n=183); symptoms of delirium summarised for discharge, for the national sample (n=2367) and Wales (n=178).

45%

85%

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Initial screening for delirium Clinical assessment fordelirium

Symptoms of deliriumsummarised for discharge

% o

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Type of delirium assessment

National average % Wales %



Key recommendations: Delirium

Medical and Nursing Directors should: Ensure that hospitals have robust mechanisms in place for assessing delirium in people with

dementia including:• At admission, a full clinical delirium assessment, whenever indicators of delirium are identified.• Cognitive tests administered on admission and again before discharge.• Delirium screening and assessment fully documented in the patients notes (regardless of the

outcome).• Care offered in concordance with the delirium evidence-base recommendations when the

assessment indicates symptoms of delirium.• Results recorded on the electronic discharge summary.

Ensure staff receive training in delirium and its relationship to dementia, manifestations of pain,and behavioural and psychological symptoms of dementia.

Personal information about the person with dementia

Information about the collection and use of personal information for people with dementia was collected via the organisational checklist, casenote audit, staff questionnaire and carer questionnaire. Although some items on the organisational checklist suggested that the use of personal information collection tools was at close to 100%, items from the other audit tools suggest that in practice, this figure is lower. Figures 2 to 5 show data about personal information collection in practice.

Hospitals were asked to complete a mini spot check of whether patients who should have a personal information document in their notes had one. Figure 2 shows the results of this ‘mini audit’.

Figure 2: Results from the ‘mini audit’, showing the percentage of patients checked who had a personal information document present. National sample (median number checked=10) and Wales sample (n=160).

49% 51%

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Figure 3 shows that some pieces of personal information are more often found in patient notes than others. At a national level, the pieces of information recorded least often are factors which may cause distress and actions which can help to calm the patient. An unknown response was provided for these questions in Round 3 for hospitals to indicate where this information is usually recorded in a document which accompanies the patient (e.g. “This is Me” or patient passport) and no copy was available in the notes.

Figure 3: Percentage of casenotes where information about the person with dementia had been collected. National sample and Wales sample (see Appendix C for sample sizes).

The carer questionnaire asked carers how well informed they thought staff were about the needs of the person with dementia. The results are shown in Figure 4.

47% 44%55%

33% 28%

43%

33% 34%

30%

38%39%

35%

20% 22%15%

29% 33%22%

46%43%

68%

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Personal detailsand

preferences

Food and drinkpreferences

Support withpersonal care

Factors maycause distress

Actions whichcan calmpatient

Details to aidcommunication

% o

f ca

sen

ote

s

Information in the casenotes about the person with dementia

National average % (Yes responses)

National average % (No responses)

National average % (Unknown responses)

Wales % (Yes responses)


Figure 4: Carers’ perspective on how well informed staff were about the needs of the person with dementia. National sample (n=4578) and Wales sample (n=255).

The staff questionnaire also assessed availability of personal information for people with dementia by asking staff whether this information was accessible to them. The results of this are shown in Figure 5.

Figure 5: Staff perspective on the availability of personal information to help them care for/support people with dementia. National sample (n=14345) and Wales sample (n=957).

47% 50%

43%43%

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Do you feel that hospital staff were well informed and understood the needs of the person you look after?

Yes, definitely Yes, to some extent No

21% 17%

39%36%

33%37%

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In your current role, do you think that personal information is available to you to help you care for/ support people with dementia?

Yes, always Yes, most of the time Yes, sometimes No


Key recommendations: Personal information

National Commissioners (Welsh Government, NHS England) should propose a nationallybacked monitoring programme aimed at embedding the collection, sharing and use of personcentred information. This should include a clear expectation that once gathered, this informationwill follow the patient between providers, and this will be monitored.

Ward Managers should audit implementation/use of personal information collected to improvecare for patients (e.g. This is Me or other locally developed document). The result of the auditshould be fed back to the dementia champions/dementia lead and ward staff.

Nutritional needs of people with dementia

The staff questionnaire collected data on aspects of patient nutrition and hydration. Figures 6, 7 and 8 show staff responses to three of these questions. Figure 6 shows that nationally, almost a quarter of staff thought that the nutritional needs of people with dementia were not met at least most of the time.

Figure 6: Staff perspective on meeting the nutritional needs of patients with dementia. National sample (n=12263) and Wales sample (n=805).

The staff questionnaire asked nurses and healthcare assistants working on wards at mealtimes about accessing finger foods and snacks between meals for people with dementia. The results are presented in Figures 7 and 8.

26% 28%

50% 47%

19% 19%

5% 6%

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Do you think that people with dementia you care for/ support, have their nutritional needs met while on the ward(s) you work on?



Figure 7: Staff perspective on access to finger foods for people with dementia. National sample (n=8822) and Wales sample (n=602).

Figure 8: Staff perspective on access to snacks for people with dementia. National sample (n=9119) and Wales sample (n=626).

38% 35%

27%27%

23% 26%

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Can you access finger food for people with dementia as an alternative to main meals?


45% 41%

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21%25%

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Can you access snacks for people with dementia in between meals?



Key recommendations: Nutrition

Clinical Commissioning Groups and Health Board commissioning services should ensure thattenders let by Trusts for new catering contracts always specify provision of finger foods for mainmeals and access to a range of snacks 24 hours a day.

Medical and Nursing Directors should promote the attendance of key carers to support care,but ensure that this is complementary to, and not instead of, care delivered by staff. The level ofinput by carers, and how carers feel about the level of input they have been asked to delivershould be monitored through carer feedback, complaints and PALS enquiries. Carer satisfactionshould be seen as a marker of good care. Ward managers should be supported to ensure carerssupporting patients should not be asked to leave at mealtimes/stopped from helping with meals(this excludes emergency and urgent care and treatment).

Support for staff

The staff questionnaire asked staff about various aspects of support provided to them when caring for or supporting people with dementia. Figures 9, 10 and 11 demonstrate how staff rated some of these aspects of support. Figure 9 shows how prepared staff felt after completing one or more forms of training provided by the hospital they currently work in. Responses where the respondent indicated they were answering about training received elsewhere were not included in analyses.

Figure 9: Staff view of training provided by their current hospital. National sample (n=10670) and Wales sample (n=624).

The staff questionnaire also asked staff how well supported they felt by the specialist services for dementia in their hospital. It is notable that the national view of the availability of support services out of hours is rated much more negatively (Figure 11) than support during office hours (Figure 10). Hospitals may wish to consider how they can improve the availability of this specialist support for staff during the night and at weekends.

42%29%

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Following your training at this hospital, do you feel better prepared to provide care/ support to people with dementia?

Yes, much better prepared Yes, somewhat better prepared No


Figure 10: Staff perspective on support available from specialist dementia services during office hours. National sample (n=14024) and Wales sample (n=938).

Figure 11: Staff perspective on support available from specialist dementia services out of hours. National sample (n=11207) and Wales sample (n=772).

Key recommendation: support for staff

The Chief Executive Officer should ensure that there is a dementia champion available tosupport staff 24 hours per day, 7 days per week. This could be achieved through ensuring thatpeople in roles such as Site Nurse Practitioners and Bed Managers have expertise in dementiacare.

29%16%

33%

28%

27%

35%

12%21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


% o

f st

aff

Do you feel supported by specialist services for dementia in your hospital during office hours?


8% 4%

16%9%

28%

24%

49%

63%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


% o

f st

aff

Do you feel supported by specialist services for dementia in your hospital out of office hours?



Involving the person with dementia in decision making

National data from England and Wales showed that in 34% of cases where a referral to a social worker was made for a proposed change in residence post discharge, consent from the person with dementia (or a best interests decision making process when the person did not have capacity to make this decision) is not recorded in the notes. To compare this national data with data from Wales, please go to the discharge theme chapter (casenote audit, question 27).

Key recommendation: Decision making

The Safeguarding Lead should ensure that staff are trained in the Mental Capacity Act, includingconsent, appropriate use of best interests decision making, the use of Lasting Power of Attorneyand Advance Decision Making. Training should cover supportive communication with familymembers/carers on these topics.

The opinion of carers

One of the key aims for this round of audit was to collect feedback from carers which could be compared across hospitals, and to ask them to rate the care that was received by the person they care for, while in hospital. Hospitals report taking steps to involve carers, including development of strategies for engaging carers and adopting the aims of John’s Campaign (allowing a family carer to remain with a person with dementia and support them during admission). The carer questionnaire aimed to see whether carers themselves reported the same. Below are some key points from the carer questionnaire. Please also see your scores for overall carer rating of patient care, and carer rating of information and communication on page 10.

At a national level, the most positively answered question on the carer questionnaire asked carers whether the person they look after was treated with respect.

Figure 12: Carer perspective on whether the person with dementia was treated with respect. National sample (n=4569) and Wales sample (n=253).

76%87%

21%12%

3% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


% o

f ca

rers

Was the person you look after treated with respect by hospital staff?

Yes, definitely Yes, to some extent No


Figure 13 shows data from the only question on the carer questionnaire which asked carers how well supported they themselves felt by the hospital while the person they care for was admitted.

Figure 13: Carer view of support provided to them by the hospital. National sample (n=4379) and Wales sample (n=239).

The carer questionnaire also asked carers for their overall opinion of the care provided to the person they care for while in hospital. This question makes up the score for carer rating of patient care.

Figure 14: Carer overall view of patient care provided by the hospital. National sample (n=4645) and Wales sample (n=255).

50%62%

34%

29%

10%5%

6% 4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


% o

f ca

rers

Overall, how satisfied are you with the support you have received from this hospital to help you in your role as a carer?

Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied

35% 40%

34%

41%

17%

11%10%

8%5% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


% o

f ca

rers

Overall, how would you rate the care received by the person you look after during the hospital stay?

Excellent Very good Good Fair Poor


R Assessment

Information and communication

Staffing and training

Nutrition

Discharge and hospital transfer

Governance


Assessment

Items presented in this theme are from the casenote audit and refer to assessments done upon or during admission. Assessments completed for discharge can be found in the discharge theme chapter.

Presentation of items and scoring

For information on how the data tables in the chapters are laid out, please see page 8.

The assessment theme has an associated score. The score for Wales and the national mean average are shown in table 4. For further information on scoring, please see page 6.

Table 4: Assessment score for Wales

Assessment score (%)

Wales’s average and range 78.2% (60.4% - 90.4%)

National average and range 83.7% (48.7% - 99.1%)


I. Multi-disciplinary assessment

Std no.

[Type] Question number and text


% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

1.9 [1]

14 CA

An assessment of mobility was performed by a healthcare professional: (y/n/could not be assessed for recorded reasons)

93.8% 8558/9126

88.3% 669/758

89.1% 501/562

15 CA

An assessment of nutritional status was performed by a healthcare professional: (y/n/could not be assessed for recorded reasons)

89.8% 8832/9837

81.7% 662/810

85.2% 505/593

15a CA

(If Q15=Yes) The assessment of nutritional status includes recording of BMI (Body Mass Index) or weight: Yes, there is a recording of the patient’s BMI or weight

85.9% 7580/8822

77.6% 513/661 59.8%

289/483 Other action taken

4% 352/8822

3.5% 23/661

1.10 [1]

16 CA

Has a formal pressure ulcer risk assessment been carried out and score recorded? (y/n)

95.5% 9590/10044

93% 774/832

87.8% 533/607

1.12 [1]

17 CA

As part of the multidisciplinary assessment has the patient been asked about any continence needs? (y/n/could not be assessed for recorded reasons)

88% 8572/9744

84% 676/805

91.8% 525/572

1.11 [1]

18 CA

As part of the multidisciplinary assessment has the patient been assessed for the presence of any pain? (y/n/could not be assessed for recorded reasons)

83.2% 8185/9840

79.4% 646/814

84.8% 485/572

1.13 [1]

19 CA

Has an assessment of functioning been carried out? Yes, a standardised assessment has taken place

45.3% 4212/9294

40.1% 300/749

32.8% 179/545

Yes, an occupational therapy and/or a physiotherapy assessment has taken place

42.8% 3977/9294

38.5% 288/749

New answer options for

Round 3 Yes, other

1.7% 161/9294

3.1% 23/749

Yes (all options) 89.8%

8350/9294 81.6%

611/749


II. Mental state assessment

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

1.3 [2]

20 CA

Has a standardised mental status test been carried out? (y/n/could not be assessed for recorded reasons)

54% 4684/8682

29.9% 229/766

28.3% 154/545

1.4 [2]

21 CA

Has an assessment been carried out for recent changes or fluctuation in behaviour that may indicate the presence of delirium? Yes, and there were indications that delirium may be present

25.9% 2603/10047

22% 183/832

18.8% 114/607

Yes, but there was no indication that delirium may be present

18.5% 1863/10047

14.4% 120/832

17.5% 106/607

Yes (both options) 44.5%

4466/10047 36.4%

303/832 36.3%

220/607

1.5 [2]

21a CA

(If Q21=Yes) Has the patient been clinically assessed for delirium by a healthcare professional? (y/n)

85.3% 2220/2603

81.4% 149/183

80.7% 92/114


Information and Communication

Items presented in this theme are from the organisational checklist, casenote audit, staff questionnaire and carer questionnaire. The questions relate to personal information collected about people with dementia, communication between staff members and communication between staff and carers.



The information and communication theme has two associated scores. One score for carer rating of information and communication and one for staff rating of information and communication. The scores for Wales and the national mean averages are shown in table 5. For further information on scoring, please see page 6.

Table 5: Information and communication scores for Wales

Carer rating (%) Staff rating (%)


59.9% (52.2% - 70.4%)

National average and range 64.4% (22.2% - 89.3%)

64.8% (48.1% - 82.7%)


I. Information about the patient with dementia a. Data from the organisational checklist and casenote audit

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

1.14 [1]

16 OC

There is a formal system (pro-forma or template) in place in the hospital for gathering information pertinent to caring for a person with dementia: (y/n)

98.5% 196/199

100% 17/17

64.7% 11/17

22 CA

Does the care assessment contain a section dedicated to collecting information from the carer, next of kin or a person who knows the patient well? (y/n)

57.2% 5727/10010

51.6% 429/832

60.1% 365/607

17a OC

(If Q16=Yes) Information collected by the pro-forma includes personal details, preferences and routines: (y/n)

100% 196/196

100% 17/17

100% 11/11

22a CA

(If Q22=Yes) Has information been collected about the patient regarding personal details, preferences and routines?

Yes 47.4%

2669/5626 45.9%

192/418 44.4%

158/356

Unknown* 33.1%

1865/5626 15.1% 63/418

New answer option for Round 3

17b OC

(If Q16=Yes) Information collected by the pro-forma includes reminders or support with personal care: (y/n)

98.5% 193/196

100% 17/17

100% 11/11

22c CA

(If Q22=Yes) Has information been collected about the patient regarding reminders or support with personal care?

Yes 55.3%

3116/5631 67.5%

284/421 67.7%

241/356

Unknown* 29.9%

1685/5631 13.3% 56/421


17c OC

(If Q16=Yes) Information collected by the pro-forma includes recurring factors that may cause or exacerbate distress: (y/n)

100% 196/196

100% 17/17

100% 11/11

22d CA

(If Q22=Yes) Has information been collected about the patient regarding recurring factors that may cause or exacerbate distress?

Yes 32.6%

1818/5583 33.3%

137/412 29.1%

101/347

Unknown* 37.8%

2110/5583 18%

74/412


17d OC

(If Q16=Yes) Information collected by the pro-forma includes support or actions that can calm the person if they are agitated: (y/n)

99% 194/196

100% 17/17

100% 11/11


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

22e CA

(If Q22=Yes) Has information been collected about the patient regarding support or actions that can calm the person if they are agitated?

Yes 28.2%

1564/5539 26.7%

109/408 19.9% 69/347

Unknown* 39.1%

2167/5539 16.9% 69/408


18 OC

(If Q16=Yes) Information collected by the pro-forma includes how the person with dementia communicates with others/ understands communication: (y/n)

99.5% 195/196

100% 17/17

New question for Round 3

1.15 [3]

17e OC

(If Q16=Yes) Information collected by the pro-forma includes life details which aid communication: (y/n)

99.5% 195/196

100% 17/17

100% 11/11

22f CA

(If Q22=Yes) Has information been collected about the patient regarding life details which aid communication?

Yes 43.1%

2413/5598 48%

199/415 44.2%

153/346

Unknown* 35.3%

1977/5598 13.3% 55/415


1.14 [1]

22b CA

(If Q22=Yes) Has information been collected about the patient's food and drink preferences?

Yes 44.1%

2476/5616 42.9%

179/417 New question for Round 3

Unknown* 34.1%

1916/5616 14.4% 60/417

19 OC

(If Q16=Yes) The form prompts staff to approach carers or relatives to collate necessary information: (y/n)

93.4% 183/196

88.2% 15/17

100% 11/11

20 OC

Documenting use of personal information in practice: Hospitals selected three adult inpatient wards which had the highest admissions of people with dementia. Ten patients in these wards were checked to see if the personal information document was present. Included were patients with dementia who needed a personal information document such as “This is Me” Number of patients checked: -


Range 0-40 3-19 Median 10 10 Number of these patients where the information was present:

-


Percentage of patients where the information was present:

-

Range 0-100% 10-100% Mean 49% 54% Median 50% 50%

*Unknown response options refer to situations in which the information is usually recorded in a document which

accompanies the patient (e.g. “This is Me” or patient passport) and no copy is available in the notes.


b. Data from the carer and staff questionnaires

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

1.14 [1]

7 CQ

Did hospital staff ask you about the needs of the person you look after to help plan their care?

Yes, definitely 45.4%

2053/4524 55%

137/249 New tool for

Round 3 Yes, to some extent

34.5% 1563/4524

34.1% 85/249

No 20.1%

908/4524 10.8% 27/249

9.3 [1]

1 CQ



2130/4578 50.2%



43.3% 1980/4578

43.1% 110/255

No 10.2%

468/4578 6.7%

17/255

3 SQ

In your current role, do you think that personal information is available to you to help you care for/ support people with dementia? E.g. their likes/ dislikes, preferred name, past job.

Yes, always 21.4%

3072/14345 16.5%

158/957

New tool for Round 3

Yes, most of the time 38.5%

5525/14345 35.9%

344/957

Yes, sometimes 33%

4734/14345 37.1%

355/957

No 7.1%

1014/14345 10.4%

100/957

3a SQ

Do you have the opportunity to use this information to help you care for/ support people with dementia?

Yes, always 26.6%

3549/13329 21.5%

185/860



5454/13329 39.5%

340/860

Yes, sometimes 30.6%

4074/13329 35.3%

304/860

No 1.9%

252/13329 3.6%

31/860

7.4 [2]

4 SQ

In your current role, do you feel encouraged to accommodate the individual needs and preferences of people with dementia? E.g. taking time to speak and interact at the pace of the person with dementia, permitting them to walk around the ward.

Yes, always 28.9%

4145/14333 22%

211/957



4759/14333 28.2%

270/957


3913/14333 34.6%

331/957

No 10.6%

1516/14333 15.2%

145/957


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

2 CQ

Do you feel confident that hospital staff delivered high quality care that was appropriate to the needs of the person you look after?


2489/4592 59%



36.4% 1672/4592

37.1% 95/256

No 9.4%

431/4592 3.9%

10/256

4 CQ


Yes, definitely 76%

3471/4569 86.6%



20.8% 952/4569

12.3% 31/253

No 3.2%

146/4569 1.2% 3/253

II. Communication between staff

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

9.3 [1]

21 OC

There is a system in place across the hospital that ensures that all staff in the ward or care area are aware of the person's dementia or condition and how it affects them: (y/n)

90.5% 180/199

100% 17/17

58.8% 10/17

21a OC

(If Q21=Yes) Please say what this is:

A visual indicator, symbol or marker 91.1%

164/180 100% 17/17

60% 6/10

Alert sheet or electronic flag (updated option for Round 3)

23.9% 43/180

0% 0/17

0% 0/10

A box to highlight or alert dementia condition in the notes or care plan

33.9% 61/180

5.9% 1/17

0% 0/10

Other 18.9% 34/180

5.9% 1/17

40% 4/10

22 OC

There is a system in place across the hospital that ensures that staff from other areas are aware of the person's dementia or condition whenever the person accesses other treatment areas: (y/n)

70.4% 140/199

64.7% 11/17

47.1% 8/17


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

9.3 [1]

22a OC



122/140 81.8% 9/11

50% 4/8

Alert sheet or electronic flag (Updated option for Round 3)

18.6% 26/140

0% 0/11

0% 0/8


20.7% 29/140

0% 0/11

0% 0/8

Other 17.9% 25/140

18.2% 2/11

50% 4/8

7.12 [1]

6 SQ

As a team, how often do you talk about the way you care for/ support people with complex needs (including dementia)?

Frequently 49.8%

6203/12457 43.3%

359/830


Occasionally 37.2%

4636/12457 42%

349/830

Almost Never 9.7%

1210/12457 10%

83/830

Never 3.3%

408/12457 4.7%

39/830

III. Involvement of carers and people with dementia

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

9.7 [2]

5 CQ

Were you (or the patient, where appropriate) kept clearly informed about their care and progress during the hospital stay? For example, about plans for treatment and discharge.


1908/4566 45.1%



40.4% 1843/4566

44.7% 114/255

No 17.8%

815/4566 10.2% 26/255

9.11 [2]

6 CQ

Were you (or the patient, where appropriate) involved as much as you wanted to be in decisions about their care?


2138/4497 58.8%



36.4% 1637/4497

31.6% 79/250

No 16.1%

722/4497 9.6%

24/250

9.13 [2]

23 OC

The dementia lead or dementia working group collates feedback from carers on the written and verbal information provided to them: (y/n)

81.9% 163/199

11.8% 2/17



Staffing and Training

Items presented in this theme are from the organisational checklist, staff questionnaire and carer questionnaire. Questions relate to hospital staffing levels and the training available to staff on dementia care.



The staffing and training theme has no associated score. This is because there was insufficient data nationally for this theme. For further information on scoring, please see page 6.


I. Staffing levels

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

N7a [3]

10 OC

Ward staffing levels (nurses, midwives and care staff) are made available for the public to view on a monthly basis: (y/n)

88.4% 176/199

5.9% 1/17


11 OC

An evidence-based tool is used for establishing ward staffing levels: (y/n)

99% 197/199

100% 17/17


4.9 [2]

9 SQ

Do you think the ward(s) you work on is able to respond to the individual needs of people with dementia as they arise? E.g. pain relief, personal care, toileting, mobility assistance.

Yes, always 30.4%

2785/9148 33.1%

207/625



4352/9148 41.9%

262/625


1708/9148 20.5%

128/625

No 3.3%

303/9148 4.5%

28/625

10 SQ

Is additional staffing support provided if dependency needs on the ward(s) you work on increase?

Yes, always 10.7%

977/9143 11.1% 70/628



2516/9143 27.7%

174/628


3887/9143 46%

289/628

No 19.3%

1763/9143 15.1% 95/628

1.14 [1]

3 CQ

Was the person you look after given enough help with personal care from hospital staff? For example, eating, drinking, washing and using the toilet.


2456/4433 62%



34.2% 1515/4433

31.8% 81/255

No 10.4%

462/4433 6.3%

16/255

II. Guidance for staff

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

7.1 [2]

31 OC

There is a named dignity lead to provide guidance, advice and consultation to staff: (y/n)

70.4% 140/199

76.5% 13/17

88.2% 15/17


III. Training and knowledge framework

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

7.2 [2]

24 OC

There is a training and knowledge framework or strategy that identifies necessary skill development in working with and caring for people with dementia: (y/n)

95.5% 190/199

88.2% 15/17

64.7% 11/17

7.11 [3]

26 OC

Involvement of people with dementia and carers and use of their experiences is included in the training for ward staff: (y/n)

82.4% 164/199

82.4% 14/17

52.9% 9/17

IV. Dementia care training

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

7.5 [3]

27 OC

What format is used to deliver basic dementia awareness training?

eLearning module 72.9%

145/199 94.1% 16/17


Workshop or study day 91%

181/199 94.1% 16/17

Higher education module 22.6% 45/199

35.3% 6/17

Other 29.1% 58/199

11.8% 2/17

7.4 [2]

2 SQ

What form did your dementia training at this hospital take? Please tick all that apply:


5653/13205 48.4%

426/880


Workshop or study day 53.2%

7030/13205 39.1%

344/880

Higher education module 5.4%

713/13205 4.4%

39/880

Workbook 7.7%

1018/13205 2.7%

24/880

Other 7.3%

961/13205 4.7%

41/880 I have not received any dementia training at this hospital

17.3% 2278/13205

26.5% 233/880

2a SQ


Yes, much better prepared 42.2%

4502/10670 28.5%


Round 3 Yes, somewhat better prepared

50.5% 5390/10670

60.3% 376/624

No 7.3%

778/10670 11.2% 70/624


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

25 OC

The question below is about training that is provided to acute healthcare staff who are involved in the care of people with dementia (or suspected dementia): Dementia awareness training is:

Doctors

Mandatory 46.2% 92/199

52.9% 9/17

0% 0/17

Provided on induction 63.3%

126/199 58.8% 10/17

23.5% 4/17

Provided in the last 12 months 58.8%

117/199 70.6% 12/17

88.2% 15/17

Not provided in the last 12 months 8.5%

17/199 11.8% 2/17

11.8% 2/17

Nurses

Mandatory 51.8%

103/199 70.6% 12/17

0% 0/17


148/199 70.6% 12/17

35.3% 6/17


136/199 88.2% 15/17

88.2% 15/17

Not provided in the last 12 months 1%

2/199 0%

0/17 11.8% 2/17

Healthcare assistants

Mandatory 51.8%

103/199 70.6% 12/17

0% 0/17


142/199 76.5% 13/17

35.3% 6/17


136/199 82.4% 14/17

88.2% 15/17


2/199 0%

0/17 11.8% 2/17

Other allied healthcare professionals, e.g. physiotherapists, dieticians


58.8% 10/17

0% 0/17


129/199 64.7% 11/17

23.5% 4/17


135/199 88.2% 15/17

64.7% 11/17

Not provided in the last 12 months 3.5% 7/199

0% 0/17

35.3% 6/17

Support staff in the hospital, e.g. housekeepers, porters, receptionists


58.8% 10/17

0% 0/17


115/199 70.6% 12/17

23.5% 4/17


127/199 70.6% 12/17

52.9% 9/17


11.8% 2/17

47.1% 8/17


Nutrition

Items presented in this theme are from the organisational checklist and staff questionnaire. Questions relate to the provision of food and drink for people with dementia and hospital schemes such as protected mealtimes.



The nutrition theme has an associated score. The score for Wales and the national mean average are shown in table 6. For further information on scoring, please see page 6.

Table 6: Nutrition score for Wales

Nutrition score (%)


National average and range 83.8% (36.3% - 100%)


I. Protected mealtimes

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

3.7 [1]

12 OC

Protected mealtimes are established in all wards that admit adults with known or suspected dementia: (y/n)

98% 195/199

88.2% 15/17

100% 17/17

12a OC

(If Q12=Yes) Wards’ adherence to protected mealtimes is reviewed and monitored: (y/n)

88.7% 173/195

100% 15/15

94.1% 16/17

12 SQ

In the last week (except in emergency situations), were patient mealtimes kept free of any clinical activity on the ward(s) you work on?

Yes, always 28.3%

2488/8788 31.6%

189/598



3456/8788 36.6%

219/598


1476/8788 14.9% 89/598

No 15.6%

1368/8788 16.9%

101/598

3.8 [1]

13 OC

The hospital has in place a scheme/ programme which allows identified carers of people with dementia to visit at any time including at mealtimes (e.g. Carer’s Passport): (y/n)

88.9% 177/199

76.5% 13/17


7 SQ

Can carers of people with dementia visit at any time on the ward(s) you work on? i.e. visits are not limited to normal visiting hours and may include mealtimes.

Yes, always 51.2%

6131/11978 43.4%

340/783



3271/11978 25.9%

203/783


1927/11978 21.5%

168/783

No 5.4%

649/11978 9.2%

72/783


II. Catering arrangements

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

N3b [2]

35 OC

The hospital can provide finger foods for people with dementia (please select one option only): Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery (finger food) on every day

65.3% 130/199

70.6% 12/17


Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on four to six days per week or more

1% 2/199

0% 0/17

Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on two or three days per week or more

0% 0/199

0% 0/17

Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on only one day per week

0% 0/199

0% 0/17

Finger food consists of sandwiches/wraps only 33.7% 67/199

29.4% 5/17

Patients who may be unable to use cutlery will never be admitted to the hospital

0% 0/199

0% 0/17

13 SQ

Can you access finger food (i.e. food which can be eaten without a knife/ fork/ spoon) for people with dementia as an alternative to main meals?

Yes, always 38%

3356/8822 35.2%

212/602



2398/8822 26.6%

160/602


1983/8822 25.6%

154/602

No 12.3%

1085/8822 12.6% 76/602

3.11 [2]

36 OC

The hospital can provide 24 hour food services for people with dementia (please select one option only): In addition to the main meals, other food, for example toast, sandwiches, cereals, soup, and lighter hot dish(es) are available 24 hours a day

50.8% 101/199

47.1% 8/17


In addition to the main meals, other food, for example toast, sandwiches, cereals, soup are available, but less than 24 hours a day

10.6% 21/199

11.8% 2/17

Simple food supplies for example bread, cereal, yoghurt and biscuits are available 24 hours a day

32.2% 64/199

35.3% 6/17

Only snacks (biscuits, cake) are available 24 hours a day

3% 6/199

0% 0/17

Food is not available 24 hours a day 3.5% 7/199

5.9% 1/17


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

14 SQ


Yes, always 44.5%

4060/9119 40.9%

256/626



2615/9119 26.8%

168/626


1886/9119 24.6%

154/626

No 6.1%

558/9119 7.7%

48/626

III. Communication

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

N3a [2]

15 SQ

Are the nutrition and hydration needs of people with dementia communicated at handovers/ safety briefings?

Yes, always 46.2%

4199/9090 52%

325/625



3039/9090 26.9%

168/625


1408/9090 16.5%

103/625

No 4.9%

444/9090 4.6%

29/625

IV. Overall

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

7.18 [1]

8 SQ

Do you think that the people with dementia you care for/ support, have their nutritional needs met while on the ward(s) you work on?

Yes, always 25.9%

3181/12263 27.7%

223/805



6149/12263 47.3%

381/805


2357/12263 18.6%

150/805

No 4.7%

576/12263 6.3%

51/805


Discharge

Items presented in this theme are from the organisational checklist and the casenote audit. The questions ask about discharge planning, assessment for discharge and discharge notice.



The discharge theme has an associated score. The score for Wales and the national mean average are shown in table 7. For further information on scoring, please see page 6.

Table 7: Discharge score for Wales

Discharge planning score (%)


National average 72.7% (22% - 98.5%)


I. Assessment before discharge

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

5.3 [2]

23 CA

At the point of discharge the patient's level of cognitive impairment, using a standardised assessment, was summarised and recorded: (y/n)

22.4% 1639/7329

17.3% 96/556

12.7% 50/394

23a CA

(If 23=No) Please comment:

Patient too unwell/ not responsive 3.3%

189/5690 1.1% 5/460


Patient has advanced dementia (i.e. patient’s advanced dementia makes the assessment not appropriate)

1.9% 110/5690

1.3% 6/460

Not routine/ not standard practice 5.8%

331/5690 0%

0/460

Not documented/ unknown reason 78.1%

4444/5690 95%

437/460 Dementia diagnosis (i.e. dementia diagnosis mentioned as a reason for not completing assessment)

10.8% 616/5690

2.6% 12/460

24 CA

At the point of discharge the cause of cognitive impairment was summarised and recorded: (y/n)

69.1% 5067/7329

47.1% 262/556

52% 205/394

25 CA

Have there been any symptoms of delirium? (y/n)

32.3% 2367/7329

32% 178/556

25.4% 100/394

25a CA

(If Q25=Yes) Have the symptoms of delirium been summarised for discharge? (y/n)

47.9% 1133/2367

34.8% 62/178

51% 51/100

26 CA

Have there been any persistent behavioural and psychiatric symptoms of dementia (wandering, aggression, shouting) during this admission? (y/n)

19.4% 1425/7329

21.6% 120/556

23.4% 92/394

26a CA

(If Q26=Yes) Have the symptoms of behavioural and psychiatric symptoms of dementia been summarised for discharge? (y/n)

44.5% 635/1426

39.2% 47/120

47.8% 44/92


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

27 CA

Is there a recorded referral to a social worker for assessment of housing and care needs due to a proposed change in residence?

65.5% 1649/2519

68.8% 148/215


27a (i) CA

(If Q27=Yes): There are documented concerns about the patient’s capacity to consent to the referral:

70.4% 1161/1649

72.3% 107/148


27a (ii) CA

The patient had capacity on assessment and their consent is documented

11.9% 138/1161

5.6% 19/107

The patient lacked requisite capacity and evidence of a best interests decision has been recorded

69.9% 811/1161

76.6% 82/107

There is no record of either consent or best interest decision making*

18.3% 212/1161

17.8% 19/107

27a (i) CA

There are no documented concerns about the patient’s capacity to consent to the referral:

29.6% 488/1649

27.7% 41/148

27a (iii) CA

The patients consent was requested and this is recorded

29.1% 142/488

14.6% 6/41

There is no record of the patients consent*

70.9% 346/488

85.4% 35/41

27a (ii & iii) CA

Consent or best interests (responses options combined)

66.2% 1091/1649

63.5% 94/148

No consent or best interests (response options combined)

33.8% 558/1649

36.5% 54/148

5.5 [2]

36 CA

An assessment of the carer's current needs has taken place in advance of discharge: (y/n/na)

67.3% 2605/3868

49.7% 162/326

66.9% 170/254

*Please note that these figures include 1.9% of casenotes where it was specified that the capacity assessment information is kept with social worker notes, which are unavailable to the auditor.

I. Discharge planning and coordination

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

6.4 [2]

32 OC

There is a named person/ identified team who takes overall responsibility for complex needs discharge and this includes people with dementia: (y/n)

95.5% 190/199

100% 17/17

76.5% 13/17

6.5 [2]

33a OC

(If Q32=Yes) This person/ team has training in ongoing needs of people with dementia: (y/n)

92.6% 176/190

94.1% 16/17

76.9% 10/13

6.6 [3]

33b OC

(If Q32=Yes) This person/ team has experience of working with people with dementia and their carers: (y/n)

98.4% 187/190

100% 17/17

100% 13/13


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

6.4 [2]

28 CA

Did a named person/ identified team co-ordinate the discharge plan? (y/n/na)

82% 5807/7083

77.3% 408/528

66.2% 233/352

5.4 [1]

29a CA

Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the person with dementia? (y/n/na)

53.9% 3327/6169

47.5% 237/499

51.6% 179/347

29b CA

Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the person's carer/ relative? (y/n/na)

80.7% 5597/6935

75.6% 391/517

74.5% 286/384

29c CA

Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the consultant responsible for the patient's care? (y/n)

75.1% 5501/7329

69.8% 388/556

68.3% 269/394

29d CA

Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with other members of the multidisciplinary team? (y/n)

81.5% 5971/7329

74.5% 414/556

74.9% 295/394

5.6 [1]

30 CA

Has a single plan/ summary for discharge with clear updated information been produced? (y/n)

85.1% 6234/7329

73.7% 410/556

61.9% 244/394

5.7 [2]

31 CA

Are any support needs that have been identified documented in the discharge plan/ summary? (y/n/na)

60.2% 4211/6995

49.5% 250/505

68.4% 242/354

5.8 [1]

32 CA

Has the patient and/ or carer received a copy of the plan/ summary? (y/n/na)

80.6% 5621/6975

39.4% 194/492

43.1% 170/394


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

5.1 [2]

34 CA

Was discharge planning initiated within 24 hours of admission? (y/n/na)

47.4% 2483/5242

33.6% 148/440

19.9% 70/352

34a CA

(If Q34=N/A) Please select the recorded reason why discharge planning could not be initiated within 24 hours:

Patient acutely unwell 62.5%

1306/2088 69.8% 81/116

59.5% 25/42

Patient awaiting assessment 9.1%

190/2088 7.8% 9/116

2.4% 1/42

Patient awaiting history/ results 6.1%

127/2088 5.2% 6/116

2.4% 1/42

Patient awaiting surgery 9.6%

200/2088 8.6%

10/116 11.9% 5/42

Patient presenting confusion 5.7%

120/2088 4.3% 5/116

14.3% 6/42

Patient on end of life plan 0%

1/2088 0%

0/116 -

Patient being transferred to another hospital 0.1%

2/2088 0%

0/116 0%

0/42

Patient unresponsive 0.3%

6/2088 0.9% 1/116

2.4% 1/42

Patient being discharged to nursing/ residential care

6.5% 136/2088

3.4% 4/116

0% 0/42

Not recorded - - 7.1% 3/42

Other 0%

0/2088 0%

0/116 0%

0/42

II. Notice of discharge

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

N5a [3]

14 OC

Instances where less than 24 hours notice of discharge has been given to carers or family are compiled and reported to the Executive Board:

Yes, within the past 6 months 4%

8/199 0%


Yes, within the last year 1.5% 3/199

0% 0/17


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

5.10 [2]

35 CA

Carers or family have received notice of discharge and this is documented:

Less than 24 hours 19.5%

1432/7329 18.3%

102/556 12.2% 48/394

24 hours 12.2%

897/7329 8.8%

49/556 7.9%

31/394

25 - 48 hours 14.7%

1075/7329 9.9%

55/556 15.5% 61/394

More than 48 hours 27.1%

1985/7329 24.3%

135/556 34%

134/394

No notice at all 0.5%

35/7329 0.4% 2/556

0.5% 2/394

Not documented 24.2%

1770/7329 36.2%

201/556 29.7%

117/394

No carer, family, friend/ could not contact 1.8%

132/7329 2.2%

12/556 0.3% 1/394

Patient specified information to be withheld 0%

3/7329 0%

0/556


N5b [2]

33 CA

Was a copy of the discharge plan/ summary sent to the GP/ primary care team on the day of discharge? (y/n/na)

93.6% 6701/7156

75.1% 387/515



Governance

Items presented in this theme are from the organisational checklist, staff questionnaire and carer questionnaire. The questions relate to such topics as the environment in the hospital, involvement of the executive board, services available to carers and patients and engagement with carers.



The governance theme has an associated score. The score for Wales and the national mean average are shown in table 8. For further information on scoring, please see page 6.

Table 8: Governance score for Wales

Governance score (%)


National average and range 65.1% (12.5% - 100%)


I. Environment a. Physical environment on the ward

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

N8a [3]

39 OC

The physical environment within the hospital has been reviewed using an appropriate tool (e.g. King’s Fund Enhancing the Healing Environment) to establish whether it is “dementia-friendly”:

Throughout the hospital 42.7% 85/199

23.5% 4/17


All adult wards/ areas 13.6% 27/199

5.9% 1/17

All care of the elderly wards/ areas 18.1% 36/199

17.6% 3/17

Designated dementia wards only 3%

6/199 0%

0/17

Other 13.1% 26/199

11.8% 2/17

No 9.5%

19/199 41.2% 7/17

40 OC

(If Q39=Yes) Environmental changes based on the review are:

Completed 15%

27/180 10% 1/10


Underway 56.7%

102/180 60% 6/10

Planned but not yet underway 10%

18/180 0%

0/10

Planned but funding has not been identified 15.6% 28/180

30% 3/10

Plans are not in place 2.8% 5/180

0% 0/10

41 OC

(If Q39=Yes) Service users/ carers/ lay volunteers have been part of the team reviewing the environment:


20% 2/10


All adult wards/ areas 9.4%

17/180 10% 1/10


0% 0/10


9/180 0%

0/10

Other 13.3% 24/180

30% 3/10

They have not been part of the team 22.2% 40/180

40% 4/10


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

42 OC

(If Q39=Yes) There are plans to further review the changes implemented: Yes, we are already undertaking/ have already done this

49.4% 89/180

10% 1/10


Yes, once the work is completed 40%

72/180 90% 9/10

No plans are in place 10.6% 19/180

0% 0/10

b. Social environment on the ward

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

6.11 [3]

38 OC

Opportunities for social interaction for patients with dementia are available (e.g. to eat/ socialise away from their bed area with other patients):

On all adult wards 15.1% 30/199

11.8% 2/17


On care of the elderly wards 38.7% 77/199

58.8% 10/17

Other 30.2% 60/199

5.9% 1/17

No 16.1% 32/199

23.5% 4/17

II. Dementia champions and specialist services

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

4.11 [2]

5 OC

There are champions for dementia at:

5a OC

Directorate level (y/n) 81.9%

163/199 76.5% 13/17

64.7% 11/17

5b OC

Ward level (y/n) 93.5%

186/199 82.4% 14/17

64.7% 11/17


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

1 SQ

Do you feel supported by specialist services for dementia in your hospital? E.g. dementia specialist team, mental health liaison, dementia champions.

1a SQ

During office hours i.e. Monday-Fri, 9am-5pm

Yes, always 28.7%

4026/14024 15.9%

149/938



4614/14024 27.7%

260/938


3760/14024 35%

328/938

No 11.6%

1624/14024 21.4%

201/938

1b SQ

Out of office hours

Yes, always 7.8%

874/11207 4%

31/772



1763/11207 9.1%

70/772


3129/11207 23.7%

183/772

No 48.6%

5441/11207 63.2%

488/772

III. Continuity of care

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

N3c [3]

15 OC

Instances of night time bed moves (i.e. between the evening meal and breakfast the next morning) are noted and reported at Executive Board level: (y/n)

38.2% 76/199

11.8% 2/17


11 SQ

Are night time bed moves for people with dementia avoided where possible on the ward(s) you work on? By night time bed moves, we mean bed moves between the evening meal and breakfast the next morning.

Yes, always 16.3%

1474/9047 19.5%

120/614



2942/9047 30.9%

190/614


2506/9047 24.4%

150/614

No 23.5%

2125/9047 25.1%

154/614

6.2 [2]

30 OC

The hospital has access to intermediate care services, which will admit people with dementia: (y/n)

93% 185/199

94.1% 16/17

58.8% 10/17


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

6.3 [3]

30a OC

(If Q30=Yes) Access to intermediate care services allows people with dementia to be admitted to intermediate care directly and avoid unnecessary hospital admission: (y/n)

84.3% 156/185

87.5% 14/16

70% 7/10

IV. Engagement with carers

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

N4b [3]

7 OC

Has a strategy or plan for carer engagement been produced (e.g. using Triangle of Care self-assessment tool)? (y/n)

76.9% 153/199

58.8% 10/17


8 OC

(If Q7=Yes) Is implementation of the strategy or plan scheduled for review?

Yes, more than once a year 41.2% 63/153

30% 3/10


Yes, once a year 34.6% 53/153

0% 0/10

Yes, less than once a year 20.3% 31/153

60% 6/10

6.7 [2]

34 OC

There is a social worker or other designated person or team responsible for working with people with dementia and their carers, and providing advice and support, or directing to appropriate organisations or agencies: (y/n)

75.9% 151/199

52.9% 9/17

70.6% 12/17

6.10 [2]

37 OC

There is access to advocacy services with experience and training in working with people with dementia: (y/n)

95% 189/199

94.1% 16/17

76.5% 13/17

8

CQ


Excellent 34.5%

1602/4645 39.6%

101/255


Very good 33.9%

1575/4645 41.2%

105/255

Good 17%

790/4645 10.6% 27/255

Fair 9.6%

446/4645 7.8%

20/255

Poor 5%

232/4645 0.8% 2/255


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

10 CQ


Very satisfied 50.3%

2204/4379 62.3%

149/239


Somewhat satisfied 34%

1487/4379 28.5% 68/239

Somewhat dissatisfied 9.9%

434/4379 5.4%

13/239

Very dissatisfied 5.8%

254/4379 3.8% 9/239

V. Involvement of the executive board

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

4.4 [2]

3 OC

The Executive Board regularly reviews the number of in-hospital falls and the breakdown of the immediate causes, in which patients with dementia can be identified (y/n)

60.3% 120/199

35.3% 6/17

23.5% 4/17

4.5 [2]

4 OC

The Executive Board regularly receives feedback from the following:

4a OC

Clinical Leads for older people and people with dementia including Modern Matrons/ Nurse Consultant (y/n)

84.9% 169/199

47.1% 8/17

76.5% 13/17

4b OC

Complaints – analysed by age (y/n) 52.3%

104/199 41.2% 7/17

41.2% 7/17

4c OC

Patient Advice and Liaison Services (PALS) – in relation to the services for older people and people with dementia (y/n/na)

58.6% 106/181

N/A N/A

4d OC

Patient/ public forums or local Healthwatch – in relation to services for older people and people with dementia (y/n)

67.3% 134/199

58.8% 10/17

52.9% 9/17

4.7 [2]

2 OC

The Executive Board regularly reviews information collected on:

2a OC

Re-admissions, in which patients with dementia can be identified in the total number of patients re-admitted (y/n)

31.7% 63/199

5.9% 1/17

5.9% 1/17

2b OC

Delayed discharge/ transfers, in which patients with dementia can be identified in the total number of patients with delayed discharge/ transfers (y/n)

31.7% 63/199

29.4% 5/17

29.4% 5/17


VI. Dementia working groups

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

N4c [3]

9 OC

A Dementia Working Group is in place and reviews the quality of services provided in the hospital: (y/n)

93.5% 186/199

70.6% 12/17


9a OC

(If Q9=Yes) The group meets:

Annually 0.5% 1/186

0% 0/12


Bi-annually 0.5% 1/186

8.3% 1/12

Quarterly 30.1% 56/186

50% 6/12

Six-weekly 4.3% 8/186

0% 0/12

Monthly 33.3% 62/186

25% 3/12

Bi-monthly 29%

54/186 16.7% 2/12

Weekly 0.5% 1/186

0% 0/12

Unknown 1.6% 3/186

0% 0/12

9b OC

(If Q9=Yes) The group includes:

Healthcare professionals 100%

186/186 100% 12/12


Organisations e.g. Alzheimer’s Society 64%

119/186 66.7% 8/12

Carer/ service user representation 66.1%

123/186 100% 12/12

VII. Care pathway

Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

4.1 [2]

1 OC

A care pathway or bundle for patients with dementia is in place:

Yes 60.8%

121/199 35.3% 6/17

17.6% 3/17

In development 26.1% 52/199

17.6% 3/17

64.7% 11/17

4.2 [2]

1a OC

(If Q1=Yes or In development) A senior clinician is responsible for implementation and/ or review of the care pathway: (y/n)

97.1% 168/173

100% 9/9

78.6% 11/14


Std no.



% Num/Den

Wales Round 3:

% Num/Den

Wales Round 2:

% Num/Den

4.1 [2]

1b OC

(If Q1=Yes or In development) The dementia care pathway/ bundle is integrated within or linked to the following care pathways:

Delirium

Yes 65.9%

114/173 66.7%


Pathway in development 26.6% 46/173

33.3% 3/9

Stroke

Yes 32.9% 57/173

55.6% 5/9 New question

for Round 3 Pathway in development

21.4% 37/173

11.1% 1/9

Fractured neck of femur

Yes 43.6% 75/172

22.2% 2/9 New question

for Round 3 Pathway in development

24.4% 42/172

11.1% 1/9


Carer expectations from the national report

Full list of recommendations from the national report


Carer expectations from the national report What should carers expect from hospitals when a person with dementia is admitted?

"Carers have a crucial role to play in the care of people with dementia. When a person with dementia develops a physical health problem and/ or their behaviour changes the carer is often the first to be aware of this. If that person is admitted to hospital or a care home it is often the carer who knows the person’s history and is able to provide care staff with crucial information. Carers can also help support communication and share information with the person with dementia. This helps to ensure that the right care and treatment is provided which takes into account additional support needs and preferences.

Carers want a collaborative team approach to care, and to be seen as partners in care. Carers want to be kept involved and informed throughout assessment, treatment and discharge planning for the person they care for.

Carers of people with dementia also have their own needs, which need to be assessed and taken into account. Research shows that carers of older people with dementia experience greater strain and distress than carers of other older people. In addition, many carers of people with dementia are older people themselves, with physical frailty and health conditions of their own.

It is carers who are responsible for care when the professionals aren’t there, and as the condition progresses are commonly faced with co-ordinating and managing complex needs".

Triangle of Care, Carers Trust and the Royal College of Nursing, 2013.

“Carers should be welcomed. They are an essential part of the patient’s team.”

John’s Campaign.

"Carers of people with dementia should be able to spend as much time as necessary with the person, whenever they need to.”

Hospital Care, Alzheimer’s Society.

When a person with dementia goes into hospital, a person who cares for them can expect:

1. To be able to visit at any time to provide care or support whenever this is needed, including overnight.

2. That the nature of their relationship to the person with dementia is respected: the carer's presence is welcome to support good care, but should not be depended on as necessary to provide personal care and support, unless this is their expressed wish.

3. The hospital and staff to recognise the value of carer input to the care of the person with dementia.


4. To receive clear written information from the hospital designed for carers, including: Any times when carers may not be present, e.g. to protect the privacy of the person they are

visiting or other patients Information about how to communicate with staff in the hospital and who to contact Information about any help provided by the hospital e.g. with refreshments, meals or parking.

With the consent of the person with dementia, or as part of a best interests decision making process:

5. To be kept clearly informed about the care and progress of the person with dementia during the hospital stay, including being involved in decisions made about care.

6. To be involved in the discussion about place of discharge and support needs of the person with dementia, including adequate notice of discharge.

7. To receive a copy of the discharge plan.

This should be a written care plan that sets out the support that will be provided to meet the assessed needs of the carer and/ or person with dementia.

8. That the hospital will seek current personal information (as distinct from medical information) to

help provide the best possible care for the person with dementia. This will include details such as the persons preferred name, parts of their life story that they like to talk about (family, pets, work, hobbies), personal preferences (food, drink, how they like to communicate), whether they need help or support with personal care, whether there is anything that is likely to cause distress (e.g. sudden noise) and how to help them if this occurs.

9. That healthcare professionals will have awareness and understanding of the standard of care required by people with dementia, delirium and cognitive impairment admitted to hospital and of the local care pathway or other procedures in place.

10. That the person with dementia is not excluded from therapeutic interventions aimed at improving mobility or cognitive stimulation and that healthcare professionals can accommodate their needs to provide adequate support.

11. That the person with dementia receives adequate support with nutrition and hydration.

12. That appropriate food choices are available for the person with dementia, including finger food, snacks and lighter meal options. The menu should include photos to help them choose.

13. To be appropriately directed to services that can provide further advice and support, including a referral to the local authority for a carer’s assessment. A carer’s assessment from the local council (adult social services department) will determine whether carers are eligible for support. Support could include services provided directly to the carer, or services provided to the person they care for.

14. That carers are represented within the hospital/ Trust Dementia Working Group, and asked regularly to provide anonymous feedback to help improve the quality of care.


Full list of recommendations from the national report National Commissioners should: Propose a nationally backed monitoring programme aimed at embedding the collection, sharing and use

of person centred information. This should include a clear expectation that once gathered, this information will follow the patient between providers, and that this will be monitored.

Clinical Commissioning Groups/ Health Boards should: Specify in contracts with care homes that the personal care story/ information sheet that is completed for

each resident should accompany them on any admission to hospital.

Ensure that tenders let by Trusts for new catering contracts always specify provision of finger foods for main meals and access to a range of snacks 24 hours a day.

Trust Boards/ Council of Governors/ Board of the Health Board should: Request that the information they receive on delayed discharges and patient safety indicators including

falls, pressure ulcers and readmissions can identify the proportion of the patient population with dementia.

The Chief Executive Officer should: Ensure that there is a dementia champion available to support staff 24 hrs per day, 7 days per week. This

could be achieved through ensuring that people in roles such as Site Nurse Practitioners and Bed Managers have expertise in dementia care.

Ensure that carers for people with dementia can communicate with clinicians in order to share and receive information. Carers should be given the opportunity to speak to staff privately, ensuring that their privacy and that of patients is respected.

Ensure that there is an activity program which provides opportunities for social interaction for people with dementia.

Ensure that this report and the local audit report are disseminated to the appropriate staff members (i.e. ward managers, dementia leads etc).

Publish progress made against these recommendations as part of an annual statement on dementia care quality, accessible via the Trust/ Health Board website.

(With the Directors of Medicine and Nursing) monitor support available to staff outside of weekday hours. This should be considered for inclusion in the NHS staff survey as a local question.

Ensure that a Trust dementia lead is nominated to work with teams to: • Target, agree and implement local quality improvement initiatives that are aligned to areas of need as

highlighted by the local and national dementia report (2017) findings • Agree action plans and deadlines for implementing changes in advance of the next main round of

audit in 2018 • Report dementia QI outputs back to the Trust Board.


The Medical Director should: Ensure information on the dementia pathway/ bundle and its links to pathways for other conditions, is

available and accessible to other organisations to facilitate development and discussion.

The Medical Director and Nursing Directors should: Ensure that hospitals have robust mechanisms in place for assessing delirium in people with dementia

including: • At admission, a full clinical delirium assessment, whenever indicators of delirium are identified • Cognitive tests administered on admission and again before discharge • Delirium screening and assessment fully documented in the patients notes (regardless of the

outcome) • Care offered in concordance with the delirium evidence-base recommendations when the assessment

indicates symptoms of delirium • Results recorded on the electronic discharge summary.

Ensure that structured pain assessments are in use and properly recorded for people with a diagnosis or current history of dementia.

Incorporate a heading for discussions with relatives/ carers within the patient notes/ healthcare records, and ensure staff are aware of its purpose.

Promote the attendance of key carers to support care, but ensure that this is complementary to, and not instead of, care delivered by staff. The level of input by carers, and how carers feel about the level of input they have been asked to deliver should be monitored through carer feedback, complaints and PAL enquiries. Carer satisfaction should be seen as a marker of good care. Ward managers should be supported to ensure carers supporting patients should not be asked to leave at mealtimes and/ or stopped from helping with meals. (This excludes emergency and urgent care and treatment).

Ensure that dementia champions are identified at directorate level as well as ward level.

(With the Education Lead for the Trust or Health Board) ensure that training in dementia awareness is a

priority for all staffing groups. eLearning should not be relied on as the sole medium for delivering training in dementia awareness.

Ensure staff receive training in delirium and its relationship to dementia, manifestations of pain, and behavioural and psychological symptoms.

(With the Head of Therapy Directorate) keep central training records on all staff receiving training in dementia, enabling them to be aware of the levels of awareness and expertise in the hospital.

The Director of Nursing and Head of Therapy Directorate should: Work with dementia and therapy leads to create or enhance activity programs to provide opportunities for

social interaction for people with dementia - especially for patients experiencing longer lengths of stay.


The Director of Nursing should: Incorporate into existing feedback mechanisms survey information from carers on the quality of care for

people with dementia, or collect this information via a biannual carer survey. The NAD tool is recommended as a validated instrument to collect anonymous feedback. The Director of Nursing should report to the Board on the feedback obtained.

The Senior Clinical Lead for Dementia should: Build clear links to the delirium pathway into the dementia pathway, care bundle or protocol.

Ensure that copies of the personal information document (such as Alzheimer’s Society This is Me or other

locally developed document) are available on the ward and that the information is kept accessible to staff and visiting carers.

Work with clinical teams to target local Trust quality improvement initiatives aimed at improving care by

developing and implementing integrated evidence-based care pathways for people with dementia and delirium. These should include: • Falls and fractured hips • UTIs • Chest infections • Stroke The overlap and learning from other audits such as the National Audit of Inpatient Falls should be acknowledged and incorporated in this work, and highlighted within staff training.

Target local Trust quality improvement initiatives aimed at ensuring the nutritional needs of people with dementia are met.

Safeguarding and Dignity Leads should: Ensure staff are properly trained and informed on the need for the appropriate presence and participation

of the patient in discussions about the patient’s care, treatment and discharge. Discharge discussions should include a comprehensive note of who was present and the views expressed. The appropriate presence and involvement of the carer(s), as determined by patient consent or best interest decision, should also be recorded.

Ensure that staff are trained in the Mental Capacity Act, including consent, appropriate use of best interests decision making, the use of Lasting Power of Attorney and Advance Decision Making. Training should cover supportive communication with family members/ carers on these topics. (See e.g. NHS England’s Dementia: Good Care Planning).

Ward Managers and Multidisciplinary teams should: Audit implementation/ use of personal information collected to improve care for patients (e.g. This is Me

or other locally developed document). The result of the audit should be fed back to the dementia champions/ dementia lead and ward staff.

Encourage carers to attend mealtimes whenever they want and ensure their input is valued.


Health Education England/ Care Council for Wales should: Incorporate training on delirium and its presentation in people with dementia, including Behavioural and

psychological symptoms of dementia, into Tier 1/ “Informed” level training for healthcare staff.

National Audit of Dementia Project Team should: Consider developing standards on the implementation and frequency of Deprivation of Liberty

Safeguarding orders within acute hospitals.


Appendix A – Organisational checklist data

Appendix B – Patient Demographics

Appendix C – Casenote audit data

Appendix D – Carer demographics

Appendix E – Carer questionnaire data

Appendix F – Staff Demographics

Appendix G – Staff questionnaire data


Introduction to the appendices These are the appendices for the Welsh report. The appendices present data from Round 3 of the National Audit of Dementia, both at a national level and for the four English regions and Wales. The table below shows how the data tables in the appendices are laid out and what information you can find in each cell.

Std no. [Type]

Question number and text

National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den

Midlands & East of England

Round 3: %

Num/Den

North of England Round 3:

% Num/Den

South of England Round 3:

% Num/Den

Wales Round 3:

% Num/Den

Standard reference and type. Standards document

can be found on the audit website.

Question number. Orange items in the

casenote audit appendix show low inter-rater

reliability.

Question wording as in tool.

The national audit refers to all hospitals

from England and Wales

that participated

in Round 3 of the audit.

Data for London from

Round 3.

Data for Midlands and

East of England from Round 3.

Data for North of

England from Round 3.

Data for South of

England from Round 3.

Data for Wales from Round 3.

We have provided the percentage ‘yes’ response (unless otherwise indicated) and the numerator/denominator. The denominator will change throughout the appendices, depending on whether questions were routed (not asked in some instances), ‘N/A’ responses were chosen (these

have been excluded from the analyses), or where staff and carers did not respond. For the organisational checklist, data from 199 hospitals are included in the national audit column (all the registered participants). 195 hospitals participated in the casenote audit, returning 10047 casenotes and this is shown in the national audit column. The national audit column for the casenote audit also shows the median and the inter quartile range for each question (where applicable). Question items which were found to have lower agreement in the inter-rater reliability analysis (see audit website) have been coloured orange. 196 hospitals returned carer questionnaires. Data from all questionnaires (4664) is presented in the national column in the carer questionnaire data tables (Appendix E). 198 hospitals returned staff questionnaires. Data from all questionnaires (14416) is presented in the national column (Appendix G). For some questionnaire items, the data for the two most positive answers have been combined, as well as being presented separately. This is provided both at a national level and for your region.





Appendix A: Organisational checklist data

Governance and delivery of care

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

4.1 [2]

1

A care pathway or bundle for patients with dementia is in place:

Yes 60.8%

121/199 60.7% 17/28

65.3% 32/49

57.6% 34/59

69.6% 32/46

35.3% 6/17

In development 26.1% 52/199

21.4% 6/28

20.4% 10/49

37.3% 22/59

23.9% 11/46

17.6% 3/17

4.2 [2]

1a (If Q1=Yes or In development) A senior clinician is responsible for implementation and/ or review of the care pathway: (y/n)

97.1% 168/173

100% 23/23

95.2% 40/42

94.6% 53/56

100% 43/43

100% 9/9

4.1 [2]

1b

(If Q1=Yes or In development) The dementia care pathway/ bundle is integrated within or linked to the following care pathways: Delirium

Yes 65.9%

114/173 69.6% 16/23

73.8% 31/42

58.9% 33/56

65.1% 28/43

66.7% 6/9


13% 3/23

21.4% 9/42

32.1% 18/56

30.2% 13/43

33.3% 3/9

Stroke

Yes 32.9% 57/173

47.8% 11/23

28.6% 12/42

28.6% 16/56

30.2% 13/43

55.6% 5/9


4.3% 1/23

23.8% 10/42

33.9% 19/56

14% 6/43

11.1% 1/9

Fractured neck of femur

Yes 43.6% 75/172

65.2% 15/23

31% 13/42

41.1% 23/56

51.2% 22/43

22.2% 2/9


8.7% 2/23

23.8% 10/42

32.1% 18/56

25.6% 11/43

11.1% 1/9


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

4.7 [2]

2 The Executive Board regularly reviews information collected on:

2a Re-admissions, in which patients with dementia can be identified in the total number of patients re-admitted (y/n)

31.7% 63/199

17.9% 5/28

20.4% 10/49

42.4% 25/59

47.8% 22/46

5.9% 1/17

2b

Delayed discharge/ transfers, in which patients with dementia can be identified in the total number of patients with delayed discharge/ transfers (y/n)

31.7% 63/199

25% 7/28

32.7% 16/49

33.9% 20/59

32.6% 15/46

29.4% 5/17

4.4 [2]

3

The Executive Board regularly reviews the number of in-hospital falls and the breakdown of the immediate causes, in which patients with dementia can be identified (y/n)

60.3% 120/199

46.4% 13/28

55.1% 27/49

69.5% 41/59

71.7% 33/46

35.3% 6/17

4.5 [2]

4 The Executive Board regularly receives feedback from the following:

4a Clinical Leads for older people and people with dementia including Modern Matrons/ Nurse Consultant (y/n)

84.9% 169/199

92.9% 26/28

87.8% 43/49

88.1% 52/59

87% 40/46

47.1% 8/17

4b Complaints – analysed by age (y/n) 52.3%

104/199 57.1% 16/28

46.9% 23/49

59.3% 35/59

50% 23/46

41.2% 7/17

4c

Patient Advice and Liaison Services (PALS) – in relation to the services for older people and people with dementia (y/n/na (hospitals in Wales))

58.6% 106/181

48.1% 13/27

55.1% 27/49

54.2% 32/59

73.9% 34/46

N/A

4d Patient/ public forums or local Healthwatch – in relation to services for older people and people with dementia (y/n)

67.3% 134/199

64.3% 18/28

53.1% 26/49

79.7% 47/59

71.7% 33/46

58.8% 10/17


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

4.11 [2]

5 There are champions for dementia at:

5a Directorate level (y/n) 81.9%

163/199 78.6% 22/28

79.6% 39/49

88.1% 52/59

80.4% 37/46

76.5% 13/17

5b Ward level (y/n) 93.5%

186/199 92.9% 26/28

89.8% 44/49

98.3% 58/59

95.7% 44/46

82.4% 14/17

N4a [3]

6

Dementia specialist nurses are employed in line with Royal College of Nursing guidance (there is at least one full time dementia specialist nurse for every 300 admissions of people with dementia per year): (y/n)

This question is not reported on as feedback showed hospitals found it difficult to interpret.

N4b [3]

7 Has a strategy or plan for carer engagement been produced (e.g. using Triangle of Care self-assessment tool)? (y/n)

76.9% 153/199

75% 21/28

73.5% 36/49

84.7% 50/59

78.3% 36/46

58.8% 10/17

8

(If Q7=Yes) Is implementation of the strategy or plan scheduled for review?

Yes, more than once a year 41.2% 63/153

47.6% 10/21

19.4% 7/36

46% 23/50

55.6% 20/36

30% 3/10

Yes, once a year 34.6% 53/153

38.1% 8/21

47.2% 17/36

28% 14/50

38.9% 14/36

0% 0/10

Yes, less than once a year 20.3% 31/153

9.5% 2/21

27.8% 10/36

22% 11/50

5.6% 2/36

60% 6/10


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

N4c [3]

9 A Dementia Working Group is in place and reviews the quality of services provided in the hospital: (y/n)

93.5% 186/199

92.9% 26/28

93.9% 46/49

94.9% 56/59

100% 46/46

70.6% 12/17

9a

(If Q9=Yes) The group meets:

Annually 0.5% 1/186

3.8% 1/26

0% 0/46

0% 0/56

0% 0/46

0% 0/12

Bi-annually 0.5% 1/186

0% 0/26

0% 0/46

0% 0/56

0% 0/46

8.3% 1/12

Quarterly 30.1% 56/186

15.4% 4/26

37% 17/46

14.3% 8/56

45.7% 21/46

50% 6/12

Six-weekly 4.3% 8/186

0% 0/26

10.9% 5/46

5.4% 3/56

0% 0/46

0% 0/12

Monthly 33.3% 62/186

53.8% 14/26

26.1% 12/46

37.5% 21/56

26.1% 12/46

25% 3/12

Bi-monthly 29%

54/186 26.9% 7/26

19.6% 9/46

42.9% 24/56

26.1% 12/46

16.7% 2/12

Weekly 0.5% 1/186

0% 0/26

2.2% 1/46

0% 0/56

0% 0/46

0% 0/12

Unknown 1.6% 3/186

0% 0/26

4.3% 2/46

0% 0/56

2.2% 1/46

0% 0/12


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

N4c [3]

9b

(If Q9=Yes) The group includes:

Healthcare professionals 100%

186/186 100% 26/26

100% 46/46

100% 56/56

100% 46/46

100% 12/12

Organisations e.g. Alzheimer’s Society 64%

119/186 76.9% 20/26

58.7% 27/46

66.1% 37/56

58.7% 27/46

66.7% 8/12

Carer/ service user representation 66.1%

123/186 65.4% 17/26

58.7% 27/46

64.3% 36/56

67.4% 31/46

100% 12/12

N7a [3]

10 Ward staffing levels (nurses, midwives and care staff) are made available for the public to view on a monthly basis: (y/n)

88.4% 176/199

96.4% 27/28

93.9% 46/49

94.9% 56/59

100% 46/46

5.9% 1/17

11 An evidence-based tool is used for establishing ward staffing levels: (y/n)

99% 197/199

96.4% 27/28

98% 48/49

100% 59/59

100% 46/46

100% 17/17

3.7 [1]

12 Protected mealtimes are established in all wards that admit adults with known or suspected dementia: (y/n)

98% 195/199

100% 28/28

98% 48/49

100% 59/59

97.8% 45/46

88.2% 15/17

12a (If Q12=Yes) Wards’ adherence to protected mealtimes is reviewed and monitored: (y/n)

88.7% 173/195

85.7% 24/28

95.8% 46/48

86.4% 51/59

82.2% 37/45

100% 15/15

3.8 [1]

13

The hospital has in place a scheme/ programme which allows identified carers of people with dementia to visit at any time including at mealtimes (e.g. Carer’s Passport): (y/n)

88.9% 177/199

82.1% 23/28

95.9% 47/49

84.7% 50/59

95.7% 44/46

76.5% 13/17


Discharge and transfer monitoring

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

N5a [3]

14

Instances where less than 24 hours notice of discharge has been given to carers or family are compiled and reported to the Executive Board:

Yes, within the past 6 months 4%

8/199 3.6% 1/28

0% 0/49

8.5% 5/59

4.3% 2/46

0% 0/17

Yes, within the last year 1.5% 3/199

3.6% 1/28

4.1% 2/49

0% 0/59

0% 0/46

0% 0/17

N3c [3]

15

Instances of night time bed moves (i.e. between the evening meal and breakfast the next morning) are noted and reported at Executive Board level: (y/n)

38.2% 76/199

25% 7/28

38.8% 19/49

39% 23/59

54.3% 25/46

11.8% 2/17


Use of personal information documents

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

1.14 [1]

16

There is a formal system (pro-forma or template) in place in the hospital for gathering information pertinent to caring for a person with dementia: (y/n)

98.5% 196/199

96.4% 27/28

100% 49/49

98.3% 58/59

97.8% 45/46

100% 17/17

17a (If Q16=Yes) Information collected by the pro-forma includes personal details, preferences and routines: (y/n)

100% 196/196

100% 27/27

100% 49/49

100% 58/58

100% 45/45

100% 17/17

17b (If Q16=Yes) Information collected by the pro-forma includes reminders or support with personal care: (y/n)

98.5% 193/196

96.3% 26/27

95.9% 47/49

100% 58/58

100% 45/45

100% 17/17

17c (If Q16=Yes) Information collected by the pro-forma includes recurring factors that may cause or exacerbate distress: (y/n)

100% 196/196

100% 27/27

100% 49/49

100% 58/58

100% 45/45

100% 17/17

17d (If Q16=Yes) Information collected by the pro-forma includes support or actions that can calm the person if they are agitated: (y/n)

99% 194/196

100% 27/27

98% 48/49

100% 58/58

97.8% 44/45

100% 17/17

1.15 [3]

17e (If Q16=Yes) Information collected by the pro-forma includes life details which aid communication: (y/n)

99.5% 195/196

100% 27/27

100% 49/49

98.3% 57/58

100% 45/45

100% 17/17

1.14 [1]

18

(If Q16=Yes) Information collected by the pro-forma includes how the person with dementia communicates with others/ understands communication: (y/n)

99.5% 195/196

100% 27/27

98% 48/49

100% 58/58

100% 45/45

100% 17/17

19 (If Q16=Yes) The form prompts staff to approach carers or relatives to collate necessary information: (y/n)

93.4% 183/196

96.3% 26/27

95.9% 47/49

91.4% 53/58

93.3% 42/45

88.2% 15/17


Std no. [Type]

Question number and text National

audit Round 3:

London Round 3:


Round 3:



Wales Round 3:

20

Documenting use of personal information in practice: Hospitals selected three wards (not mental health wards) which had the highest admissions of people with dementia. 10 patients in these wards were checked to see if the personal information document was present. Included were patients with dementia who needed a personal information document such as “This is Me” (any patients with dementia who did not require a personal information document were excluded). Number of patients checked: Range 0-40 0-30 0-30 8-40 7-30 3-19 Median 10 10 10 10 10 10 Percentage of patients where the information was present: Range 0-100% 0-100% 0-100% 0-100% 0-100% 10-100% Mean 49% 48% 47% 48% 53% 54% Median 50% 50% 48% 42% 57% 50%


Recognition of dementia

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

9.3 [1]

21

There is a system in place across the hospital that ensures that all staff in the ward or care area are aware of the person's dementia or condition and how it affects them: (y/n)

90.5% 180/199

89.3% 25/28

83.7% 41/49

91.5% 54/59

93.5% 43/46

100% 17/17

21a



164/180 88%

22/25 90.2% 37/41

87% 47/54

95.3% 41/43

100% 17/17

Alert sheet or electronic flag 23.9% 43/180

12% 3/25

36.6% 15/41

18.5% 10/54

34.9% 15/43

0% 0/17


33.9% 61/180

16% 4/25

17.1% 7/41

46.3% 25/54

55.8% 24/43

5.9% 1/17

Other 18.9% 34/180

4% 1/25

26.8% 11/41

18.5% 10/54

25.6% 11/43

5.9% 1/17

22

There is a system in place across the hospital that ensures that staff from other areas are aware of the person's dementia or condition whenever the person accesses other treatment areas: (y/n)

70.4% 140/199

64.3% 18/28

69.4% 34/49

76.3% 45/59

69.6% 32/46

64.7% 11/17

22a



122/140 88.9% 16/18

82.4% 28/34

86.7% 39/45

93.8% 30/32

81.8% 9/11

Alert sheet or electronic flag 18.6% 26/140

11.1% 2/18

32.4% 11/34

15.6% 7/45

18.8% 6/32

0% 0/11


20.7% 29/140

16.7% 3/18

2.9% 1/34

37.8% 17/45

25% 8/32

0% 0/11

Other 17.9% 25/140

11.1% 2/18

26.5% 9/34

15.6% 7/45

15.6% 5/32

18.2% 2/11

9.13 [2]

23

The dementia lead or dementia working group collates feedback from carers on the written and verbal information provided to them: (y/n)

81.9% 163/199

82.1% 23/28

81.6% 40/49

94.9% 56/59

91.3% 42/46

11.8% 2/17


Training, learning and development

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

7.2 [2]

24

There is a training and knowledge framework or strategy that identifies necessary skill development in working with and caring for people with dementia: (y/n)

95.5% 190/199

96.4% 27/28

89.8% 44/49

98.3% 58/59

100% 46/46

88.2% 15/17

7.4 [2]

25

The following questions are about training that is provided to acute healthcare staff who are involved in the care of people with dementia (or suspected dementia): Dementia awareness training:

Doctors


42.9% 12/28

40.8% 20/49

49.2% 29/59

47.8% 22/46

52.9% 9/17


126/199 71.4% 20/28

63.3% 31/49

54.2% 32/59

71.7% 33/46

58.8% 10/17


117/199 67.9% 19/28

53.1% 26/49

55.9% 33/59

58.7% 27/46

70.6% 12/17

Not provided in the last 12 months 8.5%

17/199 7.1% 2/28

16.3% 8/49

3.4% 2/59

6.5% 3/46

11.8% 2/17

Nurses

Mandatory 51.8%

103/199 60.7% 17/28

46.9% 23/49

45.8% 27/59

52.2% 24/46

70.6% 12/17


148/199 85.7% 24/28

73.5% 36/49

67.8% 40/59

78.3% 36/46

70.6% 12/17


136/199 82.1% 23/28

61.2% 30/49

64.4% 38/59

65.2% 30/46

88.2% 15/17


2/199 0%

0/28 4.1% 2/49

0% 0/59

0% 0/46

0% 0/17


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

7.4 [2]

25

Healthcare assistants

Mandatory 51.8%

103/199 60.7% 17/28

49% 24/49

45.8% 27/59

50% 23/46

70.6% 12/17


142/199 85.7% 24/28

67.3% 33/49

61% 36/59

78.3% 36/46

76.5% 13/17


136/199 82.1% 23/28

63.3% 31/49

64.4% 38/59

65.2% 30/46

82.4% 14/17


2/199 0%

0/28 4.1% 2/49

0% 0/59

0% 0/46

0% 0/17

Other allied healthcare professionals, e.g. physiotherapists, dieticians


42.9% 12/28

44.9% 22/49

45.8% 27/59

52.2% 24/46

58.8% 10/17


129/199 71.4% 20/28

63.3% 31/49

55.9% 33/59

73.9% 34/46

64.7% 11/17


135/199 78.6% 22/28

59.2% 29/49

64.4% 38/59

67.4% 31/46

88.2% 15/17


0% 0/28

12.2% 6/49

1.7% 1/59

0% 0/46

0% 0/17

Support staff in the hospital, e.g. housekeepers, porters, receptionists


35.7% 10/28

38.8% 19/49

35.6% 21/59

47.8% 22/46

58.8% 10/17


115/199 53.6% 15/28

55.1% 27/49

50.8% 30/59

67.4% 31/46

70.6% 12/17


127/199 67.9% 19/28

55.1% 27/49

61% 36/59

71.7% 33/46

70.6% 12/17


21.4% 6/28

18.4% 9/49

8.5% 5/59

0% 0/46

11.8% 2/17

7.11 [3]

26 Involvement of people with dementia and carers and use of their experiences is included in the training for ward staff: (y/n)

82.4% 164/199

67.9% 19/28

79.6% 39/49

89.8% 53/59

84.8% 39/46

82.4% 14/17


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

7.5 [3]

27

What format is used to deliver basic dementia awareness training?


145/199 57.1% 16/28

63.3% 31/49

83.1% 49/59

71.7% 33/46

94.1% 16/17

Workshop or study day 91%

181/199 96.4% 27/28

95.9% 47/49

81.4% 48/59

93.5% 43/46

94.1% 16/17

Higher education module 22.6% 45/199

3.6% 1/28

26.5% 13/49

20.3% 12/59

28.3% 13/46

35.3% 6/17

Other 29.1% 58/199

35.7% 10/28

38.8% 19/49

23.7% 14/59

28.3% 13/46

11.8% 2/17

7.5 [3]

28 Hospitals were asked to provide figures on the number of staff trained in dementia awareness. Only 34 hospitals could provide this for at least one of the years specified. Therefore, there is no data on training figures.

N7b [3]

29 What is the total number of adult beds excluding maternity and mental health beds in your hospital at 31 March 2016? This information was to compare with question 28 so is therefore not included.


Specific resources supporting people with dementia

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

6.2 [2]

30 The hospital has access to intermediate care services, which will admit people with dementia: (y/n)

93% 185/199

89.3% 25/28

89.8% 44/49

91.5% 54/59

100% 46/46

94.1% 16/17

6.3 [3]

30a

(If Q30=Yes) Access to intermediate care services allows people with dementia to be admitted to intermediate care directly and avoid unnecessary hospital admission: (y/n)

84.3% 156/185

76% 19/25

90.9% 40/44

83.3% 45/54

82.6% 38/46

87.5% 14/16

7.1 [2]

31 There is a named dignity lead to provide guidance, advice and consultation to staff: (y/n)

70.4% 140/199

50% 14/28

77.6% 38/49

66.1% 39/59

78.3% 36/46

76.5% 13/17

6.4 [2]

32

There is a named person/ identified team who takes overall responsibility for complex needs discharge and this includes people with dementia: (y/n)

95.5% 190/199

96.4% 27/28

91.8% 45/49

98.3% 58/59

93.5% 43/46

100% 17/17

6.5 [2]

33a (If Q32=Yes) This person/ team has training in ongoing needs of people with dementia: (y/n)

92.6% 176/190

92.6% 25/27

91.1% 41/45

91.4% 53/58

95.3% 41/43

94.1% 16/17

6.6 [3]

33b (If Q32=Yes) This person/ team has experience of working with people with dementia and their carers: (y/n)

98.4% 187/190

96.3% 26/27

95.6% 43/45

100% 58/58

100% 43/43

100% 17/17

6.7 [2]

34

There is a social worker or other designated person or team responsible for working with people with dementia and their carers, and providing advice and support, or directing to appropriate organisations or agencies: (y/n)

75.9% 151/199

78.6% 22/28

73.5% 36/49

78% 46/59

82.6% 38/46

52.9% 9/17


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

N3b [2]

35

The hospital can provide finger foods for people with dementia (please select one option only): Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery (finger food) on every day

65.3% 130/199

53.6% 15/28

59.2% 29/49

71.2% 42/59

69.6% 32/46

70.6% 12/17

Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on four to six days per week or more

1% 2/199

0% 0/28

2% 1/49

0% 0/59

2.2% 1/46

0% 0/17

Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on two or three days per week or more

0% 0/199

0% 0/28

0% 0/49

0% 0/59

0% 0/46

0% 0/17

Patients can choose a complete meal option (including vegetarian) that can be eaten without cutlery on only one day per week

0% 0/199

0% 0/28

0% 0/49

0% 0/59

0% 0/46

0% 0/17

Finger food consists of sandwiches/wraps only

33.7% 67/199

46.4% 13/28

38.8% 19/49

28.8% 17/59

28.3% 13/46

29.4% 5/17

Patients who may be unable to use cutlery will never be admitted to the hospital

0% 0/199

0% 0/28

0% 0/49

0% 0/59

0% 0/46

0% 0/17


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

3.11 [2]

36

The hospital can provide 24 hour food services for people with dementia (please select one option only): In addition to the main meals, other food, for example toast, sandwiches, cereals, soup, and lighter hot dish(es) are available 24 hours a day

50.8% 101/199

39.3% 11/28

57.1% 28/49

55.9% 33/59

45.7% 21/46

47.1% 8/17

In addition to the main meals, other food, for example toast, sandwiches, cereals, soup are available, but less than 24 hours a day

10.6% 21/199

7.1% 2/28

18.4% 9/49

5.1% 3/59

10.9% 5/46

11.8% 2/17

Simple food supplies for example bread, cereal, yoghurt and biscuits are available 24 hours a day

32.2% 64/199

35.7% 10/28

20.4% 10/49

35.6% 21/59

37% 17/46

35.3% 6/17

Only snacks (biscuits, cake) are available 24 hours a day

3% 6/199

10.7% 3/28

0% 0/49

1.7% 1/59

4.3% 2/46

0% 0/17

Food is not available 24 hours a day 3.5% 7/199

7.1% 2/28

4.1% 2/49

1.7% 1/59

2.2% 1/46

5.9% 1/17

6.10 [2]

37 There is access to advocacy services with experience and training in working with people with dementia: (y/n)

95% 189/199

85.7% 24/28

93.9% 46/49

98.3% 58/59

97.8% 45/46

94.1% 16/17


Environment

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

6.11 [3]

38

Opportunities for social interaction for patients with dementia are available (e.g. to eat/ socialise away from their bed area with other patients):

On all adult wards 15.1% 30/199

10.7% 3/28

20.4% 10/49

20.3% 12/59

6.5% 3/46

11.8% 2/17

On care of the elderly wards 38.7% 77/199

60.7% 17/28

34.7% 17/49

23.7% 14/59

41.3% 19/46

58.8% 10/17

Other 30.2% 60/199

17.9% 5/28

28.6% 14/49

35.6% 21/59

41.3% 19/46

5.9% 1/17

No 16.1% 32/199

10.7% 3/28

16.3% 8/49

20.3% 12/59

10.9% 5/46

23.5% 4/17

N8a [3]

39

The physical environment within the hospital has been reviewed using an appropriate tool (e.g. King’s Fund Enhancing the Healing Environment) to establish whether it is “dementia-friendly”:


42.9% 12/28

40.8% 20/49

42.4% 25/59

52.2% 24/46

23.5% 4/17

All adult wards/ areas 13.6% 27/199

17.9% 5/28

20.4% 10/49

8.5% 5/59

13% 6/46

5.9% 1/17


17.9% 5/28

16.3% 8/49

23.7% 14/59

13% 6/46

17.6% 3/17


6/199 7.1% 2/28

2% 1/49

3.4% 2/59

2.2% 1/46

0% 0/17

Other 13.1% 26/199

10.7% 3/28

6.1% 3/49

20.3% 12/59

13% 6/46

11.8% 2/17

No 9.5%

19/199 3.6% 1/28

14.3% 7/49

1.7% 1/59

6.5% 3/46

41.2% 7/17


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

N8a [3]

40

(If Q39=Yes) Environmental changes based on the review are:

Completed 15%

27/180 11.1% 3/27

14.3% 6/42

17.2% 10/58

16.3% 7/43

10% 1/10

Underway 56.7%

102/180 40.7% 11/27

50% 21/42

67.2% 39/58

58.1% 25/43

60% 6/10

Planned but not yet underway 10%

18/180 18.5% 5/27

14.3% 6/42

5.2% 3/58

9.3% 4/43

0% 0/10

Planned but funding has not been identified 15.6% 28/180

25.9% 7/27

19% 8/42

6.9% 4/58

14% 6/43

30% 3/10

Plans are not in place 2.8% 5/180

3.7% 1/27

2.4% 1/42

3.4% 2/58

2.3% 1/43

0% 0/10

N8a [3]

41

(If Q39=Yes) Service users/ carers/ lay volunteers have been part of the team reviewing the environment:


37% 10/27

33.3% 14/42

32.8% 19/58

48.8% 21/43

20% 2/10

All adult wards/ areas 9.4%

17/180 11.1% 3/27

14.3% 6/42

6.9% 4/58

7% 3/43

10% 1/10


14.8% 4/27

11.9% 5/42

17.2% 10/58

11.6% 5/43

0% 0/10


9/180 7.4% 2/27

4.8% 2/42

6.9% 4/58

2.3% 1/43

0% 0/10

Other 13.3% 24/180

3.7% 1/27

9.5% 4/42

19% 11/58

11.6% 5/43

30% 3/10

They have not been part of the team 22.2% 40/180

25.9% 7/27

26.2% 11/42

17.2% 10/58

18.6% 8/43

40% 4/10

42

(If Q39=Yes) There are plans to further review the changes implemented: Yes, we are already undertaking/ have already done this

49.4% 89/180

33.3% 9/27

42.9% 18/42

62.1% 36/58

58.1% 25/43

10% 1/10

Yes, once the work is completed 40%

72/180 51.9% 14/27

40.5% 17/42

29.3% 17/58

34.9% 15/43

90% 9/10

No plans are in place 10.6% 19/180

14.8% 4/27

16.7% 7/42

8.6% 5/58

7% 3/43

0% 0/10


Appendix B: Patient demographics

Age range National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

34 - 65 2.2% (221) 2.5% (33) 2% (50) 2.2% (68) 2.1% (48) 2.6% (22)

66 - 80 24.3% (2445) 24% (320) 23.4% (578) 26% (800) 22.1% (517) 27.6% (230)

81 - 100 73% (7332) 72.7% (971) 74% (1825) 71.3% (2193) 75.4% (1764) 69.6% (579)

101 - 108 0.4% (39) 0.7% (10) 0.4% (10) 0.3% (10) 0.3% (8) 0.1% (1)

Unknown 0.1% (10) 0.1% (1) 0.1% (2) 0.2% (6) 0% (1) 0% (0)

Age National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Range 34 - 108 43 - 105 42 - 107 36 - 108 38 - 105 34 - 101

Mean 84 84 85 84 85 83

Median 85 85 86 85 86 84

Gender National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Male 40.1% (4029) 40% (534) 41.1% (1012) 39.1% (1204) 40% (936) 41.2% (343)

Female 59.9% (6018) 60% (801) 58.9% (1453) 60.9% (1873) 60% (1402) 58.8% (489)


Ethnicity National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

White/ White British 82.1% (8250) 69% (921) 86.7% (2136) 87.1% (2679) 86.7% (2026) 58.7% (488)

Black/ Black British 1.2% (123) 6.8% (91) 0.9% (21) 0.1% (3) 0.3% (8) 0% (0)

Asian/ Asian British 1.9% (193) 8.1% (108) 2.2% (53) 0.7% (22) 0.3% (8) 0.2% (2)

Chinese 0.1% (10) 0.2% (3) 0% (1) 0.1% (4) 0.1% (2) 0% (0)

Mixed 0.1% (11) 0.4% (5) 0.2% (4) 0.1% (2) 0% (0) 0% (0)

Not documented 2.1% (210) 7.9% (106) 1.5% (37) 0.8% (25) 1.5% (35) 0.8% (7)

Other 12.4% (1250) 7.6% (101) 8.6% (213) 11.1% (342) 11.1% (259) 40.3% (335)

First language National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

English 77.4% (7778) 66.8% (892) 83.4% (2057) 81.4% (2505) 74.4% (1739) 70.3% (585)

Welsh 0.6% (61) 0.1% (1) 0% (1) 0% (0) 0% (1) 7% (58)

Other European language 1% (96) 3.6% (48) 0.9% (21) 0.4% (11) 0.5% (12) 0.5% (4)

Asian language 1.4% (144) 5.5% (74) 1.6% (40) 0.7% (22) 0.2% (5) 0.4% (3)

Not documented 19% (1909) 21.9% (292) 13.5% (333) 17.3% (533) 24.6% (574) 21.3% (177)

Other 0.6% (59) 2.1% (28) 0.5% (13) 0.2% (6) 0.3% (7) 0.6% (5)


Primary diagnosis/ cause of admission*


% (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Respiratory 19.9% (1998) 21.3% (284) 19.2% (474) 19.5% (600) 20.2% (473) 20.1% (167)

Fall 13.3% (1332) 13.7% (183) 14.5% (358) 12.8% (395) 13.5% (315) 9.7% (81)

Urinary/ renal 9% (901) 10.8% (144) 8.6% (213) 8.2% (252) 8.9% (207) 10.2% (85)

Hip dislocation/ hip fracture 7.5% (754) 5.1% (68) 7.6% (188) 7.1% (218) 9.2% (215) 7.8% (65)

Sepsis 6.3% (633) 5.9% (79) 7.1% (176) 5.5% (168) 7.3% (170) 4.8% (40)

Delirium/ confusion 6% (604) 6.3% (84) 5.4% (134) 7% (214) 5.5% (129) 5.2% (43)

Gastrointestinal 5.9% (595) 6.3% (84) 6% (147) 6.1% (189) 5.4% (127) 5.8% (48)

Cardiac/ vascular 5.1% (517) 4.1% (55) 5.1% (126) 5.8% (177) 4.4% (102) 6.9% (57)

Stroke 3.8% (380) 2.2% (29) 3.6% (89) 4.5% (138) 4% (94) 3.6% (30)

Neurological 3.6% (364) 4.1% (55) 3.9% (96) 3.2% (99) 3.8% (89) 3% (25)

Skin lacerations/ lesions 2% (204) 3% (40) 1.8% (45) 2% (63) 1.8% (41) 1.8% (15)

Impaired consciousness 2% (198) 1.8% (24) 2.1% (51) 2% (62) 1.7% (40) 2.5% (21)

Dementia** 1.9% (195) 1.8% (24) 1.5% (37) 2.1% (65) 2.4% (55) 1.7% (14)

Other 1.9% (192) 0.8% (11) 2.1% (51) 2.3% (71) 1.5% (34) 3% (25)

Unable to cope/ frailty 1.6% (160) 1.9% (26) 1.5% (37) 1.5% (46) 1.9% (44) 0.8% (7)

Dehydration 1.4% (143) 1% (14) 2.1% (52) 1.3% (41) 1.1% (26) 1.2% (10)

Haematology 1.1% (115) 0.9% (12) 1.3% (33) 1.2% (37) 1% (23) 1.2% (10)

Endocrine/ metabolic 1.1% (112) 2.2% (29) 1% (24) 1% (31) 0.7% (17) 1.3% (11)

Other fractures 1% (96) 0.4% (5) 0.7% (18) 1.2% (37) 1.2% (27) 1.1% (9)

Cancer 0.9% (94) 1.3% (17) 0.7% (17) 0.9% (29) 0.8% (19) 1.4% (12)

Surgical/ non-surgical procedure

0.9% (86) 0.4% (6) 0.7% (17) 0.9% (27) 0.9% (20) 1.9% (16)

Pain/ swelling 0.8% (85) 0.9% (12) 0.7% (18) 0.8% (25) 0.9% (21) 1.1% (9)

Hepatology 0.8% (84) 0.8% (11) 0.7% (18) 1.1% (33) 0.6% (13) 1.1% (9)


Primary diagnosis/ cause of admission*


% (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Oral/ visual/ auditory 0.4% (45) 0.3% (4) 0.4% (9) 0.6% (18) 0.4% (9) 0.6% (5)

Rheumatic 0.4% (45) 0.7% (9) 0.5% (13) 0.4% (13) 0.3% (8) 0.2% (2)

Psychiatric 0.4% (42) 0.6% (8) 0.4% (10) 0.3% (10) 0.5% (11) 0.4% (3)

Adverse reaction to medication/ allergy/ overdose

0.3% (28) 0.4% (5) 0.2% (6) 0.3% (8) 0.3% (6) 0.4% (3)

Injury/ trauma 0.2% (24) 0.4% (6) 0.2% (5) 0.1% (4) 0% (1) 1% (8)

Not documented/ unknown 0.2% (21) 0.5% (7) 0.1% (3) 0.2% (7) 0.1% (2) 0.2% (2)

*Primary cause of admission was taken as the first reason entered on the casenote audit. **Out of 195 noted with Dementia as cause of admission, 142 of these had dementia as the only cause of admission.


Speciality of the ward patients spent the longest

time in


% (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Care of the Elderly/ Complex Care

41.1% (4125) 54.6% (729) 40.4% (997) 38.6% (1187) 40.2% (941) 32.6% (271)

General Medical 23.5% (2359) 18.4% (246) 21.8% (538) 24.3% (748) 23.8% (557) 32.5% (270)

Other Medical 9.9% (999) 7.9% (106) 10.9% (268) 11.8% (364) 7.8% (183) 9.4% (78)

Orthopaedics 8.9% (892) 4.9% (66) 9.2% (226) 8.4% (259) 10.6% (248) 11.2% (93)

Surgical 6.8% (681) 6.2% (83) 6.5% (159) 6.7% (205) 7.6% (178) 6.7% (56)

Stroke 4.5% (456) 3.1% (41) 5.1% (125) 4.7% (146) 5.1% (119) 3% (25)

Cardiac 2.5% (248) 1.3% (18) 2.2% (54) 2.8% (86) 2.9% (67) 2.8% (23)

Other 1.4% (136) 2.4% (32) 1.4% (34) 1.4% (42) 1% (24) 0.5% (4)

Nephrology 0.5% (52) 0.1% (1) 1.3% (32) 0.3% (10) 0.3% (6) 0.4% (3)

Obstetrics/ Gynaecology 0.4% (41) 0.2% (3) 0.5% (13) 0.5% (15) 0.3% (6) 0.5% (4)

Critical Care 0.2% (23) 0.5% (7) 0.3% (8) 0.2% (6) 0.1% (2) 0% (0)

Oncology 0.2% (22) 0.2% (3) 0.3% (7) 0.1% (4) 0.3% (6) 0.2% (2)

Unknown 0.1% (13) 0% (0) 0.2% (4) 0.2% (5) 0% (1) 0.4% (3)


Patients who: National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Died in hospital 12.8% (1285) 10.8% (144) 13.8% (340) 10.8% (331) 13.9% (326) 17.3% (144)

Self-discharged from hospital 0.1% (12) 0.2% (2) 0.3% (6) 0.1% (3) 0% (0) 0.1% (1)

Were marked ‘fast track discharge’/ ’discharge to assess’/ ’transfer to assess’/ expedited with family agreement for recorded reasons

5.5% (482) 4.9% (58) 7.1% (151) 4.6% (125) 6.1% (122) 3.8% (26)

Received end of life care in hospital/ was on an end of life care plan

13% (1302) 12.5% (167) 14.3% (353) 11.3% (349) 13.4% (314) 14.3% (119)


Length of stay in the hospital National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

2 - 10 days 45.3% (4553) 41.7% (557) 48.9% (1205) 47.1% (1448) 43.6% (1020) 38.8% (323)

11 – 20 days 25.5% (2559) 24.3% (324) 26.6% (655) 25.1% (773) 26.4% (618) 22.7% (189)

21 – 30 days 11.3% (1132) 11.9% (159) 10.7% (264) 10.6% (325) 11.9% (278) 12.7% (106)

31 – 40 days 6.7% (671) 7.8% (104) 6.2% (152) 6.5% (200) 6.5% (151) 7.7% (64)

41 – 50 days 4.2% (418) 4.9% (66) 3.4% (84) 3.6% (110) 4.9% (115) 5.2% (43)

51 – 60 days 2.3% (230) 3.1% (42) 1.5% (37) 2.3% (72) 2.2% (51) 3.4% (28)

61 – 70 days 1.7% (168) 2.3% (31) 1% (24) 1.7% (53) 1.9% (44) 1.9% (16)

71 – 80 days 1% (102) 1% (14) 0.7% (17) 1.1% (33) 1% (23) 1.8% (15)

81 – 90 days 0.6% (62) 0.8% (11) 0.6% (14) 0.5% (14) 0.6% (13) 1.2% (10)

More than 90 days 1.5% (152) 2% (27) 0.5% (13) 1.6% (49) 1.1% (25) 4.6% (38)

Length of stay in the hospital National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Range 2-775 2 - 226 2 - 386 2 - 775 2 - 424 2 - 300

Median (days) 12 13 11 11 12 15


Place of residence before/ after admission

National audit Round 3: % (N)

Wales Round 3:

% (N)

London Round 3:

% (N)

Before After* Before After* Before After*

Own home 57.7% (5793) 40.2% (3519) 53.8% (448) 35.8% (246) 67.3% (898) 51.5% (613)

Respite care 0.8% (80) 1.6% (136) 0.5% (4) 0.6% (4) 0.6% (8) 1% (12)

Rehabilitation 0.4% (37) 2.4% (207) 0.1% (1) 1.2% (8) 0.4% (5) 2.9% (34)

Psychiatric ward 0.5% (48) 0.7% (62) 0.8% (7) 0.9% (6) 0.4% (6) 0.8% (10)

Carer’s home 2.1% (212) 2.1% (181) 3.4% (28) 2.9% (20) 1.7% (23) 1.8% (22)

Intermediate care 0.3% (27) 2% (172) 0% (0) 0% (0) 0.1% (2) 1% (12)

Residential care 16.9% (1701) 17.7% (1551) 15.1% (126) 14.8% (102) 9.9% (132) 10.7% (128)

Nursing home 19.7% (1981) 28.7% (2511) 23.7% (197) 31.1% (214) 18% (240) 26.4% (315)

Palliative care 0% (5) 0.6% (54) 0% (0) 0.1% (1) 0% (0) 0.9% (11)

Transfer from another hospital 1.4% (145) 3.9% (343) 2.5% (21) 12.6% (87) 1.3% (18) 2.5% (30)

Long stay care 0.2% (18) 0.3% (26) 0% (0) 0% (0) 0.2% (3) 0.3% (4)

Place of residence before/ after admission

Midlands & East of England Round 3:

% (N)


% (N)


% (N)

Before After* Before After* Before After*

Own home 55.7% (1372) 38.5% (819) 55.3% (1702) 38% (1043) 58.7% (1373) 39.7% (798)

Respite care 1.1% (28) 1.7% (37) 1% (30) 2.3% (64) 0.4% (10) 0.9% (19)

Rehabilitation 0.4% (9) 2.4% (52) 0.4% (13) 2% (54) 0.4% (9) 2.9% (59)

Psychiatric ward 0.4% (10) 0.5% (10) 0.6% (18) 0.9% (24) 0.3% (7) 0.6% (12)

Carer’s home 2.4% (60) 2.5% (54) 1.6% (50) 1.7% (48) 2.2% (51) 1.8% (37)

Intermediate care 0.4% (10) 2% (42) 0.2% (7) 2.9% (79) 0.3% (8) 1.9% (39)

Residential care 19.7% (485) 21% (446) 17.6% (541) 18.6% (511) 17.8% (417) 18.1% (364)

Nursing home 18.6% (459) 27.3% (581) 21.5% (662) 30.4% (834) 18.1% (423) 28.2% (567)

Palliative care 0.1% (2) 0.9% (20) 0.1% (2) 0.5% (15) 0% (1) 0.3% (7)

Transfer from another hospital 1.1% (27) 2.7% (57) 1.5% (45) 2.4% (66) 1.5% (34) 5.1% (103)

Long stay care 0.1% (3) 0.3% (7) 0.2% (7) 0.3% (8) 0.2% (5) 0.3% (7)


Change in residence* National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

No change 73.4% (6428) 76.9% (916) 74.4% (1580) 73.8% (2027) 70.5% (1419) 70.6% (486)

Own/ carer’s home to nursing/ residential care

11.1% (972) 10.9% (130) 11.5% (244) 10.3% (283) 12.2% (246) 10% (69)

*These figures exclude patients who died while in hospital.


RAppendix C: Casenote audit data

Assessment

Multidisciplinary assessment

Std no. [Type]


National audit

Round 3: %

Num/Den (Median, IQR)

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

1.9 [1]

14 An assessment of mobility was performed by a healthcare professional: (y/n/could not be assessed for recorded reasons)

93.8% 8558/9126

(96%, 91-98%)

95.6% 1130/1182

93.6% 2065/2207

94% 2670/2839

94.6% 2024/2140

88.3% 669/758

15 An assessment of nutritional status was performed by a healthcare professional: (y/n/could not be assessed for recorded reasons)

89.8% 8832/9837

(93%, 86-96%)

90.5% 1187/1312

92.5% 2233/2413

91.7% 2768/3019

86.8% 1982/2283

81.7% 662/810

15a

(If Q15=Yes) The assessment of nutritional status includes recording of BMI (Body Mass Index) or weight:

Yes, there is a recording of the patient’s BMI or weight

85.9% 7580/8822

(89%, 79-96%)

90.2% 1071/1187

84.5% 1884/2230

85.7% 2370/2766

88.1% 1742/1978

77.6% 513/23

Other action taken 4%

352/8822 (2%, 0-5%)

3.1% 37/1187

4.5% 101/2230

4.5% 124/2766

3.4% 67/1978

3.5% 23/661

Yes or other action taken 89.9%

7932/8822 (93%, 85-98%)

93.3% 1108/1187

89% 1985/2230

90.2% 2494/2766

91.5% 1809/1978

81.1% 536/661

1.10 [1]

16 Has a formal pressure ulcer risk assessment been carried out and score recorded? (y/n)

95.5% 9590/10044

(98%, 94-100%)

94.9% 1266/1334

97.8% 2412/2465

96.6% 2970/3076

92.8% 2168/2337

93% 774/832

1.12 [1]

17

As part of the multidisciplinary assessment has the patient been asked about any continence needs? (y/n/could not be assessed for recorded reasons)

88% 8572/9744

(92%, 85-97%)

79.8% 1026/1286

91.3% 2181/2389

92.2% 2767/3002

85% 1922/2262

84% 676/805

1.11 [1]

18

As part of the multidisciplinary assessment has the patient been assessed for the presence of any pain? (y/n/could not be assessed for recorded reasons)

83.2% 8185/9840

(90%, 77-98%)

82.9% 1088/1312

83% 2002/2413

84.8% 2554/3011

82.8% 1895/2290

79.4% 646/814


Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

1.13 [1]

19

Has an assessment of functioning been carried out?

Yes, a standardised assessment has taken place

45.3% 4212/9294

(45%, 23-66%)

46.8% 578/1236

47.4% 1067/2249

42.5% 1224/2877

47.8% 1043/2183

40.1% 300/749

Yes, an occupational therapy and/or a physiotherapy assessment has taken place

42.8% 3977/9294

(44%, 26-58%)

44.7% 552/1236

40.4% 908/2249

44.7% 1287/2877

43.2% 942/2183

38.5% 288/749

Yes, other 1.7%

161/9294 (0%, 0-2%)

2.6% 32/1236

1.6% 35/2249

1.6% 47/2877

1.1% 24/2183

3.1% 23/749

Yes (all options) 89.8%

8350/9294 (92%, 85-96%)

94% 1162/1236

89.4% 2010/2249

88.9% 2558/2877

92% 2009/2183

81.6% 611/749


Mental State Assessment

Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

1.3 [2]

20 Has a standardised mental status test been carried out? (y/n/could not be assessed for recorded reasons)

54% 4684/8682

(55%, 38-72%)

68.9% 772/1120

52.5% 1123/2138

47.8% 1243/2603

64.1% 1317/2055

29.9% 229/766

1.4 [2]

21

Has an assessment been carried out for recent changes or fluctuation in behaviour that may indicate the presence of delirium?

Yes, and there were indications that delirium may be present

25.9% 2603/10047 (24%, 14-36%)

33% 440/1335

22.9% 564/2465

25.3% 780/3077

27.2% 636/2338

22% 183/832

Yes, but there was no indication that delirium may be present

18.5% 1863/10047 (15%, 6-25%)

27.3% 365/1335

15.5% 382/2465

17.6% 543/3077

19.4% 453/2338

14.4% 120/832

Yes (both options) 44.5%

4466/10047 (42%, 27-60%)

60.3% 805/1335

38.4% 946/2465

43% 1323/3077

46.6% 1089/2338

36.4% 303/832

1.5 [2]

21a (If Q21=Yes) Has the patient been clinically assessed for delirium by a healthcare professional? (y/n)

85.3% 2220/2603

(90%, 78-100%)

91.6% 403/440

83.7% 472/564

82.6% 644/780

86.8% 552/636

81.4% 149/183


Information about the person with dementia

Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

1.14 [1]

22

Does the care assessment contain a section dedicated to collecting information from the carer, next of kin or a person who knows the patient well? (y/n)

57.2% 5727/10010 (58%, 31-85%)

54.4% 722/1328

50.6% 1239/2451

58.5% 1800/3076

66.2% 1537/2323

51.6% 429/832

22a

(If Q22=Yes) Has information been collected about the patient regarding personal details, preferences and routines?

Yes 47.4%

2669/5626 (53%, 30-77%)

41.1% 289/703

49% 594/1213

46.5% 829/1782

50.7% 765/1510

45.9% 192/418

Unknown* 33.1%

1865/5626 (14%, 0-44%)

42.8% 301/703

27.5% 334/1213

36.6% 652/1782

34.1% 515/1510

15.1% 63/418

22b

(If Q22=Yes) Has information been collected about the patient's food and drink preferences?

Yes 44.1%

2476/5616 (50%, 29-71%)

38.9% 274/705

45.3% 547/1208

45.3% 806/1779

44.5% 670/1507

42.9% 179/417

Unknown* 34.1%

1916/5616 (16%, 3-48%)

42.8% 302/705

29.7% 359/1208

36.5% 650/1779

36.2% 545/1507

14.4% 60/417

22c

(If Q22=Yes) Has information been collected about the patient regarding reminders or support with personal care?

Yes 55.3%

3116/5631 (64%, 42-80%)

47.6% 337/708

60.2% 730/1212

50% 890/1780

57.9% 875/1510

67.5% 284/421

Unknown* 29.9%

1685/5631 (13%, 0-37%)

41.2% 292/708

21.9% 266/1212

35.1% 624/1780

29.6% 447/1510

13.3% 56/421


Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

1.14 [1]

22d

(If Q22=Yes) Has information been collected about the patient regarding recurring factors that may cause or exacerbate distress?

Yes 32.6%

1818/5583 (35%, 18-56%)

30.5% 214/702

30.2% 363/1201

32.4% 574/1769

35.4% 530/1499

33.3% 137/412

Unknown* 37.8%

2110/5583 (20%, 5-50%)

46.9% 329/702

34.3% 412/1201

40% 707/1769

39.2% 588/1499

18% 74/412

22e

(If Q22=Yes) Has information been collected about the patient regarding support or actions that can calm the person if they are agitated?

Yes 28.2%

1564/5539 (26%, 13-50%)

25.4% 177/698

26.4% 315/1192

28.4% 499/1758

31.3% 464/1483

26.7% 109/408

Unknown* 39.1%

2167/5539 (20%, 7-52%)

47.9% 334/698

37.4% 446/1192

41.2% 724/1758

40.1% 594/1483

16.9% 69/408

1.15 [3]

22f

(If Q22=Yes) Has information been collected about the patient regarding life details which aid communication?

Yes 43.1%

2413/5598 (50%, 25-70%)

38% 268/706

42.4% 511/1204

41.3% 732/1771

46.8% 703/1502

48% 199/415

Unknown* 35.3%

1977/5598 (17%, 3-46%)

45.2% 319/706

33.3% 401/1204

37.4% 663/1771

35.9% 539/1502

13.3% 55/415

*Unknown response options refer to situations in which the information is usually recorded in a document which accompanies the patient (e.g. “This is Me” or patient passport) and no copy isavailable in the notes.


Discharge

Assessment before discharge

Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

5.3 [2]

23

At the point of discharge the patient's level of cognitive impairment, using a standardised assessment, was summarised and recorded: (y/n)

22.4% 1639/7329

(17%, 9-30%)

27.2% 278/1021

16.8% 296/1763

22.4% 524/2342

27% 445/1647

17.3% 96/556

23a

(If 23=No) Please comment:

Patient too unwell/ not responsive 3.3%

189/5690 7.1%

53/743 2.5%

36/1467 2.9%

52/1818 3.6%

43/1202 1.1% 5/460

Patient has advanced dementia (i.e. patient’s advanced dementia makes the assessment not appropriate)

1.9% 110/5690

2.4% 18/743

1.5% 22/1467

2.3% 41/1818

1.9% 23/1202

1.3% 6/460

Not routine/ not standard practice 5.8%

331/5690 8.5%

63/743 7.8%

115/1467 5.6%

101/1818 4.3%

52/1202 0%

0/460

Not documented/ unknown reason 78.1%

4444/5690 76.9%

571/743 75.8%

1112/1467 71.9%

1308/1818 84.5%

1016/1202 95%

437/460 Dementia diagnosis (i.e. dementia diagnosis mentioned as a reason for not completing assessment)

10.8% 616/5690

5.1% 38/743

12.4% 182/1467

17.4% 316/1818

5.7% 68/1202

2.6% 12/460

24 At the point of discharge the cause of cognitive impairment was summarised and recorded: (y/n)

69.1% 5067/7329

(72%, 57-84%)

78.9% 806/1021

68.8% 1213/1763

66.8% 1564/2342

74.2% 1222/1647

47.1% 262/556

25 Have there been any symptoms of delirium? (y/n)

32.3% 2367/7329

(33%, 22-41%)

35.6% 363/1021

30.6% 540/1763

31.8% 744/2342

32.9% 542/1647

32% 178/556

25a (If Q25=Yes) Have the symptoms of delirium been summarised for discharge? (y/n)

47.9% 1133/2367

(45%, 33-64%)

47.4% 172/363

43.7% 236/540

51.1% 380/744

52.2% 283/542

34.8% 62/178

26

Have there been any persistent behavioural and psychiatric symptoms of dementia (wandering, aggression, shouting) during this admission? (y/n)

19.4% 1425/7329

(19%, 13-26%)

20.3% 207/1021

19.7% 348/1763

19.3% 452/2342

18.1% 298/1647

21.6% 120/556


Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

5.3 [2]

26a (If Q26=Yes) Have the symptoms of behavioural and psychiatric symptoms of dementia been summarised for discharge? (y/n)

44.5% 635/1426

(40%, 23-60%)

58.9% 122/207

39.5% 138/349

43.6% 197/452

44% 131/298

39.2% 47/120

27 Is there a recorded referral to a social worker for assessment of housing and care needs due to a proposed change in residence?

65.5% 1649/2519

(71%, 53-89%)

64% 210/328

63.2% 354/560

66.8% 530/793

65.3% 407/623

68.8% 148/215

27a (i)

(If Q27=Yes):

There are documented concerns about the patient’s capacity to consent to the referral:

70.4% 1161/1649

(75%, 50-89%)

78.1% 164/210

65% 230/354

68.1% 361/530

73.5% 299/407

72.3% 107/148

There are no documented concerns about the patient’s capacity to consent to the referral:

29.6% 488/1649

(25%, 11-50%)

21.9% 46/210

35% 124/354

31.9% 169/530

26.5% 108/407

27.7% 41/148

27a (i) There are documented concerns about the patient’s capacity to consent to the referral:

27a (ii)

The patient had capacity on assessment and their consent is documented

11.9% 138/1161

(0%, 0-20%)

9.8% 16/164

11.3% 26/230

14.7% 53/361

12.4% 37/299

5.6% 6/107

The patient lacked requisite capacity and evidence of a best interests decision has been recorded

69.9% 811/1161

(75%, 50-90%)

78.7% 129/164

63.9% 147/230

68.4% 247/361

68.9% 206/299

76.6% 82/107

There is no record of either consent or best interest decision making*

18.3% 212/1161

(14%, 0-33%)

11.6% 19/164

24.8% 57/230

16.9% 61/361

18.7% 56/299

17.8% 19/107

27a (i) There are no documented concerns about the patient’s capacity to consent to the referral:

27a (iii)

The patients consent was requested and this is recorded

29.1% 142/488

(25%, 0-50%)

47.8% 22/46

26.6% 33/124

28.4% 48/169

30.6% 33/108

14.6% 6/41

There is no record of the patients consent* 70.9%

346/488 (75%, 50-100%)

52.2% 24/46

73.4% 91/124

71.6% 121/169

69.4% 75/108

85.4% 35/41

27a (ii & iii)

Consent or best interests (responses options combined)

66.2% 1091/1649

(67%, 50-86%)

79.5% 167/210

58.2% 206/354

65.7% 348/530

67.8% 276/407

63.5% 94/148

No consent or best interests (response options combined)

33.8% 558/1649

(33%, 14-50%)

20.5% 43/210

41.8% 148/354

34.3% 182/530

32.2% 131/407

36.5% 54/148

* Please note that these figures include 1.9% of casenotes where it was specified that the capacity assessment information is kept with social worker notes, which are unavailable to the auditor

.

Discharge coordination and multi-disciplinary team input

Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

6.4 [2]

28 Did a named person/ identified team co-ordinate the discharge plan? (y/n/na)

82% 5807/7083

(89%, 72-96%)

84% 839/999

78.8% 1340/1701

84.8% 1916/2260

81.8% 1304/1595

77.3% 408/528

5.4 [1]

29a

Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the person with dementia? (y/n/na)

53.9% 3327/6169

(55%, 38-72%)

66.7% 532/798

47.2% 701/1486

52% 1027/1976

58.9% 830/1410

47.5% 237/499

29b

Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the person's carer/ relative? (y/n/na)

80.7% 5597/6935

(82%, 71-91%)

81.6% 789/967

77.8% 1283/1649

82.5% 1848/2239

82.3% 1286/1563

75.6% 391/517

29c

Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with the consultant responsible for the patient's care? (y/n)

75.1% 5501/7329

(81%, 63-91%)

79.3% 810/1021

67.4% 1188/1763

79.4% 1860/2342

76.2% 1255/1647

69.8% 388/556

29d

Is there evidence in the notes that the discharge coordinator/ person or team planning discharge has discussed place of discharge and support needs with other members of the multidisciplinary team? (y/n)

81.5% 5971/7329

(85%, 76-93%)

85.8% 876/1021

77.2% 1361/1763

83.9% 1964/2342

82.3% 1356/1647

74.5% 414/556

5.6 [1]

30 Has a single plan/ summary for discharge with clear updated information been produced? (y/n)

85.1% 6234/7329

(92%, 77-97%)

88.4% 903/1021

81.8% 1443/1763

86.6% 2028/2342

88% 1450/1647

73.7% 410/556

5.7 [2]

31 Are any support needs that have been identified documented in the discharge plan/ summary? (y/n/na)

60.2% 4211/6995

(61%, 44-79%)

65.6% 653/995

52.9% 888/1679

65.1% 1439/2210

61.1% 981/1606

49.5% 250/505


Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

5.8 [1]

32 Has the patient and/ or carer received a copy of the plan/ summary? (y/n/na)

80.6% 5621/6975

(94%, 72-100%)

91.6% 897/979

80.3% 1380/1719

81.9% 1809/2210

85.1% 1341/1575

39.4% 194/492

N5b [2]

33 Was a copy of the discharge plan/ summary sent to the GP/ primary care team on the day of discharge? (y/n/na)

93.6% 6701/7156

(98%, 93-100%)

94.3% 952/1010

96.4% 1666/1729

95.8% 2178/2273

93.2% 1518/1629

75.1% 387/515


Discharge planning

Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

5.1 [2]

34 Was discharge planning initiated within 24 hours of admission? (y/n/na)

47.4% 2483/5242

(48%, 27-67%)

59.4% 443/746

40% 536/1340

46.7% 716/1532

54.1% 640/1184

33.6% 148/440

34a

(If Q34=N/A) Please select the recorded reason why discharge planning could not be initiated within 24 hours:

Patient acutely unwell 62.5%

1306/2088 71.6%

197/275 54.4%

230/423 67.9%

550/810 53.4%

248/464 69.8% 81/116

Patient awaiting assessment 9.1%

190/2088 7.6%

21/275 9.5%

40/423 9.5%

77/810 9.3%

43/464 7.8% 9/116

Patient awaiting history/ results 6.1%

127/2088 3.3% 9/275

5.9% 25/423

5.2% 42/810

9.7% 45/464

5.2% 6/116

Patient awaiting surgery 9.6%

200/2088 8%

22/275 13.2% 56/423

7.3% 59/810

11.4% 53/464

8.6% 10/116

Patient presenting confusion 5.7%

120/2088 4.7%

13/275 5.2%

22/423 4.9%

40/810 8.6%

40/464 4.3% 5/116

Patient on end of life plan 0%

1/2088 0%

0/275 0%

0/423 0.1% 1/810

0% 0/464

0% 0/116

Patient being transferred to another hospital 0.1%

2/2088 0.4% 1/275

0% 0/423

0% 0/810

0.2% 1/464

0% 0/116

Patient unresponsive 0.3%

6/2088 0%

0/275 0.5% 2/423

0.1% 1/810

0.4% 2/464

0.9% 1/116

Patient being discharged to nursing/ residential care

6.5% 136/2088

4.4% 12/275

11.3% 48/423

4.9% 40/810

6.9% 32/464

3.4% 4/116

Other 0%

0/2088 0%

0/275 0%

0/423 0%

0/810 0%

0/464 0%

0/116


Support for carers and family

Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

5.10 [2]

35

Carers or family have received notice of discharge and this is documented:

Less than 24 hours 19.5%

1432/7329 11.9%

122/1021 23.4%

412/1763 21.4%

502/2342 17.9%

294/1647 18.3%

102/556

24 hours 12.2%

897/7329 12.7%

130/1021 8.8%

155/1763 16%

375/2342 11.4%

188/1647 8.8%

49/556

25 - 48 hours 14.7%

1075/7329 14.9%

152/1021 14.9%

262/1763 14.6%

341/2342 16.1%

265/1647 9.9%

55/556

More than 48 hours 27.1%

1985/7329 34%

347/1021 24.6%

433/1763 25.1%

587/2342 29.3%

483/1647 24.3%

135/556

No notice at all 0.5%

35/7329 0.7%

7/1021 0.7%

12/1763 0.2%

5/2342 0.5%

9/1647 0.4% 2/556

Not documented 24.2%

1770/7329 22.2%

227/1021 26.3%

463/1763 21.1%

495/2342 23.3%

384/1647 36.2%

201/556

No carer, family, friend/ could not contact 1.8%

132/7329 3.5%

36/1021 1.4%

25/1763 1.5%

36/2342 1.4%

23/1647 2.2%

12/556

Patient specified information withheld 0%

3/7329 0%

0/1021 0.1%

1/1763 0%

1/2342 0.1%

1/1647 0%

0/556

5.5 [2]

36 An assessment of the carer's current needs has taken place in advance of discharge: (y/n/na)

67.3% 2605/3868

(70%, 50-88%)

73.7% 387/525

63.7% 581/912

69.7% 901/1292

70.6% 574/813

49.7% 162/326


Appendix D: Carer demographics

Age range National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

18 – 24 years 1% (48) 1.3% (10) 0.8% (9) 1.6% (22) 0.4% (5) 0.8% (2)

25 – 34 years 2.9% (133) 3.9% (30) 2.9% (31) 2.8% (38) 2.6% (30) 1.6% (4)

35 – 44 years 5.6% (259) 9.1% (71) 5.3% (57) 5% (67) 4.8% (56) 3.2% (8)

45 – 54 years 16.2% (749) 19.3% (150) 16.3% (175) 15.6% (210) 13.8% (162) 20.6% (52)

55 – 64 years 25.8% (1193) 26.4% (206) 24.7% (266) 28.6% (384) 23.3% (273) 25.3% (64)

65 – 74 years 20.8% (960) 18.7% (146) 21.3% (229) 19.6% (263) 22.6% (265) 22.5% (57)

75 – 84 years 19.1% (885) 13.9% (108) 19.3% (208) 19.3% (259) 22.4% (263) 18.6% (47)

85 years or over 7.4% (343) 6% (47) 8.1% (87) 6.6% (89) 9.1% (107) 5.1% (13)

Prefer not to say 1.2% (56) 1.4% (11) 1.3% (14) 0.9% (12) 1.1% (13) 2.4% (6)


Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Male 30.6% (1413) 31.7% (247) 29.2% (314) 29.8% (401) 32.2% (378) 29% (73)

Female 68.1% (3150) 66.7% (519) 69.3% (746) 69.4% (933) 66.3% (778) 69% (174)

Other 0.1% (4) 0% (0) 0.1% (1) 0.1% (1) 0.1% (1) 0.4% (1)

Prefer not to say 1.2% (57) 1.5% (12) 1.4% (15) 0.7% (10) 1.4% (16) 1.6% (4)



Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

White/ White British 88.4% (4079) 65.8% (510) 90% (962) 94.2% (1268) 93.7% (1095) 96.4% (244)

Black/ Black British 3% (140) 12.4% (96) 2.1% (22) 0.9% (12) 0.9% (10) 0% (0)

Asian/ Asian British 3.3% (152) 9.2% (71) 3.4% (36) 2% (27) 1.4% (16) 0.8% (2)

Mixed 1% (44) 2.6% (20) 0.7% (7) 0.6% (8) 0.7% (8) 0.4% (1)

Chinese 0.2% (9) 0.5% (4) 0.2% (2) 0% (0) 0.3% (3) 0% (0)

Other 1.4% (64) 5.2% (40) 0.8% (9) 0.6% (8) 0.5% (6) 0.4% (1)

Prefer not to say 2.7% (124) 4.4% (34) 2.9% (31) 1.7% (23) 2.7% (31) 2% (5)

Relationship to patient National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Spouse or partner 33.5% (1558) 25.1% (197) 34.6% (374) 29.4% (398) 43.4% (510) 31.2% (79)

Family member 55.9% (2597) 61.1% (480) 54% (584) 59.1% (799) 49.1% (577) 62.1% (157)

Friend 4.4% (203) 5.7% (45) 4.6% (50) 4.7% (63) 3.1% (37) 3.2% (8)

Professional carer (health or social care)

5.4% (249) 7.3% (57) 6.1% (66) 5.9% (80) 3.2% (38) 3.2% (8)

Other 0.9% (41) 0.8% (6) 0.6% (7) 1% (13) 1.2% (14) 0.4% (1)

One of main carers for patient National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Yes 77.8% (3356) 76% (560) 75.4% (760) 74.5% (924) 84.5% (927) 80.1% (185)


Appendix E: Carer questionnaire data

Patient care

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

9.3 [1]

1



2130/4578 48.2%

369/766 46.3%

496/1071 48.5%

642/1324 42.6%

495/1162 50.2%

128/255

Yes, to some extent 43.3%

1980/4578 44.8%

343/766 42.7%

457/1071 42.7%

566/1324 43.4%

504/1162 43.1%

110/255

No 10.2%

468/4578 7%

54/766 11%

118/1071 8.8%

116/1324 14%

163/1162 6.7%

17/255

7.4 [2]

2

Do you feel confident that hospital staff delivered high quality care that was appropriate to the needs of the person you look after?


2489/4592 54.2%

413/762 53.4%

570/1067 56.4%

754/1338 51.4%

601/1169 59%

151/256


1672/4592 38.1%

290/762 37.5%

400/1067 35%

468/1338 35.8%

419/1169 37.1% 95/256

No 9.4%

431/4592 7.7%

59/762 9.1%

97/1067 8.7%

116/1338 12.7%

149/1169 3.9%

10/256

1.14 [1]

3

Was the person you look after given enough help with personal care from hospital staff? For example, eating, drinking, washing and using the toilet.


2456/4433 55.8%

415/744 56%

574/1025 56.9%

734/1291 51.4%

575/1118 62%

158/255


1515/4433 34.9%

260/744 34.5%

354/1025 33.8%

437/1291 34.3%

383/1118 31.8% 81/255

No 10.4%

462/4433 9.3%

69/744 9.5%

97/1025 9.3%

120/1291 14.3%

160/1118 6.3%

16/255


Std no. [Type]


National audit

Round 3: %


London Round 3:

% Num/Den

Midlands & East of

England Round 3:

% Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

7.4 [2]

4


Yes, definitely 76%

3471/4569 75.3%

575/764 74.6%

794/1065 77.1%

1026/1330 74.1%

857/1157 86.6%

219/253


952/4569 22.4%

171/764 22.5%

240/1065 20.5%

272/1330 20.6%

238/1157 12.3% 31/253

No 3.2%

146/4569 2.4%

18/764 2.9%

31/1065 2.4%

32/1330 5.4%

62/1157 1.2% 3/253


Communication

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

9.7 [2]

5

Were you (or the patient, where appropriate) kept clearly informed about their care and progress during the hospital stay? For example, about plans for treatment and discharge.


1908/4566 45.3%

343/758 41.2%

440/1067 42.6%

564/1323 38.3%

446/1163 45.1%

115/255


1843/4566 39.2%

297/758 40.7%

434/1067 39.9%

528/1323 40.4%

470/1163 44.7%

114/255

No 17.8%

815/4566 15.6%

118/758 18.1%

193/1067 17.5%

231/1323 21.2%

247/1163 10.2% 26/255

9.11 [2]

6

Were you (or the patient, where appropriate) involved as much as you wanted to be in decisions about their care?


2138/4497 50.3%

376/747 46.1%

486/1054 48.7%

632/1297 43.3%

497/1149 58.8%

147/250


1637/4497 36.9%

276/747 36.1%

381/1054 36.4%

472/1297 37.3%

429/1149 31.6% 79/250

No 16.1%

722/4497 12.7% 95/747

17.7% 187/1054

14.9% 193/1297

19.4% 223/1149

9.6% 24/250

1.14 [1]

7

Did hospital staff ask you about the needs of the person you look after to help plan their care?


2053/4524 48.4%

370/765 45.4%

479/1056 46.3%

605/1307 40.3%

462/1147 55%

137/249


1563/4524 34.8%

266/765 35.3%

373/1056 33%

431/1307 35.6%

408/1147 34.1% 85/249

No 20.1%

908/4524 16.9%

129/765 19.3%

204/1056 20.7%

271/1307 24.1%

277/1147 10.8% 27/249


Overall

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

8


Excellent 34.5%

1602/4645 32.8%

257/783 35.8%

387/1082 35.1%

473/1349 32.7%

384/1176 39.6%

101/255

Very good 33.9%

1575/4645 37%

290/783 31.9%

345/1082 34.8%

470/1349 31%

365/1176 41.2%

105/255

Good 17%

790/4645 17.5%

137/783 18%

195/1082 16.8%

226/1349 17.4%

205/1176 10.6% 27/255

Fair 9.6%

446/4645 9.5%

74/783 9.1%

99/1082 8.7%

117/1349 11.6%

136/1176 7.8%

20/255

Poor 5%

232/4645 3.2%

25/783 5.2%

56/1082 4.7%

63/1349 7.3%

86/1176 0.8% 2/255

9

How likely would you be to recommend the service to friends and family if they needed similar care or treatment?

Extremely likely 42.5%

1933/4544 41.4%

315/760 43.8%

466/1063 43.8%

580/1324 39.4%

451/1144 47.8%

121/253

Likely 34.1%

1551/4544 36.1%

274/760 33.2%

353/1063 34.4%

455/1324 33%

378/1144 36%

91/253

Neither likely nor unlikely 14.3%

648/4544 15.4%

117/760 14.3%

152/1063 13.1%

173/1324 15.7%

180/1144 10.3% 26/253

Unlikely 4.8%

220/4544 4.2%

32/760 4.1%

44/1063 4.8%

64/1324 6.2%

71/1144 3.6% 9/253

Extremely unlikely 4.2%

192/4544 2.9%

22/760 4.5%

48/1063 3.9%

52/1324 5.6%

64/1144 2.4% 6/253


Support for the carer

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

10


Very satisfied 50.3%

2204/4379 50.8%

370/729 49.2%

502/1021 52.1%

658/1264 46.6%

525/1126 62.3%

149/239

Somewhat satisfied 34%

1487/4379 36.6%

267/729 35%

357/1021 34%

430/1264 32.4%

365/1126 28.5% 68/239

Somewhat dissatisfied 9.9%

434/4379 8.6%

63/729 10.3%

105/1021 8.8%

111/1264 12.6%

142/1126 5.4%

13/239

Very dissatisfied 5.8%

254/4379 4%

29/729 5.6%

57/1021 5.1%

65/1264 8.3%

94/1126 3.8% 9/239


Appendix F: Staff demographics

% of patients encounter in role who have dementia/

possible dementia


% (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Up to 25% 31.9% (4559) 27.2% (487) 29% (861) 35.4% (1734) 32.6% (1194) 29.8% (283) 26 - 50% 25.6% (3651) 24.4% (438) 23.2% (690) 24.9% (1221) 26.7% (981) 33.8% (321) 51 - 75% 24.4% (3489) 27.9% (501) 25.1% (746) 22.5% (1101) 24.6% (903) 25% (238) More than 75% 18.1% (2588) 20.5% (367) 22.7% (674) 17.3% (848) 16.1% (590) 11.5% (109)


Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Male 15.7% (2260) 18.7% (339) 15% (448) 15.4% (757) 15.8% (582) 14% (134) Female 83.2% (11954) 80.4% (1456) 84% (2510) 83.7% (4118) 83% (3058) 84.8% (812) Other 0.2% (34) 0.2% (4) 0.1% (4) 0.2% (11) 0.3% (11) 0.4% (4) Prefer not to say 0.8% (113) 0.7% (13) 0.8% (25) 0.7% (34) 0.9% (33) 0.8% (8)


Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

White/ White British 79.9% (11467) 54% (978) 78.5% (2345) 88.6% (4358) 79.9% (2942) 88.1% (844) Black/ Black British 4.1% (594) 16% (289) 4.3% (128) 1.4% (70) 2.7% (98) 0.9% (9) Asian/ Asian British 8% (1150) 13.6% (247) 9.4% (281) 4.9% (240) 8.8% (324) 6.1% (58) Mixed 1.3% (183) 2.4% (44) 1.4% (43) 0.9% (42) 1.3% (49) 0.5% (5) Chinese 0.5% (73) 1% (19) 0.6% (18) 0.4% (18) 0.5% (17) 0.1% (1) Other 4.5% (646) 10.7% (194) 4.1% (123) 2.5% (125) 4.9% (182) 2.3% (22) Prefer not to say 1.7% (241) 2.2% (39) 1.6% (48) 1.3% (66) 1.9% (69) 2% (19)


Job role National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Registered nurse (Band 5 or 6) 29.9% (4300) 28.1% (508) 30.2% (901) 30.5% (1498) 30.5% (1123) 28% (270) Registered nurse (Band 7 or above)

12.7% (1831) 15.5% (281) 12.8% (381) 12.5% (616) 12.6% (465) 9.1% (88)

Healthcare assistant 23.1% (3324) 16.4% (297) 24.8% (741) 23.9% (1176) 22.5% (829) 29.2% (281) Doctor 11.5% (1645) 14.1% (256) 10.7% (318) 12% (589) 10.5% (387) 9.9% (95) Allied healthcare professional 11.9% (1713) 15.2% (276) 11.2% (333) 10.7% (528) 12.4% (458) 12.3% (118) Therapy assistant/ allied healthcare professional assistant

2.6% (367) 2.4% (43) 2.3% (68) 2.4% (116) 3% (112) 2.9% (28)

Student 2.3% (332) 2.9% (52) 2% (61) 2.3% (114) 1.7% (64) 4.3% (41) Ward based administrators 4% (571) 3.4% (61) 3.8% (113) 3.7% (182) 5.1% (187) 2.9% (28) Other/ unknown 1.9% (279) 2% (36) 2.3% (69) 2% (100) 1.6% (60) 1.5% (14)

Hours worked per week National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Up to 29 hours 13% (1866) 7.8% (140) 13.3% (397) 13.4% (655) 15% (551) 12.9% (123) 30 hours or more 87% (12458) 92.2% (1662) 86.7% (2584) 86.6% (4251) 85% (3127) 87.1% (834)

Time worked in the hospital National audit

Round 3: % (N)

London Round 3:

% (N)


Round 3: % (N)


% (N)


% (N)

Wales Round 3:

% (N)

Less than 6 months 8% (1148) 11% (199) 7.1% (211) 6.6% (324) 9.1% (335) 8.3% (79) 6 - 11 months 9.5% (1364) 12.4% (224) 10.1% (302) 8.1% (397) 9.7% (356) 8.9% (85) 1 - 2 years 15.6% (2242) 20.8% (375) 15.2% (454) 13.7% (671) 16.3% (600) 14.8% (142) 3 - 5 years 16.4% (2350) 15.8% (285) 16.9% (503) 15.4% (758) 17.3% (636) 17.6% (168) 6 - 10 years 15.9% (2283) 14.6% (264) 16.4% (490) 16.6% (815) 15.6% (573) 14.7% (141) 11 - 15 years 12.1% (1739) 11.5% (208) 12.3% (366) 13.1% (641) 11.1% (409) 12% (115) More than 15 years 22.4% (3205) 13.8% (248) 22% (656) 26.5% (1303) 21% (771) 23.7% (227)


Appendix G: Staff questionnaire data

Specialist services for dementia

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

4.11 [2]

1 Do you feel supported by specialist services for dementia in your hospital? E.g. dementia specialist team, mental health liaison, dementia champions.

1a

During office hours i.e. Monday-Fri, 9am-5pm

Yes, always 28.7%

4026/14024 36.1%

646/1791 31%

902/2907 27.5%

1320/4797 28.1%

1009/3591 15.9%

149/938


4614/14024 29.6%

531/1791 33.5%

975/2907 33%

1582/4797 35.3%

1266/3591 27.7%

260/938


3760/14024 24.8%

444/1791 26.1%

760/2907 26.9%

1288/4797 26.2%

940/3591 35%

328/938

No 11.6%

1624/14024 9.5%

170/1791 9.3%

270/2907 12.7%

607/4797 10.5%

376/3591 21.4%

201/938

Yes, always & Yes, most of the time combined 61.6%

8640/14024 65.7%

1177/1791 64.5%

1877/2907 60.5%

2902/4797 63.4%

2275/3591 43.6%

409/938

1b

Out of office hours

Yes, always 7.8%

874/11207 9.6%

129/1337 6.9%

162/2355 8.9%

348/3907 7.2%

204/2836 4%

31/772


1763/11207 15.7%

210/1337 15.6%

367/2355 16.9%

661/3907 16%

455/2836 9.1%

70/772


3129/11207 26.2%

350/1337 28.8%

678/2355 28.3%

1104/3907 28.7%

814/2836 23.7%

183/772

No 48.6%

5441/11207 48.5%

648/1337 48.7%

1148/2355 45.9%

1794/3907 48.1%

1363/2836 63.2%

488/772


2637/11207 25.4%

339/1337 22.5%

529/2355 25.8%

1009/3907 23.2%

659/2836 13.1%

101/772


Dementia care training

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

7.4 [2]

2

What form did your dementia training at this hospital take? Please tick all that apply:

eLearning 42.8%

5653/13205 34.9%

563/1615 36.2%

1000/2766 49.5%

2273/4596 41.5%

1391/3348 48.4%

426/880

Workshop/ study day 53.2%

7030/13205 61.2%

988/1615 59.5%

1645/2766 46.9%

2157/4596 56.6%

1896/3348 39.1%

344/880

Higher education module 5.4%

713/13205 4.6%

74/1615 6.2%

171/2766 5.4%

246/4596 5.5%

183/3348 4.4%

39/880

Workbook 7.7%

1018/13205 5.6%

90/1615 5.9%

162/2766 10.8%

496/4596 7.3%

246/3348 2.7%

24/880

Other 7.3%

961/13205 9.1%

147/1615 8%

220/2766 5.7%

262/4596 8.7%

291/3348 4.7%

41/880 I have not received any dementia training at this hospital

17.3% 2278/13205

15.7% 254/1615

16.9% 467/2766

16.5% 759/4596

16.9% 565/3348

26.5% 233/880

2a


Yes, much better prepared 42.2%

4502/10670 50.3%

664/1320 44%

988/2248 40.3%

1515/3761 42.6%

1157/2717 28.5%

178/624

Yes, somewhat better prepared 50.5%

5390/10670 45.1%

595/1320 48.5%

1090/2248 52%

1955/3761 50.6%

1374/2717 60.3%

376/624

No 7.3%

778/10670 4.6%

61/1320 7.6%

170/2248 7.7%

291/3761 6.8%

186/2717 11.2% 70/624


Information and communication

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

9.3 [1]

3

In your current role, do you think that personal information is available to you to help you care for/ support people with dementia? E.g. their likes/ dislikes, preferred name, past job.

Yes, always 21.4%

3072/14345 25.4%

459/1808 22.8%

680/2977 20.8%

1021/4914 20.4%

754/3689 16.5%

158/957


5525/14345 36%

651/1808 38.7%

1152/2977 38.6%

1895/4914 40.2%

1483/3689 35.9%

344/957

Yes, sometimes 33%

4734/14345 31.4%

568/1808 32.3%

963/2977 32.7%

1609/4914 33.6%

1239/3689 37.1%

355/957

No 7.1%

1014/14345 7.2%

130/1808 6.1%

182/2977 7.9%

389/4914 5.8%

213/3689 10.4%

100/957


8597/14345 61.4%

1110/1808 61.5%

1832/2977 59.3%

2916/4914 60.6%

2237/3689 52.5%

502/957

3a

Do you have the opportunity to use this information to help you care for/ support people with dementia?

Yes, always 26.6%

3549/13329 31%

520/1676 28.1%

786/2794 25.4%

1151/4526 26.1%

907/3473 21.5%

185/860


5454/13329 40.6%

680/1676 40.1%

1120/2794 41.4%

1874/4526 41.5%

1440/3473 39.5%

340/860


4074/13329 26.6%

446/1676 30%

837/2794 31.3%

1416/4526 30.8%

1071/3473 35.3%

304/860

No 1.9%

252/13329 1.8%

30/1676 1.8%

51/2794 1.9%

85/4526 1.6%

55/3473 3.6%

31/860


9003/13329 71.6%

1200/1676 68.2%

1906/2794 66.8%

3025/4526 67.6%

2347/3473 61%

525/860


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

7.4 [2]

4

In your current role, do you feel encouraged to accommodate the individual needs and preferences of people with dementia? E.g. taking time to speak and interact at the pace of the person with dementia, permitting them to walk around the ward.

Yes, always 28.9%

4145/14333 33.5%

606/1810 30.2%

896/2969 28%

1376/4912 28.7%

1056/3685 22%

211/957


4759/14333 35.6%

644/1810 32.4%

962/2969 32.9%

1616/4912 34.4%

1267/3685 28.2%

270/957


3913/14333 24.5%

444/1810 26.3%

781/2969 27.6%

1357/4912 27.1%

1000/3685 34.6%

331/957

No 10.6%

1516/14333 6.4%

116/1810 11.1%

330/2969 11.5%

563/4912 9.8%

362/3685 15.2%

145/957


8904/14333 69.1%

1250/1810 62.6%

1858/2969 60.9%

2992/4912 63%

2323/3685 50.3%

481/957

7.12 [1]

6

As a team, how often do you talk about the way you care for/ support people with complex needs (including dementia)?

Frequently 49.8%

6203/12457 59.1%

935/1583 50%

1304/2608 48.6%

2078/4273 48.3%

1527/3163 43.3%

359/830

Occasionally 37.2%

4636/12457 31.5%

498/1583 37.1%

967/2608 37.4%

1599/4273 38.7%

1223/3163 42%

349/830

Almost Never 9.7%

1210/12457 7.4%

117/1583 9.7%

252/2608 10.8%

461/4273 9.4%

297/3163 10%

83/830

Never 3.3%

408/12457 2.1%

33/1583 3.3%

85/2608 3.2%

135/4273 3.7%

116/3163 4.7%

39/830


Patient care and nutrition

Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

3.8 [1]

7

Can carers of people with dementia visit at any time on the ward(s) you work on? i.e. visits are not limited to normal visiting hours and may include mealtimes.

Yes, always 51.2%

6131/11978 48.3%

745/1543 54.7%

1375/2513 49.1%

2007/4091 54.6%

1664/3048 43.4%

340/783


3271/11978 28.6%

441/1543 24.5%

616/2513 28.3%

1159/4091 28%

852/3048 25.9%

203/783


1927/11978 17.2%

266/1543 15.5%

390/2513 16.8%

686/4091 13.7%

417/3048 21.5%

168/783

No 5.4%

649/11978 5.9%

91/1543 5.3%

132/2513 5.8%

239/4091 3.8%

115/3048 9.2%

72/783


9402/11978 76.9%

1186/1543 79.2%

1991/2513 77.4%

3166/4091 82.5%

2516/3048 69.3%

543/783

7.18 [1]

8

Do you think that the people with dementia you care for/ support, have their nutritional needs met while on the ward(s) you work on?

Yes, always 25.9%

3181/12263 27%

421/1559 27.3%

705/2580 27%

1135/4197 22.3%

697/3122 27.7%

223/805


6149/12263 48%

749/1559 50.1%

1292/2580 49.7%

2088/4197 52.5%

1639/3122 47.3%

381/805


2357/12263 20.7%

323/1559 17.9%

462/2580 18.7%

785/4197 20.4%

637/3122 18.6%

150/805

No 4.7%

576/12263 4.2%

66/1559 4.7%

121/2580 4.5%

189/4197 4.8%

149/3122 6.3%

51/805


9330/12263 75%

1170/1559 77.4%

1997/2580 76.8%

3223/4197 74.8%

2336/3122 75%

604/805


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

4.9 [2]

9

Do you think the ward(s) you work on is able to respond to the individual needs of people with dementia as they arise? E.g. pain relief, personal care, toileting, mobility assistance.

Yes, always 30.4%

2785/9148 34.8%

368/1057 30.5%

600/1970 29.6%

937/3163 28.8%

673/2333 33.1%

207/625


4352/9148 44.9%

475/1057 48.2%

949/1970 47.1%

1491/3163 50.4%

1175/2333 41.9%

262/625


1708/9148 18%

190/1057 17.9%

352/1970 19.7%

624/3163 17.7%

414/2333 20.5%

128/625

No 3.3%

303/9148 2.3%

24/1057 3.5%

69/1970 3.5%

111/3163 3%

71/2333 4.5%

28/625

Yes, always & Yes, most of the time combined 78%

7137/9148 79.8%

843/1057 78.6%

1549/1970 76.8%

2428/3163 79.2%

1848/2333 75%

469/625

4.9 [2]

10

Is additional staffing support provided if dependency needs on the ward(s) you work on increase?

Yes, always 10.7%

977/9143 18.9%

199/1054 11.7%

230/1969 8.7%

274/3160 8.7%

204/2332 11.1% 70/628


2516/9143 30.2%

318/1054 29.5%

580/1969 25.4%

804/3160 27.4%

640/2332 27.7%

174/628


3887/9143 36%

379/1054 42.2%

830/1969 43.1%

1361/3160 44.1%

1028/2332 46%

289/628

No 19.3%

1763/9143 15%

158/1054 16.7%

329/1969 22.8%

721/3160 19.7%

460/2332 15.1% 95/628


3493/9143 49.1%

517/1054 41.1%

810/1969 34.1%

1078/3160 36.2%

844/2332 38.9%

244/628


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

N3c [3]

11

Are night time bed moves for people with dementia avoided where possible on the ward(s) you work on? By night time bed moves, we mean bed moves between the evening meal and breakfast the next morning

Yes, always 16.3%

1474/9047 20.1%

208/1037 16.2%

316/1947 15.2%

478/3136 15.2%

352/2313 19.5%

120/614


2942/9047 29.9%

310/1037 32.8%

638/1947 32.4%

1017/3136 34%

787/2313 30.9%

190/614


2506/9047 26.6%

276/1037 27.9%

544/1947 26.7%

838/3136 30.2%

698/2313 24.4%

150/614

No 23.5%

2125/9047 23.4%

243/1037 23.1%

449/1947 25.6%

803/3136 20.6%

476/2313 25.1%

154/614


4416/9047 50%

518/1037 49%

954/1947 47.7%

1495/3136 49.2%

1139/2313 50.5%

310/614

3.7 [1]

12

In the last week (except in emergency situations), were patient mealtimes kept free of any clinical activity on the ward(s) you work on?

Yes, always 28.3%

2488/8788 31.8%

328/1031 32.6%

613/1883 27.3%

829/3039 23.6%

529/2237 31.6%

189/598


3456/8788 36.5%

376/1031 39.5%

743/1883 39.8%

1211/3039 40.5%

907/2237 36.6%

219/598


1476/8788 17.1%

176/1031 15.3%

288/1883 16.2%

492/3039 19.3%

431/2237 14.9% 89/598

No 15.6%

1368/8788 14.6%

151/1031 12.7%

239/1883 16.7%

507/3039 16.5%

370/2237 16.9%

101/598


5944/8788 68.3%

704/1031 72%

1356/1883 67.1%

2040/3039 64.2%

1436/2237 68.2%

408/598


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

N3b [2]

13

Can you access finger food (i.e. food which can be eaten without a knife/ fork/ spoon) for people with dementia as an alternative to main meals?

Yes, always 38%

3356/8822 27.2%

282/1036 39.4%

748/1900 42.2%

1283/3042 37.1%

831/2242 35.2%

212/602


2398/8822 24%

249/1036 28.5%

541/1900 27.8%

846/3042 26.9%

602/2242 26.6%

160/602


1983/8822 29.4%

305/1036 21.9%

417/1900 19.8%

601/3042 22.6%

506/2242 25.6%

154/602

No 12.3%

1085/8822 19.3%

200/1036 10.2%

194/1900 10.3%

312/3042 13.5%

303/2242 12.6% 76/602


5754/8822 51.3%

531/1036 67.8%

1289/1900 70%

2129/3042 63.9%

1433/2242 61.8%

372/602

3.11 [2]

14


Yes, always 44.5%

4060/9119 41.6%

440/1057 48%

942/1963 44.3%

1394/3146 44.2%

1028/2327 40.9%

256/626


2615/9119 28.6%

302/1057 27.9%

547/1963 29.5%

927/3146 28.8%

671/2327 26.8%

168/626


1886/9119 23.1%

244/1057 19%

372/1963 20.6%

647/3146 20.2%

469/2327 24.6%

154/626

No 6.1%

558/9119 6.7%

71/1057 5.2%

102/1963 5.7%

178/3146 6.8%

159/2327 7.7%

48/626


6675/9119 70.2%

742/1057 75.9%

1489/1963 73.8%

2321/3146 73%

1699/2327 67.7%

424/626


Std no. [Type]


National audit

Round 3: %

Num/Den

London Round 3:

% Num/Den


Round 3: %

Num/Den


% Num/Den


% Num/Den

Wales Round 3:

% Num/Den

N3a [2]

15

Are the nutrition and hydration needs of people with dementia communicated at handovers/ safety briefings?

Yes, always 46.2%

4199/9090 46.9%

492/1050 45.9%

896/1953 48.2%

1511/3135 41.9%

975/2327 52%

325/625


3039/9090 33.4%

351/1050 33.5%

655/1953 33.3%

1044/3135 35.3%

821/2327 26.9%

168/625


1408/9090 15.9%

167/1050 15.6%

305/1953 13.8%

434/3135 17.1%

399/2327 16.5%

103/625

No 4.9%

444/9090 3.8%

40/1050 5%

97/1953 4.7%

146/3135 5.7%

132/2327 4.6%

29/625


7238/9090 80.3%

843/1050 79.4%

1551/1953 81.5%

2555/3135 77.2%

1796/2327 78.9%

493/625


List of Web Resources

The following documents can be downloaded on the audit website: www.nationalauditofdementia.org.uk

Reports from all rounds of audit • Report on the third round of audit published in July 2017 • Report on the second round of audit published in 2013 • Report on the first round of audit published in 2011

Standards documents and audit tools from all rounds of audit

Lists of participating Trusts/ Health Boards and hospitals in all rounds of audit

Report from the pilot audit carried out in community hospitals

Comparison between national Round 2 and Round 3 audit data


http://www.nationalauditofdementia.org.uk/

Royal College of Psychiatrists’ Centre for Quality Improvement 21 Prescot Street London E1 8BB

The Royal College of Psychiatrists is a registered charity in England and Wales (228636) and Scotland (SC038369)

© Healthcare Quality Improvement Partnership Ltd. (HQIP) 2017

www.nationalauditofdementia.org.uk

[email protected]

Commissioned by - RCPsych

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