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South West Dementia Partnership

Living well with dementia bulletin Issue 4 February 2011

Living well with dementia across the South West

The South West Dementia Partnership brings National Audit of Dementia - Interim
together organisations from health and social Report
care, the voluntary sector and people using In December 2010 the Royal College of
dementia services to drive forward Psychiatrists published a report providing the
improvements in the care of people with a interim findings from their National Audit of
dementia, and their families / carers. Dementia (Care in General Hospitals).The
report provides a snapshot of the state of
This issue focusses on the South West dementia care in hospitals twelve months ago.
Hospital Standards in Dementia Care, The findings include:
published in February 2011. The Hospital ➔ 95% of hospitals do not have mandatory
Standards have been developed by a regional training in dementia awareness for all staff
Expert Reference Group in response to the whose work is likely to bring them into
many concerns expressed about poor quality contact with patients with dementia
care experienced by some people with a ➔ About one-third of patients did not have a
dementia when they are in hospital, and by nutritional assessment recorded during
their carers and families. their admission
➔ Fewer than one-half of patients received a
⚑ Download the standards reports and formal mental status test upon admission
supporting resources on page 12.
to hospital
➔ One-third of patients referred to in-hospital
Alison Moon, Regional Champion for
psychiatry liaison services had not been
Dementia Care in Hospital, says,
seen after 96 hours

“ It has been a great pleasure working


with such committed, compassionate and
caring people, who together have not only
The aim of the interim report is to provide
participating hospitals and their partners with a
raised the profile for a group of people basis for assessing their performance so that
historically without a voice in hospitals but they can improve services ahead of the full
who have, by working together, produced a audit, which will report in December 2011.
vision of what good care looks like. With
particular thanks to people with dementia, ⚑ Download the interim report
carers and partners in the voluntary and ⚑ Download the data tables for the core
community sector.
” audit modules

www.southwestdementiapartnership.org.uk
Living well with dementia bulletin Issue 4 February 2011

The South West Hospital Standards in


Developing the Standards
Dementia Care complement the detailed
criteria and standards set out in the National
Audit of Dementia (Care in General There are a number of factors that were
Hospitals). All general hospitals in the South critical in the successful development of
the Standards. These include:
West region have participated in the national
Core Audit, and a proportion are participating ➔ Desire to put people’s needs first
in the Enhanced Audit. It is recommended that
➔ Commitment to involvement
commissioners, service providers and local
➔ Strong partnership working
stakeholders use this audit to inform the local
baseline upon which to build continuing audit, ➔ Expert opinion
monitoring and service improvement in ➔ Effective leadership
general and community hospitals. ➔ Willingness to promote change

It is intended that action over the next two


years to implement systematically these 8
Standards, will transform hospital care for
people with a dementia. Hospital staff,
patients, volunteers, relatives, carers and
commissioners all have roles to play in


achieving these standards. Local dementia
partnerships will coordinate and monitor All too often the needs of people with
delivery. dementia are not adequately met when
they are in hospital.

“ The successful development of the


Hospital Standards in Dementia Care
These Standards embody the voice of
would not have been possible without the
people with dementia, their carers and
involvement of people with dementia, their
families. They put people’s needs at the
carers and the voluntary sector in a strong
heart of the care that they should receive.
partnership with health professionals.
Those involved in the development will
By working together to achieve them, we
have a continuing vital role to play in
will help to transform the quality of care
supporting hospital staff to achieve these
that people with dementia receive while in
Standards and thereby improve the lives
of people with dementia.

hospital.
” Rachel Canning
Derek Dominey
Long term carer for wife who suffers from Expert by experience,
Alzheimer's Disease South West Hospitals
Expert Reference Group

www.southwestdementiapartnership.org.uk 2
Living well with dementia bulletin Issue 4 February 2011

Standard 1: People with dementia are ➔ Information on discharge /support


assured respect, dignity and available on admission.
appropriate care ➔ There is a named person who takes
responsibility for discharge coordination.
➔ A Dementia Ward Champion is appointed ➔ Discharge plans summarise assessment
to provide leadership for delivery and and treatment and support plan.
monitoring (where applicable), as well as
➔ There is access to intermediate care.
training.
➔ There is accessible literature on the ward Standard 3: People with dementia or
for patients, carers and staff suspected cognitive impairment who
➔ The care plan is person-centred for each are admitted to hospital, and their
patient. carers/families have access to a
➔ There is individualised and appropriate specialist mental health liaison service
risk assessment
➔ Patient care is person centred, informed ➔ There is access to a full multi disciplinary,
by Dementia Care Mapping or similar specialist mental health liaison service.
methodology. The level of service is based on assessed
➔ The trust Board regularly reviews serious need.
and untoward incidents, falls, delayed ➔ Appropriate referrals are made for further
discharges, and complaints associated assessment.
with patients with dementia. ➔ Training provided by liaison teams is
incorporated into local training strategies.
Standard 2: Agreed assessment,
admission and discharge processes are Standard 4: The hospital and ward
in place, with care plans specific to environment is dementia-friendly,
meet the individual needs of people minimising the number of ward and unit
with dementia and their carer. moves within the hospital setting and
between hospitals
➔ The lead carer is identified and provided
with information about how they can ➔ The hospital Clinical Champion
support the patient. determines appropriate signage and
➔ A booklet ‘This is me’ about each patient sensory environments across the hospital
is completed to inform care plans. and reviews quality of environment during
➔ All patients with suspected dementia peak activity so that standards do not slip.
receive a comprehensive assessment ➔ Patients with dementia should not be
with further referral to memory service if moved between wards (or hospital)
required. unless required for their care and
➔ Carers receive information about the treatment.
assessment. ➔ If a move is necessary it should be at
➔ Carers understand that an assessment of least disruptive time and carers informed
their needs can be arranged. and involved if appropriate.
➔ There is a system so that all staff are ➔ ‘This is me’ profile must accompany the
aware of the patients with dementia. patient is moved.
➔ Discharge is actively managed from 24 ➔ Daily therapeutic and recreational
hours of admission. activities are available where appropriate.

www.southwestdementiapartnership.org.uk 4
Living well with dementia bulletin Issue 4 February 2011

Standard 5: The nutrition and hydration


needs of people with dementia are well ➔ Support, feedback and training provided
met to volunteers.
➔ Regular review of recruitment and
➔ All patients have a weight assessment retention of volunteers.
and are assessed via malnutrition
screening. Standard 7: The hospital and wards
➔ Patient preferences are recorded in ‘This ensure quality of care at the end of life
is me’.
➔ GPs are informed of patients identified as
➔ Protected mealtimes with carers or
approaching end of life.
volunteers actively encouraged to assist.
➔ Patients who remain in hospital to die are
➔ Flexibility in provision and timing of food
cared for using an integrated care
and appropriate utensils / crockery.
pathway.
➔ Access to specialist assessment in 12
➔ All clinical and support staff receive
hours if swallowing difficulties.
appropriate training.
Standard 6: The hospital and wards
Standard 8: Appropriate training and
promote the contribution of volunteers
workforce development are in place to
to the well-being of people with a
promote and enhance the care of
dementia in hospital
people with dementia in general and
➔ There is designated leader within hospital community hospitals, and their
to promote volunteering for people with carers/families
dementia.
➔ The Ward Champion identifies ways to ➔ All new staff receive mandatory training.
improve patient experience by greater ➔ The hospital has a training and
involvement of volunteers.
knowledge framework in place which is
being implemented and reviewed.

www.southwestdementiapartnership.org.uk 5
Living well with dementia bulletin Issue 4 February 2011


What are the levers for implementing
The South West Hospital Standards in the Standards?
Dementia Care provide both Every general hospital in the South West has
commissioners and providers with the a named lead for dementia on the Trust
Board.
tools to benchmark and monitor progress
in providing dementia care.
The Standards can:
➔ Be included as a commissioning
The Standards are comprehensive and requirement for contracts for general and
encourage a holistic approach to community hospitals in 2011-2012.

improving the experience for the person ➔ Inform the delivery of QIPP plans.
➔ Provide a basis for discussion about
with dementia and their carer - it is easy to
CQUIN payments between
focus on one aspect like improving the commissioners and their providers.
environment, but in isolation this won't ➔ Inform Trust Quality Accounts.
make a significant impact. ➔ Be reflected in published Local Action
Plans to demonstrate delivery of the
National Dementia Strategy.
Patient and carer involvement will be
critical to the successful implementation of
How do these Standards fit with other
the Standards. In carers groups I've met, requirements?
there is a strongly held belief that all
experiences of hospital will be bad for the The Standards are aligned to:
person with dementia, and they like all the ➔ Liberating the NHS: Transparency in the
outcomes - a framework for the NHS.
good ideas about change but are sceptical
➔ Care Quality Commission (CQC) core
about how much difference will be made. quality and safety standards with key
There are a growing number of ‘Dementia aspects of good dementia care.
Care Mappers’ in Gloucestershire, and I ➔ National Institute for Health and Clinical
Excellence (NICE) Quality statements.
believe that this is a powerful tool that if
➔ National Audit of Dementia (Care in
done sensitively will help healthcare General Hospitals) 2010/11.
professionals understand how to improve ➔ South West Strategic Framework for
the wellbeing of patients with dementia Improving Health 2008/09 to 20010/11.
and so make a difference.

Helen Vaughan
➔ South West Strategic Health Authority
2010 Performance Assessment
Framework for delivery of the National
Dementia Strategy.
Commissioning Development Manager,
Dementia, NHS Gloucestershire

www.southwestdementiapartnership.org.uk 6
Living well with dementia bulletin Issue 4 February 2011

How will these Standards be achieved?

➔ The Standards will be locally owned and


implemented.
➔ Each hospital will undertake a self-
assessment of current practice against
the Standards and agree an action plan.
➔ Some Standards will be directly within the
control of ward staff. Others may require
additional input from the NHS, social care,
and local partners.
➔ Greater engagement of patients, family,
carers, friends and a range of volunteers
is fundamental to success.
➔ The dementia Ward Champion role is
recommended. Clinical champions and
hospital Board-level leads will drive
quality improvement and report on the
necessary changes.

How will these Standards be assured? How will these Standards be widely
known and recognised?
➔ For each Standard listed there are
measures or indicators described to ➔ These Standards have been produced in
inform the monitoring of the a variety of formats for staff, patients, their
implementation of the Standard. Agreed families, carers or friends, to help people
audit processes will be connected to to understand them and hold services to
hospital governance arrangements. account.
➔ The feedback from patients, relatives, ➔ The Standards are presented in a format
carers and volunteers as well as staff that will assist staff delivering care on
delivering care will be vital in ensuring wards as well as assisting commissioner /
these Standards are being delivered. provider discussions.
➔ The dementia Ward Champion and ➔ There has been widespread distribution of
Clinical Champion will be well placed to information about the Standards to cover
ensure there is a process for measuring all interested groups and organisations in
the Standards. the South West.
➔ The local dementia improvement group ➔ Clinical and Ward Champions will be
will need to be assured of the monitoring asked to use every opportunity to aid the
arrangements and outcomes. understanding of these Standards, and
➔ South West general hospitals will take ensure that training and education
place from September 2011 to January programmes delivered within hospitals
2012, and the findings will be published. promote delivery.

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Living well with dementia bulletin Issue 4 February 2011

“ These Standards are the key to


improving patients’ and carers’ experience.
We expect to achieve improved patient
survey results - both real time and
national; we also expect to see a decrease
As lead for our acute trust, these in length of stay.
Standards not only help us to benchmark
our services but help the clinical teams
There are many challenges facing our
focus on what is important to our patients
health and local authority economies, but
and their carers.
the demand for improved dementia care is
ever increasing. We need to meet these
The Standards require the involvement of
Standards so that the voice of people with
all staff, both clinical and non-clinical, and
dementia, and their carers/families, is
as such will help us in achieving improved
heard and the quality of care provided is


patient outcomes, which in turn benefits us
the best we can achieve.
all.

Maggie Arnold
With senior managers having and owning Director of Nursing, Gloucestershire Royal
the responsibility for implementation, we Hospital NHS Foundation Trust
will monitor their actions and also the
responses from patient and carer surveys.

Gloucestershire Royal Hospital NHS Foundation Trust display stand, National Dementia Day

www.southwestdementiapartnership.org.uk 8
Living well with dementia bulletin Issue 4 February 2011

Implementation as a continuous improvement cycle


The work to implement the Hospital Standards should be seen as a continuous improvement cycle
as illustrated in the diagram below.

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Living well with dementia bulletin Issue 4 February 2011

Timetable and next steps Step 4: Peer Review

Step 1: by 31 January 2011 The Regional Expert Rerefence Group will


undertake a peer review of dementia care in
The responsible NHS commissioner should
general hospitals, in the period September
coordinate arrangements to ensure that these
2011 to January 2012. The purpose of the
Standards are presented to relevant leads and
review is to engage with local leadership and
groups established to support implementation
stake holders; validate the self-assessment
of the National Dementia Strategy (NDS). This
process and update the hospital’s position;
should include any sub group focussing on
review the hospital improvement plan; and
delivery of Objective 8 of the NDS, improved
identify and disseminate positive practice. A
quality of care for people with dementia in
report of the peer review will be produced for
general hospitals. Members of these groups
each stakeholder group, and an overview
should ensure that the organisation they
report of the implementation of the South
represent is briefed about these Standards.
West Hospital Standards will be published. A
briefing will be produced for the South West
Step 2: January 2011 to March 2011 Dementia Partnership, and the NHS South
Each general hospital should undertake a self- West Board.
assessment of current practice against the 8
Standards outlined below, using the NHS Step 5: by 31 March 2012
South West Self Assessment Framework for The hospital improvement plan should be
Dementia Care in Hospitals. reviewed at agreed intervals by
commissioners with hospital NDS leads,
Step 3: by 30 June 2011 governence and implementation groups, and
The results of this self-assessment should be the priority areas for action to deliver the
presented and discussed with the members of Standards should be determined. This should
the relevant local NDS leads, governance and take into account the final report of the
implementation groups, and the priority areas National Audit of Dementia Care, due to be
for action to deliver the Standards should be published December 2011, and the outcome
determined. of the regional peer review.

A comprehensive hospital improvement plan A comprehensive general hospital


for the period 2011/12 should be agreed, improvement plan for the period 2012/13
including monitoring and governance should be agreed, including monitoring and
arrangements, accountabilities, milestones governance arrangements, accountabilities,
and key dates for reporting to key leads and milestones and key dates for reporting to key
group/s. Hospitals, with their commissioners leads and group/s. General hospitals should
and local stakeholders should also indicate also indicate when they will be publishing the
when they will be publishing the outcomes outcomes and arrangements for continued
and arrangements for continued improvement. improvement.

Commissioners are asked to submit a copy of


Commissioners and service providers should
the hospital improvement plan to NHS South
aim to extend the implementation of the South
West, by 30 June 2011.
West Standards for hospital care within
community hospitals, by March 2012.

www.southwestdementiapartnership.org.uk 10
Living well with dementia bulletin Issue 4 February 2011

31 March 2012 Step 5: development of Community


Hospital Dementia Care Improvement
Plan 2012/13 including milestones,
targets, and dates for continuing
monitoring.

Sept-Dec 2011 Step 4: Regional Peer Review takes place.


Review National Dementia Audit results
(Final Report, published Autumn 2011);
review delivery and implementation of
improvement plan. Continue to monitor.

30 June 2011 Step 3: development of Hospital Dementia Care


Improvement Plan 2011/12 including milestones,
targets, and dates for continuing monitoring.
Submit to NHS South West.(See Annex 3: South
West Hospital Standards in Dementia Care
improvement plan template)

31 March 2011 Step 2: Self-assessment: review standards; review


National Dementia Audit results (Interim Report); Core
Audit report. Collect and review additional data and
evidence to inform delivery of standards, where
required. Produce report for stakeholder group.

31 Jan 2011 Step 1: Lead dementia commissioner convenes group to


review dementia care in hospitals. Agree terms of reference;
links with hospital governance structures; communications
plan. Review data; identify additional information required;
agree action plan and next steps. (See Annex 2: South West
Hospital Standards in Dementia Care self-assessment
template)

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Living well with dementia bulletin Issue 4 February 2011

Implementation tools and resources


A range of implementation tools, local audit tools and promotional materials are available to
support the South West Hospital Standards in Dementia Care. You can download them at
www.southwestdementiapartnership.org.uk/hospital-standards/

Implementation
tools

n al
io s L
ot ial au oca
r to d l
r om ate ol it
P m s

South West Hospital Standards in


Dementia Care
⚑ Full Report
Local audit tools:
⚑ Executive Summary
NHS Gloucestershire has shared audit
Implementation tools: tools developed to support the monitoring
⚑ Implementation guidance and assesment of the delivery of the
⚑ Annex 1: Links to national resources standards of care locally.

⚑ Annex 2: Self assessment template We encourage local improvement teams


⚑ Annex 3: Improvement plan template to share the local audit tools that they
develop. Please send them by email to
Promotional materials: hospitalstandards@southwestdementiapa
⚑ Summary presentation rtnership.org.uk.
⚑ Standards diagram
⚑ Standards wall chart
⚑ Dementia ward champions job description

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Living well with dementia bulletin Issue 4 February 2011

inform the named nurse of any areas for


Innovative practice across the region improvement.
This section provides brief details about ➔ Support the dementia clinical audits and
innovative practice in improving the quality of the implementation of actions from the
care for people with a dementia while in findings.
hospital. Further detail will be made available
Further information: Rob Conway, Matron,
at www.southwestdementiapartnership.org.uk/
Emergency and uplanned care division,
hospital-standards/. If you would like to share
Taunton and Somerset NHS Foundation Trust.
information about a local innovation please let
Telephone: 01823 343856. Bleep 2007.
us know by email hospitalstandards@south
Robert.Conway@tst.nhs.uk
westdementiapartnership.org.uk.

Dementia liaison in Cornwall


Somerset Dementia Ward Champions
Cornwall’s dementia liaison team is ensuring
A number of hospitals are adopting a that cognitive assessments are now routine on
Dementia Ward Champions in addition to a admission to hospital. Working with staff in
senior hospital clinical lead. Dementia hospitals and care homes, the service is
champions will be well placed to ensure there helping to improve patient experience by
is a process for measuring delivery against facilitating timely, appropriate discharge and
the Standards. reducing unnecessary transfers.
Further information: Beverley Chapman,
The Dementia Ward Champion role has been Cornwall and Isles of Scilly Primary Care
developed at Musgrove Park Hospital, part of Trust, beverley.chapman@ciospct.cornwall.
Taunton and Somerset NHS Foundation Trust. nhs.uk
The Dementia Ward Champions:
➔ Provide a single point of contact for the
ward team caring for dementia patients,
to cascade information from the
dementia working group to their own
clinical area.
➔ Provide an essential link between
practice areas across the hospital.
➔ Are vital in supporting the hospital to
execute its responsibilities to safeguard
patients with dementia.
➔ Know the named and designated leads
for dementia and know how to access Bath Hospital Dementia Charter Mark
them. The Royal United Hospital Bath NHS Trust
➔ Alert the named nurse to any serious or dementia strategy working group has
significant incident or concern relating to developed a Dementia Charter Mark to
the welfare of a patient with dementia. improve the quality of care for people with
dementia. Ward staff are encouraged to: learn
➔ Identify gaps in service provision and
more about how to care for people with

www.southwestdementiapartnership.org.uk 13
Living well with dementia bulletin Issue 4 February 2011

dementia; improve the ward environment, Further information: Frank Herrity, Avon and
better meet patients’ nutritional needs, and Wiltshire Mental Health Partnership NHS
ensure there are suitabilelevels of staffing. Trust, frank.herrity@awp.nhs.uk Tel. 0117
342234
Further information: Dr Chris Dyer, Royal
United Hospital Bath NHS Trust,
chris.dyer1@nhs.net, 01225 821008 Dementia education and training in
Devon
South Devon Healthcare NHS Foundation
Specialist day unit provision in Dorset
Trust has a comprehensive dementia training
The Barnes Unit at Dorset County Hospital, and education programme. It includes
part of Dorset County Hospital NHS dementia awareness sessions for all levels of
Foundation Trust, provides a supportive staff including a pocket guide on how to
environment for patients with mild cognitive communicate with people with a dementia in
impariment or dementia as they receive 12 steps. The programme also includes
medical treatment for other health conditions. workshops that cover all aspects of care from
Staff are on hand to care for dementia patients ‘What is dementia?’ to ‘End of life care’.
using reminiscence therapy, memorabilia, and
other effective approaches. They help to ease
In addition, a forum for link nurses meets
the concerns of possibly confused elderly
quarterly and members are encouraged to
patients as they receive treatment for their
make small changes of practice relevant to
health problems.
their own area. The Trust are in the process of
Further information: Debbie Baxter, Barnes facilitating a knowledge unit aligned with the
Ward Head Sister, Dorset County Hospital Skills for Care Qualification and Credits
01305 255213 Framework. The Trust also plans to evaluate
its 20 credit degree module run with Plymouth
Mental health liaison in Bristol University.

The mental health liaison team works in wards Further information: Maggi Douglas-Dunbar,
where there is a high proportion of people with South Devon Healthcare NHS Foundation
mild cognitive impariment or dementia. The Trust, maggi.douglas-dunbar@nhs.net, 01803
team offers rapid specialist mental health 655859
assessment and follow-on reviews
alongside treatment of the primary condition
leading to admission, resulting in increased
accuracy of assessment, diagnosis and
timely and appropriate treatment.
Collaboration with hospital social work and
discharge nurse teams helps maintain the
independence of patients with dementia,
increasing return home rates, reducing
lengths of stay where appropriate and
resulting in fewer unnecessary delays and
readmissions.

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Living well with dementia bulletin Issue 4 February 2011

Plymouth 10 minute teach aim is that everybody should be able to teach


Plymouth memory service assisted by Dr San the slides. This enables teaching ‘dementia for
Sreenath has developed a core knowledge set profession by profession’ starting with core
about dementia for the workforce. Topics base knowledge. Slides are randomly
covered include: neurological examination, allocated to staff through a ‘tombola’ to make
bloods, the geography of the brain, scans and it fun. This has created a safe space for
terminology. people to ask questions and learn about new
approaches and evidence based practice.

The topics are introduced during the end of Further information: Kate Anderson, Clinical
weekly team meetings using a slide set. The Psychologist, NHS Plymouth,
kate.anderson@plymouth.nhs.uk

South West Expert Reference Group for


Dementia Care in Hospital
The ERG is leading on a range of work ➔ working with the End of Life Care
priorities throughout 2011/12. programme, to review and improve
standards in end of life care for people
This includes:
with dementia.
➔ supporting and monitoring the ➔ reviewing and producing information for
implementation of the South West people with memory problems, their
Hospital Standards in Dementia Care. carers, families and friends.
➔ developing a route map for the individual ➔ commissioning a project to improve
journey – as a guide to ensure that a volunteering in hospitals.
person with dementia receives the right ➔ disseminating positive practice, including
assessments, treatment and care at all the production of a series of themed
stages regardless of whether they are in bulletins and resources for hospital staff.
hospital for planned care or as an
➔ hosting a regional conference jointly with
emergency and whatever the reason they
the Royal College of Psychiatrists on 05
are in hospital.
July 2011 to review the findings of the
National Audit of Dementia Care in
Hospitals, and focus on positive practice.

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Living well with dementia bulletin Issue 4 February 2011

Forthcoming ERG meetings Further information

➔ 04 April 2011 - focus on workforce Further details about the ERG work, members
development and the role of volunteers and meetings are available via the Partnership
and voluntary agencies. website at www.southwestdementia
➔ 05 July 2011 - regional conference jointly partnership.org.uk/hospitals-erg
with the Royal College of Psychiatrists to
review the findings of the National Audit of
Dementia Care in Hospitals, and focus on
positive practice

More information The Alzheimer’s Society website


www.alzheimers.org.uk offers a wide range
The South West Dementia Partnership of fact sheets, studies, discussion forums,
website www.southwestdementia advice and sources of support.
partnership.org.uk provides further
information about implementing the strategy Regional leads
along with examples of innovative practice.
➔ Catherine Pascoe, Policy
The National Dementia Strategy Implementation Project Manager,
website www.dementia.dh.gov.uk provides Department of Health South West,
access to the latest national policies and catherine.pascoe@swdc.org.uk, 07920
research findings. 207106
➔ Kate Schneider, Programme Lead,
The Dementia Gateway Mental Health and Wellbeing; Dementia,
www.scie.org.uk/publications/dementia/ South West Strategic Health Authority,
produced by the Social Care Institute for kate.schneider@southwest.nhs.uk,
Excellence(SCIE) offers high quality 01823361227, 07973732766.
information, video and training programmes.

A partnership to promote living well with dementia

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