Learning to Lead Excellent Practice in Dementia Care: Reflections from 1000 days teaching Professor Dawn Brooker Association for Dementia Studies Presentation HEE Conference Dawn Brooker Oxford Dementia Centre

The Association for Dementia Studies Established 2009 as a university research centre aligned with the National Dementia Strategy Multi-professional group of educationalists, researchers and practitioners Cutting edge contribution to developing evidence-based practical ways of working with people living with dementia, their families, friends and carers that enable them to live well. Using this evidence we deliver education programmes that empower people to provide skilled, competent and compassionate care University of Worcester Association for Dementia Studies 2

Association for Dementia Studies Director - Professor Dawn Brooker Early interventions and Primary Care Lead on Timely Diagnosis Recommendations for EU ALCOVE programme Development of Primary Care Dementia competencies In-depth evaluation of the Worcestershire Early Intervention Dementia Service & the Dementia Adviser Service Specialist Education Modules in Early interventions & primary care PhD research on Early Cognitive Change ADS is a multi-professional group of educationalists, researchers and practitioners with many years of experience in the field of person-centred dementia care and support. The perspective of people living with dementia, their families and their carers are intrinsic to the work of ADS at all stages.   We make a cutting edge contribution to developing evidence-based practical ways of working with people living with dementia, their families, friends and carers that enable them to live well. We do this primarily through research, education, scholarship and policy advice. We draw on and contribute to the international evidence base for person-centred dementia care. Using this evidence we deliver education programmes that empower people  to provide skilled, competent and compassionate care Excellence in person-centred care in care homes PIECE-dem observational framework for advanced dementia CHOICE – organisational culture and care experiences in care homes ‘Care Fit for VIPS’ free web-based toolkit for care homes www.carefitforvips.co.uk Specialist education modules in care home leadership and dementia specialists FITS – Focussed Interventions in Training and Support to reduce anti-psychotic prescribing; funded by the Alzheimer’s Society Living well with dementia Supporting people from all communities to live well with dementia ESRC Seminar Series: Age, Race and Ethnicity Connecting Communities Programme evaluation Innovative interventions to support people and their families, including new service model for RSAS. Development and evaluation of MEETING DEM in UK, Italy & Poland JPND/ESRC funded Research network and conferences in creative therapies and dementia. Understanding Dementia and sight loss: Dementia-friendly hospital care Development and evaluation of a suite of interventions including a care bundle approach with the Royal Wolverhampton Hospitals Trust Steering group membership of the National Audit of Dementia Partners in NIHR Delirium Programme and PIE observation tool Dementia Leadership and Specialist education modules in acute and community hospital dementia care. End of life care evaluation Supporting choice and control at home and in supported housing The Enriched Opportunities Programme The ASSET project – adult social care in housing with care schemes PhDs on direct payments in rural areas and on home-based support in Israel For more information please contact: dementia@worc.ac.uk, call us on 01905 542531 or visit our website at http://www.worcester.ac.uk/discover/association-for-dementia-studies.html

Association for Dementia Studies Core Team June 2013

University of Worcester Association for Dementia Studies The experience of people living with dementia and their families inform the work of ADS at all stages. University of Worcester Association for Dementia Studies

Bespoke courses – early adopters? Type of Commissioning Organisation Number of organisations (approx days) 2011-14 Types of providers covered Local authorities, city councils, county councils 8 (550) Care homes, dom care, extra care housing, mental health, acute hospitals NHS Trusts 10 (70) Acute hospitals, community hospitals, community health teams, early intervention team Care Providers (charitable, not for profit) 5 (140) Care homes, extra care & dom care Others: FITS programme 30 (100 plus 90) 100 care homes to reduce anti-psychotic prescribing

Number of participants Dates Specialist Managers Acute Primary care Other Total 01/09/12 – 31/08/13 307 193 58 41 48 647 01/09/13 – 10/01/14 234 85 17 - 15 351 541 278 75 63 998 This shows the number of participants completing a pre-course questionnaire © The Association for Dementia Studies

© The Association for Dementia Studies Job roles (3) 1187 responses from 998 participants. © The Association for Dementia Studies

Time spent working with people with dementia © The Association for Dementia Studies

© The Association for Dementia Studies Age information © The Association for Dementia Studies

The Challenge for existing workforce Overwhelmed Lacking knowledge about dementia Lacking skills to help The way services are set up work against people with dementia and their families getting the best help Delivering brief sessions that raise awareness of short-fall may actually make the situation worse University of Worcester Association for Dementia Studies

Leadership Historically education in dementia care has: Focused on training those at the ‘coal face’ of health and social care. Inspired staff to make changes only to be faced with barriers when returning to the work place One of those barriers is that the ‘leaders’ of the service do not recognise their crucial role in culture change. University of Worcester Association for Dementia Studies

Tiered Educational model The Association for Dementia Studies education programme is based on research that has considered ways of increasing the likelihood of services improving, and more importantly maintaining this improvement. University of Worcester Association for Dementia Studies

ADS TIERED MODEL OF DEMENTIA Leadership Managing Dementia Care Services (Leadership for managers) Dementia Specialist Practitioner (Leadership at the individual service user level) Fundamentals in Dementia Care (all staff) Start the education programme with the Managers Managers choose specialists to act as a co-partners in leading and embedding change Who are the Awareness sessions for? ADS mirrors the concepts presented in the PM’s Challenge i.e. that everyone should be ‘dementia aware’ including the general public.

Managing Dementia Care: leading the team (4-8 days) Senior staff / managers Provide clear vision, using VIPS framework. Ensure know what “good” looks like. Identifying priorities for change, who, what, when, how and identify barriers Person centred management style Increased confidence and competence to lead others and find solutions. Working across service boundaries. University of Worcester Association for Dementia Studies

Leading by example Dementia Specialists (5-10 days) Managers cannot make the change alone. This is where the second part of the model comes into action– the specialists. These are motivated staff members who are supported through the education programme to be specialists in their area in working directly with people with dementia and families. Chosen by managers to be part of the change in practice. University of Worcester Association for Dementia Studies

Specialist’s role Role model person centred care. Expert up-to date knowledge & tool-kit in their specific area Offer support and guidance to other staff. Develop other staff through a coaching model. Act as a link between leaders and other staff members. University of Worcester Association for Dementia Studies

4 key elements of learning 1 Interactive Workshops; hearts & minds 2 Self Learning / Inquiry relating to specific work setting 3 4 Putting into Practice –Trying out new ways of working completed project (university module 20 credits) University of Worcester Association for Dementia Studies

Reflections on knowledge The lack of knowledge and confidence, even at senior levels, is serious There is an active dynamic between attitude change and knowledge acquisition Aim to support staff to operate with clarity, creativity, and resilience and rather than with insecurity and doubt. 

Reflections on People This is an experienced and intelligent work-force Need to equip staff to make good decisions not to think there is an instruction to follow Recognise changing the culture of care is about people’s hearts and minds. This is a people service; tools need to be well cared for, staff need to feel valued for a job well done.

Reflections on change Research consistently points to  the high failure rate of change initiatives - not because of poor strategies or funding but rather a result of poor attitudes and behaviours. The combination of empowering leadership at management and specialist level is powerful Once these are unlocked the potential for change is great

Reflection on whole system working By having leaders who can remove the grit that is blocking  the system  we can support sustainable change within and across organisations. Dementia is complex – all staff need to know who to call on when they are out of their depth Competence needed across the whole system – eg If GPs or mental health services are not competent/ accessible even the best skilled care services struggle.

Care Fit for VIPS website www.carefitforvips.co.uk Dementia Pledge

Thank you for listening! Professor Dawn Brooker University of Worcester Association for Dementia Studies d.brooker@worc.ac.uk http://www.worc.ac.uk/discover/association-for-dementia-studies.html Photographs of people living with dementia taking part in ExtraCare Charitable Trust Enriched Opportunities Programme University of Worcester Association for Dementia Studies