1. Rachael Mercer, Speech and Language Therapist, Outpatient Team
Outpatient SLT Provision for People with Dementia and Their Carers
Rachael Mercer, Speech and Language Therapist, Outpatient Team
Introduction 
Dementia is currently a priority for the Scottish Government. They have produced national targets, Local Delivery Plan (LDP) standards (priorities that are set and agreed between the Scottish Government and NHS Boards) and commitments designed to help deliver change and improve services for people with dementia and their carers. The Royal College of Speech and Language Therapists (RCSLT) have also recently produced a Position Paper with recommendations for Speech and Language Therapy (SLT) provision for people with dementia. These new guidelines and standards inspired the SLT outpatient team to carry out a research project to determine how we can improve the provision of SLT to patients with dementia and their carers.
Results & Conclusions
This project was successful in achieving its aims.
Aim 1: Determine what our service should be providing based on new guidelines and policies:
 By conducting a literature search this project has determined that all of the guidelines and research advise that early intervention (post diagnostic support, information and therapy) and working closely with carers and the third sector is the best and most effective way to manage dementia.
Aim 2: Determine what our service currently provides:
The audit of referrals showed that our referral rate for patients with dementia is low. It also showed that the referrals that we receive tend to be for swallowing difficulties and, on average, are made over 2 years post diagnosis. This demonstrates a lack of understanding of the SLT role in dementia and the services that we could provide at an earlier stage. This is backed up by the piece of work that was carried out by Alison McKean (AHP project lead for post diagnostic support in GG&C) which showed that post diagnostic link workers (the person who provides the year post-diagnostic support that the government has guaranteed) do not know a lot about the different AHPs and what services they can offer/provide.
Aim 3: Scope what services are currently being provided – both by the third sector and other SLT services:
The scoping exercises demonstrated that currently the SLT team do not provide any input into post-diagnostic support services, therapy is provided on a 1:1 basis and there are no group therapy or information/training sessions carried out. At the moment we do not provide any input into the services that are run by Alzheimer’s Scotland but they would be keen for us to be more involved with these.
Aim 4: Highlight areas for improvement.
Correspondence with an SLT from another health board has shown what can be done to improve the service for people with dementia and their carers, e.g. Establish links with post-diagnostic support teams, provide training about the SLT role in dementia, run groups and attend dementia cafes. An informal focus group at a local dementia café identified that people with dementia and their carers do not know about SLT or the support that can be provided for communication and swallowing difficulties. They were keen for general information/advice and felt that it would be beneficial to have this at a relatively early stage post diagnosis. We could work in conjunction with Alzheimer’s Scotland to provide this kind of input at their venues and groups. We could also provide more input for communication difficulties, rather than just swallowing, and this could be in a group format.
Aim
The main aims of this project were to:
1.  Determine what our service should be providing based on new guidelines and policies.
2. Determine what our service currently provides.
3. Scope what services are currently being provided – both by the third sector and other SLT services.
4. Highlight areas for improvement.
Method
Literature search to determine what we should be providing.
Scoping exercise to determine what is currently being provided; Interview with dementia AHP Consultant for GG&C (Christine Steel), interview with dementia advisor from Alzheimer’s Scotland (Kevin Black), attended a talk by Tommy Whitelaw (Dementia Carer Voices, The Alliance), correspondence with SLT (Jenny Keir) from NHS Tayside and a focus group with SLTs in outpatient team.
Audit of referrals made to outpatient SLT team for people with dementia. This was to determine how long post diagnosis the referral was made, who referred the patient, if it was the patient’s first involvement with SLT and if the referral was for communication support, swallowing difficulties or both.
World café with patients with dementia and their carers. This was to determine what patients and carers know about SLT and what they would like from our service.
Next Steps
The next steps are for the outpatient team to reflect on the outcomes of this project and consider which aspects the SLT department may be able to take forward. Below are some suggestions as to how the outcomes of this project may be taken forward:
 Establish more links with post-diagnostic support teams.
Build on the new relationships with Alzheimer’s Scotland.
Look at providing joint information/training sessions with Alzheimer’s Scotland.
To be more visible in local Alzheimer’s Scotland resource centres/cafes (perhaps quarterly attendance).
Pilot a conversation/communication group for people with dementia.
Input into current work being done by Alison McKean (AHP project lead in post diagnostic support) re. triggers for SLT referrals for link workers.
In the future, another audit of SLT referrals for patients with dementia would help to determine if carrying out the above “next steps” increases the number of referrals that we receive.
References
RCSLT Position Paper (2014) Speech and Language Therapy Provision for People with Dementia.
The Scottish Government (2016)
Acknowledgements
Eleanor Slaven (SLT and mentor for the project), the SLT outpatient team, the staff from Alzheimer’s Scotland (particularly Kevin Black, Margo Sweeney and Marilyn Boyd, Christine Steel (Dementia AHP Consultant), Jenny Keir (SLT) and the people with dementia and their carers who participated in discussions at the dementia cafe.