Two thirds of hospital staff think their training in dementia is inadequate

BMJ 2011; 343 doi: (Published 16 December 2011) Cite this as: BMJ 2011;343:d8227
  1. Matthew Limb
  1. 1London

Many hospitals in England and Wales are failing to care adequately for people with dementia, says the Royal College of Psychiatrists after an audit.

Its national audit of 210 hospitals has identified the need for “significant improvements,” including better training of staff in catering to patients’ needs.

Although it found that care was basically safe, too many patients with dementia endure distress in unfamiliar environments without sufficient help or communication.

The research, for the first audit of its kind, included questionnaires to 2211 staff, analysis of ward data, and observations of care by hospital staff.

It found that staff often failed to greet or talk to patients during care, explain choices to them, or in some cases respond to patients’ requests for help.

Peter Crome, chairman of the audit’s steering group, said it was clear that care of patients with dementia needed a “radical shake-up.”

He said, “The results of the audit overall suggest that the majority of hospitals have yet to consider and implement measures which would address the impact of the hospital experience on people with dementia and to assess the impact on the hospital of admitting people with dementia.”

The audit was carried out by the Royal College of Psychiatrists’ Centre for Quality Improvement, in partnership with other organisations. It looked at the quality of care received by people with dementia in general hospitals between March 2010 and April 2011.

At any one time up to a quarter of acute hospital beds are in use by people with dementia over the age of 65. Many with complex needs require access to specialist services.

For half of the audited hospitals (104 of 210) direct access to intermediate care for people with dementia could not be achieved.

The review says that a lack of mental health assessment during admission and at discharge showed that mental health needs were still often overlooked in general hospitals.

Only 12 (6%) of the 210 hospitals had a care pathway in place for people with dementia at the time of the audit, although 92 (44%) were developing one.

Just under a third of staff (713 of 2211) said that their training and development in dementia care was sufficient. Training in communication skills was rated insufficient by a half of staff, and 54% said that they weren’t trained adequately to deal with challenging or aggressive behaviour.

Very few wards demonstrated a culture that was “person-centred,” the review concluded.

Only 15% of wards (22 of 144 wards) used colour schemes to help patients with dementia find their way around the ward.

The audit report suggests that much could also be done at hospital level and ward level to improve nutritional standards.

The Royal College of Psychiatrists recommends that all hospital staff should receive basic training in dementia awareness and that some staff should receive higher level training.

Each hospital should have a senior clinical lead for dementia to implement and review the dementia pathway and identify dementia champions in each hospital department and at ward level.

Ward managers should ensure that staff members can involve people with dementia and their carers in discussions of care, treatment, and discharge.

Professor Crome said that it was good that several hospitals were implementing improvements in response to interim findings but that more action was needed.

“Hopefully, real change will be seen in the results of the next national audit, which is due to be published in June 2013,” he said.

The minister for care services, Paul Burstow, said that improving dementia care was a government priority.

“That is why we are putting in place a new financial incentive for hospitals that identify patients at risk so they get the specialised care they need,” he said.


Cite this as: BMJ 2011;343:d8227