A new report setting out how staffing gaps and lack of training are impacting people living with dementia in England has prompted fresh calls for investment in specialist nurses.
The Care Quality Commission (CQC) has today published a report on the experiences of individuals with dementia using health and care services across the country.
“This report shines a light on the challenges that people with dementia and those who care for them face”
James Bullion
It highlighted severe staffing shortages, a lack of dementia-specific training for nurses and delayed patient diagnoses, alongside examples of good practice.
The findings were based on engagement with people living with dementia and their loved ones, as well as an analysis of data held by the CQC.
The regulator found that around two-thirds of care homes support at least one person with dementia and, in around a third of care homes, the majority of residents have the condition.
Care homes with a higher number of people with dementia were more likely to report staffing issues, “which can prevent people from receiving high-quality care”, said the report.
In the care homes analysed, as the proportion of people with dementia increased, staff-to-patient ratios decreased, staff turnover increased and there were fewer qualified staff.
It comes as the Department of Health and Social Care estimates that the number of people living with dementia across England is around 700,000.
The CQC warned that diagnosis delays were increasing as services struggled to meet demand due to insufficient staffing.
Respondents described “a lack of ongoing care and support for dementia in the community”.
One said: “There does not seem to be ongoing care for people living with Alzheimer’s disease, or their carers.
“I have had to seek out community charity support groups. We have not seen a doctor, consultant or nurse on an individual basis for over a year.”
Meanwhile, the report found that acute hospital staff “do not always understand the specific care needs of people with dementia”.
It warned the busy nature of an acute environment “can lead to the needs of dementia patients being overlooked”.
One respondent said: “Being the wife of [a patient], I did feel that doctors and nurses did not fully understand patients with dementia.
“I realise this was not a purely dementia ward, but felt a little more understanding should be given.”
“It’s vital that the findings from this work help to drive real improvements to dementia diagnosis and care”
Jen Keen
The report also identified positive examples of dementia care, noting that this was most likely to happen “in considered environments by well-trained, compassionate professionals”.
Providers recognised the need to improve staff knowledge of effective dementia care, with some enrolling their staff on specific training.
One said: “We have introduced training support from a registered mental health nurse to support staff with information and training specific to people with dementia.”
Adult social care providers also told the CQC that they often made referrals to specialist dementia services, including dementia specialist nurses.
Similarly, providers reported engaging with dementia care and research charities for specialist support and guidance.
One provider said of a patient: “He requires support from several multidisciplinaries, including the dementia team, Parkinson’s nurses, Macmillan nurses, the diabetic nurse and the GP.
“Having an established relationship with the above allows us to access specialist care and advice as required.”
Caroline Scates, deputy director of Admiral Nurse development at Dementia UK, told Nursing Times that the report “shines a light on some of the pressing issues” contributing to poorer health outcomes for people with dementia.
She said: “For too long, health and social care services have experienced a chronic lack of funding, leading to an overstretched system with staff burnout and leaving people living with dementia unsupported and facing excruciating delays for care.
“This, coupled with the complexities of dementia and the lack of understanding regarding the needs of those living with it, can lead to carer overwhelm and crisis.”
Admiral Nurses – specialist dementia nurses supported by the charity – “play a critical role in closing this gap”, argued Ms Scates.
She added: “They work closely with families with dementia as well as health and social care professionals to ensure that people receive the care and support that they need.”
As such, Ms Scates called for increased sustainable funding for specialist dementia nurses, reduced waiting times for local care assessments, and improved access to person-centred support in the community.
The findings of the CQC report will inform the regulator’s new dementia strategy.
As part of this, the CQC is set to produce statutory guidance for providers on how to care for people with dementia, as well as a definition of good practice.
James Bullion, interim chief inspector of adult social care at the CQC, said: “This report shines a light on the challenges that people with dementia and those who care for them face when accessing and using health and social care services.
“It also highlights the practice that some services are taking to improve people’s lives and those who care for them.
“We will use the findings from this report to develop, alongside people with lived experience, providers and other stakeholders, a definition of what good, joined-up dementia care looks like so that we can apply it to all areas of our regulatory activity.”
The publication of this report has coincided with Alzheimer’s Society’s Dementia Action Week.
Jen Keen, Alzheimer’s Society’s associate director of evidence, policy and influencing, welcomed the report and the CQC’s commitment to developing a dementia strategy.
She said: “It’s vital that the findings from this work help to drive real improvements to dementia diagnosis and care, including a statutory duty for dementia-specific training for all care providers registered with the CQC, as well as a long-term social care workforce strategy.
“We want to ensure people living with dementia can access safe, affordable, high-quality care delivered by a well-trained and fairly paid workforce.”
