Dementia: From difficult conversations to better outcomes

ContactDr Nicola Decker, Clinical Lead for Dementia, North Hampshire CCG
Telephone01256 770212
AddressCentral 40, Lime Tree way, Chineham Business Park, Basingstoke, RG24 8GU

This project aims to affect behaviour change amongst health and social care staff in Hampshire so they are better equipped to support people with dementia and their carers to achieve their care preferences to the very end of their lives.

The project will provide training through a voluntary sector provider for GPs, Primary Health and Acute Hospital Staff and Care Home Staff to identify, initiate discussions, undertake advance care planning and share information amongst relevant teams so that people affected by dementia are cared for in their place of choice with the interventions they choose. The project will support the improvement of dementia care and ensure both patient and carer access to appropriate services.


The project will address the current inequality in service provision for people with dementia and will:

  • Adopt and adapt the National Council for Palliative Care (NCPC) evaluated model of GP training to be dementia specific
  • Train 300 staff across care settings in dementia specific communication skills and the core principles of good end of life care
  • Train 40 staff to facilitate their own training sessions within their own organizations and localities
  • Include people with personal experience of dementia in the training sessions to motivate and educate staff

The programme will include

  • The case for change including a personal account from a person with dementia or a carer
  • Dementia specific communication skills to increase the confidence of staff to initiate and undertake end of life care conversations
  • Use of national and regional care planning tools
  • Involving people with personal experience in the design and delivery of your services
  • Shared decision making
  • Legal and ethical issues to consider including resuscitation, loss of capacity and power of attorney, best interest decision making

The resource pack will include a number of dementia specific resources produced by NCPC including:

  • Time to talk – a leaflet for patients, carers and staff
  • Difficult Conversations – communications guidance produced in partnership with people with dementia and their carers
  • Out of the Shadows – End of Life Care Guidance for Commissioners and Providers of end of life care for people with dementia
  • Planning your future care – a guide to end of life care decision making
  • Your guide to decisions about cardiopulmonary resuscitation (CPR)
  • A dementia specific communication skills DVD to help initiate and undertake end of life care conversations
  • A range of Dying Matters leaflets and posters to help with conversations

The training will:

  • build on current communication skills training for health and social care staff and will be developed jointly with the End of Life Care Programme and North Hampshire End of Life Care Strategy Group ensuring an integrated approach building on, rather than replicating current achievements
  • Communicate the learning at all levels including feeding into national working groups as well as local networks
  • Ensure a good cross section of staff including 1 GP from each of the 22 GP practices (aimed at those who liaise with care homes as a priority), care home managers and clinical staff from acute elderly care and community services + a range of staff delivering care on the ground
  • Achieve and evaluate sustained behaviour change
  • Act as an evaluated model of good practice to be replicated in other CCG areas

The project will:

  • Address the QIPP areas for end of life care for this particularly disadvantaged group
  • Inform the outcome measures in the dementia strategy
  • Increase the confidence of health and social care staff to identify dementia patients and initiate conversations about their future care wishes to enable these to be met
  • Enable people to maintain choice and control over their future care
  • Affect sustainable behaviour change, such that consideration of care planning and joint decision making with patients become routine
  • Link into and support the ‘Find your 1%’ GP Campaign to help GPs identify the likely 1% of their practice population who are in the final year of life, place them on a register and provide them with better coordinated end of life care (there is currently huge inequity in those identified as end of life with very few people with dementia appearing on the registers)
  • Provide better coordination of care between provider organizations
  • Improve communication across disciplines and care settings
  • Ensure that patients are cared for in their preferred place of care, their care choices and treatment options met and unnecessary interventions and crisis acute care admissions are avoided

The project will take 12 months to complete including an evaluation of behaviour change.

Anticipated outcomes

  • People with dementia will be offered choice and control over their future care
  • People with dementia will have peace of mind that their wishes will be communicated and respected wherever possible
  • Family and carers will have peace of mind that their loved one will be cared for according to their wishes
  • Staff will be informed, motivated and skilled to meet the wishes of their patients
  • Improve the % of people with dementia placed on end of life care registers (research shows that people on these registers receive better coordinated care)

Progress update

Working with the National Council of Palliative Care these workshops, which are based in GP surgeries are giving GPs a chance to discuss and work through many of the challenges and obstacles in delivering excellent care for Dementia patients. There has been very good engagement in the project.