North Lanarkshire Living With Dementia

Summary

This initiative is aimed at those living at home with dementia as well as other people who are undergoing memory assessment.  It is a partnership approach between the Scottish Fire and Rescue Service (SFRS) and NHS Lanarkshire’s community mental health team for older people (CMHT/OP) who are responsible for memory service in Motherwell. This facilitates critical delivery of fire safety advice and assistance to older people living in the Motherwell area of North Lanarkshire who are living with a range of memory difficulties.   

When encountering an older adult in the Motherwell locality, at an incident or whilst carrying out other duties, (who appears to be exhibiting behaviour that would suggest they had a memory difficulty or some level of confusion), SFRS personnel are able to directly discuss or refer this individual to the memory service nursing staff.

This allows the memory service staff to check if that individual is known to their service and if so, to assess if a review of a person’s care is required. In some cases an incident that SFRS has been called to may have arisen due to a person’s condition deteriorating and a referral may go some way to putting measures in place to prevent another similar incident from recurring. 

It may also highlight individuals who may not had received input and could initiate assessment and formal diagnosis to take place allowing earlier access to treatment and support.   

The memory service had proposed that to aid and assist crews in identifying people who have dementia or any other cognitive impairment, they attended Motherwell Community Fire Station to carry out awareness sessions for each Watch enabling them to gain invaluable information, advice and support.

The CMHT/OP staff will embed new practice to ensure all newly diagnosed patients with mild cognitive impairment and dementia (who have consented) will be offered and those agreeable will receive fire safety visit and be added onto SFRS fire safety awareness database to inform fire officers of any potential difficulties during future visits or evacuation.

Need for Initiative

Scotland’s first National dementia strategy (2010) cited the need for closer working with partners in health and social care, statutory, voluntary and private sectors to identify best levers for changing and improving the entire system of dementia care. Two thirds of people who have a diagnosis of dementia currently live at home – Alzheimer’s Society (2018) this highlights the important role frontline services have in supporting this group of vulnerable adults.  

Initial partnership discussions between CMHT/OP and SFRS staff prior to initiative commencing highlighted that poor communication between services often led to a delay in treatment/intervention for people living within the community with a diagnosis of dementia. Home fire safety referrals were made only by memory service staff where potential risk has been highlighted and it was decided that a proactive approach to offering this service to all would facilitate best practice and increase safety outcomes for all.

North Lanarkshire SFRS LSO area recognised that this initiative would assist in:

• Contributing towards Scotland’s casualty reduction targets to 2020.
• Reducing the number of those living at home with dementia from experiencing a fire in their homes or suffering a fatality – by CMHT/OP streamlining home fire safety referrals.
• Increasing awareness of the dangers and needs of living with dementia and other cognitive impairment.
• Enabling people with cognitive deficit to remain within their own community, within a safe home environment for longer.

Delivery 

This project aims to deliver clear partnership working between two services and has several delivery aims. SFRS personnel who encounter an individual who is exhibiting behaviour or confusion that would suggest they had a memory difficulty or cognitive impairment, could contact the CMHT/OP for support and advice. The nursing staff would check if the identified person if open to memory service staff and if so, assess if a review of that individual’s care is required. 

Currently, for people who are in need or at risk, a form is filled in and submitted to Social Services by SFRS personnel. However, following a submission of an AP1 referral to Social Services Department, it can take up to 6 weeks before a patient could be referred to the Memory Service. This initiative can therefore speed up that process facilitating quicker access and support for this group. 

Memory service nursing staff will now pro-actively offer all older adults with a dementia diagnosis a home fire safety visit as well as deliver written fire safety advice as provided by fire officers within Motherwell. Having written information allows the person with a cognitive deficit who may be unable to retain advice – an aid memoire for simple fire safety advice.

CMHT/OP Memory service nurses will attend Community Fire station (Motherwell) and provide information, support and advice re memory deficit to every ‘Watch’ to inform practice and build relationships and increase confidence in joint working.

Successes and Challenges

This initiative has increased understanding and knowledge of SFRS personnel of those living with dementia.  It provides an opportunity to engage with those with dementia with confidence through partnership engagement and home visits – providing best outcomes for all.

Impact/Change

MHT/OP nursing staff have noted that as little as 10% of patients who received a diagnosis of dementia were referred for home fire safety visit prior to commencement of this project – this has increased to 63% within the first year a vast increase in safety outcomes for this vulnerable group.  

The Lead Officer will be carrying out a review of Home Fire Safety Visit referrals to the Memory Service in order to monitor progress.

Reflections

Following review and initial evaluation within Motherwell, the project was presented to NHS Lanarkshire’s older adult clinical governance group for mental health and learning disabilities. This multi-disciplinary group discusses all aspects of care for our older adults within Lanarkshire, and jointly agree upon best practice. The value of the project was recognised and as such NHS practice improvement and development staff are working to expand the project throughout all CMHT/OP teams within North Lanarkshire, extending to the South Lanarkshire thereafter. As such, operational talks are taking place with relevant SFRS personnel to complete rollout, which will commence this summer.

There have been some challenges along the way, with staff personnel changes within both services, however we have managed to keep momentum going and continue to move forward. Both partners feel the benefit of closer collaboration and intend to continue the good work moving forward with the project expansion.

Additional Information

The Living Well with Dementia Referral Form is available to upon request.

Author and Contact Details

Martyn Brandrick
Group Manager
martyn.brandrick@firescotland.gov.uk

Hazel Boyle
Community Nurse
hazel.boyle@lanarkshire.scot.nhs.uk