#hellomynameis

Carrie Jackson and I am the Director of the England Centre for Practice Development, a unique national centre for applied health research, practice development and innovation focusing on the achievement of person centered safe and effective care across many contexts and countries.  The Centre, launched in September 2012 runs a range of innovative programmes that focus on transformation through embedded research, learning, development and improvement specifically linked to clinical and systems leadership, culture change, safety and quality as far afield as Australasia.  We achieve our reach and impact through well-established strong partnerships with an extensive network of diverse collaborators internationally including Visiting Scholars, International Fellows and Partner Organisations.  http://www.canterbury.ac.uk/health-and-wellbeing/england-centre-for-practice-development/visiting-scholars-network/visiting-network.aspx. 

One of our most recent initiatives was the launch of an International Community of Practice (ICoP) for End of Life Care committed to supporting the public, communities,families, practitioners, researchers and policy makers to work together to create dignified and compassionate end of life care services that support individual’s wishes in the last 12 months of their lives regardless of age.  This initiative has enabled us to become partners in a new EU funded project that is especially dear to my heart as my mother was diagnosed with mixed dementia in 2013 and as her main carer and a nurse, I am committed to finding cutting edge practices that will support others and enhance our collective understanding of how to transform our existing services to meet the growing demand for future.  I want to make sure we share best practices and learn from others about different social models of care at the heart of our communities that offer advice and support when we most need it (see https://carolynjacksonblog.wordpress.com/). So I am delighted to tell you about our involvement in a new project called CASCADE- Community Areas of Sustainable CareAnd Dementia Excellence in Europe

An innovative new EU project called CASCADE has received funding to improve dementia care in the United Kingdom,Belgium, the Netherlands and France. The England Centre for Practice Development is leading on the evaluation work package of this exciting project worth €9,295,278 of which €5,577,167 comes from the European Regional Development Fund with the rest being match-funded by partners.

Finding the best way to look after a growing elderly population,especially those affected by dementia is a constant challenge for health services across Europe. The 65+ age group is rising from 18.2% of total EU population to 28.7% by 2080, creating an explosion in demand for older persons care services, currently unmet appropriately. Older patients are often 'parked' in expensive hospital beds as there is no suitable local service provision. Dementia services cost the EU €130bn per annum; and 3 of the 4 countries participating in this study have higher than average dementia rates >1.55%. To avoid overwhelming health systems, new approaches are needed for elderly/dementia care (EDC) across all ages with wide applicability across different cultural/social settings which crucially must be financially sustainable. The overall objective of the project is to develop a financially sustainable approach to elderly/dementia care (EDC) that can be replicated across Europe.Uniquely this will be tested via existing state owned buildings. The facilities created will provide short term respite & longer term care & will fully engage with the local community creating a model that provides appropriate care at every point on the continuum... The approach will have wide applicability & play a significant role in addressing the increasing demand. The outcome will be a step change improvement in EDC in Europe enabling communities to live well with a continuum of porous facilities aimed at supporting people to live in their own home as long as possible.

In the UK,the CASCADE project will work in partnership with East Kent University Hospitals NHS Foundation Trust and Medway Community Healthcare to provide funds for existing housing stock owned by the NHS to be updated and converted to provide ‘state of the art’ short-term respite and longer-term care facilities,which are fully integrated into their local communities in Dover and Medway towns. Both communities have a high degree of social deprivation and unemployment and the vision will be to provide opportunity for the community to come together to provide employment and volunteering, working with schools and colleges to promote inter generational support for the communities to live well with dementia and other long term conditions.

These new centres in the region will also contain sophisticated e-learning and online consultation facilities linking them to expertise across Europe and provide cross-border inter professional centres of excellence for dementia care in the future. These, together with a new integrated care model developed in the Netherlands will be tested in 3 additional countries in both urban and rural contexts to see if it is transferable to other settings once necessary adaptations are made. Once refined, it is intended that the model will be freely available to all who wish to use it subsequently, including commercial and not for profit organisations wishing to offer new, community-focused and economically sustainable models of service provision.  CASCADE should result in the design a new model of care for the elderly and those living with dementia.

So far,small-scale 'guesthouses with care' have been trialled in the Netherlands but the evidence for their effectiveness is anecdotal at present. The evaluation provides opportunity to see whether the Guest House with Care model is successful in offering long-term stays as well as short-term care for the elderly in a hotel-type setting as a step-up or a step-down from hospital care and create new methods of service delivery for those wishing to live well in therapeutic communities rather than hospitals.

I have just come back from my first visit to care facilities in the Netherlands where, the ZorgSaaam facility at the heart of Terneuzen is one of our case study sites over the next four years.  Here a whole community of services(village)sits at the heart of the town with elderly care GP specialists running a 24 hour service embedded within the village, alongside the pharmacy, co-located services (speech and language therapy, physiotherapy, occupational therapy,rehabilitation, counselling and psychotherapy), chapel, care advisory services,hairdressers, shops, restaurants, nurseries and schools).  A rehabilitation gym provides support to both in and outpatients with independent and assisted living facilities (for PWD),short stay, physical rehab and long stay services. The focus on rehabilitation means that all care is directed to enabling people to get home to independence as soon as possible and opportunities for young and older people to network on a daily basis through the nursery and school is an important part of healthy ageing and developing awareness of how to offer mutual support networks.  The local STIMUL facility provides students with an opportunity to work with simulation through care ethics labs to literally “put nurses to bed” to learn about the experience of giving and receiving care.  STIMUL was a partner in another 2 Seas Dignity in Care project http://www.dignity-in-care.eu/portal/welcomeinvolving partners in the UK. This model of learning has had a dramatic impact on student learners, mentors and professional practitioners and managers who have also experienced being a recipient of care as part of the scheme.  Learning wards provide opportunity for student interns to mentor each other across the lifespan of their training with qualified staff acting as professional coaches and students in charge of making care decisions based around the needs of their patients.  Academic lecturers visit once a week and provide a programme of practice focused learning driven entirely by the needs of the students not the other way around.

Personally for me besides the wonderful potential for innovation in the UK, there is also the prospect of transforming our own workforce development and professional training programmes in the UK.  We will certainly need to radically transform the way in which we facilitate the development of undergraduate health professional trainees and apprentices in the coming years ahead.  Our traditional hospital based models of “teaching” will not create the clinical systems leaders of the future who are capable of innovating new services based at the heart of communities.  To do this you have to be IN the community WITH people and possess the skills to facilitate collaboration, inclusion and participation to have a meaningful dialogue with people at what matters most to them. 

CASCADE offers the potential to open the doors to new ways of thinking and doing, a new paradigm that interconnects with social models of caring generated in, with,for and by communities.  I am looking forward to reporting these findings back on a regular basis and sharing my experiences through Twitter. 

To this end I am hosting a @WeEOLC #WeEOLC Tweet Chat on the 4^th July at 8 pm.  I am interested particularly in the following areas:

1. Do we have any social living models currently in the UK where services are co-located in community villages providing seamless support for older people with long term conditions?
2. What would an integrated social living model look like for people living with dementia in the UK context?
3. How could we fund this in the UK?
4. What would policy makers need to do to shift the focus fromhospital to community co located services to support such a model?
5. What knowledge and skills would we need to ensure our future workforce possesses to make this vision a reality?

I do hope you can join me on the 4^th July for this tweet chat.  

It will be of particular interest to researchers, practitioners, experts by experience and policy makers working in the field of long term conditions and dementia care but may also be of interest to councils, social workers, welfare and housing experts and community voluntary groups looking to transform local communities.