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Training and workforce development

Diagnosis, post-diagnostic support

For most strategies, the need to improve the knowledge, skills and training of professionals across the disciplines in health and social care was seen as a central component of delivering high quality care and support to people with dementia. This included in relation to the diagnostic and treatment processes, as well as the provision of care and support in both institutional and community settings. However, the delivery of training programmes (either through continuous professional development or at the time of initial training) was not the only method to develop the workforce; other methods such as the creation of nationwide posts were proposed and have been included below.

Interdisciplinary training

The majority of strategies highlighted the need for training across health and social care, with some focused on the location or nature of the care, rather than the specific practitioner or role.

For example, the Portuguese strategy focuses on the need for practitioners across institutional settings (including residential and acute settings) to be skilled, to support better diagnosis, treatment, care and nursing for people with dementia. As part of this, the strategy identifies the need for expansion of dementia-specific training. Similarly, the Swiss strategy notes the need for high quality care services throughout the entire course of the condition, with dementia-specific professional skills being a key focus.

The Norwegian strategy, by comparison, focuses on specific programmes (“Dementia ABC Education Programme” and the “Psychosocial Intervention Programmes”), committing to develop and implement this resource amongst municipal health and care personnel. Similarly, the Scottish strategy commits to the continuation of the Promoting Excellence Framework (launched as part of Scotland’s first national dementia strategy) resource for health and social care practitioners.

On a similar theme, the Welsh strategy had a considerable focus on its “Good Work” approach, including producing cross-sector training resources, training practitioners to recognise the early signs of dementia and ensuring all public-facing NHS staff have training in dementia. In addition, the strategy also identified the need to train practitioners who could initiate conversations on serious illness. Furthermore, the English strategy suggests that all healthcare staff will receive training appropriate to their role, with the hospital regulator seeking evidence of a newly established “care certificate” as part of their inspection regime.

The Northern Irish strategy also committed to the development of a training and development plan across primary, community and secondary care, as well as in both statutory and non-statutory sectors, to improve knowledge and skills of professionals providing care to people with dementia.

The Czech and Israeli strategies identify the need to support and develop education for professionals, with the former indicating that this will be measured through the number of physicians, nurses and social services staff completing specific modules and training programmes, as part of continuous professional development.

The Maltese strategy similarly, proposes inter-disciplinary training for all professionals through continuous professional development (CPD), across settings, including focuses on non-pharmacological interventions, establishing accredited online platforms for dementia and creating dementia-specific, end of life training for health and social care professionals. Similarly, the Slovenian strategy focuses on integrating existing health professional training and CPD to support people with dementia, including neuroleptic and other non-pharmacological interventions.

The Danish strategy commits resources to cross-sectorial and inter-disciplinary courses to evaluate their existing course programmes concerning dementia and to produce knowledge based manuals for social and healthcare practice. Additional resources are also committed to improving practice-oriented skills in municipalities and regions.

Norway’s strategy was more specifically focused, examining its “learning networks” which share and spread good practice on medical/healthcare follow-up for people with dementia with complex needs who receive home care services.

The French neurodegenerative strategy contained a significant focus on continuing education and training of health and social care professionals to improve services for people affected by a neurological condition.

The Spanish neurodegenerative strategy proposed a comprehensive and integrated approach between the different levels of health and social systems. It further places responsibility on each of the autonomous communities to create a training plan for professionals working with people with neurodegenerative conditions, primarily focused on continuous professional development.

GPs/primary care

The Welsh strategy placed a focus on GPs, encouraging them to complete an additional component within its enhanced mental health service programme, reviewing and updating the dementia awareness DVD for GPs, as well as reviewing primary care practices to ensure they are dementia friendly. Additionally, the Maltese strategy commits to providing training opportunities for GPs in relation to the diagnosis, referral, disclosure and management of dementia.

On a similar theme, the Flanders strategy commits to investment in the cooperation initiatives for primary healthcare and its dementia expertise centre, to raise awareness among professionals and informal caregivers about young-onset dementia.

Secondary care settings

The German strategic document noted the intention of the German Medical Association to develop specialist training for the treatment of patients with dementia, whilst the Greek strategy committed to accelerated training programmes for a small number of existing clinicians, such as neurologists, through its proposed centres of excellence to become specialist dementia doctors.

Similarly the Slovenian strategy indicates that clinicians in general hospitals should undergo regular training on the quality of care for dementia patients, whilst the Luxembourg strategy commits to evaluating the need for continuous specialist training for professionals working in long-term institutional settings to ensure better care.

Nursing

The German strategic document also noted the intention of the Federal Government to reforming the law around nurse training, to establish a common basic training profile as well as creating an expert commission to inform the curriculum, ensuring counselling is included within the teaching.

Similarly, the Slovenian strategy committed to the introduction of additional educational programs for nurses with specialist knowledge in the field of neurodegenerative diseases, especially dementia.

Allied health professionals (AHPs)/ therapeutic interventions

The Danish strategy commits and allocates funds for training and physical activities related to rehabilitation, specifically to support training schemes and packages to ensure consistency in rehabilitation programmes.

Following on from work undertaken as part of its second national strategy (including the creation of a national dementia AHP consultant), the Scottish strategy commits to the implementation of the subsequent AHP framework which was developed, outlining how AHPs can support people with dementia, including in relation to falls preventions, rehabilitation etc. The Welsh strategy follows a similar approach, proposing to develop a national AHP post to provide advice and support to health boards and local authorities to improve services.

The Norwegian strategy highlights the creation of a national competence centre on culture, health and care to develop and disseminate therapeutic methods and ways of working in milieu therapy, with educational programmes on milieu therapy and the integrated use of music and singing designed for employees in general and dementia-specific care services.

Social care

The Israeli strategy specifically identifies the need to develop specialist training for homecare workers that provides them with the knowledge, skills and tools to address stressed behaviours of people with dementia, as well as providing the appropriate tools to provide meaningful occupation. This was also the approach of the Maltese strategy, though it focused on the training needs of day care staff.

The English strategy continued this theme to an extent, though support was focused on ensuring that social care staff working with adults and older people were able to identify the early signs and symptoms of dementia and helping people with the condition to access high quality care and support.

As part of its commitment to the provision of dementia support workers, the Welsh strategy commits to reviewing their role and to ensuring they are trained to an appropriate occupational level.

Vocational training (i.e. academic/ institutional-based training)

Some strategies identified the need for training around dementia to be a fundamental aspect of vocational training for health and social care practitioners (i.e. before they qualify and begin to practice). Other strategies proposed centres of excellence which would provide training for highly specialist practitioners.

The Welsh strategy commits to embedding its “Good Work” principles for new vocational qualifications for health and social care. Similarly, the Flanders strategy commits to a continued focus on the education and follow-up training of dementia-skilled workers.

The Finnish strategy commits to ensuring that education authorities and organisations ensure that basic, further and supplementary social welfare and health care training includes elements related to brain health promotion, detecting memory disorders in their early stages, treating and rehabilitating patients, providing palliative and end-of-life care and supporting people with dementia and their families.

The Greek strategy commits to ensuring dementia is included within the undergraduate training of relevant disciplines (including medicine, nursing, pharmacy and biology). However, it also proposes the development of ‘centres for excellence’ in dementia (public or private) which will train 18 core specialists, as well as engaging in clinical research.

The Irish strategy focuses on engaging with professional and academic organisations to develop provision of dementia-specific training, including CPD, professional peer-led support, education for GPs and nursing home staff.

The Portuguese and Maltese strategies both commit to ensuring the inclusion of units on medical, social, psychological and economic aspects of dementia for students in health/social care training programmes within academic institutions within both undergraduate and post graduate courses. The latter also commits to ensuring that all dementia training programmes delivered outside academic institutions are accredited.

The Slovenian strategy commits to the inclusion of dementia within all secondary education programmes for professions which involve regular direct contact with older people, as part of undergraduate and graduate education programmes, as well as standardising basic knowledge on dementia at a clinical level through CPD.

The Luxembourg strategy contains a proposal in relation to the country’s Ministries of Education and Vocational Training, Higher Education and Research for Cooperative Work to revise the initial training curriculum in the health domain (particularly in relation to geriatric health), including utilising or adapting international standards.

The Cypriot strategy identifies the need to empower health-care professionals with training in advanced techniques and skills, particularly around prevention, diagnosis and care. It is expected that this will be carried out through specialised centres and the establishment of specialist masters courses in ‘dementia and gerontology’. It is also proposed to strengthen the training of nursing students, as well as creating an elective course in dementia.

Non-clinical/care professions

The Welsh strategy also identifies the need to ensure training for staff who work with people who have a higher risk of developing dementia (such as those working in learning disabilities, substance misuse, ambulance and prison services), as well as for housing staff. Similarly, the Czech strategy proposes the education of workers in education and the public sector, including teachers, police, administrators etc. to raise basic awareness. Finland’s approach was similar, though had a specific focus on the promotion of brain health, training professionals across different sectors (e.g. sports, culture and education).

Ethics in practice

Both the Maltese and Norwegian strategies propose building ethical competence in municipal health and social care services, with the former linking this to quality and professional development and with the latter focused on decision-making and the personhood of persons with dementia. The Portuguese strategy also commits to examining both the ethical and legal aspects required within professions which offer support for people with dementia.

The Swiss strategy also notes the need to anchor ethical guidelines through the promotion and implementation of existing guidelines, respecting individual rights, especially regarding the law on the protection of adults and to avoid risk situations in care structures.

Quality assessment and leadership

The German strategic document notes that partners have committed to ensuring that multi-professionalism and workforce strategies are in place to ensure sufficient numbers of staff, providing high quality care, with the skills body seeking to improve qualitative and quantitative personnel assessment procedures.

The Italian strategy places importance on the evaluation of outcomes and of professionals responsible for the delivery of services. As part of the promotion of training across disciplines, the strategy proposes promoting systematic audit activities to enhance self-assessment of professionals and improve clinical practice. On a related theme, the Norwegian strategy notes the needs for a greater number of managers and improved leadership skills which resulted in the development of a national leadership training programme targeted at managers in municipal health and care services.

Other

Some measures related to the training and development of the workforce included other commitments which were either unique to their strategies or took an approach which did not correspond to the themes above.

The Welsh strategy committed to ensuring that people with dementia, their families and carers were involved in the development and delivery of dementia education and training, as well as focusing on how health and social care staff appropriately include carers in the care process. It also proposed ensuring that unpaid carers received access to training.

On the theme of carers, the Czech Republic commits to ensuring the education and offer of accredited training courses of unpaid carers (on par with social care assistants), citing the potential European Structural Funds (ESF) funding to provide this. Similarly, the Austrian, Swiss and Northern Irish strategies acknowledge the need to strengthen the skills of relatives and unpaid carers as does the Portuguese strategy which commits to considering a comprehensive training programme for both formal and informal carers. Similarly, the Norwegian strategy commits to continuing work (started under its previous strategy) to establish educational programmes and dialogue groups for family members of people with dementia.

Finland places responsibility on municipal authorities to advise and support local authorities by providing training and compiling statistics about health and well-being, to ensure that social welfare and health professionals have the skills to promote brain health so they may identify cognitive impairments and refer people as appropriate. The strategy also commits to developing national targets for the skills that professionals working with individuals with memory disorders and dementia must have.

On the matter on manpower within the workforce, the Israeli strategy commits to increasing resources to train manpower in the community and in hospitals. Similarly, the Maltese strategy focuses on ensuring there are sufficient numbers of trained health and social care workforce, including for memory services.

The Greek strategy, in addition to its development of centres of excellence and specialist training for clinicians, also calls for the establishment of 10 clinical fellowships per year and five research scholarships per year with the aim of creating specialist clinical and research practitioners in the field of dementia.

The English and Maltese strategies, alongside the German strategic document, commit to ensuring that professionals are trained and educated to identify, prevent and manage stressed and distressed behaviours in people with dementia.

The Dutch dementia strategy commits to the development of a specific database with evidence-based recommendations and information for professionals on how people with dementia may continue to live longer and more safely at home, with online resources available and professionals able to share good practice examples. The English strategy also follows a similar approach, committing to develop a clear evidence base for what works in training on dementia for health and social care staff, which would be used to develop education and training programmes.

The Norwegian strategy is the only one to specifically commit to the further development of competence-building measures in the area of end-of-life palliative treatment and care through the development of an educational programme on palliative treatment for people with dementia, as part of its Dementia ABC education programme.

 

 
 

Last Updated: Monday 29 April 2019

 

 
  • Acknowledgements

    This report received funding under an operating grant from the European Union’s Health Programme (2014-2020). The content of the Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains
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