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1. Introduction

1.1 How was the topic identified? 

The topic was debated at the Annual Delegate Conference (ADC) of the Society of Radiographers in May 2013; ADC motions 10 and 17. During the debate, delegates made clear their desire for advice and guidance for the radiographic workforce about providing better care for people with dementia who attend for imaging or radiotherapy.

1.2 Why is it important? 

This topic is important both because of the prevalence of dementia, and the role of imaging and radiotherapy in the diagnosis and treatment of illness in so many people. It is vital that radiographers and other members of the radiographic workforce are able to understand and support the needs of people with dementia and their carers.  Not only is this because all patients are entitled to the best possible, personalised care but, vitally, understanding and meeting the care needs of people with dementia will ensure the best outcomes from imaging and radiotherapy. 

The incidence of dementia is increasing, particularly in the over 65s where the total population prevalence is 7.1%1, and it is this group that is most likely to attend imaging and radiotherapy services.  Diagnostic imaging is integral to most clinical diagnoses and is also increasingly being used in minimally-invasive therapeutic interventions.  The total number of imaging examinations or tests carried out in England in 2012/13 was 41.1 million and over the past 10 years there has been a 39% increase, with the biggest growth being in MRI2

With regard to radiotherapy, in 2011 the number of new cases of cancer in the United Kingdom (UK) was 265,000 and four in ten people will receive a diagnosis of cancer at the present time.  Access rates to radiotherapy nationally have been calculated at 38%, but it is estimated that, overall, 50% of people with cancer would benefit from a course of radiotherapy3

1.3 How does it fit with existing radiographic practice?

The Society and College of Radiographers (SCoR) gives professional leadership to the radiographic workforce and offers advice and guidance that promotes patient-centred care and the highest quality services. The SCoR document library contains all of its policies, advice and guidance4. Of particular relevance is the Code of Professional Conduct 2013, Patient Advocacy 2008, Consent to Imaging and Radiotherapy Treatment Examinations 2007, Consent and Adults with Impaired Capacity 2010 and the Joint Response of the Society and College of Radiographers to the Final Report of the Independent Inquiry into care provided by Mid-Staffordshire NHS Foundation Trust, section 3, 2013. 

1.4 The policy context

Government policies over the past 15 years have been directed towards improving the quality of health and social care services through a twin-track approach of implementing systems of clinical governance to ensure consistent high standards, and developing personalisation of care through a person-centred approach5,6,7. Person-centred care entails putting patients at the centre of all care and treatment through collaborative working and fostering their active participation in decision-making. In the context of caring for people with dementia, the concept particularly emphasises the importance of not losing sight of the person and avoiding dehumanising actions and behaviours.

This challenging agenda is being taken forward in the area of dementia care and treatment through a number of recent policies and actions. A National Dementia Strategy for England, published in 2009, set new standards for care8. A quarter of hospital beds are occupied by people with dementia and every hospital has been asked to commit to becoming dementia-friendly. Funding for hospital dementia risk assessments has been linked  to the quality of care and all care homes and community services have been requested to sign up to the Dementia Care and Support Compact.

In Scotland, the Scottish Government Health Department (SGHD), in a national framework ‘Reshaping Care for Older People’9, signalled its intention to fund initiatives that move care from institutions to home and the community. A key focus of the framework is the provision of care at home for people with dementia and greater support for carers. This has been elaborated within the Scotland’s National Dementia Strategy10 and associated dementia care improvement programme.  

Similar initiatives are occurring in Wales and Northern Ireland with the publication of strategy documents11,12 by the devolved administrations leading to programmes of action for service improvements for people with dementia and their carers.   

In March 2012, the Prime Minister launched the Dementia Challenge. This set out plans to improve care in three aspects; increasing rates of diagnosis, improving the skills and awareness needed to support people with dementia and their carers and improving research. Progress is being overseen by three groups of champions each focussing on one of three main areas for action; driving improvements in health and care, creating dementia-friendly communities and improving dementia research.

A progress report in May 201313 sets out the groups’ shared ambition to ‘make a real and positive difference to the lives of people affected by dementia’. It goes on ‘We want to ensure that people with dementia and their carers receive high quality, compassionate care whether they are at home, in hospital or in a care home. We want the person with dementia, and their family and carer, to be at the heart of everything we do. We also want their wellbeing and quality of life to be first and foremost in the minds of those commissioning and providing services for them’.

Dementia is a world-wide issue and, in December 2013, the UK government hosted a G8 Dementia Summit with the aim of developing co-ordinated global action. Ahead of this, The Alzheimer’s Society and others offered their support for tackling dementia on a global scale, pointing out that there is no cure and few treatments and asking for it to be made a priority. As a result, the profile of dementia in the publics’ mind has increased significantly, the need for collaboration in delivering compassionate care has been prioritised and the government has announced that funding for research into finding treatments for dementia has doubled.

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