The Plymouth Dementia Pathway is operated by a small, specialist multi-disciplinary team including: Consultant Psychiatrists, Clinical Psychologist, Dementia Nurses, Occupational Therapists, Physiotherapist, Community Care Workers, Dementia Advisors and Administrative Staff/Medical Secretaries. The Plymouth Dementia Pathway will be growing and evolving in order to improve assessment, diagnosis and care for people with dementia and their relatives/carers. This includes timely and equal access to services, provision of evidence based treatment, monitoring and following up. Professional Responsibilities & Patient Contact: The Post-holder will: Be accountable for the direct patient care/support provided by the Plymouth Dementia Pathway at all times. Maintain high standards of clinical/professional care/support of people with dementia, their family/ carers. Work as part of a MDT to ensure that the best possible outcomes of achieved for the person with dementia and their family/carer. Have responsibility for own caseload of patients and take responsibility as lead professional or care co-ordinator as appropriate. Identify and undertake specialist and comprehensive assessments to assist in the diagnosis of people suspected of having dementia including: undertaken including the persons: life history, social and family circumstances, and preferences, as well as their physical and mental health needs and current level of functioning and abilities. Be able to inform the person with a suspected dementia and/or their family/carer about the assessment and diagnosis process. Providing knowledge about structural imagining, identifying if they want to have any scans, or if they wish to know the diagnosis and with whom this should be shared with. Take steps to obtain patient consent to care and treatment in accordance with the Mental Capacity Act, ensuring those people with dementia who lack mental capacity remain at the centre of decision-making and are fully safeguarded. Promote a recovery model that empowers people with dementia, their family/ carers to be at the forefront of decision making and ownership of their treatment plans. Assess the effectiveness of medication prescribed for the symptoms of dementia and report observations back to the prescriber as required. Be able to advise on, recommend and provide a range of effective evidence based treatment and interventions plans at all stages of a persons dementia journey that is based on sound clinical decision making. Promoting and maintaining independent of people with dementia by addressing activities of daily living that maximises independent activity, enhances function, adapt and develops skills, and minimises the need for support. Re-assess people with dementia where there are changes in emotional well-being and behaviour. Promote least restrictive practice, maximising independence and freedom, with due attention to the safety of others. Undertake risk assessments, devising and implementing actions and intervention plans which take the risk formulation fully into account. Be responsible for decision making and co-ordination in a crisis situation, where necessary seeking advice and guidance from other relevant professionals Be committed to the treatment of people with dementia in the community, reducing the number of inappropriate admissions to acute or in-patient hospital settings. Know when to consider and co-ordinate a psychiatric inpatient admission, making an application for a Mental Health Act Assessment where it is deemed necessary. Complete Social Circumstances Reports and attend the Mental Health Act Tribunals as and when required. Work with staff on the psychiatric inpatient unit to support with discharge planning and joint reviews of patients with dementia who will require ongoing input from the Plymouth Dementia Pathway. Be able to recognise end stage dementia and (when appropriate) liaise with specialists within the end of life care team to support in care delivery. Communication and Working Relationship Skills: The Post-holder will: Be able to communicate clearly and effectively with people who have dementia, their family/carers and/or other professionals involved. This will be within the boundaries of confidentiality. Be confident in communicating with people who have dementia or who have difficulties when English is not their first language using Organisation approved interpreters/services. Demonstrate a positive attitude, attending to people with dementia their family/carers with respect and courtesy. Be able to receive information, analyse and formulate professional judgements. Be confident in managing conflict between individuals as and when required. Ensure that professional boundaries are always adhered to. Be directly responsible for the collaboration and the planning of individual care with other teams and services to provide a seamless service to people with dementia, their family/carers. Attend and represent the Plymouth Dementia Pathway in meetings, e.g. Child Protection, Adult Protection, Mental Health Tribunals, CPA reviews. Attend and participate in various forums/steering groups within the organisation and the wider community as required. Knowledge and Experience: The Post-holder will: Have experience of working in partnership with people with dementia, and their family/carers in setting such as home environment, care home, hospital etc. Have a sound knowledge of dementia including: risk factors and preventative strategies, signs and symptoms, types of dementia and impact. Be aware and able to inform of assessment and diagnostic process for dementia. Demonstrate understanding on treatment options for people diagnosed with dementia including: post diagnostic support, cognitive enhancers, other service provisions. Inform others on how to effectively manage behavioural and psychological symptoms in dementia. Adhere to Policy and Legislation relating to Dementia/Mental Health, e.g. Mental Health Act 1983, Mental Capacity Act, Care Act, Equality Act, Human Rights Act, Care Programme Approach and Clinical Governance. Planning and organisational skills: The Post-holder will: Be able to support in the meeting of targets and provide information on a regular basis to enable the team and LSW to perform as expected. Ensure that members of the team are allocated in accordance with their skill mix. Prioritising and delegating accordingly. Ensure that relevant members of the team take a lead in clinical/professional meetings ensuring all patients are reviewed; decisions and plans are put into action and represent the person with dementia and their family/carers views. Attend multi-disciplinary meetings for the protection of people with dementia, family/carers, staff and public e.g. Adult Protection, Case Conference Child Protection, Risk Management. Contribute to the planning and implementation of all service developments within the Plymouth Dementia Pathway, formulating policies and protocols as required. Contribute to the review of the process and procedures within the Plymouth Dementia Pathway in line with Guidance such as: Department of Health and NICE. Analytical and Judgement Skills The Post-holder will: As and when required support in the triage of referrals to the Plymouth Dementia Pathway making reference to the eligibility criteria, providing information and advice for those referrals that are not appropriate. Provide dementia care and other interventions in the setting most appropriate to meet the patients needs. Ability to match a person with dementias need with available skills and resources. Take a lead role in crisis assessments, supporting in the identification of risk, formulation of risk management plans and communicate with the wider health and social care community. Report any incidents of harm or near miss in line with the LSW incident reporting policy. Acting appropriately so that actions are taken to reduce the risk of reoccurrence. Supporting in the investigation of complaints and review untoward incidents and serious incidents, producing chronology of events, time lines, gaining witness statements, producing reports, recommendations and action plans for improvements as and when required. Service Design and Improvement The Post-holder will: Act as a role model. Participate in, and lead where required, in the development, implementation and evaluation of strategies, service innovations whereby the Plymouth Dementia Pathway evolves to meet the needs of people with dementia and their family/carers. Support to ensure that clinical effectiveness systems are embedded and sustainable (based on audit and evidence based care). Monitor and improve quality through ensuring compliance to NICE guidelines. Empower all team members to participate in implementing change by problem solving, considering potential conflicts and planning resolution. Provide expert professional advice with regard to clinical care/professional practice, incidents and complaints as and when required. Promote a culture that incorporates LSW aims and values. Support in the development of the workforce, contributing to developing educational programmes for new and existing members of staff. Provide mentorship for students and other staff both formally and informally Work with the Team Manager in the recruitment and selection of staff for the team. Job description continued on attached document.