Evaluation of the pilot House of Memories Train the Trainer programme 2016
The Pilot House of Memories Train the Trainer Programme, led by NML and commissioned by Health Education England, was designed to meet Tier 2 objectives as defined by the national Dementia Core Skills Education and Training Framework. The programme was delivered in partnership with four NHS trust and health service organisations across the North West between November 2015 and April 2016, to over 100 health care professionals via a cascaded train the trainer model. Partners included the Countess of Chester NHS Foundation Trust; Wirral University Teaching Hospital NHS Foundation Trust; Christie NHS Foundation Trust, Manchester; and PSS Community Health (person shaped support), Liverpool. The pilot has enabled a structured consideration of its design, operational characteristics and relative impact, to inform future development and delivery of the programme.
The ICC’s Head of Research Kerry Wilson was commissioned by NML to evaluate the programme, based on an existing research partnership developed since 2013. Evaluation of the pilot, using standardised quantitative measures and supporting qualitative data, has evidenced positive outcomes and strategic strengths with reference to person-centred dementia care, which forms a central tenet of the Dementia Core Skills Education and Training Framework. Specific Tier 2 strengths included improved dementia awareness; communication, behaviour and interaction with people with dementia; understanding of the principles of person-centred dementia care; understanding of the role of families and carers; the health and wellbeing of people with dementia; and living well with dementia.
Analysis of the social value and return on investment (SROI) of the pilot programme was undertaken by ICC Research Fellow Gayle Whelan as part of the evaluation. Key outcomes were thematically grouped according to dementia awareness; improved care standards; and living well with dementia. SROI analysis uses a combination of qualitative, quantitative and financial information to estimate the amount of economic value that is created, which is typically expressed as ‘for every £1 invested, £x of social value is created’. In return for an investment of £19,800 to train a total of 112 healthcare professionals in Tier 2 dementia awareness and core skills, a total of £357,599 of social value was created, returning an SROI ratio of £1: £19.06.
Specific Tier 2 dementia care strengths such as communication, behaviour and interaction were directly attributed to the quality of training materials, including character-based documentary films and the My House of Memories app. This emphasises the cultural value of the programme as a museums-led creative intervention delivered in acute health settings and creates a strategic imperative for NML and Health Education England to advocate their work and cultural leadership, in line with national developments in the field of arts, health and wellbeing more broadly, and specific momentum behind the value of arts and culture in dementia care. This includes for example growing interest in the direct role of museums in local care landscapes (Morse and Munro, 2015; Johnson et al, 2015); the development of more meaningful activities for people with dementia, designed to support psychological wellbeing (Nyman and Szymczynska, 2016); and the role of creative technologies in fulfilling each of these objectives (Tyack et al, 2015).
The evaluation also reflects the value of the collaborative network that underpins the programme and its relative success. There has been strong partnership working between providers, commissioners and partner health services, developed over a period of time preceding delivery of the programme. This has enabled an extra layer of confidence and trust in the pilot as a museums-led health care training intervention, especially for those health care staff being trained to deliver the programme and continue to use relevant museum resources in their own professional settings.
Health Education England has shown progressive leadership in commissioning NML to deliver Tier 2 dementia care training, which should be celebrated. Once more this shows proactive responsiveness to national strategic developments with respect to cultural commissioning. A recent report on the value of art and culture to public services (NEF, 2016) recommends changes to commissioning including raising awareness of the value of arts and culture to local government and to the NHS; building the capacity of cultural organisations to bid for public sector work; engaging with the cultural sector at a strategic level; changing procurement to better engage cultural organisations; and changing evaluation approaches to focus more on outcomes. The Pilot House of Memories Train the Trainer Programme has created significant knowledge exchange opportunities for both sectors.
Operational characteristics of the pilot programme have complemented its strategic relevance. The flexibility of the programme was regarded as its key operational strength, including the extent to which its content can be adapted appropriately by different facilitators for delivery in different professional environments. Participants were also appreciative of the fact that the pilot programme was delivered on-site with health partners. Practically, this has enabled more staff to participate, particularly ward nurses who would otherwise find it difficult to create the time to undertake off-site professional development and training. In the longer term, it was felt that the physical presence of museum resources (such as the My House of Memories app) in acute care settings would help to improve the organisational culture of participating health services, creating an embedded ethos of responsive dementia care.
In taking the programme forward, it was recommended that its core Tier 2 strengths relating to person-centred dementia care be emphasised and more actively promoted. This will help to manage the expectations of participating health professionals, especially with regards to other more clinically oriented Tier 2 objectives (for example end of life care), where other training opportunities may be more relevant and appropriate.
A summary evaluation report published by NML is available from the NHS Workforce Information Network website (a plain text version of the evaluation report can be accessed here). It was estimated that the social value and return on investment of the programme could be higher as the regional roll-out continues. It was recommended therefore that more research be undertaken to map ongoing use and impact of the training materials, including extending the sample to include people with dementia and families and carers. This will be fulfilled by the wider Crossing Boundaries research programme from September 2016.