1. Values and principles

This toolkit aims to improve the core values-based skills and attitudes of staff in everyday practice. This is because research shows:

• it’s the basis for high quality person-centred care
• high-quality person-centred care supports the well-being of people with dementia and their families.

Kitwood (1997) found that person-centred care underpins dementia care in many countries. Person-centred care involves developing a value base that understands the individual needs of each person with dementia and getting a sense of their world view to support their holistic needs.

Values-based and person-centred practice are the ‘golden threads’ that should run through all dementia learning and development activities. The values-based approach views each person as unique, with individual needs, wishes and identity.

You’ll need an understanding of core values to develop a values-based approach. This includes:

• attitudes that are focused on understanding, kindness, empathy and being brave. They should be seen as a core value and the first step towards effective practice
• listening and using senses, so staff use what they see, hear and feel. This helps people with dementia be active participants in their care
• knowing that words matter and being skilful in using value-based communication. This includes promoting and using language that promotes kindness, dignity, respect and advocacy
• staff being confident they have the knowledge and skills to support people with dementia and their families to take positive risks and understand why risk-averse practice is not good for people with dementia and their families
• being sensitive to cultural diversity, ethnicity, and equity. This includes avoiding stereotyping and being aware of our unconscious biases and tendency to draw upon our long held and often biased social norms
• encouraging staff to reflect upon equality and equity, and how power relations can lead to harmful inequalities (anti-oppressive practice). At the heart of this reflection is intersectionality, which looks at the presence of lots of forms of discrimination.

Self-awareness is an important part of developing a values-based approach. We need to ‘check in’ with ourselves to acknowledge, understand and identify the nature of our biased attitudes and values (doing so with kindness and without judgment towards ourselves). This is essential to make sure we recognise our bias and its potential influence on our practice. Learning and development approaches should enable this ‘check in’.

A culture of value-based care needs to run through of organisations, teams and individuals. Practitioners at all levels should be valued, supported and empowered to work together to build a culture based on a value-based care. Learning and development activities can help build this culture.

• Improvement Cymru and Welsh Government (2021) All Wales Dementia Care Pathway.
  
  Twenty high-level descriptions of standards that set out what people think will make a positive difference to dementia care in Wales. They can support the co-production of local values.

• Nigel Hullah’s Six steps to quality-of-life is a resource developed through lived experience.
  
  It describes the six elements that underpin a pathway to quality of life, happiness and fulfilment for people with dementia or who are experiencing old age or frailty.

• Northern Ireland Government – Model for Living Well with Dementia (2016)
  A good practice example of a learning and development framework.

• Kitwood, T. (1997) Dementia reconsidered: The person comes first. Berkshire, UK: Open University Press.
  
  Published research that provides evidence that person-centred care needs to underpin dementia care and support.

• NICE (2006) Dementia: supporting people with dementia and their carers in health and social care.
  
  Clinical guidelines that set out effective practice guidance.

• NICE (2018) Dementia: assessment, management and support for people living with dementia and their carers.
  
  Clinical guidelines that make recommendations for training staff and helping carers support people living with dementia that will support you to plan local training programmes.

• Teepa Snow Positive Approach to Care website has information on Positive Approaches to Care.
  
  The Gems app allows user to quickly access principles of GEMS state model and access helpful tips about cognitive abilities and help on what to do when cognitive issues arise.
  
  Search Dementia Stages Ability Model: Teepa Snow’s GEMS in the Apple and Android app stores.

• Cardiff and Vale: Shared Values and Beliefs template.
  
  This may help you if you need to co-produce local shared values and beliefs to underpin learning and development and other improvement activities.

• Senses Framework posters that summarise the Senses Framework to help increase staff awareness.

• The Madeline Project hopes to provide a comprehensive approach to dementia education, diagnosis and care that’s easy to understand for Cardiff and the Vale of Glamorgan. It’s a model that can be used across Wales and further afield.

• PocketMedic: A series of videos about the experience of living with dementia that can be downloaded and used in training to help carers better understand dementia.
  
  The videos are available with Welsh subtitles and there are bilingual support materials, too. The videos are real life experiences of people living with dementia, in their own home.
  
  They cover topics such as the hidden dangers posed by household objects, understanding and managing anxiety, and how to respond to distressed behaviours.

Go to the next section: 2. Leadership and governance.