Hello, my name is Clare Abley and I am a nurse consultant for vulnerable older adults, ensuring the best possible care for patients living with dementia, through expert practice, service and practice development, education and research.
I see my overall role as nurse consultant to provide high quality leadership in relation to the care of vulnerable older adults.
My nursing career started when I qualified as a nurse in 1987 with a BSc Hons Nursing Studies (Kings College London) and an RGN qualification (St George’s Hospital southwest London). I was fortunate to progress relatively quickly after qualifying, from being a staff nurse to a junior sister and progressed to senior sister.
Following on from this due to a keen interest in the speciality of older people’s care, I became a clinical nurse specialist. I gained experience in acute care, rehabilitation and a day hospital, as well as in the community, all in southwest London.
In 1996 I moved to Cardiff to take up a newly established post as nursing practice development advisor for older people, which was a senior position working across the older people’s service.
My current post was the first nurse consultant post in Newcastle and one of the first for older people nationwide.
A passion for improving dementia care
I have focused on dementia care since I began working at Newcastle Hospitals, and at that time dementia care had received little attention in general hospitals (the first national audit of dementia was in 2010/11).
When I was asked by the then Director of Nursing to take the lead on dementia care I was delighted to have the opportunity to use the nurse consultant role to improve care for patients across the Trust.
Having been a nurse consultant for over ten years, I was ready for a new challenge and the move to Newcastle Hospitals came with a new direction. After the creation of the first dementia specialist post linked to the Dementia CQUIN, I was instrumental in the development of two more posts, which were funded by commissioners, and was pleased to take on the line-management responsibility for the team. I have the privilege of working with a team that are as committed and passionate about dementia care as I am.
My role was and still is to championing best practice in the Trust. I introduced the Forget-me-not cards, applied for (and secured) capital funding to refurbish the day areas on all the Older People’s Medicine Wards and took over as chair of the Trust Dementia Care Steering Group.
Around that time however, my mother was diagnosed with dementia. In parallel with my work, I was plunged into the position of advocate and carer for my mother and ‘general supporter’ for my father (and later my sister who moved in with my parents to support them). I remember the panic of realising that my mother would not know where she was when she was admitted to James Cook hospital, and then how very sad I felt when I realised, she was unable to swallow and so could not eat and drink enough to survive.
Experiencing the other side of the dementia care experience provided valuable insights and helped me enormously in my quest to deliver person centred care for every patient with dementia. We must get to know patients, make sure we have the knowledge and skills not only to communicate, but also to care effectively, and ensure equality as well as quality of care and treatment.
The principles of person-centred care (providing individualised care and treating every patient with dementia as a person), equality and effectiveness underpin all my work, informing practice and service development work, education and my research.
The golden thread of research runs through my career
My nursing degree included a module in research methods which provided an excellent grounding in research. In 1989 I registered for an MSc in Gerontology (Age Concern Institute, Kings College London), as I wanted to broaden my knowledge of ageing and the course was an opportunity to study alongside colleagues from different disciplines (social scientists, medics, researchers). Taught topics included economics, demography, psychology, sociology and biology, all in relation to ageing and old age.
My research dissertation explored how older people ‘keep warm in winter’ and involved interviewing older people in their own homes. I learnt a lot about field work with older people from this and realised how much I enjoyed listening to people’s experiences and then analysing and drawing conclusions from my data.
There was no time for research when I took up my sister’s post on an acute elderly care ward, but I soon gravitated back to research when I was a nurse specialist, carrying out an empirical study to determine if older patients in hospital could be taught how to use inhalers.
I devised and then delivered patient teaching sessions, involved ward staff in recruiting patients and undertook all the pre- and post-intervention data collection on the 8 wards that made up the older people’s services. With the advice of a statistician, I completed the necessary data analysis. I then wrote up my work, which was published in the Journal of Advanced Nursing just as I left my post for promotion and to move to Cardiff in 1996.
My next involvement in research came when I registered for a PhD at Newcastle University in 2002. Although my post was for vulnerable older adults there was little understanding as to what made an older person vulnerable. Initially I thought my line manager would have a group of vulnerable patients that she wanted me to focus on, however this was not so, and I was given a relatively free reign to establish the post. I was interested in exploring the concept of vulnerability in old age by looking at the different perspectives of older people themselves and health and social care professionals.
As the National Service Framework for Older People had just been published, which had a chapter on person centred care, and in order to ensure that my work was linked to national policy, I decided to research person centred care and vulnerability in old age. I had an interest in qualitative research methods (as opposed to quantitative research, such as RCTs) and so after much thought opted for a social constructionist approach.
My PhD took me 7 years part time, including the time I was given to make amendments after my oral exam and a period of sick leave when I had thyroid cancer. Being awarded my PhD at a graduation day in 2010 felt like a real achievement.
A focus on care for older people with dementia in hospital
My next research success came when I applied for an NIHR Clinical Lectureship to improve general hospital care for older people with dementia / delirium. With the full support of my line manager at Newcastle Hospitals I decided to focus on the care of older people with dementia in acute hospital settings. As explained above dementia care had not received much attention in acute general hospitals and this was reflected in the lack of research on the topic.
My first application in 2012 was unsuccessful, however I was very grateful for the advice from a nursing professor who suggested I should re-apply. This I duly did and was granted £190,000 to complete my research on a part time basis over 4 years starting in April 2014.
Being successful in my application was amazing and a real opportunity to make things better for patients which has always been and continues to be my main aim. NIHR fellowships focus as much on individual development as completing research and so I completed a post graduate certificate in Dementia Studies at Bradford University, as part of my award. This I completed in 2015, allowing me to keep up to date and learn about new developments in the field.
Having a post-doctoral fellowship provided an opportunity to develop my role as a clinical academic, and in doing so prepare the way for future nurses. My clinical lectureship culminated in the Dementia Care Leaders’ Toolkit which with Research Capacity Funding (RCF), was piloted in the Trust in 2019/20 and is now being rolled out across the Trust.
I shared my work with Trust dementia care leads from across England, by running two national study days held in Newcastle and London in 2018. I have also presented my findings at national conferences and written publications for peer reviewed journals, including for Nursing Older People and the British Journal of Psychiatry.
I am proud to have an honorary appointment at the Institute of Population and Health Sciences, Newcastle University as a Clinical Senior Lecturer, where I currently supervise three PhD students all undertaking dementia care related research. In 2021 I was invited to examine my first PhD which was a huge privilege.
In 2019 I was invited to be one of the editors for the 5th Edition of Redfern’s Nursing Older People textbook (publication by Elsevier, February 2023). I have commissioned new chapters on frailty and alcohol misuse in old age as part of this and have thoroughly enjoyed working with authors and my co-editors.
I was appointed to the NIHR HTA research prioritisation committee for integrated community health and social care in 2019. This is an excellent opportunity to influence research funding priorities at a national level.
Focus on strategic service development
In the last couple of years, I have been instrumental in developing the new Trust Dementia Care Plan 2022-26, which is being launched as part of the Trust NMAHPs Strategy. This is part of my work as chair of the Trust Dementia Care Steering Group (reports to the Harm Free Care Group). This plan will provide direction for our work over the next 4 years. It has been developed in partnership with key stakeholders including carers of people with dementia.
As well as my work on dementia care, I also chair of the city-wide Newcastle Safeguarding Adults Improving Practice Committee which is a sub-group of the Safeguarding Adults Board (SAB). The committee is attended by representatives from the organisations making up the Safeguarding Adults Partnership, with a broad remit to improve safeguarding adults practice in Newcastle. Working collaboratively with colleagues from other sectors, such as social care and the third sector, is a key part of my nurse consultant role and something I enjoy.
I love the challenges involved in being a nurse consultant, the variety of work and the constant need to identify new ways to influence practice for the better to ensure the very best for patients. I continue to believe it is the best job to have as a nurse!
I am totally committed to the NHS, and it is a privilege to work for Newcastle Hospitals.