Aims To increase early diagnosis and the associated benefits.
Local Context for Initiative
The service has developed over the past 10 years in line with national policy and local need.
The service now offers a responsive person centred service which provides access to assessment, diagnosis, treatment and support for people with dementia including younger people with dementia and people with learning disabilities and dementia.
The service has a well established service user pathway that includes liaison with both the Alzheimer’s Society and Age UK. Further innovative ways of working include, New Ways of Working, non medical prescribing, nurse diagnosis, nurse led clinics, a telephone monitoring service, service user and carer network groups, and input to memory cafes.
Through a variety of mechanisms including shared prescribing agreements and innovative diagnostic protocols, the memory service team has developed a highly valued partnership with primary care services. In addition, the team has been recognised and utilised as an education resource by primary care, social services, the voluntary sector and local acute trust and it has made a significant contribution to the research agenda.
Challenges - How these were addressed
With increasing rates of referral to the Memory Service, there has been an ongoing need to critically evaluate ways of working to ensure that existing resources are fully utilised. The full involvement of all staff at all levels within the service in identifying areas for positive change has been vital in this process, alongside working with key stakeholders (such as primary care, commissioners and the Alzheimer’s Society) at all stages to negotiate improvements.
As referral rates have increased, the pathway of dementia assessment and diagnosis has been adopted by the wider older people’s mental health service to ensure consistency in the standard of care and treatment provided by the whole service for people with dementia and to flexibly prevent unnecessary involvement of the Memory Service where other teams within the service (such as Rapid Access or CMHT’s) are already effectively engaging with the service user.
Effective clinical leadership within the service, working with service managers and commissioners to ensure service users, stakeholders and everyone within the team has an opportunity to highlight ideas and opportunities for continual improvement.
Effective engagement with local dementia commissioning groups and
presentation of capacity and demand information to demonstrate the need for change or investment in the service.
Transferable Learning
Involvement of the whole team, service users and other stakeholders in identifying opportunities for positive change and improvement in ways of working.
Utilising ongoing clinical audit, research and external accreditation to validate the quality of the service provided and highlight ongoing opportunities for positive change.
Ensuring there are clear and direct mechanisms to engage with commissioners and local stakeholders to explore options to address the challenge of increasing rates of referral and diagnosis of dementia.
Validation/
Evaluation
Referral rates to the service have consistently risen with 690 referrals to the service between April 2008 and March 2009.
Service users and carers have been regularly consulted to provide feedback on the service provided. Specific research and projects have provided focused evaluations. For example, one recent project has led to the development of more community orientated services, with people with dementia now having a greater choice of home or clinic based appointments. A further evaluation project has resulted in improved transport services after detailed consultation with service users and carers.
A formal evaluation of capacity and demand has also been commissioned, with an aim to provide a service that is high quality and makes best use of resources.
Sustainability/
Next Steps
There is a regular system of ongoing service user and carer evaluation, with feedback to individual clinicians on service users’ experiences of assessment and diagnostic interventions.
The service is currently participating in the Royal College of Psychiatry Memory Service Accreditation Programme in order to validate the quality of the service provided and identify any areas for improving the experience of service users.
There is an ongoing programme of clinical audit to evaluate the standard of care and treatment provided.
The local Dementia Strategy Management Group brings together commissioners and representatives from local providers including Memory Service Staff to track progress against the Strategy and plan strategic local priorities.
Key
contact/Locality
For further information about the Wakefield Memory Service contact [email protected]
Dementia Strategy Objectives
2.
APPENDIX 1: Draft synthesis of outcomes desired by people with dementia and their carers
Outcome Descriptor NICE QS NDS Objective
A I was diagnosed early People will have the information they need to understand the signs and symptoms of dementia. The time people presenting symptoms to a doctor and being
diagnosed will be as short as possible for everyone.
2, 3 1, 2
B I understand, so I make good decisions and provide for future decision making
Everyone affected by dementia will get information and support in the format and at the time that best suits them. They will be supported to interpret and act on the information so that they understand their illness and how it will impact on their lives, including any other illnesses they may already have. They will know what treatments are best for them and what the implications are and they will be supported to make good decisions.
3, 5 3, 4, 5
C I get the treatment and support which are best for my dementia, and my life
Everyone living with dementia will receive the best dementia treatment and support, no matter who they are or where they live.
They will feel that their personal needs have been appropriately assessed and that their treatment and potential
consequences of treatment have been well planned and delivered in a coordinated way that is appropriate to their individual needs and their preferences. They will be able to exercise personal choice in social care and ongoing support will be of a high quality.
1, 4, 5, 7, 8 2, 6, 8, 9, 10, 11, 13, 18
D I am treated with dignity and respect
People living with dementia will report that they are treated with dignity and respect by all those involved throughout their dementia journey. They will also be open about living with dementia without fear of stigma or discrimination. It will be well recognised and understood by the public and professionals that dementia is a condition that increasing numbers of people will live with.
1 1, 13
E I know what I can do to help myself and who else can help me
People living with dementia will be supported to self-manage the consequences of dementia and its
treatment, to the degree they are able/wish to. They will know where to turn to get the clinical, practical, emotional and financial support they need when and where they need it. They will feel confident that they can practice their faith and spirituality and that others will help them when they need support.
1, 3, 4, 5 3, 4, 5, 6, 13