Living well with dementia; a national dementia strategy
Living well with dementia
Case example
This case example covers the NDS Objectives marked with a cross
1. Awareness10. Housing
2. Early diagnosis 11. Care homes
3. Information12. End of life care
4. Easy access to care13. Workforce
5. Peer support 14. Joint commissioning
6. Community support15. Regulation
7. Carer’s support16. Research
8. General hospital care 17. Implementation
9. Intermediate care
Memory assessment services for a whole population in Cambridge and the surrounding area
Aims of the service/innovative practice:
To provide flexible, rapid assessments for people with memory problems in the community, backed up by specialist investigations as needed.
To avoid some of the problems and delays that may occur in more structured memory clinics, and to maximise the proportion of people with dementia receiving a diagnosis
Description of the service:
New referrals of possible cases of dementia are seen at home, usually by a consultant psychiatrist with responsibility for that location. The assessment consists of one visit but can then be followed up usually by the multidisciplinary community mental health team, and with the results of investigations such as brain scans. There is also a hospital based memory clinic service, where we collaborate with neurology, and this is an excellent way of assessing more complex cases or ones where more investigation is required.
We have redesigned services across our Trust into specific care pathways and the memory assessment service is part of the dementia assessment pathway.
Funding and resource implications
It is a core part of our service. The new care pathways are intended to form the basis for a tariff system for costing and evaluating our services.
Challenges and solutions in setting up and maintaining the service
The main challenge is to have sufficient medical time and to concentrate on this area of work as a priority. There have also been changes in the hospital memory clinic, as the neurologist and psychiatrist who established the clinic have recently left. We have appointed a new consultant psychiatrist to collaborate with neurology.
Outcomes of the service
We estimate that a consultant serving an elderly population of 10 000 people over 65 will have about 500 people with dementia at any one time. This will represent at least 50 new cases occurring each year. Our consultants see between one and two new cases each week, so we are confident that we are providing a diagnosis for a significant proportion of local people with dementia. It is thus unlikely that two-thirds of people with dementia go undiagnosed in our catchment area.
Future sustainability
The model is probably sustainable, though increasing numbers of older people will cause some pressure. As mentioned above, we are revising the hospital memory clinic arrangements by augmenting the psychiatric input. We hope that service line reporting will enable us accurately to cost the care pathway and that this will in future form the basis of a tariff so that we get paid for the work we do.
Contact:
Dr Tom Dening
Consultant Psychiatrist & Medical Director
Cambridgeshire & Peterborough NHS Foundation Trust
Older People’s Mental Health Service
Box 311, FulbournHospital, Cambridge
CB21 5EF
Direct line: 01223 218890
Email:
Website: