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Memory Services:

Improving Access

Helen Bown

Joint Commissioning Manager NHS Gloucestershire andGloucestershire County Council

South West Dementia Partnership Summit April 2010

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Where did we start?

Messages from carers

the importance of primary carethe timeliness of assessmentthe need for information

adopting a joint approachmake things as simple aspossible

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O ur ApproachTo work with our provider trust anduse their expertiseTo engage a GP Clinical Lead to work

across the whole pathwayTo identify resources to supportservice changeTo work with primary care via our annual summit to check on a) ideasand b) direction of travel

To work with as wide a partnershipas possibleTo promote this as work in progressSupport change within thespecification and monitoringarrangements

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Why Memory Assessment Services?

The National Dementia Strategy (Feb 2009)

Objective 2- Early Diagnosis & Support A pathway of careRapid and consistent specialistassessment and diagnosisMild to Moderate Presentation of Cognitive ImpairmentSecondary Care is the focus of specialistdiagnosis

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Why Memory Assessment Services?

New specialist services need to becommissioned to deliver good qualitydiagnosis

Single simple focus from GPsWork locally

Inclusive service for people of allages & ethnicity

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Why Memory Assessment Services?

Making the diagnosis well

Providing directly appropriate treatment, information,care and support after diagnosisOther messages:

Not designed to replace the work of Community

Mental Health TeamsCore Involvement of local third sector organisationsLocated in primary care settings rather than behospital based

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Creating a value stream for memoryassessment

Looking all the key steps

Looking at any delays andbottlenecks

Establishing the amount of time to complete a task

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Where did we want to go - whatwould the new service look like?

Single Point of A ccess

Core Team (working countywide) links to CMHT localityteamsClear process/ care pathway within agreed timescalesClear definitions of triage/ assessment/ diagnostics/post diagnostic workClear Expected Outcomes for those with:

Diagnosis of dementiaMild cognitive impairmentNo diagnosis

Clear links to other services including Dementia Care A dvisors

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The Memory A ssessment ProjectNew Operational Policy/ Care PathwayNew A ssessment Tools

Cognition

Behaviour A ctivity LimitationQuality of Life

Specialist Training & CompetencyRing fenced workers/ nurses

Clear Outcome MeasuresPre/ Post Diagnostic CareInformation Provision the right information at the right timeIT & Infrastructure

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O utcomes Measures

Initial assessment measures to benchmark

ACER (inc MMSE), HoNOS65plus, Bristol ADL scale,Carers Self Assessment

When indicatedNeuro Psychiatric Inventory, Geriatric Depression Scale,MoHOST

Repeat measures MMSE, HoNOS, Bristol ADL ScalePatient Satisfaction QuestionnaireYearly Patient Experience Report

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Where now?ChallengesValue Stream Mapping is a continuous improvement process

Refining our assessment proceduresSetting up the single point of access and core teamImplementing the outcome measures to show ushow well we are doingA ligning our services e.g. Managing Memory Together Community Dementia Nurses

VSM work underwayCommunicating and Marketing the Service

Micro site - Managingmemory 2gether.nhs.ukPosters/ information leaflets

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