Dementia Strategies and Memory Clinics

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The National Dementia Strategy for England was launched yesterday with an impressive sounding 5 year plan to increase support people who are diagnosed with dementia and take through the different aspects that need to be worked on – from early diagnosis through to raising public awareness and raising standards in nursing homes by improving training for social care workers throughout the sector.

Some of the attention has fallen on the recommendation to set up ‘Memory Clinics’ around the country to support Alzheimer’s sufferers and carers of people with Alzheimer’s. I am not sure how much additional money is being provided.

A part of the reconfiguration of services in my own service was to allow for the setting up of a Memory Clinic. Four area CMHTs were merged into two plus a Memory Clinic. It was a what the management delightfully refer to as a ‘zero cost’ change – meaning that no additional money or posts were made available.

Of course, our new memory clinic hasn’t been running too long and setting up a service from stratch is never an easy prospect but there are a few elements that have concerned me.

Firstly – and this is a personal gripe so bear with me – the team is staffed by CPNs exclusively. Not that they aren’t wonderful, of course but there was no role for any social work input and that was a very deliberate move.

Our Memory Service is about diagnosis and then referral to adult social work departments if any kind of additional care is needed. I did suggest at the time that even having an unqualified social worker in post who could set up minor care packages at the very least, might make a more seamless service but this was seen as contrary to the ‘point’ of a memory clinic. It has a purely medical  model.

The CMHTs will take on people who have particularly complex needs or who have not been engaging with services as they always did but the staff have been moved out of the CMHTs to work in the memory clinic so we are even harder pressed.

Of course it is still early days. I am sure for some people it is a much better service. It means we, as a CMHT, are able to refer more people back to the Adult Community Care. That is seen as a bonus. I don’t think it is though. I came into my job from the Adult Community Care Team. I know that they have much higher caseloads than we do. They simply do not have the time to provide the same level of support that we can. Anyway, as I said, that’s a personal gripe with the way that our service was set up.

According to the BBC, Alan Johnson, the Secretary of State for Health, states  that

The clinics would be “one-stop shops”, offering expert assessment, support, information and advice to those with memory problems and their carers.

The clinics could be housed in hospitals, GP surgeries or in the high street, and patients could refer themselves, he added.

I’m not sure that our service has reached the ‘patients referring themselves’ part yet. We get most referrals  as always from GPs. These referrals still need to come in and when you work in a particular locality you get to know the various GPs and to be honest, almost all of them are great and refer if they have any doubts or concerns.

It still needs someone to actually make that trip to the GP in the first place though – whether an individual themselves – or a family member.

I can’t be the only person this has happened to but twice in the last couple of months I have made referrals myself to my own team when I have visited a couple at home and while visiting Mrs X have noticed that Mr X seems to be having memory problems. Of course the families involved have noticed but sometimes diagnosis is a scary prospect – even when, in reality, it is just a confirmation of something that everyone knew.

With all my cynicism though, more money is now going to be pumped into dementia services which is no bad thing as long as it is targeted money. If I were able to distribute it myself, I’d put much more into carers’ support, carers’ services and carers’ allowances.

So much of a patient’s quality of life depends on informal care networks. It is important that professional networks are available and most importantly are responsive but sometimes, providing actual cash to carers is much more important.

I would say some of the more valuable work I do is with carers and supporting them, at least psychologically, through some of the paths of dementia and the expectations of what may lie ahead when it reaches that point and gently nudging them to  make plans, make arrangements and preparations so that when the time comes at least they do not feel completely isolated or alone.

I see that the strategy is going to pilot a new role of ‘Dementia Advisor’. This, I think, seems to fall into this role but it can’t be a time-limited one. Someone does not need a dementia advisor solely at the point of diagnosis but it is important that there is a consistent through the process of deterioration and change. The strategy mentions that these advisors will be a place to turn for support for the person with dementia and their carer throughout. I assume additional funding will be available for these workers.

Some more and important positives of the strategy though is the recommendation for better dementia awareness and care in general hospitals. Having a team in a hospital that will advise and support patients who have dementia and improved training in care homes who are managing patients with dementia. It is hard to think that this can be a bad thing.

And there is also more money (if I have understood correctly) being put into research. Which can never be a bad thing.

Raised awareness of dementia, it’s broad reach and the implications and paths of care are all very positive. Some of the details – well, I’ll reserve judgement.

Just a reminder too, in the UK anyway, that tonight on BBC2 there is ‘Living with Alzheimer’s’ at 9pm –

Determined to prevent it if he possibly can, Terry Pratchett takes a personal journey through the science and the reality of what it’s like to be diagnosed with Alzheimer’s.

This two part documentary follows Terry’s race to find a cure as he endeavours to find ways of slowing, mitigating or even reversing its course.

I, unfortunately, won’t be watching – well, not live anyway. The snow flurry has blown my TV aeriel down  (which, if any of you knew me, you’d know how distressing this is as I’d say ‘TV watching’ is one of my prime hobbies (!)). At least I will be able to catch it on the iPlayer though .

6 thoughts on “Dementia Strategies and Memory Clinics

  1. “I would say some of the more valuable work I do is with carers and supporting them, at least psychologically, ”

    this doesn’t surprise me at all…I bet it’s a good percentage of your job.

    I’m curious as to what happens in these memory clinics when someone walks in for help. They sound like an interesting concept–I guess they’re set up exclusively for dementia patients?

    Hello? iPlayer??? Hmmmm……..that sounds deliciously evil.

  2. A lot of the work of the memory clinics is done when people actually visit said persons’ home. Referrals come primarily from family doctors although the idea is that peopel can self-refer (although I don’t think that’s possible yet in the model we have set up). And yes, it is exclusively for people with dementia or suspected dementia as a primary function is about diagnosis.

    And I LOVE the iPlayer – such a shame it’s only available within the UK 😦

  3. The clinics would be “one-stop shops”, offering expert assessment, support, information and advice . . .
    I’d agree with this more limited viwe of a “one-stop shop” as being helpful and practicable.

    The Royal College says that all people with dementia should have denistry sorted. Makes sense. With shrinking gums, tjhe last thing you want is ill fitting dentures and pain on eating when severly demented, or dental treatment when you’re utterly cionfused and someone’s holding you down and stabbing sharp spiky bits in your mouth. A solicitor’s needed for sorting out a will (if you’ve still testamentary capacity) and considering lasting powers of attorney for financial or health/social welfare decisions. Physio, OT, speech and language therapists, dieticiana all have a role in dementia caer for some people at some stages of their illness. DVLA and fitness to drive, council tax, attendance allowance . . . lots to sort out.

    I’m therefore fully accepting of the notion that you can’t have everyone you need to sort every element of dementia care in a memory clinic, so have to prioritise.

    Equally, sorting out a change to a care schedule to move from a home carer going twice a day to three times a day can be done by an area team’s Assessment Officer, rather than an AT Social Worker, let alone needing a qualified Social Worker within a mental health Trust working as a specialist within a Memory Clinic. My social worker is a band 7 and I’d have strong views if they were spending their day on simple care schedules.

    For a memory clinic to do all “assessment, support, information and advice” I’d see that medical, nursing and social work time is necessary, I’ve an OT in mine too, and for it to be “one stop” there needs to be non-medical prescribing, also.

    We have strong links with the local Alzheimer’s Society (who can be in the next room to me) so they can support patients/families with financial and practical advice, too.

    As CB says, a Memory Clinic isn’t necessarily just a hospital out-patient clinic, a lot of work will be in peoples’ own homes, the whole team can’t descend on them so joint or collaborative working’s a necessity.

    I’m therefore sold on the notion of having the right skills in a memory clinic, but also timely access to the right staff who aren’t core to the team, and formal arrangements for Alzheimer’s Society, Age Concern or other non-statutory services who provide support (our PCT’s commissioned dementia care for carers from 2 other sources) to all work seemlessly.

    That’s my notion of a seemless service. The patient turn up once, is asked all the questions once, has a robust care package devised there and then, is given a useful outcome there and then, then others (solicitors, district nurse, area team Social Workers, dentists, DVLA, council, community physio, Alzheimer’s Society for support/benefits checks etc) all get involved to do their thing.

    . . . and patients could refer themselves, he added.
    No no no no no.

    Firstly much cognitive impairment isn’t dementia. Folk with mild cognitive impairment (MCI) usually (7 out of 8 times) don’t get worse, or in fact get better, one year on.

    Secondly much of the cognitive impairment that does mimic dementia isn’t. Depending who you believe, it’s between 1 in 8 and 1 in 12 cases of dementia aren’t caused by dementia. They’re caused by hypothyroidism or vitamin deficiencies or a blood clot that can be removed or normal pressure hydrocephalus or another cause that can be treated and the person cured. GPs have a pivotal role in effective pathways for high quality care of folk with memory problems. Although often they don’t spot the problem for me, they do the tests and give the information so when they arrive at our memory clinic and we’ve the time, inclination and expertise to sift through all the information we’re in a strong position to make a more valid diagnosis.

    Self referral would weaken this, and in advocating for high quality dementia care I oppose self-referral on this basis alone. GPs in my corner are largely very good indeed, they need to be involved.

  4. Thanks for your comments, Shrink.

    Seamless would be wonderful and our memory service is still very much in its early days, I just think it sounds in some ways, like a government sound-bite that needs to be achieved at zero-cost.

    Better service and support does need increased funding.

    We’ve never had a model of self-referral however it is becoming more popular in social care. But however much overlap, there is a massive difference as you point out.

  5. I think Memory clinics are a good idea if they are linked to other services and the person diagnosed with dementia isn’t just left thinking ‘now what?’. I consider dementia education and training is vitally important and should be introduced early on in Nursing/Residential Care Home courses. I am not just talking about the physiological changes – all ‘doom and gloom’, but education about how important it is to support the Carer as well as those with dementia. Songsconnect people together and it is important to carry on as many enjoyable activities with those who have dementia as possible – thereby breaking down the barrier of isolation. There should be much more emphasis on having fun and being optimistic about the future. Therefore there should be financial provision for Carers to take those with Dementia to Day Care Centres so that those with dementia and their Carers can participate in enjoyable activities like being part of a choir. Nurses and Care Assistants visiting those with advanced dementia at home should be educated and trained in the importance of singing together during morning washing sessions and given adequate time for this. Home visits should be more than a 10 minute vist – dashing in the car from one person with dementia to another. The visit should be a social occasion helping the main Carer as well with tea, cakes, chat, singing, dancing and perhaps getting out in the fresh air and natural light, feeling the sun, seeing the flowers, etc.
    MollyDee,North Slough, UK

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