Amy Taylor visits a “memory” service blazing a trail in the early intervention and management of dementia
It is often said that dementia care is where cancer care was 50 years ago, with support only available at crisis point. Last month the government signalled its commitment to address the issue in the form of a draft national dementia strategy for England.
The five-year strategy contains a range of proposals but the only one that’s costed is a plan for more than £200m a year to be invested in a national early diagnosis and intervention service for people suffering from the disease.
There are few of these “memory” services up and running. Croydon, in south London, has had such a facility since 2004 and is cited in the strategy as an example of best practice. It is also the subject of a Department of Health-commissioned evaluation which has reported highly positive results.
Small multidisciplinary team
The service consists of a small team of professionals from mental health and social services. This includes two social workers, one employed by Croydon Council and one employed by South London and Maudsley NHS Foundation Trust (SLaM). As a result funding comes from both Croydon Primary Care Trust and the local authority.
There is a history of reluctance among GPs to diagnose dementia early on, because of the feeling that the condition is largely untreatable and so there’s little point in giving people the bad news for what is, in the early stages, a mild problem. The strategy says this has led to a situation where only 30% of people with dementia receive a diagnosis, often in the later stages of the disease and without being given adequate information. In Croydon it is very different.
David Matthews, a consultant clinical psychologist and head of the team, says the service takes the view that the earlier people are diagnosed with the condition the better, as it allows them to control their own lives.
“It reduce the difficulties experienced by the client and their carer and the potential mental and psychological problems. If nothing else it gives them more time to come to terms with the situation,” he says.
He explains how early diagnosis allows the person with dementia and their families to make decisions about their care before things break down. The service also sees it as key to provide patients with a vast range of information about the condition so they can make informed choices.
The team, together with the community mental health teams for older adults, assesses two-thirds of dementia sufferers in Croydon. While this is much better than the average outlined in the strategy, Matthews is keen to increase it.
“There’s still one-third of people in Croydon going through their illness without a diagnosis,” he says.
Alongside the benefits to well-being there is also a strong economic argument for early diagnosis – it’s far cheaper to keep people in their own homes than pay for nursing care.
Matthews says that while some of the team’s clients are in residential care the service has helped to keep them in their own homes for longer prior to this.
“I hope we have reduced the time they would need to be in [care homes]. I suspect we have also prevented a number of admissions by allowing people to plan,” he says.
Since its inception the service has received 1,780 referrals, mainly from GPs.
Many of its clients want access to dementia medication but alongside this the treatment offered also includes talking therapies, social services interventions and attendance of specialist dementia day centres.
Assessments, diagnoses, treatment
One of the key differences between the team and traditional mental health services is that each member, regardless of whether they have a health or social care background, has been trained to provide assessments, diagnoses and treatment.
“Anyone can pick up an assessment, it will then be discussed in a team meeting and any team member can then give a diagnosis, whereas traditionally [in mental health teams] all assessments and diagnoses are given by psychiatrists,” says Matthews. He adds that this shared responsibility means the team are able to see large numbers of patients quickly, opening up the service.
Chris Wheeler, a senior social worker and the team’s deputy leader, says that as a social worker rather than a health professional she initially found diagnosis an awkward process. She says: “From a social work point of view we don’t give people bad news usually social workers pick people up when they have had bad news,” she says. “That was a change for me but it’s the right thing to do. It allows people to plan for the future and it facilitates a continuum of care, as clients have the same worker throughout.”
Matthews explains that SLaM had to make several bids to the PCT before it agreed to continue funding for the service. He says the DH will have to provide new funding if it is serious about a network of memory services being created. When the strategy is published in October it will become clear if this is the case.
Published in the 31 July edition of Community Care magazine under the heading ‘Croydon Leads on Dementia’