2. Memory assessment

10 key steps

Improve access to memory assessment

Questions to consider

what resources are in place currently?
what are the ‘unmet needs’?
could services be designed to be more effective, and more efficient?

DRIVER: True prevalence, incidence, diagnosis rates, forecast

Actions	Resources	Examples
With stake holders, model demand and supply for specialist assessments, specialist memory services; and for post-diagnosis support in the community identify outcomes and quality standards	Models of dementia assessment and diagnosis: Indicative cost review National Dementia Commissioning Pack The dementia profile	Accelerating Dementia Diagnosis 2012 action plan This plan sets out actions to accelerate dementia diagnosis across Cornwall and the Isles of Scilly. Read more »
Set trajectories for improvement in diagnosis rates. Estimate the number of specialist memory assessments which will convert to diagnosis of dementia	Dementia Prevalence Calculator The dementia profile World Alzheimer Report 2014, Dementia and Risk Reduction World Alzheimer Report 2015: The Global Impact of Dementia	Accelerating Dementia Diagnosis 2012 action plan This plan sets out actions to accelerate dementia diagnosis across Cornwall and the Isles of Scilly. Read more »
Establish cost benefits and options for service delivery	Cost of Dementia in the Pre-Enlargement Countries of the European Union Models of dementia assessment and diagnosis: Indicative cost review	Closer to home memory assessment: reaching out to rural communities in Buckinghamshire This project aims to adopt the Gnosall primary care based memory assessment approach to improve dementia diagnosis in harder to reach communities in Buckinghamshire. Read more » Collaborative dementia care in Oxfordshire This project aims to develop a more user-friendly care pathway for people living with dementia in Oxfordshire by providing easier access to assessment for early diagnosis and support within primary care settings. Read more » Early intervention and diagnosis, local delivery action plan 2012-13 This plan sets out actions to improve the diagnosis of dementia and provide better services for people living with dementia across Dorset, Bournemouth and Poole. Read more » Rotherham, Doncaster and South Humber memory service Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) provide a specialist led memory service that serves approximately 50,000 people of age 65 and over living in Rotherham, Doncaster and South Humber. Read more » South of Tyne and Wear Memory Protection Service The South of Tyne and Wear Memory Protection Service provided by the Northumberland, Tyne and Wear NHS Foundation Trust is a specialist care led service with primary care support serving 84,000 people living in Sunderland, South Tyneside and Gateshead. Read more » Worcestershire Early Intervention Dementia Service Worcestershire Early Intervention Dementia Service (EIDS) have developed a clear referral pathway, which includes pre-assessment counselling, consent, family engagement, assessment by a competent specialist and sensitive disclosure, leading to better access to treatment and support. Read more »
Produce memory service specifications to include required increase in rates of diagnosis and standards of delivery. This may include: diagnosis pathways within primary care (for example, for people presenting with at a later stage of dementia, i.e. with moderate-severe dementias) diagnosis pathways via specialist memory services (for example, for people presenting with possible mild dementias, early onset dementia; complex presentations)	Guidance and standards for diagnosing dementia NICE dementia quality standard Service specification for dementia: memory service for early diagnosis and intervention	Accelerating Dementia Diagnosis 2012 action plan This plan sets out actions to accelerate dementia diagnosis across Cornwall and the Isles of Scilly. Read more » Bristol nurse-led dementia management model Dementia-specialist nurses from the secondary care memory assessment service in Bristol are now based in primary care, supporting GPs as they regain skills in managing dementia. Read more » Gnosall dementia co-ordinators The Gnosall dementia service identifies patients at risk or in the early stages of dementia in a primary care setting. Read more » Lostwithiel nurse led memory assessment service Lostwithiel General Practice in Cornwall has introduced a nurse led memory assessment service to support detection, diagnosis, and post-diagnosis care and support. Read more » Memory First Memory First is an integrated dementia service run by a consortium of 162 GPs across 41 practices in Staffordshire. Its pioneering joined-up approach to care has cut diagnosis times from 3 years to 4 weeks and led to major improvements in patient experience. Read more » Worcestershire Early Intervention Dementia Service Worcestershire Early Intervention Dementia Service (EIDS) have developed a clear referral pathway, which includes pre-assessment counselling, consent, family engagement, assessment by a competent specialist and sensitive disclosure, leading to better access to treatment and support. Read more »
Commission specialist memory services sufficient to meet projected increase in demand.
Incorporate requirements for memory assessment services into annual contract(s), including activity and quality standards.	Payment by Results for mental health	NHS North Somerset Dementia Pathway and Payment by Results This illustrates care packages for people living with dementia across four care clusters in line with payment by results for mental health. Read more »
Introduce a set of standard Read codes to specialist memory services and ensure these are utilised in discharge.	Dementia coding clean-up exercise Dementia diagnosis and management Dementia READ codes Guidance on Dementia Coding Improving dementia care: harmonisation of practice between primary care and memory services	Improving GP coding of dementia in London This project aimed to find out whether it is possible to raise diagnosis rates through undertaking an exercise to ‘clean up’ dementia coding and records at a practice level. The hypothesis was that problems in GP coding may be contributing to the reported dementia diagnosis gap. Read more »