In 2010 it was recognised that in Dudley we were only identifying approximately a third of the number of people with dementia compared to the suggested prevalence for our population and there was limited on-going support for patients.

The service innovation

The Dudley Dementia Pathway that has been produced provides a single point of access for GPs and other health and social care professionals who can refer for assessment to specialist nurses. A central dementia register has also been developed in order to capture key details and ensure that people are regularly reviewed. This enables all services to access key information to aid decision making and prevent unnecessary hospital admissions and support early discharge.

All those diagnosed with dementia are referred on to the Dudley MBC Dementia Gateway Services and are allocated a dementia advisor to ensure support and on-going positive outcomes for the patient and their carers/families.

Outcomes

Diagnosis rates for dementia have significantly increased since the inception of the new pathway.

Evaluation has found that the efficiency, diagnosis rates and quality of assessments has improved; and referrals have risen significantly. The dementia advisors meet with the person with dementia, listen to and answer questions, discuss their personalised care plan, signpost to other support opportunities and maintain regular contact with the person.

The Gateways provide a person-centred approach via a one-stop shop of dementia services. It has also helped to reduce stigma by promoting a better understanding and openness of dementia across the Borough.

The Gateway:

• support people to remain in their own home and retain their independence, enhance the quality of life for people and their carers
• prevent premature progression of their dementia
• provide the carer with respite from caring responsibilities on a planned and regular basis, and
• ensure that all people with dementia have a personalised support plan (with input from the person) that puts them at the centre of the service.

www.dudleyccg.nhs.uk/dementia-and-dudleys-dementia-plans