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.

In brief

The memory service is led by a small team within the Older People’s Mental Health Services and referrals come from 45 GP surgeries.

The service has a personalised approach and a single point of access (SPA), taking referrals from GPs who are expected to have carried out some screening and tests before a patient is referred. The patient is referred from the SPA to the Memory Service or the Community Mental Health Team for further investigations and treatment.

They are contacted on the same day and seen in the memory service by a nurse and consultant in the next available clinic within 28 days.

Costing per patient per year is £491 and the main benefits are patients are only asked to give their information once, there is a clear agreed care plan, they have fast access to specialist services and there is continuing advice and support.

Detailed description

Although the memory service and other dementia services are part of RDaSH, they are not delivered in isolation. The Trust works in close partnership with other organisations throughout their area to deliver the best dementia services for the local population. Some of these are neighbouring Trusts, voluntary and not for profit organisations, CCGs, general practice and others.
The service has received accreditation through the Royal College of Psychiatrist’s Memory Service National Accreditation Programme (MSNAP).

In April 2014, RDaSH moved the memory provision from being a clinic to a service to assist a more personalised approach and responsiveness to increasing demand. The memory service receives referrals via a Single Point of Access (SPA) specific to the Older People’s Mental Health division. The SPA has been in place for approximately ten years so is a mature and efficient service.

The diagram below illustrates the memory service care pathway.

Referrals are made to the SPA by general practice after completing RDaSH’s referral protocol. The GP is expected to have carried out a screening assessment that includes the Six Item Cognitive Impairment Test (6CIT), an assessment of historic activity impairment and investigations to exclude other conditions that may mimic dementia. These will include comprehensive physical examination, blood work and urinalysis.

Once the referral and supporting information is received, SPA can begin to collate it and identify the most appropriate place to pass the referral on to. This may be either for specialist assessment or for SPA to provide advice to the referrer should there be no markers for dementia.

The Trust has worked hard to develop partnerships and close working with the local GP practices. Approximately 75% of the referrals SPA receives will be complete. However, the remaining referrals will have information gaps that can hold up the process.

Once the information is complete and SPA has considered it appropriate to pass the referral on for specialist assessment, the referral will go either to the Memory Service or to the Community Mental Health Team (CMHT). This will be determined by SPA based on the complexity of the patient’s need, behavioural and psychological symptoms, risk factors, etc.

If the memory service is determined to be appropriate, the patient will be contacted on the same day that the referral is received. They will be scheduled in to the next available clinic. This may take as long as 28 days depending on when in the month the referral is received. However, contact has been made and the patient and their carer(s) have information to make contact with RDaSH should there be concerns in the meantime.

RDaSH prefers that the patient go in to clinic. If absolutely necessary they will arrange home visits. However, it is not ideal as at the clinic there is access to the supporting staff, tools and information that might be needed.

At the first visit to the memory service, an assessment is conducted by nursing staff and a specialist older age consultant psychiatrist. The diagnosis will be clarified and the patient considered for medication. The patient and their carer(s) / family will be given advice and information about support available.

Information gathered at the memory clinic assessment will be taken to a multi- disciplinary team where a baseline assessment is conducted. This will include a review of the available information as well as considering carer stress, social circumstances, social functioning and a comprehensive range of health and social concerns. This team will use the results of these deliberations to determine the appropriate cluster pathway for the patient.

RDaSH has been commissioned to use the Payment by Results Clusters to deliver a structured care plan for each patient in the Older People’s Mental Health Service. The memory clinic specifically delivers standard care for clusters 18 and 19; with cluster 18 representing the least complex care and delivering standard medication and titration, Cognitive Stimulation Therapy, advice and information, regular reviews and medicine management. Cluster 19 includes the entire cluster 18 plan, but also supports access to allied health professionals if required.