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.

The service offered

The patient will be offered an appointment at home within approximately six weeks of the referral. This is carried out by a nurse who remains with the patient throughout their involvement with the service and is an opportunity to offer pre-assessment counselling and establish informed consent to proceed with an assessment. The next two appointments are held in clinic with the doctor and nurse to carry out a comprehensive assessment and formalise a diagnosis. We have access to further neuropsychological (psychologist) and functional (occupational therapist) assessment if required.

Following diagnosis, the patient and their family are offered a period of post diagnostic support (for approximately three months) which may include initiation and monitoring of cholinesterase inhibitors if indicated, referrals to external support agencies including Dementia Advisors and Admiral Nurses, carer Support, psychological support for patients and/or family members, confidence building, memory strategies, assistive technology and more. We would aim to discharge the patient with a dementia advisor in place. We are also able to refer into the CMHT if continued specialist support is required.

Before the service’s inception, it was estimated that only around 30% of those having or developing dementia were receiving any sort of treatment or intervention. At the onset of EIDS, take-up of the service was around double that expected. This has resulted in a greatly increased percentage of early stage diagnosis. Even in the first year, 86% of patients chose to continue with the service following referral.

Service benefits

The University of Worcester produced a very in-depth Evaluation Report detailing the results of the EIDS approach from July 2010 to June 2011, involving 683 referrals. The main successes of the programme included:

• a clear route towards dealing with the problem on all fronts instead of an inconsistent approach,
• the availability of specialists in a timely manner, particularly when dementia was diagnosed at an early stage while the patient was able to contribute to the process,
• a pathway capable of dealing with younger-age dementia (under 65),
• information resulting from a unified series of tests, which could be used to make life-style changes for the patient, their families and their carers,
• a network providing appropriate support as required.

Download

• Evaluation Report EIDS Executive Summary
• Report – Worcestershire Dementia Forum December 2010

The financial impact of such a development is difficult to quantify because there are so many variables involved, but improving the service in a more effective and focused way, as EIDS has done, will inevitably give better value for money. Cost per patient, including 6- to 12- month follow-up, has been reduced to £900.

The clarity of the pathway not only makes the patient experience more effective and acceptable, but all the professionals along the way – GPs, specialists, carers and support team – are content that they can deliver a better service, due to their roles being clearly defined. Rolling out the Worcestershire EIDS pathway across the country could have an invaluable effect in boosting the morale of patients and staff alike.

The service was recently awarded a £35,000 prize in the NHS Innovation Challenge Prize for Dementia