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Early Intervention in Dementia- A new service in Worcestershire

Early Intervention in Dementia- A new service in Worcestershire. Bernie Coope Lead Consultant for Old Age Psychiatry Worcestershire. What this talk covers. The journey for developing a new service A brief description of our service model Things that have worked and things that haven’t

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Early Intervention in Dementia- A new service in Worcestershire

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  1. Early Intervention in Dementia-A new service in Worcestershire Bernie Coope Lead Consultant for Old Age Psychiatry Worcestershire

  2. What this talk covers • The journey for developing a new service • A brief description of our service model • Things that have worked and things that haven’t • Encouragement to get out there and do something

  3. Why do you come to work? (Or “Isn’t this someone else’s job?) • Do you come to work to improve the lives of people touched by mental illness? • If so, how broad is your job? • Delivering a service • Teaching others to deliver a service • Auditing a service • Changing a service • Creating a service And isn’t it more rewarding to do all of the above?

  4. Long, long ago, before the National Dementia Strategy • Mental Health Strategy for the county was 16-65 (i.e. Mental Health NSF) • No new development for older people for some time • Modernisation largely saw money leave older people’s service e.g. closing continuing care • No commissioning ownership-no one to talk to. • Dementia seen as unimportant • Only interest in dementia was focused on drug treatment (“You’re prescribing too much”) • Trust performance indicators focused on younger people

  5. But • Dementia growing -3%PA in Worcestershire • Rapidly changing presentation to the service reflecting changing expectations of population “I’m worried I might have Alzheimer's’” • National Audit Office Report showed need and cost of not doing something • NICE/SCIE Guidelines

  6. The start-can hate be good?

  7. What was there to hate-local and national • A reactive service • Referral at time of crisis • No user choice • Burnt out carers • Limited therapeutic options • Most people with dementia not coming near our service

  8. Had a good moan at NIMHE • FRUSTRATION- BLOODY GOOD NEWS STORIES • Wrote and got a reply • Had a moan to David Shires (Bloody discrimination, choice, too late, exhausted families etc) • He said “This is why we set up an Early Intervention Service for Psychosis” • A Eureka moment

  9. Developing the model-Form a group! • Remit- Is there a better way of addressing the needs of people presenting now • Involved professionals • Alzheimer's Society • For Dementia • Carer consultation and input to model • Rapid development of principles • Used “Early Intervention” to distinguish from “Memory Clinic” and because of strong image in Trust

  10. Principles • To improve the lives of those affected by dementia • Respond to demand from population, early assessment, more assessment • Swift, skilled assessment • Choice all the way along (to be assessed, to hear outcome, choice for future) • Skilled communication of outcome • Support following diagnosis for a period of time • Continual evolution, especially from feedback

  11. What is Early? Contrasting views • 2/3 never get a diagnosis, so before death is early. • Most of what can be described as intervention could be relevant to anyone, it’s never too early, let’s push the boundary • Personal view- • Dementia includes significant impact on lives, conspicuous impairment • Confidence in diagnosis • Early enough to retain information and make choices • Risk of harm • Risk of wasting resources

  12. What is an Intervention • “After diagnosis people want to be shown the path, not shown the door” Terry Pratchett • Information-Knowledge is power • Emotional Journey • Discussion and decision • Plans

  13. Then The National Dementia Strategy Came Along • Early Intervention key recommendation • Financial model and proposed service structure • We all went to visit Croydon

  14. Fishing or Carving Mount Rushmore?

  15. Be prepared for false summits, lots of them • Three years I had an excited phone call from CEO • Email 2007 detailing £1M recurring investment to the service • Early Intervention “a priority” • In the age of pointless detail it is surprisingly hard to be clear about money and time.

  16. A period of hard sell • Make friends and allies • “In God we trust, everyone else must bring evidence” • Sometimes you need detail, sometimes simple messages repeated • Charming gate-crashing • Persistence

  17. So what are we doing? • Newly funded team covering the county (Rejected proposal was enhanced function of CMHTs) • Multidisciplinary (Medic, nurses, psychologist, OT) • Consultations in clinics, surgeries, home • Make the diagnosis well, share it well and deal with the consequences • Still working on the detail-support from Worcester University • Team in post by June (first wave)

  18. Contentious issues • Who do we not offer a service to? • What do we offer people with no diagnosis or MCI? • What do we offer those of working age? • How long do we see people for? • What sort of interventions can we offer (e.g. ?cognitive stimulation) • Why not self referral? • How do we go about helping people plan for the future, including end of life care? • What is the right skill mix? • What is the right setting?

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