1 / 19

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

Pat_Xavi
Download Presentation

Early Intervention in Dementia- A new service in Worcestershire

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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?

More Related