Agenda item

Purpose: To present a report on the dementia diagnosis rates and the pathway to diagnosis in West Berkshire.

Sara Johnston (Dementia Service Lead, Berkshire Healthcare NHS Foundation Trust) presented the report on the work underway to improve awareness and diagnosis of Dementia within West Berkshire.

During the presentation the following key points were made:

·       An overview of what Dementia was, the signs of Dementia and noted that medication could slow progression. An insight was given into the prevalence of Dementia and how important timely and accurate diagnosis was.

·       The NHS had a person-centred approach with key guidance to diagnose well, living well and supporting well. West Berkshire Memory Services were supported by specialist staff who assessed patients through MRI, Addenbrooks questioning, detailed history taking and speaking with Next of Kin’s. It was highlighted that mild cognitive impairment was different to Dementia which affected daily life.

·       The national diagnosis rate target of 67% was hard to achieve.

·       Waiting times locally were above the national target. The Trust was offering support to those waiting longer and they were linked in with the voluntary sector, social services and the community mental health teams to support patients and their carers. There were gaps in staffing, issues relating to Covid and high levels of referrals which had led to the longer waiting times.

·       They were doing some targeted work with some GP practices and working with harder to reach communities such as rural areas.

·       Delays in MRI scans were impacting their waiting lists.

The following points were noted during the Committee’s discussion:

·       It was confirmed that in care home settings, GP’s used a tool to diagnose advanced Dementia. Younger people however, benefitted from a longer diagnosis pathway and assessment at a memory clinic. Most GP practices also had a care navigator who was often involved with supporting patients when awaiting diagnosis.

·       The reason for lower diagnosis rates was multifactorial. It included stigma, memory assessment delays following covid and significant staffing issues in West Berkshire and with MRI issues. Combined, this put a lot of pressure on the service.

·       It was noted that issues with coding data incorrectly had created discrepancies in the overall data and it was being addressed monthly. Waiting times were impacting the Dementia Diagnosis Rate locally but this was a national issue in diagnosing people in care homes and there was work to do to reduce stigma.

·       It was advised that the Memory Service was part of national and regional forums and that they shared learning and best practice with other areas.

·       It was acknowledged that some GP Practices had lower Dementia Diagnosis Rates. They did not know the reason for that, but they had a new reporting tool which would assist for example in understanding issues in rural areas. They did regular GP education and GP’s were being tasked with annual reviews for patients with Dementia. GP’s could also diagnose patients in care homes and carry out a standard set of tests.

·       The impact of Covid and later diagnosis was discussed in terms of resources available. The rates of referral and waiting times were considered across Berkshire and resources were flexed to meet demand. There were significant staff gaps in West Berkshire and it was a challenge to recruit skilled memory clinic nurses. Their focus was on retaining nurses and developing career pathways. They had apprenticeship nursing roles and new roles such as in GP Practices where there were mental health practitioners to help people onto the right pathway quickly. These new roles were beneficial, but caused some challenges in the core functions such as in the memory clinic teams.

·       It was confirmed that additional resource had been secured to set up a partnership board for Berkshire West and to develop a BOB ICB Strategy around the Dementia pathways. There was an ambition to work more closely with public health and to work on how to keep the population healthy to prevent dementia.  There were opportunities around the 25% that end up on acute pathways and how they might divert those individuals away from hospital pathways. There was also work with care homes to help patients as their dementia advanced.

·       It was confirmed the target that they worked to was the Dementia Diagnosis Rate. It was highlighted that Berkshire West had improved by 2% over the last year and that they were comparable to the South East and were the best performing Place in the BOB area. There was more information and research around medication to slow the progress of dementia and new treatment pathways and so they hoped this would help people come forward. There was also the waiting time matrix which they were working towards getting down to six weeks.

·       Staff had been recruited and they had some posts out for recruitment. They had moved resource across the Trust to help West Berkshire with the higher referral rates. Gaps in staffing were a challenge and was one of their biggest risks. They needed to focus on retention.

·       It was confirmed that they would be looking at quality initiatives in the Dementia pathway for patients and their carer’s, and at how to personalise care. They were looking at how to improve the patient experience, how to live well with Dementia and at the end of life. They had an initiative called ‘I had great care’ which was a satisfaction questionnaire. Services also had their own way of asking locally for feedback on the service.

·       The ageing population was driving significant growth in dementia prevalence.

·       Care Navigators were in most primary care practices. They were under the same umbrella as social prescribers. The new GP contract included promotion of these services so patients could ask to be referred directly to them. Reception staff were trained to triage into these services.

·       It was highlighted that it was vital to promote healthy living but that it was difficult to measure any reduction. It was noted that prevention, new medications and research was very exciting and that it was important to measure those outcomes.

·       There was a programme called ‘Dear GP’ where care home staff were trained to recognise signs of dementia and let the GP know. There has been a lot of training for care home staff regarding dementia.

·       The NHS Health Checks programme was commissioned by Public Health. Staff delivering the programme were trained to share preventative messages particularly regarding cardiovascular disease. There was not a memory question as part of the health check programme but it could be included in discussions if there were concerns about their memory and further referrals could be made.

·       It was asked if there was more West Berkshire Council could do to get messages out to the public, improve awareness and help businesses to be more aware and Dementia friendly. It was confirmed that a lot of activity and public campaigns had happened and that the Health and Wellbeing Board might have been the place for the discussion. It was confirmed the strategic leadership piece between the organisations had been quiet for a while and so they would discuss how they could collectively make progress.  It was noted that inequalities needed to be addressed in this work.

·       It was noted that it would be useful to have a follow up on Dementia in the future.

Action: Dementia update to be added to the work programme.

RESOLVED to note the report.