Scope
The majority of people living with dementia receive little specialist assessment or care throughout their illness. There is evidence that memory services offer demonstrably improved health and social care outcomes as a result of early identification and intervention. It is argued that a memory service provides a suitable setting to generate an early diagnosis, which can enable choice and forward planning while people have capacity4.
The challenge is to provide a service which is easy and quick to access, supportive, respectful of older people’s rights and integrated with early intervention services. It should be able to offer home assessment, enable understanding, address fears and worries, help build coping strategies, provide pharmacological treatment, and provide or facilitate access to psychological and social interventions and to advocacy services.
It is recommended that a memory service is an integrated service which is effectively a starting point for professionals, patients and their carers and families. It should have a multi-disciplinary team and should not exist as only a health service and should have other core functions which include care and support for the relatives and their carers.
The successful operation of any memory service is dependent on the interaction with other services designed to support people living with dementia. This includes other services provided or commissioned by the NHS and local authorities, including those from the independent sector. The dementia care adviser role is important to the operation of any memory service as this role will work with staff at memory services to ensure a seamless service for signposting people newly diagnosed with dementia and their carers (see appendix 5).
Memory services offer both an assessment and diagnosis of dementia and support early identification. They should also engage with people living with dementia and their carers. As such, the service should have an operational policy and plans will need to show how key service components will be delivered:
• Early intervention will enable people to better plan for and manage their condition and remain in their own homes for as long as possible.
• The service will offer a range of diagnostic, therapeutic and rehabilitative services via a single assessment process.
• The service will support better individual care planning and more effective support for families and carers.
• The service will be defined locally in line with clinical engagement, current services and local population needs.
Referrals will be accepted from any source, although the process of open referral should be defined locally. The memory service will work particularly closely with GPs to support local practice awareness and detection of dementia and the timely referral of people to the service. Best practice suggests that GPs could also carry out early routine investigations, excluding physical conditions which may impact on
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4Banerjee, S and Wittenberg, R. Clinical and cost effectiveness of services for early diagnosis and intervention in dementia, 2009
functioning, for example haematology, biochemistry and basic neurocognitive screening. This would enable the results to be at the memory services in time for the patient’s first visit. Referrers will need to provide information pertaining to medical history, a copy of the patient encounter record if possible, current medication and presenting problems.
Inclusion criteria
Referral should be made when a healthcare professional has identified that there is a memory problem. The purpose of the memory service is not to screen populations but to assess those with memory loss. People will be referred and will be accepted if they meet the following criteria.
• The person is a resident from a London borough and registered with a GP belonging to a London PCT.
• The service is primarily for the diagnosis of dementia and as such, patients referred to the service should present with symptoms consistent with suspected dementia rather than a physical or functional mental illness.
• The patient may have an existing diagnosis of dementia yet require further referral and signposting according to need.
• The person does not already have an existing clinical diagnosis of dementia nor is the person currently under the care of a specialist older adult mental health team.
• The service will be needs led and for people across the age range.
It is likely that younger adults will receive a more appropriate service (where commissioned) from an early-onset dementia service as this requires different systems of support.
Exclusion criteria
The following criteria excludes a person from being admitted to the service.
• People reporting memory problems following a traumatic head injury are inappropriate for the
memory service, and should be referred to specialist neurological services, neuropsychiatry services and local authority brain injury services.
• People with an existing diagnosis of dementia made by an appropriate clinician, who are already under the care of a specialist older adult mental health team.
In all cases the memory service will be required to make a judgement as to whether it is the most clinically appropriate service to deal with the presenting situation or whether the referral, should be routed to another service. Where there is uncertainty about the most appropriate referral the memory service must ensure that the person receives an assessment of need. Where it is felt that the referral would best be dealt with elsewhere, the transfer of the referral should be conducted well e.g. urgent behavioural problems. At all times services need to be mindful of the balance between the clinical need and the dependency.
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