Agenda item

12.45 pm

Early diagnosis for people with dementia has been shown to have benefits in terms of patient and carer quality of life and independence. There is also evidence to show that there is a financial benefit as a result of delayed need for residential care.

In Oxfordshire, Quality and Outcomes Framework (QOF) data shows that 34% of people currently receive a diagnosis of dementia. Memory clinics exist , provided by both Oxford Radcliffe Hospitals Trust (ORHT) and Oxfordshire & Buckinghamshire Mental Health Foundation Trust (OBMHFT). There is currently no clear pathway and no agreed service specification, leading to uneven levels of service and post diagnostic support. There is confusion amongst GPs around where to refer a patient with suspected dementia.

Building on recommendations in the National Dementia Strategy, the proposal is to commission an integrated Memory Assessment Service involving both providers working together to maximise the strengths of both. The need for an increase in the numbers receiving a diagnosis and current capacity issues would be partially addressed by enabling a specialist dementia nurse to undertake routine follow up appointments, moving to follow up appointments into community settings, such as GP surgeries; and freeing up consultant time for diagnosis and more complex cases. Agreed information and support would be provided at, or shortly after, diagnosis.

Duncan Saunders, Service  Development Manager for Older People’s Mental Health at the PCT will present the business case, which is attached at JHO8(a)), and describe what consultation has taken place to date (JHO8(b)). The proposed Care Pathway for early diagnosis in Dementia,  is also attached at JHO8(c)).

Early diagnosis for people with dementia had been shown to have benefits in terms of patient and carer quality of life and independence. There was also evidence to show that there was a financial benefit as a result of delayed need for residential care.

In Oxfordshire, Quality and Outcomes Framework (QOF) data showed that 34% of people currently received a diagnosis of dementia. Memory clinics existed , provided by both Oxford Radcliffe Hospitals Trust (ORHT) and Oxfordshire & Buckinghamshire Mental Health Foundation Trust (OBMHFT). There was currently no clear pathway and no agreed service specification, leading to uneven levels of service and post diagnostic support. There was confusion amongst GPs around where to refer a patient with suspected dementia.

Building on recommendations in the National Dementia Strategy, the proposal was to commission an integrated Memory Assessment Service involving both providers working together to maximise the strengths of both. The need for an increase in the numbers receiving a diagnosis and current capacity issues would be partially addressed by enabling a specialist dementia nurse to undertake routine follow up appointments, moving to follow up appointments into community settings, such as GP surgeries; and freeing up consultant time for diagnosis and more complex cases. Agreed information and support would be provided at, or shortly after, diagnosis.

Duncan Saunders, Service  Development Manager for Older People’s Mental Health, Oxfordshire PCT and Marie Seaton, Head of Joint Commissioning, Older People, attended to present the business case, which was attached to the Agenda at JHO8(a)), and describe what consultation has taken place to date (JHO8(b)). The proposed Care Pathway for early diagnosis in Dementia,  was also attached at JHO8(c)).

Following the presentation, members welcomed the proposals and raised the following questions/issues:

-                      The quality of life will decrease for the carer as well as the sufferer as the disease progresses;

-                      Sufferers can become quite isolated within their own homes – a good residential home can assist in giving them a better quality of life. is there a more holistic support available for them?

-                      Care homes can be very expensive, if sufferers could be kept safely within their own homes, this would be the best option. Are the resources given to it sufficient?

-                      Can there be more done to diagnose younger people with dementia?

-                      Day centres are an important stimulation for sufferers;

-                      Is access to drugs restricted?

-                      Have you taken note of the increase in numbers of older people living in rural areas?

-                      Shouldn’t there be more GP’s specialising in dementia treatment/care?

Duncan Saunders responded to the above points as follows:

-                      Much of the above questions has been covered by the overall work on the Dementia Strategy, for example, work around improving standards of care in some care homes. Also making sure that admissions, where possible, are planned from the early days of diagnosis;

-                      It was hoped that the pathway would make it easier for younger people (ie aged 65 and under) to get a diagnosis and be referred according to their needs;

-                      The overall numbers of people suffering from Dementia were projected to be quite small, because the population of Oxford City is younger;

-                      Oxfordshire adhere’s to NICE guidelines with regard to access to dementia drugs;

-                      Ideally, finance permitting, it would be beneficial to have GPs training in diagnosis. To increase the level of diagnosis one would also need to employ specialist nurses;

-                      It was hoped that that awareness could be raised through the provision of specific guidelines.

 The Committee thanked Duncan Saunders and Marie Seaton for their attendance and for responding to questions. They wished them well, stating that they believed the proposals were the correct way forward.