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Sharing good practice and innovation in memory assessment services
Identifying innovative practice to promote and support ongoing service development at a regional, national and local level.
The Challenge
In line with National Institute for Health and Care Excellence (NICE) guidance, most new dementia diagnoses are made following referral to and assessment by a Memory Assessment Service (MAS).
It has been a national ambition and priority since 2013 that at least two-thirds of people who are estimated to have dementia have a confirmed diagnosis. As of January 2020, this ambition was being exceeded at national level (67.6%). However, since the start of the COVID-19 pandemic, dementia diagnosis rates have fallen significantly.
Operating MAS services during the pandemic has been challenging. Some had staff redeployed to other areas and many switched to remote assessment and monitoring to reduce risks to staff and patients (most of whom will be older and therefore at higher risk from COVID). Assessing levels of cognitive impairment using a remote platform is challenging, takes longer to do and maybe unfeasible for patients with more complex presentations. As a result, the backlog of patients waiting to be seen and time to be seen have grown.
To help address these challenges, there is a need to identify innovative practice within individual memory services which can be collated and shared widely with providers and commissioners of memory services at regional, national and local level.
Aim
This project aims to outline different models of MAS delivery across England and Wales, to identify and share good and innovative practice and to promote and support ongoing service development.
Methods
The project has three phases:
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Phase 1
Developing a guide to support continuous development in MAS
This phase aimed to describe what good or innovative practice in MAS might look like though consultation with key stakeholders including:
- Consultation with expert working group comprised of 29 members who are, MAS clinicians and others in MAS related roles (e.g. charities, national bodies and organisations) and Clinical Network representatives
- Consultation with our Lay Advisory Group comprised of 10 people who have accessed or supported someone who has accessed MAS
- Reference to published standards, guidelines or indicators
We have produced a guide to supporting continued development, improvement and innovation in MAS.
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Phase 2
A survey of MAS in England and Wales
This phase aimed to understand how MAS in England and Wales are designed / what their service looks like and to identify what they feel are features of good or innovative practice within their service. It included:
- Questions about the MAS, the services it is commissioned to deliver, service design and staffing
- Requests to provide examples of good or innovative practice across 13 areas of practice from the guide developed in Phase 1, which were identified as of particular interest by the expert group
- Request to provide other examples of good/innovative practice identified by the MAS
- The option for anonymous completion or to be acknowledged as contributing
The outputs for this phase feature in a full report describing national MAS service design and delivery and good and innovative practices.
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Phase 3
Case studies of good / innovative practice
This phase aimed to look in more detail at specific examples of good/innovative practice we were told about in the survey, to find out:
- How they have been put into practice (e.g., what resources and support is needed to do this)
- What perceived benefits they have for people accessing the service, their supporters and staff
- Challenges faced and overcome
The case studies collected a range of data at each site (15 sites) such as interviews (staff, patient, carer), documents and other available data (e.g. service outcomes). These have been written up as case studies and compiled in a final report.
Additional Information
The project team include Prof Claire Surr, Dr Sarah Smith, Dr Laura Booi, Rebecca Platt, Sally Brown and Amber Rithalia from Leeds Beckett University and Vicky Cartwright from NHS England and NHS Improvement.
We are supported by a lay advisory group of people who have accessed or supported someone who has accessed a MAS and by a Steering Group of MAS and Primary Care clinicians and Clinical Network representatives.
The study is funded by NHS England and NHS Improvement and is conducted in collaboration with Improvement Cymru.
Outputs
A guide to supporting continuous development, improvement and innovation in memory assessment services.
Identifying good practice examples and opportunities for improvement.
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