Dementia
View the latest from the Dementia CLG
Overarching aim: To provide leadership and advice to shape London’s dementia services so that people with dementia receive an effective diagnosis, treatment and care
Key Contacts
- Clinical Director: Dr Daniel Harwood, Consultant Psychiatrist and Clinical Director, South London and Maudsley NHS Foundation Trust
- Programme Lead: Laura Cook
- Clinical Project Manager: Helen Souris
2017/18 focus areas
Effective Diagnosis
The clinical lead for the effective diagnosis working group is Dr Jeremy Isaacs, Consultant Neurologist at St George’s University Hospitals NHS Foundation Trust. Effective diagnosis was identified as a priority area, in that improving diagnosis, including timely diagnosis, results in more effective dementia care and support.
Dementia diagnosis rates 
Achieving timely diagnosis of dementia is a national priority, identified in the National Dementia Strategy and championed by the Government. The London dementia diagnosis rate is currently 70%, which means it is predicted that there are currently 20 thousand people in London who have dementia but no diagnosis (65+ years). There is a variation in diagnosis rates across London from 59%-93%.
- Table – January 2019 London dementia diagnosis rates
- Graph – January 2019 London dementia diagnosis rates
- Access to an online interactive report can be found here.
The effective diagnosis steering group has developed a “coding clean-up” exercise for GPs to improve dementia coding and increase diagnosis rates.
Dementia diagnosis rates have significantly improved across London from 54% (August 2014) to 71% (January 2018).
This poster outlines these improvements, steps that were taken and where there are missed diagnoses. People with mild cognitive impairment not having a follow up is one of the areas where diagnoses are missed. Dr Dan Harwood has written a short guide on what to do when reviewing someone with mild cognitive impairment.
Access our diagnosis rates CCG action plan template, which provides objectives to achieve the ambition
21st – 27th May 2018 is dementia action week. This poster calls on clinicians to keep dementia in the forefront of their mind when seeing at risk patient groups.
Non dementia pathways
Not everyone who is referred to a memory service will have dementia, common non dementia causes include mild cognitive impairment, depression, and anxiety. The London Dementia Clinical Network reviewed pathways for non dementia diagnosis and has produced guidance aimed at commissioners and clinicians within memory services and primary care.
Read the non dementia pathway guidance here
Neuroimaging
The London memory service audit highlighted wide variation in the use of neuroimaging investigations in patient undergoing assessment for dementia by memory assessment services. The Dementia Clinical Network has published a guidance document to support good clinical care and a reduction in variation.
Read the imaging guidance here
Young onset dementia
As part of an investigation into young onset dementia in London, the Network attended a formal committee session at City Hall.
Read the key findings and the full report.
Diagnosing young onset dementia can be complex, leading to longer waits for a confirmed diagnosis. Monthly memory service and neurology multidisciplinary team meetings are a simple and relatively inexpensive approach to ensure accurate and timely diagnosis and avoid unnecessary duplication of clinical assessment.
Read our published guide MDT meetings, which provides the rationale for these as well as elements to ensure their success.
London Memory Assessment Network
The London Memory Assessment Network was formed in October 2014 as a project of the effective diagnosis workstream. The objective of the network is to:
- Share best practice in clinical care and service design.
- Provide CPD\learning opportunities that are not readily available elsewhere.
- Reduce variation in care and improve quality.
Previous meetings and presentations Presentations from previous meetings can be found on the meetings and events page. Select ‘dementia’ in the category box.
Clinical audit
The Memory Assessment Network carried out a clinical audit to provide a baseline picture and review memory services across London. Headline results were presented to the network in November 2015. A full report is available here. Results of a second round of clinical audit were presented at the March 2017 meeting (see meetings and events page) and poster here.
Streamlining memory service pathways
This guidance document (updated July 2017) has been developed to support memory services in London review and improve their care pathway. It offers suggestions for streamlining service pathways, whilst maintaining or improving quality of care. All recommendations made are a result of current memory service practice in London.
Dementia inequalities project
Parity of access to memory services in London for the BAME population
The Dementia Clinical Network led on a piece of research which investigated whether referrals to memory services in London reflected the ethnic diversity of the population. The paper has been published in Ageing and Mental Health, and can be viewed here.
Resources for professionals working with Black, Asian, Minority and Ethnic (BAME) groups The Dementia Clinical Network has been working with the Alzheimer’s Society to produce a resource page for health and social care professionals working with people from BAME communities. Resources include translated information, examples of good practice and outreach projects working with BAME communities, translations and cultural adaptations of cognitive assessment tools and more. This is a live resource and will be updated as new sources are identified. We hope you find this information useful. To request a resource be added, please email england.london-scn@nhs.net
Improving dementia care in acute hospitals
These projects have been led by Professor Siobhan Gregory, Head of Quality for North West London at NHS Improvement.
Delayed Discharges
In 2018, a project was completed to understand the factors contributing to delayed discharges from hospital for people living with dementia. 16 cases were reviewed across 10 hospitals. Conclusions included that true joint working, clear documentation, gaining a six month history and supporting staff with holding emotionally sensitive conversations help to support a timely discharge.
You can read the report here
Nutrition and carer involvement
In 2017 a peer review project observing nutrition and carer involvement in the first 48 hours of admission was completed in Summer 2017. A best practice guidance and audit tool was produced. Two key take home messages were highlighted:
1, The majority of older patients in the emergency department were unaccompanied
2. During mealtimes on wards good practice was witnessed – this was not the case outside meal times
You can read the project here
The next round of peer reviews in focusing on delayed discharged.
Primary care
Memantine
There were changes in prescribing recommendations in the dementia NICE guidelines (published June 18). We asked Dr Nerida Burnie for some practical advice on prescribing memantine in primary care. Read our blog here
GP-Led care home dementia diagnosis project
Some people living with dementia in care homes have not received a diagnosis. The Dementia Clinical Network has completed a project to review the effectiveness of a GP lead addressing missed diagnoses in care homes in one London borough.
Access an interactive report which includes learning and resources to support implementation of this work in other areas.
Dementia training in care homes
In June 2016 the Dementia Clinical Network collaborated with two London Academic Health Science Networks, UCLPartners and the Health Innovation Network, to spread innovative dementia training to care homes across London.The role of the training providers was to provide ‘train the trainer’ sessions to selected staff from care homes so that they could deliver the training themselves, and then support them to deliver their first training session to their peers at their own care homes. A total of 38 care homes across six boroughs participated in the project. 65 people were trained as trainers and 223 staff received local training.
- 96% of trainers reported they were confident / equipped to deliver training in their work place.
- 77% of care home staff reported an increase in their understanding of the needs of people living with dementia.
- 78% reported an increase in their understanding of how to communicate with someone with dementia.
- 55% said they would register with JDR (south London).
- 7 additional Join Dementia Research sessions held at friends and family meetings.
Access the full report and Dementia Training Resources for Care Homes
GP Leadership
The network has recently established a network of Dementia GP Leads across London. The group met for the first time on 18 October 2017 (see meetings and events page).
Care planning
ANTIPSYCHOTIC DATA
NICE dementia guidelines recommend against the use of antipsychotics for non cognitive symptoms or challenging behaviour of dementia unless the patient is severely distressed or if the patient is at risk of harm to them or others.
NHS Digital publishes data on prescribing antipsychotic medication to those people with dementia. We have reviewed London data for the percentages of people with dementia that have been prescribed antipsychotic medication. There is a variation across the CCG’s in London from 13% to 6%. It also appears that most people with a diagnosis of dementia who have been prescribed antipsychotics do not have a secondary diagnosis of psychosis.
You can view the graphs with this data here
clinical leadership group
Learn more about the Dementia Clinical Leadership Group, and download CLG resources on the Dementia CLG page.
Key national documents
- Prime Minister’s Challenge on Dementia 2020: Implementation Plan
- Dementia: Good Care Planning: information for primary care and commissioners
- Implementation guide and resource pack for dementia care
LONDON DEMENTIA CLINICAL NETWORK USEFUL RESOURCES
Download all documents and publications via our Publications page. Including:
- Commissioner checklist for dementia.
- Immediate post diagnosis support guidance.
- Guidance for post diagnosis support planning.
- Dementia training for health and social care staff.
- Dementia recognition scheme guidance.
- Managing pain for people with dementia.
- Guidance on the content of a delirium policy.
- What to expect from good quality dementia service.