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Cumbria Partnership NHS Foundation Trust

Cumbria Partnership NHS Foundation Trust provides NHS services throughout Cumbria. Memory Matters service is for anyone who has new or suspected memory problems, including those with a diagnosis of dementia, and people in later life who have anxiety, depression or psychosis made more complex by physical health needs. Memory and Later life services are available throughout Cumbria. They offer assessment and a range of evidence based interventions in a variety of settings including the person’s home, GP surgery, Care Home, clinic or hospital, depending upon the individuals’ circumstances. The teams work closely with the person and their family, as well as colleagues in other parts of healthcare, Adult Social Care and other community and third sector services. Staff within the service include Consultant Psychiatrists, Nurses, Occupational Therapists, Psychologists, Assistant Practitioners and Support Workers.

Updated:
31 May 2017
Location:
North West
Sectors:
Health, Hospitals and Hospital Trusts
Local Alliances:
Carlisle Dementia Action Alliance

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

Our service strives to provide excellent and caring services delivered in partnership, to ensure people can achieve their potential.  Services are centred on the needs and preferences of individual users, their families and carers. We will respect people’s right to dignity and choice. We aim to treat all of our service users fairly and in an equitable manner. This operational policy aims to describe the holistic and person centred approach offered by Memory services across Cumbria.

            

 ‘Memory matters’-offer a positive, family based approach which places the person with memory difficulties and their family at the centre of care. Services also utilise evidence based care pathways to offer care using best practice and targeting quality of life as the important outcome of joint approaches with community partners.

 

Care Pathways are offered for people with early memory needs; more complex dementia and/or functional mental health needs in later life; improving quality of life and mental health needs of people within care home settings.

 

The service offers a range of evidence based assessment, diagnosis and interventions in a range of settings. This also includes CHESS (Care Home Education & Support Service) aiming to combine education with practical support to care homes throughout Cumbria.

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

 

Cumbria has a significantly higher proportion of older people than the England average. This trend is set to increase over the next 20 years. This means that the numbers of people with Dementia are set to rise substantially from about 7,000 in 2010 to nearly 13,000 in 2030.

 

This demographic and geographical challenge highlighted the need to develop services further and has led to a dramatic improvement in quality and experience, while also enabling the service to effectively connect across Cumbria

 

The development of modernised memory services in line with Cumbria Dementia Strategy has enabled the service to really make a difference in improving clinical quality by focussing on the needs of the individual, enabling their carers/families and/or supporters to remain fully connected to the person’s quality of life and enable staff to feel increased value.

2. Actions

  • Improved access to flexible memory assessment throughout Cumbria

    Further to the implementation of Cumbria Dementia Pathway- Memory services across Cumbria will develop improved accessibility by connecting with local GPs, primary care services, County council services and third sector partners. This will enable greater flexibility in offering memory assessment as well as access to improved diagnosis and post diagnostic support.

    Status:
    Implementation
  • Early Memory & Wellbeing pathway

    Improvements to diagnostic and post diagnostic support pathway will enable greater quality and focus on both the person with dementia and their family. The pathway will improve understanding of wellbeing of both the person and their carer, while also supporting the person's quality of life. This will enable psychosocial approaches to be delivered as routine for all people referred to the service. This will also enable greater focus on person centred care rather just than symptom management and focus on strengths as well as need. The pathway aims to understand the PERSON and ways we can support their ongoing ability to live well.

    Status:
    Implementation
  • Carer Interventions

    The carer interventions project will enable the development of a carer lead in every local memory service with dedicated role to working with carers of people with dementia. Utilising a tiered approach- carer interventions will range from provision of information/advice & support; joint working with third sector partners; to full psychosocial interventions for carers requiring more intensive support.

    The project includes introducing routine screening for all carers of patients referred, seeking to identify current and potential carer strain. This can then enable delivery of enhanced services for carers including carer support groups, local initiatives with partners to support inclusion as well as specialist support and psychological intervention.  

     

    Status:
    Implementation