Shared learning database

 
Organisation:
Derby City Council
Published date:
September 2013

The Derby City Dementia Support Service is provided to people living in Derby who have a diagnosis of dementia or have concerns about memory or dementia like symptoms and for their informal Carers. The service assists people with dementia and their carers prior to and at the point of diagnosis and throughout their dementia journey, providing emotional support and information, supporting self-management and facilitating peer support as appropriate.

Co-locating with community mental health services and working closely with memory assessment clinics and social care, the service is embedded within the wider dementia pathway and has an important role in supporting integration of services. This example is relevant to the NICE Quality Standard 30 on supporting people to live well with dementia and particularly Quality Statement 5 on developing and maintaining relationships and Quality Statement 6 on physical, mental health and wellbeing.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
No
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Yes

Example

Aims and objectives

Aims

  • To increase the amount of support available to people affected by dementia and their carers, including those not eligible for social care services.
  • Closer partnership working to support a more integrated, co-ordinated pathway of care.
  • Greater understanding of local needs through enhanced opportunities for consultation, to act as a foundation for service improvement.
  • Targeted work in neighbourhoods with diverse demographic make-up to reach out to groups currently under-represented in peer support.
  • Targeted work with people with early onset dementia and their carers to develop improved understanding of the needs of this group.
  • Maintain independence, develop confidence in caring and delay escalation of care needs.
  • Provision of a volunteer befriending service to increase capacity.
  • To facilitate the provision of a range of cafes and groups that deliver the following benefits:
  • Expanding an existing model to provide much increased capacity and choice of activities, locations and time
  • Increased social contact and reduced isolation for people affected by dementia and their carers.
  • Delivery of key well-being and health promotion messages
  • Provision of information and support to enable carers in their role.
  • Provision of a range of stimulating therapeutic activities to promote the well-being and condition maintenance of people with dementia.
  • Structured peer support opportunities for people with dementia and their carers and the development of informal peer support networks.

A key objective of this project is to support both service users and carers to remain independent in their own homes for as long as possible. This will be achieved through:

  • Improved relationships between service users and carers by virtue of the additional positive social contact the project will allow.
  • Increased carer confidence through better access to support and learning opportunities, and contact with other carers to allow for sharing of experiences and emotional support
  • Increased awareness of services will facilitate better access to key services such as respite; psychological therapies; falls prevention and benefits advice - and thus support people to remain in their homes for longer.

Reasons for implementing your project

There was a successful but small service providing information, two dementia cafes and one carers' group. This was insufficient to meet support needs and did not fulfil the whole range of needs or areas of support identified in the Dementia Strategy to provide a comprehensive and inclusive pathway. Generic carer support was also available and the service was planned and has evolved to integrate with this provision.

Local consultation suggested a lack of awareness of available support amongst service carers as well as professionals and community organisations. Lack of awareness and service uptake was a particular problem in in BME organisations. Users of the existing service said that they valued the opportunity of being able to learn from one another and to be able to receive emotional and practical support. Carers were asked what activities / therapeutic activities they preferred. A wider consultation of stakeholders confirmed that support services were seen as a valuable part of the pathway.


How did you implement the project

The service was established as a pilot in 2009 as a dementia demonstrator site. The pilot was evaluated locally and lessons learned informed the specification of a service that was offered for tender for a three year period.

The pilot cost £140,000 over 18 months, the cost of the tendered service is £150,000 per annum. With a range of services and support already available, it was important that this service supported and complimented rather than replicated existing provision, and that as it developed it filled identified gaps. In order to achieve this the local authority commissioner worked collaboratively with the CCG in contract management and reported regularly to the Derby Dementia Board.

Following the pilot period the service was co-located with community mental health service practitioners in order to support a more streamlined delivery and close gaps in the pathway. Problems of low referral from consultants and GPS reduced effectiveness and the service responded by providing GP education sessions and by developing a close relationship with memory assessment clinics, either attending in support or following up to suit circumstances. Attending the MAS clinics had a very positive effect on service uptake and on the key aim of providing a support service throughout the dementia pathway. Actions to increase GP referral are on-going and include close links between this service and a pilot GP liaison service in the city.

This service began as a dementia demonstrator site project and for this reason was initially designed with three clearly distinct strands to meet the evaluation needs of the demonstrator site model. In practice this was restrictive for the provider and made data collection more complex. The service is better presented as a single service with outcomes defined to provide evidence based good practice and meet local need.

The service has also experienced difficulty in reaching some of the minority or hard to reach communities within the diverse population of the City. The provider has addressed this by working closely with key organisations and offering information and support in partnership with community leaders and elders, in appropriate languages and locations. This approach has been successful to date.


Key findings

The service has been successful in making support available to a much larger proportion of the affected population. Over a period of 6 months measured 75% of those attending the memory assessment service had contact and offers of on-going support from the dementia support service. About half of this number subsequently returning for on-going support. The service has been able to enhance provision from statutory services, provide effective specialist carer support to compliment generic support services, prevent carer breakdown and support families to remain together in the community for longer, delaying admission to statutory services and residential care.

An evaluation currently underway suggests that some referrers feel that the service has reduced pressure on their own services whilst carers say it has reduced stress and improved well-being. Service users suggest that the service has had an impact in reducing their reliance on statutory services as well as providing opportunities for self- expression and to make a fulfilling contribution. The service has been monitored for take-up, equality of access and achievement of the following quality outcomes, and has evaluated positively.


Key learning points

This service began as a dementia demonstrator site project and for this reason was initially designed with three clearly distinct strands to meet the evaluation needs of the demonstrator site model. In practice this was restrictive for the provider and made data collection more complex. The service is better presented as a single service with outcomes defined to provide evidence based good practice and meet local need.

The close co-operation of several statutory services has contributed to success. This has been very important in creating a service that is respected. As the service is outsourced to an independent provider, contract management is in place with collection of data and monitoring of outcomes. This has been supportive of continuous review and development which has been crucial to success.


Contact details

Name:
Jenny Appleby
Job:
Commissioning Manager
Organisation:
Derby City Council
Email:
Jenny.appleby2@derby.gov.uk

Sector:
Social services
Is the example industry-sponsored in any way?
No