The National Audit of Dementia (NAD) is a clinical audit programme commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England and the Welsh Government. Memory assessment services (MAS, sometimes known as memory clinics) provide specialist assessments and treatment for people where there are concerns about their memory. They are specialist services run by teams including medical staff, specialist dementia nurses, psychologists, and occupational therapists. They provide advice and assessment, leading to diagnosis if the person has dementia, which is followed by prescribing approved treatment to help people to live as well as possible with their condition.
All community-based memory services were invited to take part in this spotlight audit topic. The spotlight audit aimed to focus on waiting times, access to assessments, treatment and post-diagnostic support for people with dementia. The casenote audit tool comprised of 39 questions, and services were asked to sample 50-100 patients, seen consecutively from 1st January 2021.
All four NELFT’S London Boroughs – Barking & Dagenham, Redbridge, Havering and Waltham Forest, participated in this audit.
This audit is aligned with NHS England objectives as follows:
- Equal access to diagnosis for everyone
- Every person diagnosed with dementia having meaningful care following their diagnosis
Locality findings: where we have done well
- % virtual appointments are higher than national average in all the four London Boroughs
- Overall wait time from referral to diagnosis is lower than national average in WF and B&D
- Access time from referral to initial assessment is lower than national average in WF and Havering.
- Diagnosis wait time from initial assessment to diagnosis is lower than national average in WF.
- Patients are receiving all routine assessments, higher than national average in RB and B&D.
- Brain scans requested and performed, are higher than national average in RB and Havering.
- Post diagnostic interventions practiced is higher than national average in B&D
- Assessments for working age patients undertaken are higher than national average in WF and RB.
- Services should use quality improvement methods to actively monitor waiting times from referral to diagnosis, and identify problem areas and barriers to access, including demographic and other factors (e.g. care home residents), as services continue to recover from the impact of the pandemic and associated service closures and staff redeployment.
- Commissioners/Dementia Regional Boards should work with services to review a) the pathway to assessment, diagnosis and support and b) the post diagnostic pathway, to ensure that support is sufficiently flexible and person centred.
- Services should ensure that assessment appointments include discussion of hearing, alcohol consumption, eyesight and falls, and identified follow up
appointments/actions are carried out and documented.
- Services should ensure that protocols for referral for neuroimaging are in line with the NICE guideline and recommended good practice
assessed as appropriate per patient.
- Commissioners/Dementia Regional Boards should ensure that services can offer/have access to Cognitive Stimulation Therapy for patients diagnosed with mild/moderate dementia, in line with guideline NG97.
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