Is Dudley council setting out a new model for dementia care?

Is Dudley council setting out a new model for dementia care? The local authority's dementia gateway initiative is now supporting a large number of people to live well at home.

One of the most pressing problems for local authorities and the new clinical commissioning groups (CCGs) is how to provide services to people in their areas diagnosed with dementia. As the ageing population imposes even greater demands on health and social care services, a local authority in the Midlands has developed its own strategy for dementia that brings services together to support people at home.

The dementia gateway service developed by Dudley metropolitan borough council (DMBC) has been operating since November 2011 and aims to integrate early diagnosis and medical intervention for people with dementia with social care to keep the person independent and in their own home for as long as possible.

The care pathway is based on a multidisciplinary team approach, involving initial assessment by dementia nurses, with input from old age psychiatrists, mental health specialists, and dementia advisers, all of whom were part of the steering group that devised the pathway.

Matt Bowsher, assistant director, quality and commissioning at DMBC, says: "We wanted to develop a person-centred approach to dementia care based on listening to our clients and responding to their needs, and to help people avoid having premature links with 'serviceland' for as long as possible. We needed to adapt services to the needs of clients and their families rather than have a rigid system which delivered the same service to all clients."

The council estimates that it will have around 4,365 people diagnosed with dementia by 2015, but this is predicted to rise by 50% to 6,435 by 2030. There are currently around 58,200 people aged over 65 in its population of 312,000.

The government's strategy for personalisation of social care, "Making it Real", launched in 2009, prompted the council to review the way it provided dementia care and led to the setting of the steering group. Last year, prime minister David Cameron set a Dementia Challenge for councils to improve their services to local people.

"We now support high numbers of people, including some of working age, to live well with dementia at home by providing information and advice and making links to universal services so that people can still pursue their personal interests and hobbies through our adult community enablement team," says Bowsher.

The council has a dementia adviser linked into acute hospital services, who liaises with the early supported discharge team. The adviser links with the person and their relatives within a day or two of their admission to hospital, liaises with ward staff and supports an inpatient clinic. This setup enables the NHS to achieve its CQUIN targets.

The gateway offers therapeutic and creative activities to clients, and short and long-term respite to carers, as well as interventions to people living with dementia, which maintain or build on their skill levels while also reducing the need for drug therapy or early admission to residential or nursing home care. The council also works in an integrated way with its own adult social commissioners and the CCG commissioners to ensure that services are co-ordinated.

"We originally had only one dementia nurse specialist, but we now have three," says Annette Darby, dementia services manager at DMBC. "There are now three ways that clients can be progressed through the system: through GP referral to our nurse specialists, through community mental health nurses and through social workers. Our dementia advisors are also being trained to undertake the assessment of need – technically known as an MAF1/MAF2/Support Plan – to deal with presenting issues."

The CCG was involved in the service from the outset (formerly as the PCT) and believes the pathway has been very successful. Paul Maubach, the CCG's chief accountable officer, says: "We think the service is a really good example of collaboration between local authority and CCG. Dudley was in the bottom third of detection and diagnosis rates for England, and there was actually a reluctance for some GPs to diagnosis patients with dementia, because they did not feel there were adequate support services in place. Now that's changed and the gateway service has diagnosed around 400 cases in the last two years. We have a much higher rate of referral to services now and a clear pathway for patients."

He also says that the three dementia centres run by the service provide a valuable focal point for treatment and support for clients and their families. Both the council and the CCG acknowledge the crucial role played by the voluntary sector in supporting people who have been diagnosed and their families.

Janice Connolly, the Midlands locality manager for the Alzheimer's Society, says that it offers a range of services in the Dudley area and across the Midlands. "We run around 18 dementia cafes across the Midlands region and four of these are in the Dudley area.

These are monthly sessions where the person diagnosed and their family can meet others in the same situation, and this can help greatly with information-sharing and mutual support. We also run a helpline for crisis support and give advice on accessing social and domiciliary care."

The service has now gained national recognition, winning praise from health minister Norman Lamb at a recent conference and even from health secretary Jeremy Hunt. The NHS director general of social care has also paid a visit to Dudley in recent weeks to see first-hand how the service works.

As councils struggle to find resources for improving dementia care, the Dudley model could prove to be a blueprint for the future around the country. The Guardian