January_Meeting_Notes by zhangyun

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									                       WEST MIDLANDS MEMORY CLINIC NETWORK
                                    Thirteenth meeting
                       THE BEECHES LEARNING AND EDUCATION CENTRE,
                         PENN HOSPITAL, WOLVERHAMPTON WV4 5HN

                      Monday January 25th 2010             10am – 4.15pm


                                    Brief notes on the day

 Another lovely and useful day which a range of topics, much food for thought and grown
 up discussion of some knotty problems. There was the best ever turn out of walkers –
 which was especially wonderful given the recent adverse weather and remaining
 muddiness. It was good to welcome regular friends, some of whom have been recently
 absent under duress, and also to welcome newcomers including Professor Dawn Brooker
 and Jenny La Fontaine from the new academic unit at Worcester University

 Those attending were:

Samina Azeem                                          Sandwell Mental Health NHS & Social Care Trust
Paul Bradley       Trainee Clinical Psychologist      Dudley & Walsall MHPT
Dawn Brooker       Director                           University of Worcester Assoc for Dementia Studies
Anna Buckell       Clinical Psychologist              Wolverhampton Mental Health - Primary Care
Harjinder Chauhan  Senior Hospital Representative     Pfizer Neurology
Margaret Cooper    Memory Disorder Nurse              Sandwell Mental Health NHS & Social Care Trust
Steph Ellis-Gray   Assistant Psychologist             North Staffs Healthcare NHS Trust
Helena Dodd                                           Sandwell Mental Health NHS & Social Care Trust
Artur Dymko        Student                            Wolverhampton Mental Health - Primary Care
Holly Gibbons      Assistant Clinical Psychologist    Dudley & Walsall MHPT
Sandra Graham      Administrator                      for dementia plus
Moni Grizzell      Sister                             Wolverhampton Mental Health - Primary Care
Gemma Hammond      Ward Sister                        Wolverhampton Mental Health - Primary Care
Julie Heaton       Clinical Psychologist              C & W Partnership Trust
Nick Johl                                             Dudley & Walsall PCT
David Jolley       Director                           for dementia plus
Alison Jordan      Clinical Nurse Specialist          Shropshire CPCT
Monika Kennedy     NHS Sales Specialist               Eisai Ltd
Jenny la Fontaine  Senior Lecturer                    University of Worcester Assoc for Dementia Studies
Helen Marston      CPN                                Wolverhampton Mental Health - Primary Care
Judi Merricks                                         Bloxwich Hospital
Kieron Mulvihill   Student                            Wolverhampton Mental Health - Primary Care
Neil Moreland                                         for dementia plus
Kamani Pentangoda Associate Specialist in OAP         Birmingham and Solihull MH NHS Trust
Linda Randeria     Clinical Psychologist              C & W Partnership Trust
Claire Rose        Principal Clinical Psychologist    Wolverhampton Mental Health - Primary Care
Kate Ross          Consultant Clinical Psychologist   South Staffordshire Healthcare NHS Trust
Greg Spencer       Consultant Old Age Psychiatry      Dudley & Walsall MHPT
Charlotte Stocher                                     Sandwell Mental Health NHS & Social Care Trust
Samantha Templeman                                    South Staffordshire Healthcare NHS Trust
Maz Williams       Workforce Development Officer      Birmingham City Council
Becky Willis       Clinical Nurse Specialist          Memory Service, Bloxwich
Apologies were received from:

Nikki Belsham     Chartered Clinical Psychologist   Coventry Memory Clinics/YOD Team
Bob Graham        Admiral Nurse                     Worcester Mental Health Partnership Trust
Jo Heffernan      Consultant OT                     Dudley & Walsall MHPT
David Rose        Lead Psychologist                 Learning Disability Specialist Health Dementia
                                                    Service - Dudley & Walsall MHPT
Denise Westwood   Associate Trainer                 for dementia training



                                      PROGRAMME
Morning:

1000 – 1015 Assemble and Welcome: Refreshments available

1015 – 1115 Welcome: reflection on October meeting, recent developments and our use
of resources for information and education for patients and families:
The key points from the last meeting had been well received: the Birmingham model of
services for people with Learning Disability is exemplary and encourages and supports
other neighbouring services. We are pleased that colleagues in this and other LD
services may join us regularly. The presentation of CST was similarly inspiring – there
are a number of centres using the approach – Stafford is about to expand their activity in
this field and it clearly what we should be doing – as discussed later when considering
the report on antipsychotic medication. The problem is one of logistics and resource –
perhaps we can return to this.
Rosemary Clarke’s report on her work with Uniting Carers has opened up thinking on an
ongoing involvement of carers in running, reflecting and revising our activities –
Rosemary is planning to remain part of our group and will attend when she is able

There were many interesting and useful brief reports from around the region: Walsall has
some new personnel and continues to be a lively place – still using MRI scans in almost
every referral. They – indeed all present – reflect that referral rates have escalated
impressively during 2009 – following the publicity associated with the National Dementia
Strategy – People are trying to find ways of delivering an acceptable service – for the
most part without extra resource – sometimes with less. Walsall has joined with Dudley –
though they do not share a geographical boundary. Dr Spencer of Dudley described his
domiciliary approach to memory clinic functions – very person-friendly, complete yet
frugal. Wolverhampton (Moni) has turned the problem of insufficient person-power in the
clinic to advantage by recruiting time from interested staff from the ward and other parts
of the OAP service. This fosters mutual learning and the dissemination of good practice.
Nuneaton has seen imposed changes in organisation of service and the fading and loss
of the Alz Café – this latter from an insistence on providing a routine repeated
programme of ‘education’ for carers and patients instead of the flexible evolutionary
programme which had been so successful. One way to learn!
Colleagues in Sandwell find themselves very busy – there is a reduction of beds and
increased emphasis on community work. Shropshire continue to travel and we heard of
heroics in the snow. Stafford have lost Dr Dean who was a great supporter of activities
achieved without an identified budget – it seems possible that some of the progress
made will be lost – though hopefully there is appreciation of the very high quality work
which is done and prospects for redevelopments within a Regional model. Stafford are
beginning a CST group. An impressive plan is emerging for services in North Staffs –
soon to be available on a website – we reflected that other services do not currently have
open access websites – though some are represented within a Trust site – Perhaps we
can look at these at some time.
Coventry maintain a high level of activity and also report increased referrals. Jenny La
Fontaine told us more of the plans and activities of the Worcester Academic Unit – these
will include a Seminar series and Professor Steve Iliffe will present the first of these very
soon. The formal launch of the centre is at Worcester March 31st

Information and education of patients and carers:

A thoughtful discussion was stimulated from a suggestion by Bob Graham who has been
unable to be with us recently – he had posed a series of questions which he feels we
need to be able to answer:

      What information is given which explains the diagnosis?
      What information is given about available local resources?
      What information is given about available national resources?
      What information is given about other importance issues such as advanced
       planning and financial matters?
      How is this information offered? Is it tailored to individual needs, or is it given in a
       more general fashion?

These questions and more were addressed – there was particular emphasis on the need
to be flexible and sensitive: to provide information – verbally and in writing at times when
it is understood to be most relevant for that individual – A programme which simply
unloads everything immediately upon diagnosis and expects the recipient to make good
use of it, is wrong-headed and likely to produce distress rather than helpful guidance and
support.
Written materials can be helpful and most of us make use of the fact sheets from the
Alzheimer’s society or other similar sources. These may be complemented by local
information sheets, but there is always the need for ad hominem letters or notes which
address the particular features and needs of an individual and their family. Often it is
necessary to revisit the same questions several times and several ways over before the
question is answered and understood sufficiently.

Many services offer educational or information group learning experiences or workshops.
The potential need is enormous and though we may feel we know what to do and how we
wish to do it – for most we realise we meet only a fraction of the real need because of
other commitments.
The use of a local website may have high potential – this will be explored in North
Staffordshire.
DJ has a bee in his bonnet about making on line computer access available for families
to search for the information they feel they need within clinics and with guidance and
support from staff.

Some sites which may be helpful include:

www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200120&gclid=CICA9I_CvZ8CF
VBd4wodlRH3zQ

www.nice.org.uk/CG42

www.fordementia.org.uk/

www.mentalhealth.org.uk/information/mental-health-a-z/dementia/

www.dh.gov.uk/en/socialcare/deliveringadultsocialcare/olderpeople/nationaldementiastrategy/inde
x.htm
www.carers.org/articles/alzheimers-and-
dementia,48,CA.html?gclid=CKXxpOnDvZ8CFSBk4wodpy1v0Q

www.patient.co.uk/health/Memory-Loss-and-Dementia.htm

http://dementia.stir.ac.uk/

www.dementiaweb.org.uk/

www.brad.ac.uk/health/dementia/

www.scie.org.uk/publications/dementia/index.asp

http://hcd2.bupa.co.uk/fact_sheets/html/dementia.html

www.rcpsych.ac.uk/mentalhealthinfo/olderpeople/dementiakeyfacts.aspx

www.psige.org/special_interest_young_onset_dementia.php



1115 – 1130 Break

1130 – 1230 Dr Greg Spencer presented a scholarly review of the syndrome of Morbid
Jealousy. He reviewed the nature and origins of jealousy and drew illustrative material
from a range of ancient and classical sources.
He went on to present cases of Morbid Jealousy associated with dementia or other
memory disorders from his experience working as a psychiatrist with older people.
This is a fascinating and rewarded area of observation and clinical research – It
emphasises the richness of clinical practice and the formative influences of personality
and circumstances. The emotions, perceptions and beliefs of individuals are of greater
significance in determining quality of life than those aspects reflected by simple scales of
changing cognition.
Morbid Jealousy is a potentially dangerous syndrome. Dr Spencer was able to report that
most of those arising in later life can be helped and seen through to a resolution.
We mentioned a number of other interesting and important named syndromes and drew
brief reports of examples of these encountered by our members.

This was a lively and informative session. We hope that Dr Spencer will bring his work to
publication and we are encouraged to seek further presentations on interesting clinical
syndromes or individual cases in the future.



1230 – 1400 Lunch and Exercise – The Barley Mow

A brilliant turn out of walkers: Food wonderful but the service was a little slow despite our
ordering in advance – we are thinking how to respond to this
Afternoon:

1415 – 1500 Kate Ross led a consideration of:
            What do we want Memory Clinics to do?
            Using resources to the best effect

This was an important and useful session. It came in the context that Memory
Clinics are held up in the National Dementia Strategy as essential components of
good services and the key to early access to high quality assessment, diagnosis
and the setting where treatment and care planning for individuals and families
can begin. The reference model within the Strategy is that demonstrated at
Croydon. This clinic has worked hard to foster good relationships with Primary
Care and other agencies but presents itself as providing rapid access, team
assessment and diagnosis followed by discharge to Primary care and other
agencies for most clients. There are counter themes which worry about the
abilities of Primary Care doctors and other professionals and a strong and
repeated message that patients and carers value continuity in their relationships
with professionals. At the time of publications the Croydon Clinic was seeing less
than half the referrals of people with dementia coming from Primary to Secondary
care. This may have changed but the logistics of high referral rates (aiming for
100% identification of people with possible dementia) for assessment which must
be followed by continuity of professional support – and the desire for a wide
ranging comprehensive programme of education, counselling and therapy – face
us with a conundrum of what to do and how to do it with limited resource.

Kate Ross gave us a framework for discussion

FUNCTIONS of clinics/services

   •   Medical
   •   Rule out the obscure
   •   Diagnosis
   •   Prescribing

   •   Health Promotion
   •   Needs of people considering assessment
   •   Consent and capacity
   •   Information and Education
   •   Vascular management
   •   Is diagnosis good for everyone?
   •   Access to community groups and social services as appropriate

   •   Interventions
   •   Cognitive Stimulation Therapy
   •   Advice on cognitive strategies
   •   Emotional and Relationship counselling
   •   Access to behavioural management strategies before crises develop

And went on to encourage us to look at evidence from our pooled experiences:

   •   The Primary Care Model (such as Gnosall)
   •   Active recruitment of people at risk
   •   Consistency of input especially from local health visitor
   •   People are supported throughout the course of their disease
   •   Familiarity with local community and local resources
   •   Contextual appreciation of the person and their family
   •   The Secondary Care Model (various models represented amongst us and
       including the Croydon model)
   •   Availability of specialist assessment as part of diagnostic process
   •   Access to specialist therapy and advice
   •   Provision of specialist interventions
   •   A network of staff who can be provided with specialist training, supervision groups
       etc

She returned to consider the importance of continuity for patients and carers and
shared findings from a pilot flow up which the Stafford clinic has conducted – contacting
carers some 18months after diagnosis and discharge. 70% of people were successfully
contacted
This confirmed that their service was highly valued but that one in three was experiencing
difficulties which had not received a response before this contact. Two thirds of people
identified relationships as the main source of difficulty – carers want an accessible point
of contact with a service which can help them and would prefer this to be there for them
early.

A Best of Both Worlds model will utilise the advantages of local provision, local
knowledge and continuity of Primary care in combination with the extra skills and extra
facilities which are available in secondary care to reach out to patients and carers and to
ensure training, support and routine audit and research for professionals: an integrated
Primary/Secondary Care model – with additional access where need be to other experts
and academic centres.

Discussion revealed that most of us are frustrated by finding our work constrained by
resources to providing the basics of assessment, diagnosis and advice for patients and
carers – knowing that a more comprehensive follow through in association with Primary
care and other agencies is required by almost everyone – and that some patients and
families will benefit from additional interventions. Health promotional activities would be of
value to patients and carers and to people at risk of developing memory problems.


1500 – 1515 Tea

1515 – 1600 Anti-psychotic drugs (DoH), General Hospitals: Counting the cost (Alz Soc),
            Gerry Robinson, Choirs (TV):

Dementia and the media: Memory Clinic perspectives

These recent reports and media initiatives were presented for discussion in
association with commentaries on them from DJ. The increased media coverage
of dementia and related conditions is broadly welcomed by members of the
group. There is some anxiety that emphasis on numbers, difficulties and short-
comings may make people weary and fearful – the constant flow of bad news
feels to some of as a hard-sell – designed to attract funds and interest, but
risking over stating the case with the possibility of damaging the very people we
are trying to help.

The report on antipsychotics and their use in dementia focuses on good practice
using non-medication interventions in Care Homes. Memory Clinics have
potential to help with this.
Counting the Cost – looking at the immense harm sometimes achieved in
General Hospitals raises questions of service systems and practice in the care of
individuals. Both reports identify issues of ignorance and inappropriate attitudes
to people in care and their families – and failure to work effectively with them and
other professionals and agencies who have knowledge and can help.
Memory Clinics/services have potential to help.

The two programmes which charted Gerry Robinson’s failure to fix Dementia in
Care Homes have raised much interest and upset. There is much to be learned
from them. There are no cheap options. Again memory Clinics have the
knowledge to help – but the resource must be available if we are to have the
effects which everyone desires.
Choirs with Dementia a membership essential – have shown that music is a
mode of communication beyond the ordinary - as in dance, other arts and the
simple shared pleasures of walking, holding and just being there. We can be
pleased and encourage those we know to utilise the power of these non-medical
therapies. (Do you need a diagnosis to dance?)


Next Actions

Future dates of our meetings are:

Monday 10th May 2010
Monday 11th October 2010

Please put these in your diary and invite colleagues who may be interested.


1615          Depart

								
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