Growing outstanding through partnership
When we first received the news that we had been rated ‘Outstanding’ by the Care Quality Commission (CQC), I was overwhelmed. It is so rare for the CQC to award this as an overall rating and I feel really proud of the team and the journey that we’ve gone on together working with patients, carers and key organisational partners to understand the pressures in the system to create a new Memory Assessment Service (MAS) for Brighton and Hove. It has taken years of hard work and while the awards that we’ve won for our innovation are indicators that we’re doing something right, what’s most important is we know we’re really delivering what people need. Patient feedback told us of the value we have been delivering in the community and this recognition felt like the icing on the cake. We know that none of this would have been possible without the partnerships we’ve created together and we are very grateful to our partners for coming with us on this journey. Partnership working is part of our DNA, reflected in the fact that our fellow community service, Sussex MSK Partnership, has also been rated as part of Here’s ‘Outstanding’ contribution to local healthcare.

Putting patients at the heart of our learning
Since we collaboratively redesigned the service in 2016 we have continued to build on our understanding of what’s needed by the community we serve. The redesign was born from the understanding we achieved by asking the questions: What do our patients want? What could a memory service do if we weren’t focusing just on contractual targets? What else is important? How can we provide the meaningful and practical support people want? These are the kind of questions we continue to ask in order to keep learning and shaping the service.

The CQC really commended us for putting patients at the heart of the enquiry. By consulting with them, their carers and our frontline staff we were better able to understand how the system was currently working before organising ourselves to respond best to their needs. So, it wasn’t led by one person, it wasn’t one person’s vision – it was about giving patients and carers the choice and the service acting as their champions, their advocates and delivering on their needs. The CCG were part of the process as well and it has led to a continuation of the service well beyond its initial contract which began in 2013.

Shaping the future of memory services
Part of our goal has always been to help shape what future memory services look like because previously it was embedded in secondary care and bringing it into the community in 2013 was innovative in itself. We are a nurse lead service with embedded support from our Consultant Psychiatrist and GPwSI. We are essentially a specialist community service operating across the city in primary care locations with the specialist support of secondary care. We are commissioned to provide a support service after a diagnosis is made, but we heard clearly from people that support at the start of their journey is crucial. We now deliver added value by providing support at the point of referral to all people with memory problems. We give holistic support, focussing on what people want and helping people maintain and hopefully improve their quality of life regardless of a diagnosis. We know this also helps safeguard our patients, improves risk management and supports the wider healthcare system by mitigating the need for crisis intervention. We allow patients to set the pace of their journey as we recognise that people are referred to us at different stages in journey. Our patients told us that diagnosis is not always their priority and fast is not always best. Dementia is a life changing diagnosis and some people and their family require time to adjust to what is a life-limiting degenerative condition. By delivering support at the point of referral, needs are met and the potential risk of longer journey time to diagnosis is mitigated by the support being delivered at the point of referral. We also offer choice of locations across the city to help engagement with the service and ease of access.

Connecting with an aligned strategy across counties
Our whole approach is around being able to have meaningful conversations with patients about what matters most to them right at the start of their journey to best help them navigate the system. When you look at the UK and what memory services look like, they’re all different and through various networks that are being set up, learning is starting to be shared more widely. We’re part of the MSNAP accreditation programme and the Kent, Surrey and Sussex Dementia Network, all of whom are trying to bring commissioners and services providers together to align strategy, service delivery and learning. For us as a provider it’s really important that our message is from our patients and the story of our redesign is shared. It’s already received a lot of attention and interest, both locally and nationally.

Creating a new culture of care through social enterprise
Taking a systems approach changed my focus. In my earlier management roles I’ve been driven by the contract, and to question this was completely new to me. Seeing an approach that systematically listened to patients and then translated that into a care pathway was a learning process for me. It helped me evaluate my purpose and role rather than just being focused on KPIs. I feel a lot more connected to the service and the clinical team as a result, and feel able to ask questions and challenge the way things are done in the system despite not having a clinical background.

Getting all of our staff involved created a culture of being champions and advocates, and anchors all our work around ‘what is the benefit’ to the person – is this the right thing for them? For Here to be rated outstanding is a real affirmation for us. Sharing what we are learning and continuing to bring creative partnerships together feels like the way forward to me. Being a social enterprise has enabled us to work to our own values, and go outside the remit of what we are commissioned for, in a way that actually led to us becoming more effective and efficient. We have only been able to do this by drawing on the resource of the wider social enterprise of Here, with its own purpose and culture around care, innovation and partnership working. That ‘can do’ attitude that mobilises and enables a creative, collaborative and flexible approach to bringing the right talent and skill together around meaningful common purpose. I’m looking forward to building on this to think about what memory services will look like in the future.

View the report here on the CQC website.