Health services delivery

Designing and delivering award-winning memory assessment service

Service: Brighton and Hove Memory Assessment Service (MAS)

Partners: We are head contract holder working in partnership with Sussex Partnership NHS Foundation Trust and the Brighton and Hove Carers Centre. We also work in alliance with the Alzheimer’s Society.

Reach: Brighton and Hove population – c358K

Our innovative dementia service

Unlike other memory assessment services, we offer support from the point of referral to all. We provide a dedicated worker to proactively support each person in the service, starting with ‘what matters to you’ conversations and providing care navigation, social prescribing, and dementia-specific pre- and post-diagnostic support that includes Dementia Care Planning.

Operating as an integrated clinical and support community service, we measure our performance with a Local Quality Requirement (LQR) metric that measures people’s quality of life using the QOL-AD framework. We call this our ‘How Are You?’ questionnaire.

Brighton and Hove MAS impacts

100%

of patients felt staff treated them with compassion, respect and dignity

623

‘What Matters To You’ conversations were had from July – September 2024

83.3%

of people who use our service tell us that they are maintaining or even improving their quality of life after being referred to us

(previously 73%)

At Brighton and Hove MAS, we pride ourselves on being a service that cares. We care about our patients and what is important to them, and tailor our service to meet those needs. The results of this can be seen in 100% of our patients reporting that they were treated with compassion, dignity and respect.

Samantha Stevens

Integrated Care Manager at Brighton and Hove Memory Assessment Service

Feedback for our service

South Asian man sat talking to a clinician in a medial consultation room

I just want to express my eternal thanks for the help, support and understanding that I receive each time I contact the Memory Assessment Service. As a Nurse in a Dementia Nursing Home, I am fully aware that this is not always so positive for others when they try to access services within the NHS. It always feels that my concerns are shared and responded to in such a positive, empathetic manner from all concerned.

I feel like the sun has come out as I have support and access to information. I refuse to be afraid and feel that having information and support gives me the possibility to feel safer and get on with my life.

I always feel better after our telephone calls. You go above and beyond to provide support, and you really care. You live for your jobs and it really shows.

Thank you for your kind, gentle approach to Mum’s telephone assessment. Your caring manner put her at ease. This was a huge step for mum to make, and you made it as comfortable as possible.

How we deliver dementia services

When we started in 2013, only around 30% of the population expected to have dementia in Brighton and Hove had a formal diagnosis compared to the national target of 66.7%. Patient journey times were between 1 and 2 years against a national target of 10 weeks.

We redesigned the service, using a “systems thinking” approach that put patients and their loved ones at the heart of service design. We drew on the knowledge of people working in the service and commissioners to ask what was important.

By doing so, we closed the substantial Dementia Diagnosis Rate (DDR) target gap we inherited in 2013 and reduced patient journey times from up to 2 years to 6.73 weeks pre-pandemic.

Following the COVID-19 pandemic, we worked hard to clear down accrued waits and by March 2023 had restored DDR compliance, significantly exceeding the national average with referral to diagnosis recorded at 20 weeks.

We now operate as an integrated clinical and support community service, bringing together clinicians from both secondary (nurses and consultants) and primary care (General Practitioners with Extended Roles) who work alongside support workers, offering a holistic and personalised service to patients and their loved ones.

We believe this approach underpins the outstanding level of care that the CQC recognises in its rating, our consistently high levels of delivery against LQR performance indicators, and, most importantly, the way people who use our service tell us that we’re helping them maintain or improve their quality of life.

Meet Elspeth, a Brighton and Hove Memory Assessment Service (MAS) patient, talk about her experiences of being diagnosed with Alzheimer’s disease: