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Jersey

2012: National Dementia Strategies (diagnosis, treatment and research)

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

The Jersey Health and Social Services Department (HSSD) signed up to the equivalent of the UK National Dementia Strategy in October 2009. An initial meeting was held between the department and Jersey Alzheimer’s Association but very little has been done since then.

However, the Jersey HSSD is in the process of putting together an Outline Business Case to present to the Government for increased funding for dementia care. It incorporates a lot of the points which were covered in the National Dementia Strategy and will probably supersede it. As the initial document signed by the HSSD may be different to that which is finally implemented, it will be referred to hereafter as “the Plan”.

Duration of the National Dementia Strategy

The initial goal of the Plan was to transform the way that people with dementia and their carers are cared for in the next five years. However, as stated above, nothing has been done since the signing of the document in 2009.

How the National Dementia Strategy is funded

There is no specific funding for the Plan.

Provisions or procedure for implementing the Strategy

Nothing specific has been agreed.

Procedure for monitoring progress made in achieving the goals set

Nothing has been agreed.

Involvement of the Alzheimer association (and/or people with dementia)

Jersey Alzheimer’s Association was instrumental in drawing up the Plan and getting it adopted by HSSD. The implementation of the Plan was to be a joint project between Jersey Alzheimer’s Association and HSSD

Alzheimer association’s overall assessment of the National Dementia Strategy

The Jersey Alzheimer’s Association considers the Plan, as drawn up by them, good.

Diagnosis treatment and research

Issues relating to diagnosis

Timely diagnosis in the National Dementia Strategy

In the Plan, there are three recommendations which are specifically related to the issue of timely diagnosis:

Recommendation 1: Increased public and professional awareness of dementia

According to Jersey Alzheimer’s Association, poor public and professional awareness about dementia is one of the most significant problems to overcome. People currently wait up to three years before seeking help after symptoms first develop. A long-term programme of public education is needed in order to arrive at a situation whereby people know what dementia is and that help is available. It must also ensure that when people ask for help, doctors and social workers are in a position to know what can be done. It was also stated that public and professional awareness and understanding of dementia should be improved and the stigma associated with it addressed. Individuals should be informed of the benefits of timely diagnosis and care, the prevention of dementia should be promoted, and social exclusion and discrimination should be minimised.

Recommendation 2: good quality early diagnosis and intervention for all

The third recommendation states that all people with dementia should have access to a pathway of care that delivers:

- a rapid and competent specialist assessment;

- an accurate diagnosis that is sensitively communicated to the person with dementia and their carers; and,

- immediate treatment, care and support following diagnosis.

It is further stated that the system must have the capacity to see everyone with dementia. The development of specialist memory services is proposed, including consultants, social care workers and the voluntary sectors to ensure effective diagnosis and access to ongoing information and support.

Jersey Alzheimer’s Association points out that people with dementia are often told that forgetfulness is just a natural part of ageing or are wrongly diagnosed with depression. Sometimes they have to go back to the doctor three or four times before they are referred on for help, or there is no developed diagnostic service available. When a diagnosis is made it is often made inappropriately. The development of memory assessment services, which can act as a hub for diagnosis and access to information and advice, would be a significant and positive development in dementia care. 

Recommendation 3: good quality information for those with dementia and their carers throughout the course of their care

The Plan proposes that this could be in the form of an information prescription on diagnosis where people are given information about local services and support available.

Jersey Alzheimer’s Association points out that people with dementia and their families want to have good information about their condition and what they can expect. They also want to take control of their lives by having information about what sources of help are available. Improving access to information will significantly improve the current situation. Such information should be available in paper and electronic versions as well as by phone.

Which healthcare professionals are responsible for diagnosing dementia

GPs usually raise the possibility of dementia and refer people on to the Memory Clinic for further investigation. Diagnoses of dementia and/or Alzheimer’s disease are therefore usually made by the Memory Clinic.

GPs have consultation times of 10 – 15 minutes but these can be extended at the discretion of the GP in the case of dementia. Multiple appointments are also an alternative. All GPs are encouraged to use 6CIT screening tool which is quick and evidence based.

There are as yet no incentives for GPs to improve or increase timely diagnosis.

Type and degree of training of GPs in dementia

GPs receive training in dementia through psychiatry/medical attachments as a student/junior doctor.

Continuing education is an obligation for GPs. There is an appraisal system in place to help doctors identify deficiencies and opportunities for further learning.

Required tests to diagnose dementia

GPs are encouraged to perform a battery of blood tests before referral to identify any underlying cause. More sophisticated psychometric tests are the province of specialists.

Issues relating to medical treatment

The availability of medicines in general

Pharmaceutical products are free at the point of delivery for Jersey residents.

The availability of Alzheimer treatments

All four AD drugs are available. They are all prescribed as generics.

Conditions surrounding the prescription and reimbursement of AD drugs

Certain tests are expected to be performed by GPs in the first instance and then more sophisticated tests are performed by specialists once patients have been transferred. There are no strict cut-off scores on the MMSE and people who live alone as well as those living in nursing homes receive AD drugs if indicated. As AD drugs are free at the point of delivery, the issue of reimbursement for initial or continuing treatment does not arise.

Prescription and reimbursement

Donepezil

Rivastigmine

Galantamine

Memantine

Available

Yes

Yes

Yes

Yes

Reimbursed

N/A

N/A

N/A

N/A

Initial drug reimbursed if prescribed by

N/A

N/A

N/A

N/A

Continuing treatment reimbursed if prescribed by

N/A

N/A

N/A

N/A

Required examinations

Assessment in Memory Clinic

Assessment in Memory Clinic

Assessment in Memory Clinic

Assessment in Memory Clinic

MMSE limits

No strict limits

No strict limits

No strict limits

No strict limits

Issues relating to research

Jersey is not involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) or in the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

References

National Dementia Strategy drawn up by the Jersey Alzheimer’s Association

Acknowledgements

Kim Averty, Honorary Secretary of the Jersey Alzheimer’s Association

 

 
 

Last Updated: Tuesday 14 May 2013

 

 
  • Acknowledgements

    The above information was published in the 2012 Dementia in Europe Yearbook as part of Alzheimer Europe's 2012 Work Plan which received funding from the European Union in the framework of the Health Programme. Alzheimer Europe gratefully acknowledges the support it has received from the Alzheimer Europe Foundation for the preparation and publication of its 2012 Yearbook.
  • European Union
 
 

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