Seminar 2: Diagnostic pathway Introduction Welcome and - PowerPoint PPT Presentation

Dementia United Greater Manchester Health GM MAS SUMMIT – 13 AUGUST 2020 and Social Care Partnership Seminar 2: Diagnostic pathway Introduction Welcome and introductions: • The introduction of social distancing guidelines has altered the way we approach diagnosis. In many cases this has necessitated a move towards a blended model for assessments, combining remote and face-to-face assessments, where feasible and necessary. Many GM services have already made great strides in adapting to this new way of working. • With any approach, services are needing to be mindful to mitigate risk, ensure equality of access and ensure that support offered is needs-led; with these needs being identified by patients and family members. We intend to first highlight good practice before opening the floor to questions then a broader discussion. • Good practice speaker: Dr Jennifer Thompson, Lead Neuropsychologist and Honorary Research Fellow and Dr Matt Larbey, Clinical Psychologist; Cerebral Function Unit, Salford Royal NHS Foundation Trust • The session will be recorded, for us to take notes and share these following the Summit. • Please raise your hand if you wish to ask a question, following the presentation Emma is available throughout the morning and if you lose connection emma.smith96@nhs.net

Dementia United Greater Manchester Health GM MAS SUMMIT – 13 AUGUST 2020 and Social Care Partnership Seminar 2: Diagnostic pathway Speaker Slide(s) Good Practice: Cerebral Function Unit – Matt and Jennifer to share their slides

Dementia United Greater Manchester Health GM MAS SUMMIT – 13 AUGUST 2020 and Social Care Partnership Seminar 2: Diagnostic pathway Discussion Key points :  Prioritising good practice recommendations (see the next slide) - the must do's • What would we want as a minimum for Greater Manchester  Identifying the challenges (solutions to these), opportunities of these recommendations - what is the variability in GM  What are the rules of engagement for next steps associated with these recommendations. Possible seminar topics: • Collecting patient history and triaging to further assessment. • Cognitive testing and neuropsychiatric assessment; telephone vs video, vs face-to-face: best practice. • Brain scans: need, alternatives and safety considerations • Open, person-centred dialogue discussing diagnosis/ process/risks and current situation

Dementia United Greater Manchester Health GM MAS SUMMIT – 13 AUGUST 2020 and Social Care Partnership Seminar 2: Good practice recommendations emerging from evidence 1 • The capacity of services must be sufficient to meet (and be responsive to) the needs of people referred for assessment. • New working practices should overcome and not add to inequality of access. • Newly configured services need to recognise the risks , be honest and transparent with patients and their families about these risks and take steps to mitigate their effects. Build in continued monitoring and review of these risks. • For example, risks associated with using technology confidentiality of the remote appointment, use of interpreters, meeting the needs of people with sensory impairment etc. • All practitioners to have access to appropriate evidence-based tools as well as technical equipment in order to offer remote/virtual assessment and appointments. • Workforce : Clinical training and supervision, administration staff time and preparation are all key to the success of working remotely. • Applying research and evaluation , as a golden thread enables services to reflect and learn as they develop. Consider obtaining lived experience feedback; value of Greater Moments DU lived experience barometer.

Dementia United Greater Manchester Health GM MAS SUMMIT – 13 AUGUST 2020 and Social Care Partnership Seminar 2: Good practice recommendations emerging from evidence 1 • 'Blended model' service offer is dependent on the patient choices and needs-led (needs identified by patients) • Consideration of sensory impairment when assessing : some good practice principles: • Hearing Do you have any aids? Are you wearing them, when did you last change batteries, can you turn off background noise, how do you judge your hearing, ask if they have a predominant ear; ask the person to repeat back instructions to test out they have heard. • Vision do you wear glasses, are you wearing the ones you usually wear, any eye surgery, have you ever been told you have any eye conditions, ask about lighting. For both, some testing is better than no testing; we are not after the score rather the areas of need. • Have a structure and script to follow, for telephone consultation; • Reassure it is secure and confidential, verify identity • The tone of your voice and how you say things is vital • Paraphrase, summarise back, check if they have questions as you go. • Clarify and ask about future consultations

Dementia United Greater Manchester Health GM MAS SUMMIT – 13 AUGUST 2020 and Social Care Partnership Seminar 2: Good practice recommendations emerging from evidence 2 • Pre-planning and setting up for video assessments where these involve visual stimuli, the device will need to be at least as large as a standard iPad (9”). Have a pre-assessment discussion on the telephone to consider the following; • Ask the patient if they would like a family member or friend to join them. check requirements for interpretation • If you are working from home, choose a neutral setting and background so that the patient is not distracted by glimpses of your domestic circumstances. • Make sure you will not be interrupted, and that background sounds are not intrusive • Landscape format is felt to be better than portrait as it feels more natural and gives a feeling of a comfortable separation between you and the patient. Adjust your position so that your head is central in the patient’s view • The patient should be able to see your facial expression without straining, and preferably also your hands, as hand gestures are an important part of communication • Make sure your face is well lit and avoid a source of bright light behind you • Have a script and aspects to consider for a video consultation agreed in advance.

Dementia United Greater Manchester Health GM MAS SUMMIT – 13 AUGUST 2020 and Social Care Partnership Seminar 2: Good practice recommendations emerging from evidence 2 • Neuropsychiatric assessments: The British Psychological Society, Division of Neuropsychology has released guidance regarding the remote administration as have GMC; • Attention needs to be given to clinician familiarity with the remote administration of the test, training, practice and usage, and the patient’s ability and willingness to engage in remote assessment, to enable effective assessment and interpretation of test results. • There is an encouraging evidence base indicating that valid results can be achieved by remote administration of neuropsychological tests e.g. the Repeatable Battery for Assessment of Neuropsychological Status. • Alternatives to brain scanning ; there are clinical situations where a scan may not be necessary. It must be remembered that a scan does not in itself diagnose dementia it provides support for the clinical diagnosis and can help establish the sub-type (cause). • Communicating the diagnosis of dementia : doing so in a way that is sensitive, informative and constructive is a fundamental element. The point where the diagnosis of dementia is communicated is critical for the health and wellbeing of people with dementia and their families. Plan for this to be over several remote/telephone appointments.

Dementia United Greater Manchester Health GM MAS SUMMIT – 13 AUGUST 2020 and Social Care Partnership Guidance on joining the main meeting Please leave this meeting and rejoin the meeting that started at 09:30. Please aim to do this by 11:50. • Emma is available throughout the morning and if you lose connection to the main meeting or cannot access it on Teams please email: emma.smith96@nhs.net