Hywel Dda University Health Board Memory Assessment Service Redesign

With a growing aging population across the globe, dementia has emerged as one of the most pressing health issues in recent years, with west Wales being no exception. According to the West Wales Care Partnership(WWCP), current population projections suggest there will be a rise in those aged over 65 years from 88,200 in 2013 to 127,700 by 2031. According to data published in the Hywel Dda University Health Board (HDdUHB) Three Year Plan the number of people aged 65+ in Hywel Dda with dementia in 2020 was 6,884. This is expected to increase by 31.0% to 9,020 in 2030, and 62.8% to 11,210 in 2040, reflecting the picture of increasing pressures relating to dementia across Wales.


Following considerable work undertaken in HDdUHB to understand the changes needed in services to meet the needs of people living with a diagnosis of dementia, as well as those who have yet to have a formal diagnosis, Yma in partnership with Here were invited to support a patient-centred process of discovery and design around the current Memory Assessment Service, with the intention of bringing alive the WWCP Dementia[JP1]  Strategy. With experience in creating innovative sharing and learning environments, facilitators, subject matter experts and project management colleagues from Yma and Here were well-placed to nurture a truly collaborative learning coalition.


Drawing on the project management and facilitation expertise of Yma and Here and the service knowledge and experience of the commissioning leadership, the project was organised into two phases, Phase 1: Engagement& systems thinking design process and Phase 2: Evaluation of findings and pilot recommendations. A series of seven discovery sessions were held virtually and in-person with the aim to bring together stakeholders from the MAS, and associated health and wellbeing services. General practice, pharmacy, Marie Curie, The Alzheimer’s Society, Admiral nurses and PAVS (Pembrokeshire Association of Voluntary Services) amongst others joined to explore the problem in a neutral and supportive space.


The sessions focussed on memory assessment from the patient and carers perspective and challenged the current measurement of “excellent care” being based around diagnostics. The group heard from case studies how patients have different needs, and that diagnosis isn’t the right path for all of them, but they do all need support on their journey. The creation of statements from patient and carer perspectives formed the beginnings of a new service constitution for dementia wellbeing in HDdUHB. Alongside this, participants were given the opportunity to pilot four test-of-change experiments over a period of six weeks, with results helping to shape final recommendations.


The project generated five main recommendations, aligned with the National Dementia Standards. The recommendations are informed by what we have seen, heard, and felt from those working in the service and alongside it. They are designed to dovetail into the ongoing work on Workstream 1 and 2 while maintaining the momentum and patient focus generated during this project. The recommendations are cumulative, each building on the work of the previous:

•     Focus on the data – invest in current and future collection and use of meaningful data

•     Support for Workstreams – additional support for those responsible for delivery of workstreams 1 and 2 to carry forward the learning from this work

•     Continuing the discovery – Building a learning coalition to bring new pilots to fruition to test small changes in practice which could have a large impact on patients and carers

•     Learning through doing – Delivery of a primary care led specialist role to work with the MAS and contribute capacity and integration

•      Accelerated change – a clinically led project management office and eventually a primary care-led integrated dementia wellbeing service.


Following completion Phases 1 and 2, Yma produced a report detailing the project findings, with recommendations now being considered alongside ongoing work on the future of dementia care in HDdUHB. We are looking at ways to share what we have learnt herewith others, from primary care clusters all the way up to health boards.


References and further information:


Hywel Dda Three Year Plan 2022/25

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