David Jolley makes a valuable point about the need for ongoing support for patients receiving a dementia diagnosis and we agree that all patients deserve such input. 1 We disagree that our patients are failed by either the memory clinic combined with the community mental health team (CMHT) service or the traditional CMHT service described in our paper, 2 as both services have good relationships with general practitioners (GPs), who can refer rapidly into the CMHT arms of both services as any behavioural and psychological symptoms of dementia arise. Jolley criticises post-diagnostic signposting to the third sector as leaving patients and their relatives adrift. But these post-diagnostic services have been specifically commissioned from a third sector organisation and not from secondary care, which has the disadvantage of not being part of psychiatric services but is an acceptable, ‘non-medicalised’ service that can be accessed at any time. The study of the third sector organisation was not within the remit of our paper.
We did not comment specifically on referral rates and this study examined only a small part of the service in these trusts, so we are not certain where the figure of 5 per 1000 that Jolley quotes is derived from. In fact, the services have quite different levels of staffing (both medical and non-medical) and there are other memory services in the region provided by neurologists and geriatricians as well (not examined in our paper), so we had specifically not commented on referral rates in total but only on these small patches within the service.
Both services have changed considerably since 2011 and some service improvements have been inspired specifically by this evaluation. Both services now ensure multidisciplinary follow-up for all patients (where patients and their carers are advised verbally and in writing how to contact various local services according to their needs in the future) and the memory-clinic-based service has cut down on some paper assessment tools. More therapy treatments are offered in both services. Other changes include the introduction of nurse specialists to assist in the memory-clinic-based service. The CMHT service continues to offer consultant medical domiciliary diagnostic assessment, with prescribing now done by GPs from the outset and initial monitoring and post-diagnostic support provided through the CMHT.
We are concerned about the lack of research into these services, rapidly changing across the country. The introduction of new models should be accompanied by robust independent evaluation and evidence of sustained benefit over a sufficient period to prove worth. Multiple innovations in the context of constantly reorganised health and social care systems have no evidence base to justify them from the perspective of frail older people where continuity has been demonstrated to be highly valued.