Tuesday, 23 April 2013

Caring for dementia patients: what's best?

We are regularly bombarded with news stories about the aging population and inevitable increase in people with dementia (44% predicted increase by 2021 in Powys), and I wondered what services were available in North Powys. Just a short walk from where I am based, here at Ponthafren in Newtown, is the Fan Gorau older people’s assessment unit, a modern compact building based in Newtown hospital grounds. The unit allows a short term admission of people over 65 who need an assessment in order to provide future care, be it at home or a suitable home that is able to meet the individual’s needs. The focus is on people with dementia and related illnesses whilst those experiencing mental distress because of depression or schizophrenia, for example, are cared for through The Redwoods Centre at Shrewsbury Hospital.

A few days ago I met two of the staff at the unit – Nicki Sayce, Memory Clinic Nurse and Julie Jones, Ward Manager. I wanted to find out more about what is actually provided at Fan Gorau, and I had heard there were some changes in the way Memory Clinic services were being delivered. (You can find out more about Memory Clinics here).

Julie and Nicki are clearly passionate about the work they do, providing support not only to the people staying at Fan Gorau but their families. “Husbands and wives of those at the unit are often left at home without their partner for the first time in many years which can make it very difficult.”  There are support mechanisms in place, be that The Alzheimer’s Society locally, or the Dementia Advisor Heather Lewis (based at Welshpool), but it can still be tough.

People are assessed and diagnosed initially by doctors when referred, and all efforts are made to admit them to Fan Gorau. However, occasionally people may have to be admitted elsewhere, such as Wrexham, or even further afield. The staff explained that “Fan Gorau is a small assessment unit and relatives need to be aware that once the assessment process is completed, then the unit does not provide long term care. If the individual is not able to return home then care placements need to be made, potentially in a home which is not the first choice whilst a place is awaited in that first choice home.”

The new initiative I had heard about was the creation of a Memory Clinic nurse post. Whilst the move to provide these services in North Powys is excellent news, and in line with the Welsh Government's dementia action plan, it is just one post. In South Powys there is apparently a whole team providing this service.

I gave an update recently on the new Home Treatment Team in North Powys (again, a case of catching up with the South), and both Nicki and Julie spoke enthusiastically about the need for an equivalent service for older people with dementia. (The new HTT will provide crisis support for older people with mental health conditions but not dementia). They believe that many people with dementia should continue to live at home with their families if a strong support network is in place, including crisis support as required. However, resources for the service are focused on the inpatient service with nothing spare to resource a community service.

The irony is that in 2009 the local community fought to keep Fan Gorau open when it was threatened with closure. The Accident and Emergency Unit in the main hospital building at Newtown had already been lost… and instinct seems to keep people fighting for buildings… but listening to Julie and Nicki I had to wonder -  perhaps the best outcome for people with dementia and their families lies in developing more community based services…?

Increasingly mental health and dementia services in North Powys are focussing on community rather than inpatient services - including a Young Onset Dementia post and a new Senior Practitioner post. And then there’s the new Home Treatment Team. Should this trend continue? What do you think?


  1. Community based services..yes good if you have the resources to do that. North Powys doesnt, therefore we would yet again end up with a very poor service. That doesnt mean to say that this shouldnt be worked on, however, even if good community services were able to be provided I don't feel it should be instead of Fan Gorau.

    If Community based services could be developed and provided in the North, this may well help with the bed blocking that occurs at Fan Gorau and make that unit more efficient and run more as its intended purpose of a short stay assessment unit.

    1. Hi Anonymous

      Many thanks for your comment, it's really interesting to hear other people's views.

      I'm not advocating any party's politics, but I think Glyn Davies summed it up well in late 2009 in a blog post he made about Fan Gorau: "Put bluntly, our society does not put a sufficiently high value on caring for our elderly people. Massive amounts of money has been, and is being put into extending life, and b***** all into making that extension a meaningful existence. Its an imbalance that needs to change." You can read his full post, it also gives a bit of history (which you may be aware of) but could be of interest to readers - A view from Rural Wales

  2. Caring for a spouse, parent or a loved one with memory loss, Alzheimer's disease or any other types of dementia requires a commitment to cope each day with patience, compassion and flexibility.

    Dementia Clinic

  3. Hi all, I have been waiting for an appointment for at least 6 months now - I am 52 and my memory problems are due to severe head injuries. As this cause is not mentioned at all above I am wondering whether I this is in fact the right clinic! The Headway Forum is full of accounts of people who feel that they fall between all the stools/departments/definitions of the NHS.

    1. Hi Caroline

      Many thanks for commenting and I suggest you send us an email with further information and contact details:


      We will then follow up with you.


    2. To all the above respondees, please see my webpage:
      http://www.pavo.org.uk/help-for-people/nvp.html. As the Voice for people with Neuro Conditions and Carers, I would very much like to hear your stories and pass your comments on to service providers.