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Key Achievements and actions 2022-2023

Here are the key achievements for Dementia Together in the first year:

  • Dementia Coordinator role in primary care for early identification and support for those at risk of developing dementia.
  • Weekly Brain Health Café with Dementia Forward to provide a wide range of support for people, carers and their families awaiting dementia diagnosis.
  • People are now automatically referred to a Dementia Forward Adviser after diagnosis.
  • Access to a Specialist Dementia Nurse in Primary Care to support those with increased need, including those living in a care home.
  • Weekly Dementia Wellbeing Café, which is an integrated health and social care offer providing information, guidance, and clinical advice, as needed for people with dementia and their carers/families.
  • Dedicated space for dementia on the Live Well York website, with additional funding to co-produce an online ‘Well Pathway’ for dementia.
  • Worked in partnership with York Learning to develop dementia inclusive courses for Arts & Crafts and Keep Fit - in recognition of the benefits of ongoing learning for both physical and mental wellbeing.
  • Developed strong links with St Leonard's Hospice to deliver dementia specific Advance Care Planning to professionals (and families).
  • Supporting the Cognitive Rehabilitation pilot - a therapy that supports people with mild to moderate dementia to regain skills that are important to them.
  • Working with Access Able and Dementia Forward to ensure community buildings are accessible for all people living with dementia in the City. Promoting research opportunities from the Memory Service and Primary Care.
  • Ran a workshop to understand our current community crisis and hospital response across health, social care and the voluntary sector for people living with dementia. Work is underway to develop the findings and identify new work streams - need for dementia and
    delirium training is one.
  • Supported the embedment of John's campaign in York Hospital to ensure extended visiting rights for family carers of people in Hospital.
  • Intergenerational training in schools provided by Dementia Forward.

The drop-down boxes below show the actions for the next year under the five stages of the National Dementia Well Pathway:

We will:

• Develop the work of the Ageing Well partnership to increase awareness about dementia and reduce associated stigma.
• Have a forward plan for preventative campaigns, including York being a carbon net zero city.
• Develop an online platform for information and advice about Dementia on Live Well York.
• Ensure NHS Health Checks include advice on lowering the risk of dementia.
• Connect people to support in their communities.
• Support improvements around diagnosis and treatment of depression in older adults in the city.
• Support improvements around diagnosis and treatment of depression in older adults in the city.

We will:

• Ensure the dementia diagnosis experience is timely, high quality, and carried out in an appropriate setting.
• Increase dementia awareness through campaigns, staff training, media communications
and social networking.
• Improve diagnostic rates through G.P practices supported by Dementia Coordinators.
• Use tools to support timely diagnosis for people with symptoms of advanced dementia living in a care home setting.
• Strive to develop and implement a shared care record across health and social care services.
• Improve the offer of dementia advice and community support
within GP practices.

We will:

• Create Dementia Hubs so that people living with dementia and their carers can visit to access information, advice, and support.
• Develop a clear pathway of support following diagnosis.
• Improve the way people are supported when in crisis through joined up and co-ordinated support.
• Develop evidence-based, person-centred interventions and support.
• Establish a framework for dementia training across the health and care workforce.
• Develop the work of the Care Homes and Dementia Team to ensure that people living within care homes have the same access to diagnosis and support.
• Increase the number of people who have a safe and timely discharge from hospital to the place of their choice with the right level of support.
• Ensure that the right opportunities and support are available for carers

We will:

• Promote dementia friendly services and buildings.
• Work to reduce health and social care inequalities for people living with dementia and their families.
• Contribute to York’s Inclusive Transport Strategy to ensure that nonvisible disabilities are acknowledged and addressed.
• Develop information, guidance, and advice to support the stages of the ‘Dementia Well’ Pathway.
• Encourage open and ongoing conversations about creating the sort of city in which people with dementia and their carers can live good lives.
• Contribute to campaigns and intergenerational projects that improve dementia care.
• Ensure that the right opportunities and support are available for carers of

• Ensure that people receive appropriate end of life care regardless of the setting.
• Develop information and guidance that supports people living with dementia and their families to make decisions about their end-of-life care options.
• Provide dementia specific advanced care planning across the health and social care workforce to improve person centred end-of-life care.
• Ensure we have appropriate support in place for families and carers when their loved one approaching the end-of- their life.
• Audit and monitor the availability of palliative care and set out a framework of monitoring and review to ensure quality

Last updated: 09/10/2023