Into the wild: letting your project grow and spread

Dr David Pearce is Associate Specialist at Devon Partnership NHS Trust. He is part of a team based at the Devon Memory Service in Torquay, committed to helping people with mild cognitive impairment (MCI). The team has tested the use of self-management techniques to help patients with MCI by running groups to support patients to take an active role in their health and care. These are called THYMe courses (Think Health for Your Memory) and emphasise the links between physical and mental health. 

The team is now working in partnership with Age UK, to spread the reach of the programme to enable more patients to access it. Testing the programme locally, the team hopes that eventually it could be made available through Age UK branches across the UK. We spoke to David about how this third sector partnership is helping to overcome some of the real barriers to spreading the work more widely, and how it feels to relinquish control and release your project ‘into the wild’.

Mild cognitive impairment – a difficult diagnosis

David and the project team work in a memory clinic where about 20% of people are diagnosed with MCI, which is often thought to be an intermediate stage between what would be considered normal ageing and dementia.

David says, ‘We know that probably about half the people with MCI that we see will eventually go on to develop dementia, but at present we can’t say exactly who.’

This lack of certainty can be difficult for patients diagnosed with MCI. Patients can be told they have an approximately 50% chance of developing dementia, are given information to take away and are invited to come back if they think that they are deteriorating. 

‘The vast majority of people with mild cognitive impairment were effectively being told, "you might or might not develop dementia, let us know how it goes". That left people feeling abandoned and it left the memory clinic staff feeling frustrated that we couldn’t offer more.’

The self-management project

The project built on David’s experience of using self-management techniques in mental health, and on evidence that shows lifestyle changes can reduce the risk of dementia. Bringing together people with MCI for five group sessions, the project aimed to educate participants about the risk factors for dementia, what they could do to alter them, and to give advice on memory strategies. Rather than simply being sent home to wait passively and see what happened, patients could now take some action.

Trials have shown that people who are at risk of cognitive decline can reduce their risk by doing physical exercise and improving their diet. David says, ‘The problem with the studies that have been done is that they’re all fearsomely expensive – for example, using psychologists to run groups, exercise co-ordinators and dieticians. Given the many thousands of people in the country with MCI, that’s just not realistic.’ Using a self-management approach and having non-specialists lead groups would be much more cost-effective.

A plan to spread the approach

Following on from the success of the self-management groups run by Devon Partnership NHS Trust, David and his team are starting to work with Age UK to spread the programme more widely.

After enthusiastic discussions with Age UK nationally and locally, the THYMe team are about to begin a pilot with a local Age UK branch. Over the next two months, they will be training people who work at local Age UK organisations to deliver the programme. If the pilot is successful, further plans include a multi-centre trial of Age UK volunteers running the groups, to demonstrate feasibility and measure impact.

David can see the advantages of spreading the project with Age UK as a partner. Age UK provides a range of other services – such as befriending – which programme participants can access. For the patient, ‘one of the big problems with delivering self-management courses in the NHS is the fact that they are all time-limited, which can lead to a loss of momentum when the course is over.  We know that confidence to self-manage needs regular nurturing. Here it would be seamless. You could go to the groups around self-management and memory techniques and you’d be introduced to all the other services in the local area that Age UK offers’.

There is a manual for the programme, so that a facilitator can pick it up and work through it. David acknowledges that some techniques aren’t easy to learn from a manual – for example watching a facilitator work on goal-setting with participants is more powerful than reading about it. His team have a plan for this. ‘We’ve been in touch with a local TV studio, and our plan is to create a video and put it online, so you can watch it in action.’

Working with the third sector

In addition to the advantages of giving participants seamless access to other services, the ease of communication between branches of Age UK is also appealing. Working within the NHS, with its many trusts and networks can make communicating new ideas challenging, and David believes a national organisation with local branches can be more effective at communication.

David is positive about spreading the work with a third sector partner. Spreading work inevitably means having less control about how it is delivered and allowing it to be adapted for different settings, but for David, ‘that’s part of having a small project and then spreading it out – you have to let it go out into the wild’.

This project was initially funded by a Health Foundation Shine 2014 grant and is now being supported by a small scale Spreading Improvement grant. For more information on the project contact david.pearce3@nhs.net