This collaborative project between Health Innovation Manchester, Linus Health and participating GP practices and Primary Care Networks is a Greater Manchester proof of value for enabling targeted case-finding of cognitive impairment.

Dementia is one of the greatest health challenges facing Greater Manchester. In addition to the significant impact it has on patients and their families, the estimated cost to the taxpayer for health and social care for people with dementia across Greater Manchester is £270m per year (Dementia United Implementation Plan 2017).

The current system for dementia and cognitive impairment is reactive with many people only presenting once they have symptoms, this is where most of the costs are to the system along with a significant proportion spent on caring for dementia.

The aim of this project is to shift towards a more upstream approach that will proactively case-find patients in the early stages of cognitive decline to delay the onset of dementia and reduce the severity of symptoms.

The earlier healthcare professionals can detect and diagnose people, the earlier they can provide interventions such as lifestyle advice. Lifestyle interventions have the potential for wider health and well-being benefits so they could result in cost savings in other parts of the health and care system and deliver a broader social return on investment too. There are also opportunities to signpost people to research including trials for disease-modifying treatments.

Investing in upstream interventions will mean that people enter the system earlier and this will have benefits for a patient’s quality of life as well as delaying and potentially preventing downstream, reactive costs.

Linus Health offers a digital cognitive assessment platform that enables targeted case-finding of early cognitive impairment in a primary care setting. It can be delivered irrespective of setting and the platform can be used in practices, in care homes, in a patient’s home, or a drive-through setting depending on the patient’s circumstances.

Health Innovation Manchester has consulted with dementia specialists who have given their support for the use of the platform in this context. This includes Professor Alistair Burns, Professor of Old Age Psychiatry, University of Manchester and National Clinical Director for Dementia and Older People’s Mental Health, and Dr. Ross Dunne, Consultant Old Age Psychiatrist, University of Manchester, and Clinical Director, GM Dementia Research Centre.

In addition, we’ve consulted with the NHSE/I Dementia Policy team. This includes Mark Thaxter, Senior Programme Manager for Dementia & Older People’s Mental Health. Mark was supportive of the proposal which aligns with the national priorities, commenting that “it does address a couple of our current concerns, viz prevention/ modifiable behaviours and MCI.”

We have consulted with the Department of Health and Social Care dementia team including Clare Lucas, Senior Policy Advisor. Clare commented that the proposal aligned with the national direction of travel.

The case-finding for cognitive impairment will be undertaken through the GMCR BI platform. Practices will have access to a dashboard that will provide them with a list of patients in their practice who meet the search criteria (i.e. people who are 55+ with a diagnosis of hypertension).

The assessments take between 5-8 minutes and provide sensitive, scientifically validated, and actionable assessments.

Patients will be provided with appropriate follow-up which will depend on the outcome of the assessment and the commissioning arrangements in that locality.