Freedom of Information Request – Ref: FOI 118-2025
Thank you for your recent Freedom of Information request. Please find our response below.
You asked:
I am interested in knowing about the prevalence of various dementia diagnostic pathways in NHS Trusts. I would be most grateful if you could kindly provide me the following information pertaining to your organisation.
1: Please could you confirm whether the following model(s) for diagnosis of dementia are used at your organisation: either routinely or on infrequent basis, for non-urgent referrals from primary care. For the purpose of this request, ‘infrequent’ may be taken as less than 10% of total instances.
Our response:
| Yes: routinely | Yes: infrequent (less than 10% of occasions) | Never | Not applicable | |
| 1.1. The initial assessment, including cognitive testing of the patient, is completed by a nurse. A brain scan CT or MRI may also be requested at this time. | Yes: routinely | |||
| The nurse presents the findings to a psychiatrist, who makes or excludes a diagnosis of dementia without having any contact with the patient (either face-to-face, video or telephone consultation). | Yes: infrequent (less than 10% of occasions) | |||
| The initial assessor nurse subsequently meets the patient, provides diagnosis feedback, explains plan of management, and gains the patient’s consent to Rx. | Yes: infrequent (less than 10% of occasions) | |||
| Hallmark: The diagnostician does not see the patient or develop a first-hand objective impression of the patient. | Never | |||
| If the psychiatrist finds it difficult to make a diagnosis on the basis of provided information and scan findings, then a subsequent face-to-face interview with a psychiatrist is arranged. | Yes: routinely | |||
| 1.2. After the initial assessment by a nurse, the findings are discussed with a Multidisciplinary Panel (which may comprise, among others, clinical psychologists, occupational therapists, senior nurses; but excludes psychiatrist, neurologist or another medical practitioner). | Never | |||
| This panel discusses the findings and may arrive at a diagnosis of dementia or other cause of cognitive impairment (or alternatively, may exclude dementia). Depending on the diagnosis made at the time, specific treatment for the patient may also be recommended to the GP. | Not applicable | |||
| Hallmark: The diagnostician(s) do not see the patient either face-to-face or via video consultation, and the diagnosis is fed back to the patient by the initial nurse assessor. | Not applicable | |||
| If no diagnosis is made at this time, then a face to face assessment with a psychiatrist is organised for a future time. | Not applicable | |||
| 1.3. Similar to 1.2 above, but the findings are presented to a Multidisciplinary Panel that includes one or more doctors with relevant experience – such as psychiatrist, neurologist or geriatrician. |
Yes: routinely | |||
| This panel discusses the findings and may arrive at a diagnosis of dementia or other cause of cognitive impairment, and treatment in the form of medication may be recommended to the GP. | Yes: routinely | |||
| Hallmark: The diagnostician(s) do not see the patient, and the diagnosis is fed back to the patient by the initial nurse assessor | Yes: infrequent (less than 10% of occasions) | |||
| If the panel is unable to arrive at a diagnosis, then a subsequent face-to-face review with an old age psychiatrist is organised. | Yes: routinely |
Note: Should there be sufficient evidence for a diagnosis to be made at MDT this may well be delivered by the nurse assessor.
You asked:
2. If the answer to any of the above (1.1 to 1.3) is ‘yes’, then
(a) The total number of patients who were diagnosed with dementia or mild cognitive impairment at your organisation from 1st January 2024 to 31st December 2024.
(b) The number of patients who had their initial diagnosis made via one of the above pathways (1.1 to 1.3) over the same period – irrespective of whether the diagnosis was subsequently changed or not.
(c) Do the clinicians use Artificial Intelligence (LLM or other models – but excluding note taking or transcribing agents) to aid the making of dementia diagnosis at your organisation?
Our response to questions 2 a and b combined:
782 patients received a diagnosis of dementia or mild cognitive impairment in the time frame requested.
As diagnosis has been requested, we have only included cases where a diagnosis has been recorded as confirmed.
There may be other patients that have been referred and/or treated where the condition is apparent or suspected but has not been recorded as confirmed.
Please note only medics can confirm a diagnosis. If a diagnosis is recorded by a nurse this will not be recorded as a confirmed diagnosis and not captured in the data analysis for the time period requested.
As per the NICE guidance issued in 2018 there is an emphasis on primary care diagnosis. Therefore the figures do not give the total of people diagnosed across the county.
Our response to question 2 c:
No
You asked:
3. Please could you send me, either via email or post:
(i) A copy of the current pathway(s) for diagnosis and management of patients with memory and/or cognitive difficulties referred to the older adult mental health teams or memory clinic at your organisation.
(ii) A copy of the patient information leaflet provided by your organisation that explains what the above patients (with memory difficulties) might expect during their assessment and follow up with the relevant team(s) of your organisation.
(iii) If the clinicians use any Artificial Intelligence (LLM or other models) to aid the making of a diagnosis of dementia (or excluding it) and the assessment of risk, then the relevant policy for such use of AI at your organisation.
Please see our response to questions 3 (i) and (ii) on the links below:
Please note that the operational policy is awaiting ratification and publication.
Our response to question 3 (iii):
We do not use AI at the moment
Next steps:
Should you have any queries in relation to our response, please do not hesitate to contact us. If you are unhappy with the response you have received in relation to your request and wish to ask us to review our response, you should write to:
Louise Moss
Head of Legal Services / Associate Director of Corporate Governance
c/o Gloucestershire Health and Care NHS Foundation Trust
Edward Jenner Court
1010 Pioneer Avenue
Gloucester Business Park
Brockworth, GL3 4AW
E-mail: louise.moss@ghc.nhs.uk
If you are not content with the outcome of any review, you may apply directly to the Information Commissioner’s Office (ICO) for further advice/guidance. Generally, the ICO will not consider your case unless you have exhausted your enquiries with the Trust which should include considering the use of the Trust’s formal complaints procedure. The ICO can be contacted at: The Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF.