Table 6

Quotes illustrating theme 3

QuotePerceptions of rationale, aims and impacts of case-finding
18I think the motivation with a lot of these things it is financial, for example, when one has a CQUIN then there’s a big push to do it (Hospital staff 06)
19That ticks the boxes and we’ve fulfilled our CQUIN requirement, but there’s… no-one seems to be assessing whether what we’re doing is appropriate or correct or whether the care plan is written in an appropriate way (Hospital staff 10)
20…we request that they’re brought back to the Care of the Elderly outpatient clinic and we will revisit it then again to see actually has the patient regained their abilities, are they back to their norm, and I think it’s quite unique to [Hospital 14] because when I meet with the collaborative CQUIN groups for [Place name 12], not all hospitals offer that facility (Hospital staff 09)
21I think it is an opportunity for people who would have been missed, who wouldn’t have gone to their GP…I think it’s great that we get an opportunity to pick people up and it improves that and it can open up other services and help with support for them, so I think that bit’s great (Hospital staff 15)
22I think it’s actually something that is still worth doing because, actually, this is about quality care and quality of diagnosis (Hospital staff 07)
23…we don’t always want to give them a dementia label, because it might make a massive impact on their relocation from their home to somewhere else (GP 11)
24…it has not only increased awareness, but other departments are now making commitments to ensure that… Their patients may have dementia… and therefore they need to ensure that the appropriate steps are taken (Hospital staff 20)
25There seems to be a little bit of misunderstanding amongst junior doctors of the difference between delirium and dementia (GP 13)
26…sometimes they send lots of people out saying their memory is a problem and whenever you actually get them in it’s not really a problem, but if you have a tick box approach to it that’s what can… ends up being the difficulty that takes up a lot of GP time to untangle that (GP 02)
27When they are ill, they are very often confused, especially if they’ve got a UTI [Urinary tract infection] or something… I know perfectly well, because I saw the patient the week before they went into hospital, that actually they’re functioning perfectly well and don’t need further referral (GP 09)
28I think in A&E somebody should be making those calls to establish which patient is a known dementia patient rather than just assumed, which is what tends to happen… So they now filter through to the wards with dementia, dementia, dementia until we come and say “This patient doesn’t have dementia, don’t put the yellow flag on this patient, there’s no evidence of dementia” (Hospital staff 21)
29Sometimes they really appreciate it and it’ll open the flood gates, as it were, in terms of you’ve asked that question and suddenly they’re like, “Oh yeah, we have been having problems actually, this has happened, yeah, he’s getting really confused about his daily activities of living,” and things, so it’s… sometimes it’s really helpful (Hospital staff 09)
30The impact is quite variable. I think it’s a matter of communication, but you can see that patients can become a little upset that they can’t remember, and we have to explain why we’re doing this, not to embarrass them (Hospital staff 20)
31…in a good world you will have, actually have an assessment by an old age psychiatrist, someone with real skill in the area (GP 08)
32The family is saying “Dementia, we were never told he had dementia”, so actually it’s not… The communication is not there, and then they’re very upset with us by having it on their records here (GP, focus group 1)
33…obviously it raises then worries, sometimes worries for the patient as well ‘cos it’s a scary thing to be told you might have dementia, it’s scary for people (GP 16)
34We have found that it can sometimes become less meaningful if it’s more of an automatic tick box, certainly from one hospital (GP 10)
35Usually it’s been people that we already knew, you know, it’s either you know, it’s already been flagged up by their family, so we’re sort of monitoring it (GP 17)
36…sometimes… I’ve already spoken to the patient about it and they don’t want to be referred at that stage, or they don’t see the point in being referred or they want to wait – (GP 16)
37I’m not really sure that case-finding dementia is helpful in a world that is the cutting services of people with dementia (GP 03)
38Large amounts of money have been put into doing all this and I wonder whether it wouldn’t be better spent elsewhere (GP 10)
39It often raises hopes from the family that something exciting is going to happen and someone’s going to help dad who lives on his own, and he’s usually sent home, I mean most discharges are pretty unsafe to start with (GP, Focus group 1)
40I wouldn’t say that the case-finding coming out of the hospital has made a significant impact on our number of dementia cases at all (GP 12)
  • A&E, accident and emergency; CQUIN, Commissioning for Quality and Innovation; GP, general practitioner.