Brain Health Service pilot: evaluation - final report

Executive summary

This report presents detailed findings from Blake Stevenson’s independent evaluation of the Brain Health Service demonstrator in Aberdeen, developed and delivered collaboratively by NHS Grampian, Alzheimer Scotland, and the Scottish Government. The evaluation is an early deliverable for the ten year dementia strategy.

Introduction

Conducted between March 2024 and May 2025, this evaluation assesses the context, delivery, outcomes, sustainability, and potential scalability of an innovative brain health model. The evaluation adopts a comprehensive mixed-methods approach, incorporating qualitative service-user feedback and stakeholder engagement and service and clinical data analysis.

Context

Dementia prevention has become an increasing focus of public health driven by emerging evidence that a significant proportion of dementia cases may be preventable through targeted interventions. Within Scotland’s national dementia strategy is the commitment to evidence -informed delivery and enhancing the approach to dementia prevention, early intervention, and support services. The Brain Health Service demonstrator was introduced in Aberdeen to test a public health-based model aimed at early intervention, lifestyle modification, and dementia risk reduction. The service seeks to promote long-term cognitive health through structured stages, from early engagement and awareness-raising to reduce dementia risk (Stage 1) through to specialist clinical assessments with the Nurse Practitioner (Stage 2) and the Consultant (Stage 3).

Evaluation purpose

The evaluation aimed to

• understand the service’s effectiveness in reaching intended populations, particularly those at risk of cognitive decline;
• assess the quality and outcomes of interventions provided across all service stages;
• evaluate the integration and sustainability of the service within NHS Grampian’s existing healthcare infrastructure;
• examine levels of public awareness and the effectiveness of promotional strategies; and
• identify the broader implications for public health policy and future scaling across Scotland.

Key Findings

Service reach and engagement

The Brain Health Service officially launched in December 2023 and undertook a wide-ranging public awareness campaign in early 2024 to raise its profile across Aberdeen and surrounding areas. This included bus and radio advertisements, targeted social media, NHS Grampian communication channels, and the distribution of posters and leaflets in GP surgeries, pharmacies, libraries, and other community venues. Community outreach was also prioritised, with over 30 presentations and networking events engaging community groups, healthcare workers, public event attendees, and strategic partners.

These activities generated high levels of visibility and public engagement was further supported by public health professionals who played a key role in spreading awareness.Despite these efforts, feedback from service users and stakeholders indicated there is still limited awareness of the service which highlights the importance of ongoing awareness-raising and clear messaging about the preventative and proactive nature of the service.

Between December 2023 and January 2025, 159 people engaged with Stage 1 of the Brain Health Service. Most were aged 60–79, with women slightly more represented (55%). The vast majority identified as White (91%) and more than half (56%) lived in Aberdeen City. Only 18% of users were under 50, and individuals from Black and Minority Ethnic communities were underrepresented.

Most users accessed the service through informal channels—74% walked into the Resource Centre, while others were supported via Healthpoint (15%) or GP referrals (11%).

Users reported diverse motivations for accessing the Service, ranging from memory concerns and family history of dementia to physical or mental health challenges (e.g., hypertension, diabetes, anxiety, stress). Others were motivated by lifestyle concerns or a proactive desire to maintain cognitive wellbeing.

Effectiveness and user outcomes

The evaluation found that the Brain Health Service was widely perceived by users as positive, person-centred, and reassuring. Users highlighted the empathetic and knowledgeable approach of staff, the welcoming environment of the Resource Centre, and the comfort they felt during their consultations—key factors in encouraging initial engagement and building trust.

A feature of the Service’s effectiveness was the use of personalised action plans. These plans offered tailored, achievable suggestions for lifestyle modifications based on each individual’s circumstances, covering areas such as physical activity, diet, social engagement, mental stimulation, and alcohol intake. Service users valued the relevance and accessibility of the advice and many noted that, while they had been aware of the general benefits of healthy lifestyles, the service played a key role in reinforcing this information and motivating change. One user remarked that the service “hammered it home,” helping him act on existing knowledge.

There was strong evidence of self-reported behaviour change among users following their engagement with the service. Common changes included increased walking or physical activity, more attention to mental engagement (e.g., puzzles, reading), healthier eating habits, and moderation of alcohol use. In some cases these changes were supported by structured follow-up, especially for those who progressed to later stages of the service. Users with additional sessions or reviews were more likely to report maintaining or deepening the changes they initiated.

Stages 2 and 3 offered more detailed clinical assessments. These stages were particularly effective in identifying early cognitive issues and coexisting health concerns such as anxiety, depression, and physical comorbidities. This helped inform appropriate referrals and further interventions, reinforcing the tiered service model as both responsive and holistic.

Despite these strengths, some limitations were noted. The variability in how action plans were developed and recorded meant that, whilst personalised, there was a lack of consistency in the approach. Additionally, while Stage 2 was seen as highly beneficial, it was resourced to only be available to residents of Aberdeen City. This created inequity, with some users in Aberdeenshire unable to access the next stage of support despite being suitable candidates—a frustration shared by both staff and users.

Implementation

The implementation of the Brain Health Service was underpinned by a well-defined model and delivered in collaboration between NHS Grampian and Alzheimer Scotland. The service is based in the Alzheimer Scotland Resource Centre in Aberdeen and brought together NHS Grampian Healthpoint staff, clinicans and third sector support via the Centre Manager. The operational model was seen by staff and stakeholders as coherent, clearly articulated, and strongly person-centred.

The physical space of the Resource Centre was described as welcoming and informal, helping to reduce anxiety and encourage honest discussions. Stakeholders praised the quality of staff team and the strength of inter-agency cooperation at the delivery level. Nonetheless, the service’s implementation also revealed the difficulty of introducing a preventive offer into a system largely structured around diagnosis and treatment. It required careful communication and positioning to differentiate the service from dementia diagnosis or support for people already experiencing cognitive decline.

Integration

While the Brain Health Service succeeded in establishing an operational model within NHS Grampian, improving integration with the wider local healthcare system emerged as a key priority for staff and stakeholders. Initially, the novelty of the Brain Health Service meant that efforts were focused on setting up the model and delivering support, which limited early opportunities to build strong connections with NHS colleagues. The Resource Centre, while consistently praised by service users for its accessible and informal setting, the clinic based in the Centre was separate from NHS Grampian clinical environments. This separation contributed to a perception that the service operated in parallel rather than as part of a cohesive system. One stakeholder described this as “working in silos rather than as a cohesive system.”

GP engagement with the service was also more limited than anticipated, in part due to the pressures on general practice and a need for clearer communication around referral pathways. Similarly, while informal links existed with services such as neurology, psychiatry, and allied health professionals, staff noted that more formalised referral routes would enhance the service’s ability to connect users with appropriate follow-on care.

By the end of the evaluation period, there were some signs of improved integration—for example, secretarial teams in older adult psychiatry had begun redirecting referrals to the Brain Health Service. Staff also recognised opportunities for greater collaboration, particularly with services supporting individuals with mild cognitive impairment who may not meet thresholds for traditional support but are well suited to the Brain Health Service’s proactive model.

Sustainability

In terms of sustainability, despite the clear benefits of the Service, the test site’s longer term viability was uncertain because of funding constraints Stakeholders with expertise in brain health emphasised the growing importance of services like the Brain Health Service, citing several key factors. Advances in diagnostics and emerging therapeutics are increasing the need for early intervention pathways, as biomarker technologies and treatment options become more widely available. The service also fills a critical gap in current healthcare models by offering preventative support to individuals with mild cognitive impairment (MCI) or early symptoms—groups often underserved until formal diagnosis. Integrating brain health services into wider public health strategies was seen as essential, with Stage 1 demonstrating potential to drive behaviour change and reduce long-term dementia risk. Although this evaluation did not measure cost-effectiveness directly, stakeholders noted that early detection and intervention are likely to improve resource use and make better use of clinical expertise as new treatments become available.

Recommendations

The evaluation identified eight key recommendations.

Recommendations for the Aberdeen Service and others considering a dementia prevention model:

• Enhance integration: formalise referral pathways and consider transferring management of the clinic aspect from public health to clinical services;
• Improve data sharing: address NHS Grampian’s data governance issues to facilitate improved communication between the clinical team and the Stage 1 service;
• Introduce follow-up support: Explore ways to offer consistent, person-led follow-up within Stage 1 of the Service, to support individuals to reflect on their progress and encourage ongoing engagement with behaviour change;
• Assess population awareness: consider how to assess and enhance local awareness to ensure equitable service access, especially targeting underrepresented groups; and
• Long-term outcomes monitoring: incorporate longitudinal tracking to accurately measure long-term behaviour change and health outcomes in future evaluations.

Recommendations for local and national policymakers:

• Demonstrate economic value: collaborate to produce evidence of the cost savings of proactive dementia prevention;
• Promote brain health within public health: encourage other areas to integrate brain health services within broader public health strategies; and
• Integrate brain health into national policy: embed proactive, preventive brain health strategies within national dementia and healthcare policies to support widespread and consistent adoption.