Brain Health Service pilot: evaluation - final report

6. Conclusion and recommendations

In this closing chapter, we summarise the findings from the evaluation and suggest changes or enhancements that could support the development of the Brain Health Service in Aberdeen, other areas exploring a similar service and local and national stakeholders.

Summary

The Aberdeen demonstrator, delivered collaboratively by NHS Grampian and Alzheimer Scotland, aims to offer proactive brain health service through early engagement, risk identification, lifestyle modification, and clinical interventions. The evaluation findings highlight its effectiveness in improving public awareness of brain health, supporting personalised behavioural changes, and facilitating early identification of cognitive impairments. Despite operational challenges, users consistently reported high satisfaction, emphasising the value of accessible, empathetic, and stigma-free support.

Demographics and motivations

Service users mainly fell within the 60-79 age group, with a slight female majority. Users generally sought the service due to concerns about memory, cognitive health, family history of dementia, or lifestyle-related risks. Engagement was driven significantly by the desire for reassurance, early intervention, and preventative guidance.

Service awareness and reach

Efforts to raise awareness involve extensive multi-channel campaigns, community events, and stakeholder engagement. Although these initiatives successfully reached many individuals, further improvements in communication clarity about the preventative nature of the service and enhanced targeted outreach to underserved demographics and geographical areas would be beneficial.

User experiences and expectations

Users frequently described their interactions positively, citing compassionate staff, welcoming environments, and efficient access to support. The service surpassed user expectations by providing meaningful interactions and comprehensive clinical assessments.

Personalised action plans and behaviour change

Personalised action plans were important in supporting behavioural modifications, including improvements in physical activity, dietary changes, alcohol reduction, cognitive stimulation, and social engagement. However, the inconsistency in the format and documentation of action plans potentially limited user clarity. When there was follow-up, it was particularly welcomed by service users and was effective in reinforcing changes and lifestyle adjustments.

Brain health awareness

Service engagement markedly increased users' awareness of modifiable risk factors and preventive strategies, particularly through tailored educational discussions and supportive resources. The service’s role in enhancing public understanding was considered essential amidst advancing therapeutic options and biomarker technologies for early dementia detection.

Integration with other services

The demonstrator successfully linked with external healthcare and community services, though clearer referral pathways and stronger clinical integration with existing NHS infrastructure were identified as key areas for improvement. Addressing limitations in data sharing and streamlining referral processes were highlighted as necessary steps for enhancing service efficiency and continuity of care.

Sustainability and scalability

Stakeholders recognised the essential role of brain health services in preventive healthcare, particularly with emerging therapeutics and biomarkers improving early detection. Key sustainability challenges included funding stability, clinical integration, and managing resource allocation effectively. There was a clear recognition of the potential for replicating the service model, emphasising adaptability and careful resource planning tailored to local contexts.

Recommendations

In the last section of this report, recommendations are identified for the demonstrator site and for local and national policymakers to consider.

Recommendations for the Aberdeen Service

Whilst these recommendations relate to the Aberdeen service they are factors that should be considered by other areas exploring preventative dementia services.

R1 - Enhance integration into local healthcare system: NHS Grampian and Alzheimer Scotland should collaboratively formalise and clearly document referral pathways and protocols between the Brain Health Service and NHS clinical services. This should include explicit guidance for primary care providers, specialists in neurology, psychiatry, and allied health professionals, to ensure seamless integration and enhanced continuity of care. Consideration should also be given to shifting the management of stages 2 and 3 of the Service from public health to a clinical service.

R2 - Improve data sharing: action should be taken to address barriers related to NHS Grampian’s data-sharing and information governance policies. This should enable effective two-way communication between clinical staff and the Alzheimer Scotland-employed Centre Manager ensuring comprehensive and coordinated support for service users.

R3 - 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.

R4 - Assessing population awareness: to ensure equitable access and maximise the impact of the Brain Health Service, it is recommended that NHS Grampian considers how to assess awareness and understanding of the Service so that those in most need know of its availablity, purpose, and how to access it this would highlight potential gaps in awareness.

R5 - Long term outcomes monitoring: to fully understand the impact of the Brain Health Service and accurately capture behaviour change and long-term outcomes, it is recommended that future evaluations (commissioned by local or national stakeholders) incorporate longitudinal tracking of service users. This longer-term monitoring will provide stronger evidence of the service's impact on individuals' cognitive health trajectories and will support continuous improvement and resource prioritisation.

Recommendations for local and national policymakers

R6 - Demonstrate the economic value of dementia prevention services: given the fragility of funding and the significant pressures on public finances, clear evidence of the short-, medium-, and long-term benefits of investing in brain health services and other interventions is needed if other areas are to consider sustained investment during tight fiscal periods. It is recommended that local and national partners come together to develop evidence that demonstrates potential cost savings and resource reallocation opportunities through early intervention, dementia prevention, and sustained behaviour change.

R7 - Promoting brain health within broader public health approaches: given the positive outcomes observed in Aberdeen’s pilot, it is recommended that other areas across Scotland consider how they can embed a distinctive brain health offer within existing public health priorities and potentially minimal investment. This would recognise the value in positioning dementia prevention and brain health alongside other preventive public health strategies, enhancing early intervention and proactive health management at a population level.

R8: - Integrate brain health into national policy: The Scottish Government should explicitly integrate proactive, preventative brain health strategies within national public health frameworks, dementia strategies, and broader healthcare policies. This will reinforce dementia prevention priorities at a national level and promote consistency in approach across Scotland.