utilities

Dementia is conspicuously absent from new NHS priorities

Hilary Evans

This is a cross-post with the Health Service Journal.

It’s been a month of big announcements for the NHS: the commitment to a 3.4% annual budget increase, the development of a 10-year strategic plan, and new priorities laid out by leadership for both health and social care policy and NHS England. This will hopefully lead to significant change for the health system and the hardworking professionals across NHS and social care.

However, in all the developments so far there has been no specific mention of dementia.

Despite a 2018 poll of UK adults putting dementia in the top three health areas the NHS should focus on over the next decade, it was not included in the initial five priorities laid out by NHS England Chief Executive Simon Stevens for the 10-year plan. Nor was it included by Mr Hancock in his first speech last Friday, which laid out his top three priorities for the health system.

It is difficult to imagine any strategic plan for the NHS that fails to acknowledge the UK’s leading cause of death.

A dangerous oversight

As every NHS and social care professional will know, dementia also has a huge impact on day-to-day resource: one in four hospital beds today are being occupied by someone over the age of 65 with dementia and the condition costs the UK economy £26bn each year across health, social and informal care.

In recent years, support for research and emphasis given to areas like cancer, respiratory diseases and circulatory diseases have resulted in lower mortality rates from these conditions. This unfortunately is not the case for dementia: in 2017, dementia death rates increased to 13 percent across the UK.

When NHS leadership have discussed dementia in recent months and years, it is typically framed as a future problem. While it is true we do not yet have a life-changing treatment, the narrative of dementia as a challenge for tomorrow fails those living with the condition and the medical professionals working to provide the best care possible today.

This narrative means there is a danger the 10-year plan will miss the opportunity for much needed improvements in care and support, and crucially, to prepare for future treatments in the drug development pipeline. In the past, we have seen people wait for new treatments when the health system was unprepared to manage the cost, demand and resources needed, as in the case of Sofosbuvir, the 2014 drug breakthrough to treat Hepatitis C.

Setting it straight

Priorities set out for both the health system and NHS England should ensure we are responding to the challenges posed by dementia, both now and in the future.

This should be demonstrated by increasing NHS infrastructure to manage growing demand and complemented by greater government funding for dementia research to widen the search for effective treatments. Despite the incredible cost of this condition to the UK economy, government only commits £83.1m annually to dementia research, an investment that falls significantly short of other major disease areas.

We must also work to improve early detection and accurate diagnosis of the diseases that cause dementia, so we can better treat and care for people living with the condition today. This includes ensuring frontline staff have the training and resources to identify the early signs of dementia and mild cognitive impairment.

As outlined by Mr Hancock, we must capitalise on advances in technology to ensure the latest diagnostic procedures are implemented in our health system. We must harness the potential of integrated care records to improve our ability to recognise dementia, track the progression of people with dementia through the health system, and flag other chronic health conditions they typically face.

Government should also lead a public campaign to increase understanding of dementia, improve awareness of risk reduction, and promote better brain health. The recent inclusion of dementia prevention messaging to the NHS Health Check for people over 40 will impact overall awareness, but we must push to do more.

If we hope to one day prevent people from developing dementia, we must begin now to change the narrative on brain health, reframing the issue as a crucial part of overall wellbeing. Our medical professionals and health system leadership are essential to this effort and we must see dementia included as a specific component of the focus on prevention.

Dementia at the heart

Our government must put dementia at the heart of its priorities, not in 10 years’ time, but now if we are to improve the lives of people living with dementia and enable the NHS to meet the growing demand dementia brings.

Anything less would fall short of a sustainable long-term plan and would be an injustice to the hundreds of thousands living with the condition today and the millions more who face developing it in the future.

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