DoH Unveils Plan For Dementia Care

When care services minister Ivan Lewis recently admitted that the government was ‘failing’ people with dementia and their carers, he acknowledged what many nurses already knew to be tragic fact.

Yet, with the launch of the first ever national dementia strategy for England, both carers and campaigners have welcomed the overdue official recognition of the scale of the problem now facing the NHS, social services and society as a whole.

Indeed the DoH’s decision to commission a new dementia plan has been hailed as a major turning point. It aims to tackle what it describes as ‘one of the great challenges facing society’ through increased awareness, earlier diagnosis and better treatment.

Neil Hunt, the chief executive of the Alzheimer’s Society, says that the plan represents ‘a pivotal moment for millions of families’. “For too long dementia has been at the bottom of health and social care pile,” he says. “This is an exciting opportunity to make sure the knowledge and expertise we now have about dementia care and treatment makes a difference to the lives of thousands of people.”

Gordon Lishman, director general of Help the Aged, says that he hopes a national strategy will end the treatment of vulnerable people as ‘second class citizens.’ He adds: “This strategy must ensure that people with dementia get the best possible support and care whether they are at home, in hospital or at the end of their lives.”

But the big question is, whether the dementia plan can deliver the kind of change that campaigners want to see? Mr Lewis has already indicated that three key areas have been identified for improvement: the need to raise awareness and reduce the stigma surrounding dementia; the need for earlier diagnosis by clinicians, to speed up support for families; and the need for improved treatment to enhance quality of life and ensure people are treated ‘with dignity and respect.’

The experts tasked with drawing up the strategy will explore ideas including an information campaign. This will give advice on detecting the first signs of dementia, staff training to improve diagnosis, and guidance for the NHS and social care to manage the care of people with dementia.

The development of the strategy will be led by Professor Sube Banerjee, professor of mental health and ageing at the Institute of Psychiatry, King’s College London and Jenny Owen, executive director of adults, health and community wellbeing in Essex in conjunction with a stakeholder group led by Neil Hunt. There is likely to be some overlap with the ongoing work to review the government’s carers’ strategy.

Campaigners will almost certainly have to wait until next year for any major announcements; the DoH says that ‘by the summer of 2008’ a ‘transformation plan’ will be announced to ensure dementia services are improved in all parts of the country. Yet no one is under any illusions about the huge amount of work that needs to be done not only to improve services now, but to ensure services can cope with the expected increases in people with dementia in the future.

In July, a National Audit Office (NAO) report revealed that the number of people with dementia in England is expected to rise from the estimated 560,000 people today to 750,000 by 2020. According to the NAO, current spending on dementia services is already running at £3.3 billion, but the true cost to the economy is estimated at a staggering £14.3 billion.

Much of the burden of dementia falls on the shoulders of carers, who bear the equivalent of £5.2 billion in informal care costs and pay for around a third of the £5.8 billion spent on care homes for people with dementia. “Without redesign, services for people with dementia are likely to become increasingly inconsistent and unsustainable,” the NAO warned.

Mr Hunt acknowledges that ‘a huge task’ lies ahead. ‘Currently, 600,000 people have dementia in England yet more than half of these will never receive a formal diagnosis and families are often left to cope alone until they reach crisis point.’

Another challenge will be the continuing controversy over the availability of drug treatment for patients with dementia. For many campaigners, it was a bitter irony that only a few days after the announcement of the dementia plan, hopes of reversing the restrictions imposed by NICE on the prescribing of drugs for Alzheimer’s disease were dashed.

A judicial review by the High Court ruled in favour of NICE on five out of six grounds, and as a result donepezil, galantamine, and rivastigmine continue to be recommended only for people with moderate Alzheimer’s disease.

The issue is unlikely to go away, however, with campaigners pledging to keep up the pressure to make the drugs available across the UK. “We know they’re not wonder drugs and they don’t help everyone,” says Jim Jackson, chief executive of Alzheimer Scotland.

“But we cannot agree that it is not cost-effective to offer people diagnosed with this devastating illness the chance of a better quality of life early on, while they still have a chance of regaining or maintaining something like their normal abilities.”

With so many older people likely to be affected in the future, the dilemma facing the government will be, can society afford to care for people with dementia – or can it afford not to?