Dementia: the £20bn issue we can no longer ignore

Increased longevity and the health-related problems that go hand-in-hand with getting older are proving increasingly challenging for the NHS and its partners, says Maria Kane, chief executive of Barnet, Enfield and Haringey Mental Health NHS Trust

The prevalence of chronic long-term illnesses like diabetes, heart disease and obesity increase with age and one of the biggest social and economic challenges is now posed by dementia.

This largely misunderstood but devastating illness affects more than 750,000 people in the UK at an estimated cost of £20bn a year – outstripping the combined care costs of cancer and heart disease.

The number affected is expected to rise to one million within the next decade at a cost of more than £27bn.

Growing concern over the social and economic impact of dementia was discussed by an all-party parliamentary committee earlier this summer, set up to consider the evidence of more than 200 experts.

The committee admitted that “we have reached a point where we can no longer ignore the issue” with 100,000 people being diagnosed with the disease every year.

Dementia is an age-related condition where the brain slowly closes down, leaving patients increasingly forgetful and confused until they are unable to perform even the most basic functions like dressing and eating.

Care costs steadily increase as a patient’s condition worsens and they often spend the last months and years of their lives in hospitals and care homes requiring round-the-clock care. Two thirds of care home residents have dementia.

It is estimated that someone with dementia costs the economy around £27,000 a year – without taking into account the health impact on the small army of carers who look after their relatives at home.

Financial support is complicated because people with dementia often straddle the care system. On the one hand they require the support of the NHS with medical assessments and treatment. On the other hand, social care, such as home help, is provided by cash-strapped local authorities.

Social care is means-tested and any requirements that social services will not pay for have to be met by the person with dementia and their family, often resulting in a heavy financial burden.

The parliamentary committee made eight recommendations, including the need for better collaboration and integration between health services and local authorities, sharing expertise, early intervention, better diagnosis and more effective training for health and social care staff including GPs.

Simon Williams, of the Association of Directors of Adult Social Services, summed up a practical way forward when giving evidence to the committee.

He told MPs: “We really just want to sit down with our health colleagues amid all the change and say let’s really look at where the money is leaking out of our shared system, using evidence of public health and all that stuff and really focus on four or five things where we can move money around to make a difference.”

Dementia care has historically been a low priority for successive governments and those commissioning health and social care services and I agree that we need to raise our game in terms of partnership working both in and outside the National Health Service.

Dementia is a collective responsibility and services need to be dovetailed, including improved sharing of information and data and, as the committee highlighted, increased use of key workers to act as single points of contact and coordinators of care.

It’s a huge challenge given the fiscal reality facing the public sector, the potential closure of care facilities and the recent news that the UK’s largest provider of care homes, Southern Cross, has gone to the wall.

However, I believe that truly shared ownership of the problem between primary and secondary care and local authorities will offer a way forward.

There is a common belief that the best solutions come from a blank canvas combined with unlimited amounts of time, money and staff.

In reality, working within tight parameters of time and resources inevitably makes you focus on delivering practical effective solutions. Dementia presents us with that challenge and the clock is ticking.

For a detailed resource on dementia and more information on the findings of the all-party parliamentary committee go to www.alzheimers.org.uk/ dementiamap