How can England uncover its hidden dementia cases?
England’s health service has been set a target of finding more than 300,000 people who currently have dementia but haven’t yet been diagnosed.
At the moment around half of the estimated 683,000 people with dementia in England are undiagnosed and are missing out on NHS care and support.
Health experts agree that the next few decades will see a huge rise in the number of patients with Alzheimer’s disease and other dementias, placing a huge burden on health care, social care and families.
But diagnosis is not the only problem – there are currently no treatments which can effectively tackle the disease, and health and social care systems are not set up to meet the complex needs of patients.
Health Secretary Jeremy Hunt has said the country must make dementia a “national mission” as cases are predicted to rise to more than a million by 2020 which will put further pressure on already-overstretched NHS and social care services.
Last year, a huge row blew up between NHS England and the country’s primary care general practitioners (GPs), after they were offered £55 for every dementia diagnosis. GPs and patient groups opposed the payments, which they say could distort clinical priorities and undermine the doctor/patient relationship.
Now NHS England has backed down, and the payments will be discontinued from April. Instead, it has appointed seven dementia ‘ambassadors’ to help GPs and local clinical commissioning groups (CCGs) to increase diagnosis rates.
Dr Dan Harwood of South London and Maudsley NHS Foundation Trust is one of the dementia ambassadors, and will visit 21 CCGs to provide advice on increasing diagnosis rates and improve care.
The move comes against a backdrop of startlingly variable diagnosis rates across the UK, with some areas achieving rates of 75 per cent while others are below 40 per cent.
Harwood has been working with GPs across London, which has the lowest diagnosis rate for dementia, and has already met with 18 CCGs.
“Most of what I do is to encourage CCGs not to be overwhelmed,” he said. “There are many simple and cost neutral actions CCGs can and should take to improve diagnosis rates and the care of people with dementia and their carers.”
The UK government has made tackling dementia a priority for the NHS and – in addition to launching a series of campaigns to raise awareness – has said it intends to double funding for research to £132m by 2025.
Harwood said he is able to draw on his day-to-day clinical work with people with dementia and their carers, to make sure the advice given is “pragmatic and based on the needs of patients and carers.”
CCGs should work more closely with memory services to monitor their performance and make sure resources are being used efficiently, as well as help GPs improve the use of diagnostic codes used to identify different types of dementia and – depending on the circumstances, add patients to the GP register or refer them for assessment and post-diagnostic support, he notes.
One disincentive to diagnosis is that little treatment can be offered – current treatments don’t work for all patients, and can only temporarily slow the disease’s progression.
A report sponsored by pharma industry association the ABPI published last November found that the UK ranked eighth out of 13 European countries in its use of dementia drugs, which was an advance on its earlier position (10th) but still left it well below the group average.
Jeremy Hunt said last year that one of the main challenges to overcome was a sense of defeatism amongst those with dementia, their carers and healthcare professionals.
There are hopes that the pharmaceutical industry could eventually develop new drugs which can halt or even reverse dementia. Researchers hope that repeated late stage failures over the last decade have helped steer it in the right direction, including identifying and treating patients in the early stages of dementia, rather than when the disease is advanced.
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