Leading clinicians and researchers warn that dementia services have fallen decades behind those for other serious conditions
Dementia represents Britain’s greatest health and social care challenge, according to a group of 28 neurologists, psychiatrists, researchers and former ministers calling for urgent reform of diagnosis, treatment and continuing support.
In a letter reported by The Daily Telegraph, the experts said progress on dementia had fallen decades behind that achieved for other major conditions. They called for a transformation comparable with the changes made to cancer care, including national waiting-time targets and a clear routes from diagnosis to treatment, supported by sustained political leadership.
The signatories include former health minister Lord Bethell, Professor Nick Fox, Director of University College London’s Dementia Research Centre; Professor Gill Livingston, a leading authority on dementia prevention; and Professor Charles Marshall, NHS London’s Clinical Director for Dementia. They argue that improvements in cancer survival show what can be achieved when scientific advances are matched by political commitment and properly funded reform.
Around one million people in the UK are living with dementia, with the number forecast to reach 1.4m by 2040. Approximately one in three people with the condition remains undiagnosed, while access to assessment and continuing support varies considerably between different areas.
National direction
The intervention increases pressure on the UK government as it develops England’s first Modern Service Framework for Frailty and Dementia. The framework is intended to create more consistent care and improve access to diagnosis and continuing support. The experts want the framework to drive reform, with a national dementia tsar responsible for ensuring that services improve.
Baroness Casey of Blackstock, who is leading the Government’s independent commission on adult social care, has also criticised the pace of action. Recruitment for the dementia tsar began six months after she called for the role to be created. Lady Casey said dementia had not received the same urgency as cancer and heart disease, despite the scale of its effect on patients, families and health and social care services.
The Department of Health and Social Care said dementia had been neglected for too long. It expects the Modern Service Framework to produce significant improvements in care, with the dementia tsar overseeing progress. The Government has also brought forward the first phase of Lady Casey’s social care commission to next summer.
Earlier intervention
The calls for national reform coincide with the opening of the Manchester Brain Health Centre, described by its founders as the UK’s first service to combine advanced diagnosis, dementia prevention and continuing support in one place.
The two-year pilot will initially accept patients in central Manchester who are already experiencing problems with memory or thinking. Patients will be identified through existing memory assessment services rather than approaching the centre directly.
The service brings together psychiatrists, vascular specialists, researchers and Alzheimer’s Society advisers. Patients will be able to receive rapid assessments, brain imaging, hearing tests and cardiovascular checks, alongside personalised advice and support.
Diagnostic investigations may include MRI scans, lumbar punctures and behavioural assessments. Patients will also be assessed for hearing loss, high blood pressure and other potentially modifiable factors associated with cognitive decline.
Specialists will use the results to develop an individual treatment and support plan. Eligible patients may also be offered opportunities to participate in clinical research and trials. The model will be evaluated to determine whether it could be commissioned elsewhere in the NHS.
Alzheimer’s Society Chief Executive Michelle Dyson said identifying people earlier could allow services to address risks to brain health and potentially delay some cases of dementia. She said the Manchester approach could provide a model for other regions.
A pivotal period
Recent advances in diagnosis, biomarkers and disease-modifying treatments have increased the possibility of identifying and treating Alzheimer’s disease at an earlier stage. However, the experts warned that scientific progress will not improve care without the clinical capacity and infrastructure required to deliver it.
Faster access to accurate diagnosis will be central to any future treatment pathway. Services must also provide continuing support for people who are not eligible for new treatments and for families managing the wider effects of dementia.
The experts described the next few years as a pivotal period for dementia policy. Their central argument is that new science must now be matched by a nationally coordinated service capable of translating advances in prevention, diagnosis and treatment into better care.
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