Over the past few years there has been a growing recognition that dementia is a national and global health challenge. Yet despite increased media, public and political attention, diagnosis rates for all forms of dementia remain stubbornly low. According to research by Alzheimer’s Society, two thirds of people with a form of dementia do not have a formal diagnosis. This means that hundreds of thousands of people are not getting access to vital information, support and potential treatments.
Last week’s report by the All Party Parliamentary Group on Dementia, ‘Unlocking Diagnosis’, is a welcome contribution to the ongoing debate about diagnosis and uncovers shocking variations across the country in waiting times for diagnosis. This means that even the minority of people who actually get a diagnosis are not always getting it as early as they should be. An average waiting time for a memory clinic of three months belies the fact that people often wait much longer for a referral – the inquiry heard submissions from people having to wait over a year.
My practice is a member of Stafford and Surrounds CCG. Five years ago, a report into quality of elderly care provided a wake-up call as to what we could be doing better. With the report in mind and what we know about our ageing population, we began an anticipatory care pilot for people with dementia which forms the core of our practice today.
This model, which brings dementia diagnosis and treatment into primary care, uses practice databases and memory tests to identify those at risk or in the early stages of the condition. At a relatively small cost – £11,400 for one year for an 8,000 person pilot – the model has greatly increased our reach and, crucially, reduced diagnosis wait times from three years to four weeks.
While it’s sad that the question of cost comes into a debate which should be about patient outcomes, commissioners should note that under this approach, for every £1 spent we saved £4.
Some 40% of the clinicians who responded to the inquiry leading up to Unlocking Dementia reported that they had only received basic training in diagnosing dementia, a clear pointer to a potential block in improving diagnosis rates. The report makes a welcome recommendation that all health and social care professionals who are likely to work with people with dementia have pre and post-registration training in identifying dementia.
A quantified ambition to increase diagnosis rates is a key plank of the Prime Minister’s challenge on dementia. While this is to be celebrated, the result for GPs will undoubtedly be a spike in visits from people with memory problems. Given this, the time is now to invest resource in training people to accurately recognise dementia.
The Government should also take heed of the group’s recommendation that accreditation of memory services should be made mandatory. Whilst 94 per cent of PCTs in England have memory services, there is currently no way of judging the appropriateness of these services across the board. The current Memory Services National Accreditation Programme provides a framework to evaluate the quality of each service, but some PCTs stated that they had no intention to join the accreditation scheme.
At a time when the NHS is facing unprecedented cost pressures, there is an economic case for an approach which prioritises early diagnosis and intervention. It is estimated that commissioning better memory services to provide early diagnosis and intervention would save £245million within ten years. So getting early diagnosis right now will not only help more people to live a better quality of life but it will also help the economy. Ultimately it is a win-win situation.
Dr Ian Greaves is a GP in Gnosall, Stafford, and was part of the APPG on dementia.