The long and short of dementia care in England

Abstract

Living well with dementia, England's National Dementia Strategy launched by Health Secretary Alan Johnson on Feb 3, seeks to create an aura of leadership and confidence. The 102-page document boasts no fewer than 17 specific objectives to improve care for people with Alzheimer's disease and other forms of dementia. £150 million is to be spent over the next 2 years, but there is mention of saving some £1 billion over 10 years if care can be provided more efficiently. The strategy contrives both to please and disappoint. As flagged at the time of the consultation in 2008, for example, general practitioners will be trained to identify early signs of dementia, and memory clinics established across the country to diagnose dementia and provide support to patients and carers. Yet the evidence base is narrow—the published evaluation of the Croydon memory clinic pioneered by Sube Banerjee, co-leader of the strategy, involved just 290 patients followed up for 6 months. Has sufficient work been done to justify extension of this system nationwide? More research is desperately needed across the whole spectrum of knowledge about dementia, from basic mechanisms of disease to models of patient care. In truth, the National Dementia Strategy is long on aspiration and short on detail. It is commendable to see recognition of the long-term threat that dementia poses not only to health and social-care systems but also to society as a whole, that advice has been sought from a broad constituency, and that areas needing urgent action have been identified. In the short term, though, answers are still awaited on specific questions, such as the use of antipsychotic drugs in care. Longer term, serious doubts will remain about the health and social-care systems' ability to support people with dementia in view of the competing demands of other chronic diseases, together with background financial constraints. To be judged a success, the strategy must lead to a continuing process of evidence-based change—nothing less than a revolution in health and social care. This unremembered stateDementia is perhaps the cruellest manifestation of ageing, inexorably melting away all that which makes us individual and human. Increased life expectancy in the developed world has raised the incidence of dementia, commonly caused by Alzheimer's disease, and the burden of dementia is serious in developing countries too. Not all old people have or will have dementia, but today more than 1% of the UK's total population does, and the number of people with dementia is forecast to double in the next 30 years. Full-Text PDF A network of memory clinics: when and how?The first stage of an ambitious plan to transform dementia services in England over the next 5 years, a consultation on a National Dementia Strategy (NDS), opened for public discussion on June 19. In a country struggling to cope with the health and social care needs of more than 500 000 patients with dementia—a number expected to at least double by 2040—this is undoubtedly a much-needed approach. Neurologists, psychiatrists, geriatricians, and dementia researchers should not miss the opportunity to shape the future of dementia health services. Full-Text PDF