Despite a steeply rising trend in cases of dementia, the condition is being given too low a priority by health and social services, according to a report out today by the National Audit Office. Too few people are being diagnosed, or being diagnosed early enough, and early interventions known to be cost-effective are not being made widely available.
Dementia presents a significant and urgent challenge to health and social care in terms of both numbers of people affected and the costs. At least 560,000 people in England have dementia and, because of an ageing population, the number of cases is predicted to rise by over 30 per cent over the next 15 years. Dementia accounts directly for three per cent of all deaths, but four times as many people may die with dementia. Dementia costs the economy 14.3 billion a year, including direct costs to the NHS and social care of 3.3 billion a year.
The report points out that dementia has not received the priority status from the Department, the NHS or social care that it deserves. It has suffered historically from poor awareness and understanding; and there is a widely held perception that little can be done and a lack of urgency attached to diagnosing and treating the condition. Parallels can be drawn between dementia now and cancer in the 1950s, when there were few treatments and patients were commonly not told the diagnosis for fear of distress.
Early diagnosis and intervention in cases of dementia is known to be cost-effective. Yet only a third to a half of people with dementia ever receive a formal diagnosis. The UK is in the bottom third of countries in Europe in terms of the percentage of dementia patients receiving anti-dementia drugs, and the average time taken to diagnose patients in the UK is up to twice as long as in some other countries.
Frontline staff often lack sufficient awareness and understanding of dementia. Less than two thirds of GPs surveyed by the NAO felt that it was important to look actively for early symptoms of dementia and only 31 per cent felt they had enough training to diagnose and manage the disease. Half of the Community Mental Health Teams surveyed told the NAO that they felt acute hospital nurses were inadequately trained in dementia needs.
Failure to diagnose or treat patients with dementia can extend hospital stay, but diagnosis can, in itself, make it difficult to find a suitable location to discharge the patient to. Indeed, older people with dementia make up half of those whose discharge from hospital is delayed. For example, in the case of elderly people admitted to acute hospitals with a hip fracture, we found that effective identification of dementia and more proactive, co-ordinated management of their care and discharge could produce savings of between 64 million and 102 million nationally.
Whilst the NAO identified a number of examples of good practice, where people with dementia are receiving a high quality service, for many people there are gaps in their ability to access specialist skills and services in both the community and in care homes. Indeed, two thirds of people with dementia live in the community, largely looked after by the 476,000 or so informal carers in England. Informal carers often enable a person with dementia to continue living in their own home but these carers often lack the support they need to enable them to continue to play such a vital and cost-effective role.
Within the care home sector, less than 28 per cent of beds are a registered specialist dementia bed, which creates a lack of visibility of the need for specialist dementia training in care home settings. Appropriate end of life care for people with dementia is also very limited.
The report concludes that much needs to be done to improve health and social care services for people with dementia and the NAO has made a number of recommendations to address this. The scale, cost and impact of dementia indicates that the Department needs to actively champion and co-ordinate improvements in dementia services as an explicit part of its approach to improving health and social care, including providing strong and transparent leadership for dementia management. The Department, the NHS, social care and professional bodies need to work together to improve understanding of the needs of people with dementia and to plan services accordingly. More needs to be done to raise awareness of dementia amongst health and social care professionals and to improve diagnosis and early intervention. And all those organisations responsible for the care of people with dementia need to improve the management of services and support in the community.