So it’s official. The rise in people with dementia is, according to the Prime Minister, a ‘national crisis’. And, with one study suggesting that there will be a million people with the condition in ten years’ time, and diagnosis rates currently languishing at a poor 41%, the PM’s words are not hyperbole. Tackling poor diagnosis rates – the subject of a new Social Market Foundation report out today – is rightly a priority of the government over the next decade.
Early diagnosis, in particular, is important: it means that patients can access support and treatment to alleviate symptoms, and it allows them and their families to prepare for the future progress of the condition. Diagnosing dementia earlier also makes fiscal sense: it can reduce unnecessary admissions to care homes and hospitals, helping manage some of the £23bn per year that the condition costs the UK economy.
As with many policy problems, it would be nice if there were one easily identifiable reason why diagnosis is delayed. But the reality, as our new research confirms, is that the reasons are complex and multifaceted. People with symptoms may be slow to seek help due to reasons such as lack of knowledge about the condition, the closeness of its symptoms to those associated with ageing, and simple fear of the dementia and its implications.
Once they have entered the health system, other barriers may prevent diagnosis, including the limited time GPs have to spend with the patients, and the complexity involved in diagnosing dementia.
Because of the multitude of factors that delay diagnosis, the only way to make diagnosis happen earlier is to give commissioners and GPs the freedom to use their expertise and local knowledge to tailor their interventions to what works in their areas. In some areas, targeted screening might be the solution. In others, awareness campaigns could be a better option.
The government has recently announced more money for dementia ‘case-finding’ by GP practices – involving assessing at-risk patients. This can only be a good thing. But the real problem is that commissioning frameworks still reward static processes, like doing certain assessments, or having a register of dementia patients. This limits the flexibility that GPs and commissioners have to decide what works best in their areas. Instead, we need to move towards targeting the outcomes that we want to achieve.
The first step is to reward increased diagnosis rates in line with expected prevalence of the condition in the area. The link with expected prevalence is vital: this will ensure that the target is relevant to commissioners and practitioners in each area across the country. Incentivising GPs, clinical commissioning groups and directors of public health all to focus on the same goal will encourage them jointly to decide on the best strategy for boosting diagnoses in their patch.
The second step should be to undertake further research on expected prevalence of people at different stages of the condition, so that over time we can move to rewarding early diagnosis.
There is no one answer to increasing diagnosis rates. But by freeing up local commissioners and professionals we can help the health system overcome the barriers to early diagnosis. To do this we need broad, national outcomes related to increased diagnosis, not more process-based incentives. The PM is right that the rise in dementia is a national crisis. Now it’s time to start building a system that genuinely rewards early diagnosis.
