Flawed commissioning of healthcare is getting in the way of effectively tackling dementia, because it gives practitioners no incentive to diagnose the condition, a study claims today.
The Social Market Foundation study, A Future State of Mind, looks at why the UK has such poor dementia diagnosis rates by international standards, through a series of in-depth interviews with Alzheimer’s patients and their carers, and an analysis of the barriers to diagnosis on the practitioner side. The study concludes that barriers to early diagnosis are complex and multifaceted, stemming both from patients’ own fears and reluctance to seek diagnosis, and from clinicians’ lack of time, confidence or training.
The SMF says this is exacerbated by current commissioning systems that reward static processes, like requiring GPs to keep a register of dementia patients. These are ineffective in tackling England’s patchy performance, as they provide no incentives for diagnosis. Instead, the report argues, all healthcare commissioners in an area should be financially rewarded for the same thing: achieving increased numbers of diagnoses. As well as bringing benefits to patients, this change would open up opportunities to save money in the NHS and social care.
The study also says that commissioners should be encouraged to seek external finance to fund innovative and experimental activities that will increase diagnosis in their area, for example, through social impact bonds.
Nigel Keohane, SMF Deputy Director and co-author of the report said:
“While there is no cure for dementia, early diagnosis means that patients can access treatment and support, allowing them and their families to prepare for the future progress of the condition. Early diagnosis also makes sense from a fiscal perspective: the current cost of dementia to the UK is estimated to be £23 billion per year and this is set to rise as the population ages. Costs to the state can be reduced if diagnosis happens earlier.
“But incentives within the system are currently not set up to lead practitioners to invest in improved diagnosis rates. Our study shows that there may be a multitude of different reasons for dementia not being diagnosed early: patients may be unable to distinguish between the signs of dementia and the ageing process, they may be in denial or fearful of seeking treatment, or practitioners may be too busy or lacking in knowledge of the condition to diagnose them.
“That’s why incentives for GPs, Clinical Commissioning Groups and Directors of Public Health should be directly linked to increased diagnosis rates, and practitioners should be free to innovate. Allowing commissioners to tailor solutions to what works for patients and their local population is the best way to achieve this, rather than focusing rewards on inflexible and rigid processes.”
The Social Market Foundation study argues that incentives for tackling dementia across the healthcare system should be aligned and calls for a series of specific reforms:
- the Quality Outcomes Framework (which rewards GPs for keeping a register of dementia patients) should be linked to increased diagnosis rates;
- the Commissioning for Quality and Innovation system (which rewards increased identification of dementia amongst hospital patients) should be redesigned as a broad national outcome to be targeted by local commissioners at any local providers.
- The Commissioning Outcomes Framework and the new Health Premium should include incentives for dementia diagnosis to reward Clinical Commissioning Groups and Public Health Directors respectively.
The SMF also recommends that the Cabinet Office’s recently launched £20m Social Outcomes Finance Fund should be used to encourage commissioners to develop “dementia impact bonds”, which could fund activities such as targeted screening, outreach work, awareness campaigns and case-finding to improve diagnosis rates.
Notes to Editors
- The SMF commissioned TSN BMRB to carry out interviews with ten Alzheimer patients or their carers. The recruitment and interviews were carried out between August and October 2012.
- The SMF’s interviews with Alzheimer’s patients and their carers revealed common barriers that often prevented people seeking medical advice until triggered by a crisis, such as being lost, injured or in danger. Common barriers included:
- Lack of knowledge about Alzheimer’s disease and the closeness of its symptoms to those associated with ageing.
- Gradual manifestation of Alzheimer’s disease – and the inability to treat problems as acute and serious.
- Fear of Alzheimer’s disease, and denial of the disease and its implications.
- Lack of trust in the health system.
- Lack of support, either from family or friends.
- The SMF also carried out an extensive literature review, analysis of international performance and a regression analysis of factors that are associated with low diagnosis rates in different areas of England.
- A Future State of Mind is sponsored by Lilly UK. It will form the basis of a discussion on Thursday 13 December at the House of Commons with Rt Hon David Blunkett MP, Chris Skidmore MP, Professor Sube Banerjee and the SMF’s Nida Broughton. For more information, please see http://smf.jynk.net/events
- The Social Market Foundation (SMF) is a leading UK think tank, recently named UK Think Tank of The Year and Economic and Financial Think Tank of the Year
- The SMF develops innovative ideas across a broad range of economic and social policy, champions policy ideas which marry markets with social justice and takes a pro-market rather than free-market approach. smf.jynk.net