Major strides in tackling dementia

By Alistair Burns, national clinical director for dementia, NHS England:

For too long dementia had been an illness that went unnoticed until it was too late, and there is an unacceptable variation in dementia services across the country.

In 2013 NHS England, building on previous work, and making a commitment that two thirds of people of the estimated number of people with dementia should receive a diagnosis and post-diagnostic support, NHS England has made these issues a priority.

First, we took a step forward in tackling the fact that less than half the people with dementia receive a diagnosis and there is significant variability across the country by introducing support for Clinical Commissioning Groups.

A local ‘dementia prevalence calculator’ has been set up which assesses the number of people in a geographic area estimated to have dementia. People can see how many individuals have been given a formal diagnosis and are then able to access the right care.

Other successes have come in the areas of the enhanced service for dementia known affectionately as the DES in primary care and the general hospital CQUIN commissioning for quality and innovation for dementia.

In 2013 NHS England continued the hospital CQUIN to identify people in hospital with dementia to improve their care and an enhanced service for primary care to identify and support people known to be at risk of dementia. GPs now ask questions to try to identify more people with dementia. We know that in services such as at Gnosall in Staffordshire that innovative links between primary and secondary care can lead to more people receiving a diagnosis quickly and getting support.

And we have worked with Health Education England to ensure 100,000 members of staff are trained in dementia care in the NHS. We are also campaigning with Public Health England around the prevention of dementia.

A formal diagnosis is vital for people with dementia as that leads, for them and their carers, to the necessary help and support. By 2015 there is an ambition that two thirds of the estimated number of people with dementia will receive a diagnosis and high quality post diagnostic support.

So ensuring equitable access to high quality services for people with dementia and their carers is another key priority.

People with dementia and their carers want, and deserve, integrated health and social care approaches which fit their lifestyles and allows them to access services when it suits them, not when it suits the service. It’s crucial, therefore, that care is coordinated, person-centred and tailored to individual need.

NHS England is linking with local communities and businesses through the Dementia Friendly Community initiatives, local Dementia Action Alliances and Health and Wellbeing Boards to raise the profile of dementia and to ensure integration between health and social care services.

Walsall has demonstrated Whole System Commissioning, an approach that improves diagnosis, the experience and outcomes of people with dementia and their carers. It is about looking at the big picture, the numbers, issues, resources, views of people and planning a strategy which has to include absolutely all parties. Walsall has brought together a board to focus on dementia with representation from commissioners, CCG clinical leads, service users, voluntary sector, providers, council, public health and clinicians.

Walsall has increased the numbers of people diagnosed, supported people with dementia and their carers in a better way, increased public awareness of dementia, the attitudes towards dementia and reduced the stigma associated with it. Pieces of work include an emergency services dementia guide, improved CQUIN for acute hospitals and integrated dementia pathway.

NHS England will continue to work to see a shift in the way dementia care is organised and delivered in the UK if we are to deliver better outcomes for people, and their carers, and help them live well with dementia.

Professor Alistair Burns

Alistair Burns is Professor of Old Age Psychiatry at The University of Manchester and an Honorary Consultant Old Age Psychiatrist in the Greater Manchester Mental Health NHS Foundation Trust. He is the National Clinical Director for Dementia and Older People’s Mental Health at NHS England and NHS Improvement.

He graduated in medicine from Glasgow University in 1980, training in psychiatry at the Maudsley Hospital and Institute of Psychiatry in London. He became the Foundation Chair of Old Age Psychiatry in The University of Manchester in 1992, where he has variously been Head of the Division of Psychiatry and a Vice Dean in the Faculty of Medical and Human Sciences, with responsibility for liaison within the NHS. He set up the Memory Clinic in Manchester and helped establish the old age liaison psychiatry service at Wythenshawe Hospital. He is a Past President of the International Psychogeriatric Association.

He was Editor of the International Journal of Geriatric Psychiatry for twenty years, (retiring in 2017) and is on the Editorial Boards of the British Journal of Psychiatry and International Psychogeriatrics. His research and clinical interests are in mental health problems of older people, particularly dementia and Alzheimer’s disease. He has published over 300 papers and 25 books.

He was made an honorary fellow of the Royal College of Psychiatrists in 2016, received the lifetime achievement award from their old age Faculty in 2015 and was awarded the CBE in 2016 for contributions to health and social care, in particular dementia.

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