One year on from the Dementia Declaration, what progress has been made?

Community Care's Dementia Declaration campaign called for the ­condition to be made a political priority. The coalition has done this but the sector is pressing for more progress, finds Mithran Samuel

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Community Care‘s Dementia Declaration campaign called for the ­condition to be made a political priority. The coalition has done this but the sector is pressing for more progress, finds Mithran Samuel

“I think Community Care‘s campaign was incredibly successful. You should take some of the credit for ensuring that the coalition government has maintained dementia as a strategic priority.” These are the words of Alzheimer’s Society chief executive Jeremy Hughes on our Dementia Declaration campaign to put the condition on the political map in the run-up to last May’s general election, which was backed by all three main parties and 868 petition signatories.

With the costs of dementia support in England expected to double to £35bn over the next three decades, the campaign called for recognition that the condition should be a clear government priority.

Within weeks of taking office, the coalition made dementia a national priority by including it in the NHS operating framework, and requiring primary care trusts to produce local plans on how they were implementing the 2009 National Dementia Strategy.

Dementia’s absence from the framework was a key barrier to implementing Labour’s five-year strategy for transforming care, a National Audit Office report found last January.

The importance of change

The man appointed last year to help implement the strategy – national clinical director for dementia Alistair Burns – is clear on the importance of the change. “It does give a sign [to local NHS leaders] that things are being taken seriously,” he says.

Hughes adds: “I think it has had an effect. We’ve got strategic health authority and GP leads pushing it forward.”

A national audit of dementia services, due this spring, should indicate how far there has been progress.

However, Hughes says overall progress has been “pretty slow” under the coalition.

While Labour set 17 objectives for improving care through the strategy, the coalition has made four a priority: reducing use of antipsychotic drugs, improving care home and hospital care and providing early diagnosis for all.

Initiative

This has involved one eye-catching initiative: bringing forward from October 2012 to November 2011 Labour’s target to reduce by two-thirds the use of antipsychotic drugs for people with dementia.

Hughes says this was a “bold commitment” but it is “early days”, and the key priority is to ensure that support services are in place to provide alternatives to anti­psychotics. More generally, the four priority areas “are ones where it’s proving hard to make fast progress”.

Alzheimer’s Society and Alzheimer Scotland produced a dementia map last month showing the wide gulf in rates of diagnosis – from 26% to 69% – between areas across the UK.

But, as Burns points out and Hughes acknowledges, the national diagnosis rate – 40% – estimated by the charities is higher than previous estimates of one-third.

Research priority

The one clear commitment on dementia in the coalition’s programme for government, issued last May, was to prioritise the condition within the health research budget.

Dementia costs the UK economy five times as much as cancer, but receives 12 times less research funding, according to the Dementia 2010 report from the Alzheimer’s Research Trust (now Alzheimer’s Research UK).

The government has launched a “themed call” for dementia research, to encourage academics to bid for public funding for projects from the National Institute for Health Research.

However, both Hughes and Alzheimer’s Research UK chief executive Rebecca Wood point out that this does not guarantee increased funding.

No ring-fence

Wood says the key issue is the lack of capacity for dementia research within academia. “Dementia applications [for research funding] are not getting through in the quantities we need,” she says. “How can you ensure that a bigger slice of the NIHR pie goes into dementia if you do not increase capacity in the field?”

“The bit that’s missing is ring-fenced funding,” says Hughes.

However, Burns is clear that the approach will lead to more funding. “I’m confident that this is going to attract a lot of interest – it already has,” he says.

As social care spending cuts bite and with the NHS also under financial pressure, progress on dementia will be more difficult to maintain in the years ahead.

However, the issue appears to be more at the forefront of government policy than before the election, suggesting campaigners’ voices have been heard.

HOW COALITION HAS RESPONDED

May 2010: Pledge to make dementia a research priority.

June 2010: Dementia made an NHS priority through inclusion in NHS Operating Framework.

September 2010: Revised dementia strategy implementation plan produced.

November 2010: Target to cut antipsychotic drug use by two-thirds brought forward to November 2011 from October 2012.

January 2011: Call for bids for dementia research funding announced.

More on the Dementia Declaration

Book a place at Community Care‘s conference Improving the Quality of Dementia Care on 29 March.

This article is published in the 17 March 2011 edition of Community Care under the headline “The Dementia Declaration, one year on”

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