Dementia plan says £200m for early intervention will pay dividends

By Mithran Samuel on June 24, 2008 in Mental Health, Older people, Residential care

Department of Health ministerial advisers have called for more than £200m a year to be invested in an early diagnosis and intervention service for people with dementia.

The idea is the one costed proposal in a government consultation launched last week to transform services over the next five years in England through the first ever national dementia strategy, due in October.

Jenny Owen, vice-president of the Association of Directors of Adult Social Services, who co-leads on the strategy, said the early intervention model was not a “prescription” but pointed to its success in Croydon, south London.

Few diagnosed

The proposed service would address the fact that only 30% of people with dementia receive a diagnosis, often in the later stages or without sensitivity or adequate information. This is despite evidence early intervention can make a big difference to quality of life and prevent or delay entry to residential care – the fate of one-third of people with dementia.

Owen said: “We need to look at where we are spending money in order to stop people going into residential care unnecessarily.”

Early intervention model

Under the plan:

● Teams of nurses, doctors, psychologists and care managers would handle diagnosis and provide information and care (£95m a year).

● Capacity would be increased in older people’s community mental health teams (£70m a year) and adult social care (£55m) to handle knock-on referrals.

● Assuming 10% fall in annual residential care admissions for people with dementia, service would cost society £950m over 10 years.

● Improvements in quality of life would make it cost effective.

The draft strategy said GPs and primary care services are reluctant to diagnose because of a perception that nothing can be done to help and because some feel insufficiently competent. Also older people’s psychiatric services are too focused on severe and complex cases.

‘Like military tribunal’

Speaking at the consultation launch, Ken Clasper, who has dementia and is an ambassador for the Alzheimer’s Society, emphasised the importance of sensitive diagnosis, having undergone the process twice.

He said his first diagnosis “was like a military tribunal” where he was not told anything about the condition, while the second was “much better, much more informal”, and involved being given information and advice on managing dementia.

Other proposals included:

● People with dementia to have an adviser as a single point of contact for care information.

● All staff working with people with dementia to be trained to an agreed set of standards.

● All care homes to be registered to provide dementia care and receive ongoing input from specialist mental health services. This would include assessments for residents on admission and six-monthly reviews.

Anti-psychotic drugs

The lack of mental health support has been linked to the inappropriate prescription of anti-psychotic drugs for people with dementia, which care services minister Ivan Lewis said would be reviewed.

Owen said the review team’s key priorities during the consultation will be examining the commissioning and workforce implications of the proposals with stakeholders. She added this would help ensure “we have some real levers” to implement the strategy.

Lewis said the final strategy would include proposals for increased investment in dementia care.