Alistair Burns: My priorities for national dementia strategy

Alistair Burns takes up his post as national clinical director for dementia next week. He tells Vern Pitt of his priorities for the five-year strategy for England

There’s a reason why Dr Alistair Burns, the national clinical director for dementia, is wolfing down a couple of bananas on his way to meet Community Care. “The job requires energy, drive and enthusiasm,” he says, smiling. The latter two are apparent in his upbeat manner and, with the snack digested, he’s ready for the challenges ahead.

When the old age psychiatrist formally takes his post on 1 April, he will start to tackle in earnest the 17 objectives of the national dementia strategy for England, published last year.

He finds it impossible to pick an area most in need of action but does name early diagnosis as the cornerstone of his plans – fittingly for someone who developed a memory clinic in south Manchester to perform this role.

However, his appointment comes with the implementation of the dementia strategy in doubt. In January, the National Audit Office (NAO) said the five-year plan was at risk of failure because of the lack of local leadership and the fact that dementia had not been made an explicit priority for the NHS.

And last week, the all-party parliamentary group on dementia found that two-thirds of primary care trusts could not account for their share of £150m in dedicated funding for the strategy allocated for 2009-11. Echoing the NAO, the group said the fact that delivering the dementia strategy had not been made a national priority in the NHS operating framework meant there was no compulsion for PCTs to act on it.

Burns is more optimistic: “In my opinion it not being an explicit priority isn’t a barrier to the strategy’s success. There’s lots of work we can do at a local level and that’s the key to the implementation of the strategy.” He argues that the NHS is only half of the picture and that the relationship between PCTs and councils is more important in driving change than the priorities set for each.

He is similarly sanguine on PCT funding. “Some £8.3bn is spent on people with dementia across health and social care,” he says. “The £60m this year and the £90m next year, which is new money, is a bit of a drop in the ocean.”

Burns is confident that even a change of government would not endanger him completing the dementia strategy’s goals. “The thing about dementia is if you do dementia care well there are significant financial savings that can be made,” he says. “I think that, when we go forward, that will carry the day.”

He adds that an audit of dementia services, due to take place soon after he assumes office, will provide detailed local information to underpin action.

Burns also hopes the audit will uncover more detail on the use of antipsychotic drugs for dementia patients. One of his priorities is implementing the recommendations of an independent report last year, which found that just one in five of the 180,000 dementia patients prescribed anti­psychotics derived any benefit from them.

The report said a two-thirds reduction in prescriptions would be possible within three years. This was based on national estimates and Burns says local information is needed so that local authorities and their partners can make tangible improvements.

Another issue in Burns’ in-tray is dementia research, another priority in the strategy. According to the Alzheimer’s Research Trust only 2.5% of the government’s medical research budget is spent on dementia, a quarter of the total spent on cancer, and it has called for spending to be trebled.

At present, the government only has a single central research budget, due to hit £1.7bn by 2011. Burns says setting money aside for dementia or increasing the budget is not the way forward. He believes the key is getting more good-quality research proposals vying for government funding. He says the research the UK does in dementia is world renowned, but adds: “There is always room for improvement.”

Burns says the real measure of the ­success against the strategy’s goals is improved services. “The ultimate issue is what people with dementia and their carers say is a good service,” he says. “That goes across the piece right from early diagnosis and intervention, right through the various stages of dementia.” Burns now has until 2014 to realise the dementia strategy’s plans and effect that change.

A life in psychiatry

Alistair Burns graduated in medicine from Glasgow University in 1980 and then specialised in psychiatry at the Maudsley hospital in south London. Since 1992 he has combined practice and academic roles, latterly as professor of old age psychiatry at the University of Manchester and honorary consultant old age psychiatrist in the Manchester Mental Health and Social Care Trust. He has published 23 books.

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This article is published in the 25 March 2010 edition of Community Care under the headline “Optimist tackles fears over strategy”