International dementia care strategies

Although we may think the UK is struggling with dementia care, Sally-Marie Bamford reports that we are among the pacesetters in Europe

Although we may think the UK is struggling with dementia care, Sally-Marie Bamford reports that we are among the pacesetters in Europe

We have more in common with our European neighbours than we may think. Across the shores, politicians and policymakers are all grappling with the problem of dementia. Every 24 seconds a new case of dementia arises in Europe and, as yet, no one has hit on a winning policy formula.

There are certainly some frontrunners in the dementia policy race and, although it may not feel like it to everyone in England, we are seen to be galloping in the right direction, alongside France, Norway and the Netherlands. All of these countries have some sort of national action plan on dementia, which for many is considered the gold standard of policy intervention. Scotland, Wales and Northern Ireland are due to produce similar plans this year.

The questions are whether such plans work and whether all countries are starting from a level playing field. Certainly the prevalence of dementia varies according to country. The number of cases also depends on population size and how this population then ages. In the UK it is estimated there are about 820,000 people with the condition, a figure just below that of France (about 850,000). Germany has the highest number with more than 1.2 million. Among the smaller EU countries, Portugal is estimated to have about 140,000 people with dementia and Malta just over 4,000.

Across the EU, fewer than half of the people with dementia receive a diagnosis. With diagnosis rates ranging considerably between countries, it is difficult for many nations to know the scale of the challenge they face. What is clear is the growing recognition that dementia is a ticking timebomb that can no longer be ignored, which has led to countries comparing themselves with their neighbours.

Portugal is one. Inspired by other national dementia action plans, a number of Portuguese politicians and the country’s Alzheimer’s charity have been lobbying to have a plan of their own. They see it as essential in raising awareness of dementia and making it a national priority. Diagnosis rates are low and the real number of people with the condition in Portugal is unknown.

GPs can also be resistant to providing a diagnosis. This is not, as some might suspect, because of stigma or prejudice, but because of resources, as a diagnosis of dementia may preclude access to nursing home care. There is also a lack of suitable social support for people with dementia and their carers, with most services not tailored to them. So it seems Portugal has a long way to travel in terms of improving diagnosis, treatment and care for people with dementia and their carers. But what would a national action plan on dementia achieve in this difficult health and social care context?

Perhaps France can provide some answers on this, because it is already on its third action plan. This does not mean the first two failed. But as Florence Lustman, co-ordinator of the French Alzheimer’s plan, told an ILC-UK event in the House of Lords last year, lessons can always be learned. A main priority of the first national action plan was to increase the number of memory clinics in France. However this made no significant impact on diagnosis rates, because there remained significant inertia and reluctance on behalf of GPs to refer patients to the clinics. The third plan tried to rectify this by educating GPs. It promised a guiding framework for initial diagnosis and referrals by GPs and a wider awareness raising campaign.

The French experience shows the need for politicians and policymakers to unpick the cultural and social systems, structures and norms that frame dementia and it should never be assumed any feature of one strategy is readily transferable to another county for this very reason.

Perhaps action plans are easier to judge if we see them as part of the policy journey. They may sometimes take longer than we expected, may be subject to deviations or delays and may even necessitate a change of form.

If nothing else, they are indicative of a sign of commitment and intent, and looking across at our European neighbours, here in the UK we are managing to “keep up with the Sarkozys”, just.

Sally-Marie Bamford is senior researcher at the International Longevity Centre-UK. She is currently working on a project on older people’s mental health.

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This article is published in the 22 April 2010 edition of Community Care under the headline “Tackling dementia across the channel”

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