Submitted by Ben Nunn on 14-12-2011

The numbers are scary but well known. Dementia represents one of the most significant challenges facing health and social care services in England today, with an estimated 750,000 living with the condition and costing £20 billion a year, which is predicted to rise to over £27 billion a year by 2018.  

New figures obtained by the Alzheimer’s Society and MHP Health Mandate have also revealed a 12% rise in the number of emergency hospital admissions for people with dementia since 2006, costing the NHS an additional £2.8 million. Beyond the numbers, dementia is also a cruel disease which can have a devastating impact on the quality of life of the individual and their families.   

Yet if the problems are well known, an understanding of the solutions is perhaps less well developed.    

It is two years since the Department of Health published Living well with dementia: A National Dementia Strategy which set out a vision for transforming dementia services in England. While these are early signs of progress there has been variation in the extent to which the Strategy has been implemented locally.   

Today, delivery of the Strategy is set against the backdrop of unprecedented financial challenges and the implementation of the Government’s health and social care reforms. The reforms do offer opportunities. It is, for example, encouraging that many pathfinder clinical commissioning groups have chosen to focus on integration between health and social care. Local health and wellbeing boards could be effective in tearing down the Berlin walls that have all too often existed between the NHS and care sectors.   

However, there are also significant challenges. Cuts in local authority budgets are being reflected in funding for social care. While care in the community is repeatedly found to deliver better outcomes for people with dementia, the rise in emergency admissions shows these services are not always effective leaving the NHS as the carer of last resort. And, within this context and the overall cost of dementia to the health service, NHS dementia services will be expected to find significant savings as a result of the £20 billion Nicholson Challenge.   

In order to address this, MHP Health Mandate – working in partnership with the Alzheimer’s Society – brought together a group of experts to examine what could be done to improve dementia outcomes in the context of the Government’s health and social care reforms.   Common and complex: commissioning effective dementia services in the new world articulates the views of these experts and sets out how the reforms can be implemented to improve outcomes for people with dementia, as well as how some of the challenges might be mitigated.   

The report, as covered by the Health Service Journal this week, and on the front page of The Daily Telegraph, includes the following recommendations:  

• The development of outcome indicators for dementia for inclusion in the 2012/13 NHS Outcomes Framework, and 2012/13 Public Health and Adult Social Care Outcomes Frameworks

• Calls for the establishment of a National Dementia Experience Survey to assess the experience of care being recorded by people with dementia    

• The development of clinical networks for dementia, funded by the NHS Commissioning Board, to support improvements in the quality of dementia services

• Government departments to work to pilot new local authority multi-year budgets to encourage and deliver long-term improvements in the commissioning of dementia services

• Health and wellbeing boards to promote the use of pooled budgets between health and social care commissioners

In total Common and complex makes 20 recommendations aimed at supporting dementia services to deliver on the principles laid out in the National Dementia Strategy and is aimed at making a constructive contribution to the ongoing debate.   Anyone with an interest in long-term conditions needs to understand the opportunities and challenges presented by the ongoing reform agenda. By bringing together thought leaders with an interest in improving care for people with long term conditions such as dementia, this first in a series of new joint papers from MHP Health Mandate aims to provide a useful contribution to the debate about how the reforms can be seized upon to deliver real change and improvements for people with long-term conditions.   

If you would like to discuss the findings of the report or are interested in being involved in the next long-term conditions seminar, then please do not hesitate to contact us at health@mhpc.com.