Exclusive: PCT funding failure hits dementia care

Memory services crucial to cutting the billion-pound burden of dementia on the NHS are being critically underfunded, a GP investigation has found.

Dr Helena McKeown: 'It is highly likely that poor services are hampering early diagnosis of dementia' (Photograph: JH Lancy)
Dr Helena McKeown: 'It is highly likely that poor services are hampering early diagnosis of dementia' (Photograph: JH Lancy)

Huge discrepancies in service investment and patient access have been revealed in data provided by 134 UK primary care organisations (PCOs) following a Freedom of Information Act request.

As part of the 2009 National Dementia Strategy (NDS), the DH in England expected PCTs to set up memory services by April 2011. Similar schemes have been launched in Northern Ireland, Scotland and Wales.

GP found that 7.5% of PCOs still do not commission dedicated memory assessment services and funding for services is patchy.

Among 54 PCOs providing financial data for 2011/12, spending for each person with dementia varied 21-fold. NHS  Barnsley spent £802 per person with dementia, compared with just £38 in NHS Nottinghamshire County.

Patient access to services also varies enormously. In 2010/11, NHS Wakefield District paid for 1,875 patients to use its memory services, but just 117 patients accessed NHS Wolverhampton City’s, even though both PCTs have a similar prev­alence of dementia.

GPs warned that the lack of investment in memory services meant they could not refer patients for formal diagnosis. The Alzheimer’s Society said local memory services were ‘crucial’ to early diagnosis and improving dementia care.

The NDS sought to improve detection of dementia and the quality of care provided to patients. Cutting use of anti­psychotic drugs for people with dementia is a priority of the NDS and the Welsh government’s Dementia Plan for Wales.

Avoiding costly hospital care
Dementia costs the UK more than £17bn a year, but early dia­gnosis and care planning have been shown to avoid costly hospital care.

BMA community care committee chairwoman Dr Helena McKeown said it was ‘highly likely’ that poor services were hampering early diagnosis.

‘Most GPs will want to recognise symptoms and refer to a memory service. Very few GPs want to make a [formal] diagnosis themselves – it’s bad to get it wrong,’ she said.

The biggest impact is seen in care homes, where diagnoses are needed to avoid overuse of medication, she said. ‘Do we want to spend money on drugs, or on plenty of people to give hands-on care?’

West Midlands mental health GPSI Dr Ian Walton said: ‘GPs are blamed for not picking up dementia. But they haven’t got support from services. It’s why GPs are not inclined to refer.’

Alzheimer’s Society policy manager Louise Lakey said early diagnosis was ‘key’ to unlocking support and treatment. ‘Local memory services play a crucial role in making this happen, so the postcode lottery must improve.’

DH comment
A DH spokeswoman said: ‘It is up to local areas to decide how to fund dementia services but we have made clear in the NHS Operating Framework that is should be a priority.

‘Average PCT spending on memory services has increased by 22% between 2008/9 and 2009/10 from £486,000 to £593,000. The average number of people per PCT using a memory service increased from 605 in 2008/09 to 951 in 2010/11, an increase of 57%.’

The GP investigation comes as an expert called on the WHO to declare dementia as big a health priority as cancer, diabetes, and heart and lung diseases.

Professor Peter Piot, director of the London School of Hygiene and Tropical Medicine, said: ‘Dementia is one of the largest neglected global health challenges of our generation, with 36m people living with the condition today. What we must learn from the AIDS movement is that by investing now, we will save later.’

Jeremy Hughes, chief executive of the Alzheimer’s Society, said: ‘In the UK the way we fail to deal with dementia is a recipe for disaster. Just 40% of people have a diagnosis and the government invests eight times less in dementia research than cancer.'

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