Does Health Policy Assist in Combating Dementia in the UK - Essay Example

The term ‘Dementia’ is used to explain an illness in which there is a progressive decline in reasoning, memory, ability to carry out daily activitiesand communication skills, along with which develop psychological symptoms such as aggression, depression, wandering and psychosis (Banerjee, 2012). In 2001, the Department of Health estimated that of the total population of UK, about 5% of people aged over 65 years suffered from dementia. The latest Dementia Report from Alzheimer’s Society states that at present 800,000 people suffer from dementia in UK, of which 17,000 are young people (2012a). Looking at these alarming statistics, it can be noted that incidences of dementia will only continue to grow. Attention needs to be paid to the ways in which comprehensible plans can be laid out for service development for this illness. In this paper the author attempts to understand dementia and how it affects the UK population. Using statistics from various governmental sources, independent researches and non-governmental sources it charts out the path, people suffering from dementia have had to face. Closely examining the UK government’s latest health plan, “Living well with Dementia”; the author critically analyzes whether the policy is people friendly and is addressing the right concerns. In conclusion, the author endeavors to point out gaps that have been left out in the policy making process which needs to be filled, for people with dementia to have a better life. Understanding Dementia Dementia is most commonly found among the elderly population, it is said that, in UK, 1 in 5 people over 80 have some form of dementia while in those over the age of 65, only 1 in 20 seem to be affected (Knapp and Prince, 2007). However, this is not to say that it cannot occur in young people, a growing number of younger populations are showing early signs of dementia within UK. While no, one, clear factor has been identified as a cause of dementia, it is said that genetic background, lifestyle, age and medical history could lead to the initiation of dementia. The way each individual experiences dementia depends a lot on their physical upkeep, emotional quotient and family support. However, being a progressive illness, its symptoms eventually become more rigorous as time passes. Caring for dementia patients, in the context of their deteriorating mental health is a tedious task. In UK, Knapp and Prince (2007) estimate that among persons aged 65 and above, 36.5% live under institutionalized care, while 63.5% people continue to live in their homes. Among the family members who care for these patients, a number of burdens seem to pull them down, like for example, anxiety, increased financial burden due to medical costs, depression, inability to perform jobs efficiently and various other kinds of physical illnesses (Georges, et. al., 2008). Hence, when considering policies and state mechanisms for dementia patients, the needs of the care provider also need to be taken into account. There are many varieties of dementia and they are classified depending on the different ways in which infection affects the brain. In this paper we discuss the four major types of dementia that affect the UK population: 1. Alzheimer’s disease is the most common cause of dementia, here the changes in the chemistry and structure of the brain, cause brain cells to die (Alzheimers Society, 2012b). 2. Vascular dementia is always found in persons who have suffered a stroke (it could be a single stroke or a series of small strokes). This dementia takes form when the oxygen supply to the brain fails following a stroke and brain cells die (Alzheimers Society, 2012b). 3. Dementia with Lewy bodies is caused by tiny sphere-shaped protein lumps that develop inside nerve cells in the brain, leading to deterioration of the brain tissue (Alzheimers Society, 2012b). 4. Fronto-temporal dementia, here, damage to the brain is primarily focused on the front part affecting, behavior and personality of patients (Alzheimers Society, 2012b). The Economics of Dementia Statistics from OECD’s Health Data (2011) claim that in 2009, 9.8% of the total Gross Domestic Product was spent on health care in UK. Money spent on dementia including services provided by formal agencies and value of honorary family care, alone costs over £17.03 billion to the UK economy every year (Knapp and Prince, 2007). Of this, 41% is spent on providing accommodation to the dementia affected persons, 36% is lost employment of family members (honorary care providers), 19% are benefit allowances and the rest are spent on the National Health Service (Knapp and Prince, 2007). The Department of Health (2009) believes that these costs will further rise up to over £ 50 billion by 2038. Though dementia is a life-threatening illness, persons diagnosed with it may continue to live a diminished life for almost 7-12 more years (Department of Health, 2009). It also remains till date one of the major reasons for disability in people over the age of 65 years. According to the World Health Report – Shaping the Future (2003) approximations, among people aged 60 and above, causes for years lost with disability are most faulted with dementia which accounts for 11.2%, other diseases like stroke only come up to 9.5%, musculoskeletal disorders accounts for 8.9%, cardiovascular disease 5.0% and all forms of cancer 2.4%. With the geriatric population in UK rising every year, one can only suppose that the costs of health care will double in the coming generations. To counter these unprecedented costs, there is an urgent need for solutions. History of Dementia Policy Making The first ever policy in UK to discuss dementia was the “Forge Me Not” Report circulated by the Audit Commission (2000). This report was concerned about the mental healthcare services being provided to people over the age of 65 years. At the end of the report a comprehensive strategy to meet the lacunas identified in the field were discussed. They included the following broad categories: 1. “Vision of the future direction of mental health services should shared by all the stakeholders. 2. Provision should be appropriate to local needs and circumstances. 3. A check should be maintained on the quality of service provision. 4. Maximum and efficient utilization of resources of all agencies should take place.” (Audit Commission, 2000) Two years after this policy was brought out, the Audit Commission did another review of the conditions of people living with dementia and found little advancement in their conditions (2002). After this the National Service Framework for Older People (2001) published by the Department of Health included in its content on standards, a standard seven called, “mental health in older people”. The standard that the framework wished to establish was that, “Older people who have mental health problems (should) have access to integrated mental health services, provided by the NHS and councils to ensure effective diagnosis, treatment and support, for them and for their carers”. The action plan proposed to achieve this standard, included, examination of the curren local mental healthcare systems for older people and employment of a local protocol for primary and social care which would work towards managing dementia among younger people and older populations. Nevertheless, this policy did not make much of an impact on the actual conditions of people with dementia, mainly because coordinated efforts between different agencies that work for the elderly was difficult to come by. In 2005, “Everybody’s Business – Integrated mental health services for older adults: A Service Development Guide” was published jointly by the Care Services Improvement Partnership (CSIP) and the Department of Health. The six key messages it outlined were: 1. “Older people’s mental health is everybody’s business. 2. Improving services for older people with mental health problems will help meet national targets and standards. 3. Access to mental health services should be based on need not age. 4. Older people need holistic care in mainstream services. 5. Workforce development is central to driving service improvement. 6. Whole system commissioning and leadership are vital to deliver a comprehensive service.” (CSIP, 2005) Building on this, in 2006, a Clinical Guideline on the management of dementia was developed jointly by the Social Care Institute for Excellence (SCIE) and the National Institute for Health and Clinical Excellence (NICE). It restated the significance of “standard seven” within the National Service Framework for Older People, 2001 (NICE–SCIE Dementia Guideline, 2006). Further, it identified certain key areas that needed special attention while implementing this guideline for patients with dementia and their honorary care providers (family members). The areas identified were (NICE–SCIE Dementia Guideline, 2006): 1. Non-discrimination of patients with dementia from any service. 2. Valid consent from the patients should be sought by social and health professionals. 3. Rights of the care providers should be assured and specialist attention should be rendered to their needs. 4. Social and health care officers should work in an integrated and synchronized manner. 5. Memory assessment services should be made a single point of referral for possible diagnosis of dementia. 6. Structural imaging should be used to assess people suspected with having dementia. 7. Challenging behavior on the part of patients with dementia should be dealt with tailor-made plans and regular documented review. 8. Dementia-care training should be made available for all those involved in care of patients with dementia. 9. Mental health needs should be planned and provided for in acute and general hospitals. However, the credit for helping the UK government realize the massiveness of dementia’s impact as compared to high priority illness’ like, stroke, cancer, diabetes, HIV and heart disease, goes solely to Alzheimer’s Society. In 2007, they ordered an autonomous and completely academic research into the arena of dementia. This research, to be conducted throughout UK, was taken up by London School of Economics and the Institute of Psychiatry, King’s College, London. The details of this research were published by Alzheimer’s Society and was titled, “The Dementia UK Report”. Its key findings comprised of the following (Knapp and Prince, 2007): 1. 10% of deaths in men and 15% of deaths in women, over the age of 65 years are caused by dementia. Thus, 59,685 people over the age of 65 die each year due to dementia. If the onset of dementia is delayed by five years it would bring down the death toll by dementia to 30,000 a year. 2. 683,597 people in UK are living with dementia i.e., one in every 88 person in UK suffers from this disorder. 3. It is estimated that dementia will increase of 38% in the next 15 years and 154% in the next 45 years. 4. Of the persons over the age of 80 years, suffering from dementia 63.5% live among the community, whereas 36.5% live in care homes. The recommendations made in this report were: 1. “Make dementia a national priority 2. Increase funding for dementia research 3. Improve dementia care skills 4. Develop community support 5. Guarantee career support packages 6. Hold a national debate on who pays for care 7. Develop comprehensive dementia care models” (Knapp and Prince, 2007) Soon after this report was published, the office of the Controller and Auditor General (C&AG) which oversees the UK government expenditure, the National Audit Office (2007) came up with another report on dementia, titled, “Improving Services and Support for People with Dementia”. This report supported the claims by the “Dementia UK” Report and stated that government spending on dementia was happening at a very late stage. It purported that if quality of life was to be improved early diagnosis and early intervention, should become the focal point for government spending. Successful early detection and an upbeat and harmonized system of care management in treating dementia could produce savings of 64-102 million nationally, claimed the report. The C&AG Report (2007) was presented to the Committee of Public Accounts (PAC) of the House of Commons and a public hearing on the same was held on 15th October, 2007 where the Department of Health and National Health Service was critically examined in light of C&AG’s recommendations and censure. The consequent report, “House of Commons: Committee of Public Accounts - Improving Services and Support for People with Dementia” published in 2008, made eight major suggestions: 1. The National Dementia Strategy now being developed in the light of the C&AG’s Report (2007) should have a precise implementation timeline, an efficient communication network between all the stakeholders and should include a standard by which progress of the Strategy could be assessed. 2. Without an obvious leader the dementia care programme in UK will continue to fall back in precedence. A Senior Responsibility Officer should be appointed, who will be made accountable for improvement in services for patients suffering from dementia and their care providers. 3. Formal diagnosis of dementia needs to be ensured by making sure GP’s receive more support from mental health services; developing a passage way for dementia care in collaboration with the Royal College of Psychiatrists and the Royal College of GPs; and by propagating early and good diagnostic practices through the Institute of Innovation and Improvement. 4. An awareness campaign on dementia should be organized which highlights understanding of dementia, its different types, its various symptoms and the intervention and management possibilities of the illness for both the patient and the care provider. 5. Each person living with dementia and their care provider should be provided with an individualized contact (social worker/psychiatric nurse), who would help organize the services required by them. 6. An action plan should be initiated which would assess and help meet the requirements of the care providers. A toolkit on different alternatives and their cost benefits for providing support to dementia patients could also be a part of this action plan. 7. The Commission for Social Care Inspection should assess the in-house staff credentials of people working with dementia patients to ensure quality control and the information from such an assessment should be used when allocating resources to community mental healthcare teams so that they can provide sufficient support to care homes. 8. To improve the financial efficiency of acute care, copies of care records should be provided to care providers of dementia patients which can then be presented to paramedics in the case of an emergency, who would then be able to make an informed decision whether the person needs to be taken into a hospital or can be treated at home. In response to the PAC (2008) Report, the UK Government accepting all its recommendations generated a National Dementia Strategy which was published in 2009. The National Dementia Strategy “Living Well with Dementia” was part of the ambitious National Dementia Strategy of the UK Government. It was initiated in February 2009 by the Department of Health in collaboration with the National Health Service (NHS), four key stakeholders (namely, people with dementia, honorary care providers, anyone affected by dementia and health and social care professionals) and local authorities. The Strategy developed using inputs from more than 4000 participants, established that the UK Government had made dementia a national priority. This policy is a typical example of an evidence-based policy, where it has developed through a rigorous process of autonomous researches, public consultations and political reviews. This policy has emerged through strong partnerships fostered by the government with non-governmental groups like, Alzheimer’s Society. It recognizes three key steps to develop the quality of life of people affected by dementia and its care providers. They are: 1. Ensuring enhanced awareness and removal of stigma. 2. Ensuring early diagnosis and 3. Develop up-to-date and quality services. Within this framework the Strategy established 17 objectives: 1. “Improving public and professional awareness and understanding of dementia. 2. Good-quality early diagnosis and intervention for all. 3. Good-quality information for those with diagnosed dementia and their carers. 4. Enabling easy access to care, support and advice following diagnosis. 5. Development of structured peer support and learning networks. 6. Improved community personal support services. 7. Implementing the Carers’ Strategy. 8. Improved quality of care for people with dementia in general hospitals. 9. Improved intermediate care for people with dementia. 10. Considering the potential for housing support, housing-related services and telecare to support people with dementia and their carers. 11. Living well with dementia in care homes. 12. Improved end of life care for people with dementia. 13. An informed and effective workforce for people with dementia. 14. A joint commissioning strategy for dementia. 15. Improved assessment and regulation of health and care services and of how systems are working for people with dementia and their carers. 16. A clear picture of research evidence and needs. 17. Effective national and regional support for implementation of the Strategy.” (Department of Health, 2009) Policy Analysis The National Dementia Strategy, which spans a course of 5 years, has been allotted £150 million for its proposed work in the first 2 years. It is intensely focused on outcomes and hopes to ensure through its implementation patient-centered management. The uniqueness of the Strategy stems from the fact that it has both philosophical and economic leanings. On one hand while it emphasizes on the right of the geriatric population to care and protection, at the same time it considers the efficiency of healthcare services by demanding up-to-date and quality services. While analyzing this policy it is not enough to just look at the agenda of the policy makers or the outcomes it wishes to achieve, one needs to critically look at the enormity of the policy’s effects from an economic point of view. The policy emphasizes on early diagnosis and in doing so, contains the cost incurred by the government through prevention and management of life with dementia. Banerjee and Wittenberg (2009) in their study on cost effectiveness through early diagnosis found that, on the whole savings to the society increased through early diagnosis as it delayed the number of persons entering a care home over a 10-year period. Getsios, et al. (2012) estimates that such a saving through screening programmes could amount to about US$4000 per person. Even as the National Dementia Strategy signifies the need for early diagnosis, it misses to elucidate on how to target ethnic groups who have augmented risk of developing dementia. Ethnic elders who are prone by increased risks to dementia due to higher incidences of cardiovascular diseases, hypertension, depression and diabetes are the ones who have limited access to health services connected to dementia (Shah, 2008). Bhattacharyya, Benbow, and Kar (2012) state, “Language and communication barriers, lack of awareness or understanding of the illness and lack of culturally appropriate services deprive ethnic elders of access to services for diagnosis and treatment of dementia at an early stage of illness and contributes to caregiver stress and burden.” The All-Party Parliamentary Group on Dementia published a report in March, 2010 which analyzed the progress made in implementing this Strategy in UK. While monitoring its advancement they found high irregularities in the matter of funding. Almost two-thirds of the primary care trusts they reviewed were unable to show clearly, how and why the money allotted to them had been spent. Such serious indiscretion at such an early stage of implementation clearly shows faults in the design of the Strategy. Planning and budgeting of resources seems to not have got adequate attention in the implementation plan developed by the Department of Health in 2010. Recommendations Research needs to be initiated into the assessment of dementia to develop culturally relevant and sensitive methods of estimating the abilities of ethnic elders. This would encourage more ethnic elders to come out of the closet, to understand and accept their illness and thus seek help from a specialist. From a more generalist perception on dementia, the author believes that new research should focus more on the person-oriented approach and include in its ambit professionals from ethnic minority backgrounds. Like the Dementia Strategy states, “putting people first” (Department of Health, 2009). Staff members hired to work on the Dementia Strategy of the UK government should have a multi-racial background to represent the population they are working for. Also, for all the members involved in the strategy, training should be organized to help them understand the different cultural differences and the way dementia is perceived among the various ethnic groups. Though the Strategy seems holistic and addresses most arguments concerning dementia, the author is concerned about its practical implementation in the field given the limited resource allocation assigned to it in contrast with other illnesses, especially in the context of research on dementia. Inaction and delay into finding new care possibilities, preventable causes and definite cures for dementia could set us back financially in the coming future. Targeted expenditure in this arena will help meet prospective economic, social, personal and political concerns. Conclusion Dementia is not an illness we can shut or eyes to, it’s devastating force affects not just persons distressed by it but also a larger population which cares for and provides for the dementia affected population. To counter dementia in UK one needs proper social and healthcare services which though have been included in the National Dementia Strategy, still have a long way to go to become a practicality. Although the scale of the task ahead looks unbeatable, the author believes, commitment and hard work on part of the Government can help deliver the needs of the time. References All-Party Parliamentary Group on Dementia, 2010. A misspent opportunity - Inquiry into the funding of the national dementia strategy. London: Alzheimer’s Society. Alzheimer’s Society, 2012a. Dementia 2012 Report. [online] Available at: < http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=341> [Accessed 7 January 2013]. Alzheimers Society, 2012b. Types of dementia. [online] Available at: < http://www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200362> [Accessed 7 January 2013]. Audit Commission (2000). Forget Me Not. London: Audit Commission. Audit Commission (2002). Forget Me Not 2002. London: Audit Commission. Banerjee, S. and Wittenberg, R., 2009. Clinical and cost effectiveness of services for early diagnosis and intervention in dementia. International Journal of Geriatric Psychiatry, 24, pp.748-754. Banerjee, S., 2012.The macroeconomics of dementia - Will the world economy get Alzheimers disease? Archives of Medical Research, 43(8), pp.705-709. Bhattacharyya, S., Benbow, S. M. and Kar N., 2012. Unmet Service Needs of Ethnic Elders with Dementia in United Kingdom. Indian Journal of Gerontology, 26 (1), pp.242-258. C&AG Report, 2007. Improving Services and Support for People with Dementia. London: National Audit Commission. CSIP (2005). Everybody’s Business – Integrated mental health services for older adults: a service development guide. London: Department of Health. Department of Health, 2001. National service framework for older people. London: Department of Health Department of Health, 2009. Living well with dementia: A National Dementia Strategy. [online] Available at: [Accessed 7 January 2013]. Department of Health, 2010. Quality outcomes for people with dementia: Building on the work of the National Dementia Strategy. [online] Available at: [Accessed 10 January 2013]. Georges, J., Jansen, S., Jackson, J., et. al., 2008. Alzheimer’s disease in real life – The dementia carer’s survey. International Journal of Geriatric Psychiatry, 23, pp.546–551. Getsios, D., Blume, S., Ishak, K. J., et al., 2012. An economic evaluation of early assessment for Alzheimer’s disease in the United Kingdom. Alzheimer’s Dement, 8, pp.22-30. Knapp, M. and Prince, M., 2007. Dementia UK: A report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King’s College London, for the Alzheimer’s Society: The full report. London: Alzheimer’s Society. NICE–SCIE Dementia Guideline, 2006. Dementia: A NICE–SCIE Guideline on supporting people with dementia and their carers in health and social care. London: The British Psychological Society and Gaskell OECD, 2011. OECD Health Data 2011 - Frequently Requested Data 2011. [online] Available at: [Accessed 7 January 2013]. Committee of Public Accounts (PAC), 2008. House of Commons: Committee of Public Accounts - Improving Services and Support for People with Dementia. London: House of Commons. Shah, A. K., 2008. Estimating the Absolute Number of Cases of Dementia and Depression in the Black and Minority Ethnic Elderly Population in the United Kingdom. International Journal of Migration, Health and Social Care, 4(2), pp.4-15. World Health Organization, 2003. The World Health Report – Shaping the future. Geneva: World Health Organization. Read More