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Charity warns that NHS dementia care quality could ‘slip back’

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Dementia diagnosis and care could go backwards after being “de-prioritised” by the NHS nationally, campaigners have warned, as new ratings show some areas slipping.

Clinical commissioning groups were given overall ratings for their dementia care by NHS England last month.

“Is it appropriate to de-prioritise something that’s so fundamental?”

Jeremy Hughes

While overall performance improved, analysis by the Alzheimer’s Society has shown that 29 CCGs got worse, including three groups slipping back by two ratings. In addition, 68 CCGs improved – 20 by two ratings – and 97 remained the same in 2016-17.

The ratings are based on dementia diagnosis rates and the proportion of people with dementia who have had a face to face care plan review in the past year.

Dementia was a major priority under former prime minister David Cameron. He launched a “national challenge” on the condition in 2012 and it is one of six clinical areas CCGs are rated on.

However, it was not one of the three “national service improvement priorities” for the health service listed in March in NHS England’s Next Steps on the Five Year Forward View.

Alzheimer’s Society chief executive Jeremy Hughes said the latest figures showed that “overall things are getting better but there is still enormous variation”.

“There’s a risk that when we go for one of two things being prioritised, other things slip back,” he warned.

“If you don’t properly support dementia, then your ability to address comorbidity is limited,” he told Health Service Journal. “Is it appropriate to de-prioritise something that’s so fundamental?” he asked.

”It is still a priority for the NHS. It is a priority for NHS England”

Alistair Burns

Mr Hughes, who chairs the independent panel overseeing the dementia ratings for NHS England, noted that a “couple of years ago” there would have been “more impetus” from the centre for the worst areas to improve.

“They should be encouraged to do so,” he said. “Hopefully this assessment will make sure that does happen.”

He told Health Service Journal that some places had got worse because maintaining quality and performance “does need constant attention”.

Although spending money to improve is “cost effective for the health system” overall, Mr Hughes said “some resource to get diagnosis right” was also required.

“If you are strapped for resources and feeling pressured all the time, these are the things that don’t get prioritised,” he said.

In addition, Mr Hughes said that in future the CCG ratings would consider additional quality indicators, such as patient experience, hospital admissions and anti-psychotic prescribing.

Jeremy Hughes

Jeremy Hughes

Jeremy Hughes

In response, NHS England’s national clinical director for dementia said the “vast majority” of CCG ratings were the same or improved and that the government arm’s length body would “support those areas that for some reason may have slipped”.

Professor Alistair Burns said there had been significant improvement in recent years and more information was available on dementia standards.

“I don’t see any evidence that people aren’t interested in dementia. It is still a priority for the NHS. It is a priority for NHS England,” he said. “There is no evidence that I’ve seen that it is starting to slip back.”

He added that it was recognised that “if you get it right for dementia you will get it right for all older people”.

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