The government’s ‘Major Conditions Strategy’ must deliver for people with dementia
The government’s new ‘Major Conditions Strategy’ – announced last week – signals a new direction for people with dementia and their families. And although its holistic approach, which sets out to address the issues faced by people living with a range of conditions including dementia, is welcome – it comes after a long wait.
The previous dementia plan – which set out to make the UK the best country in the world for dementia research, care and support – expired in 2020. Since then, the challenges and inequalities for people living with the condition in the UK have only continued to grow. We hear all too often of people waiting too long for a dementia diagnosis, with all the worry and uncertainty that brings. Since the pandemic, more than 30,000 people are waiting for an appointment with a memory clinic, on average, for up to a year – and people with young onset dementia as many as four years.
There has been talk, but little action. Last May, the then-Health Secretary, Sajid Javid, acknowledged that people with dementia need urgent change and talked about plans for a ‘seismic shift’ in approach. Sadly, the political turmoil and changing cast of characters in the top jobs in government has meant that his plans for a 10-year Dementia Plan have now been dropped in favour of the newly announced holistic and integrated approach, which also includes cancer and mental health.
On the face of it, a holistic approach is sensible. We know that many people with dementia also have a range of other health conditions – it’s sometimes said that ‘dementia rarely travels alone’. But we need to see more detail about what the strategy will deliver – and there is a lot we at Alzheimer’s Research UK want to see.
Prioritising brain health
For a start, for all the welcome talk of putting prevention at the heart of public health, we want to see the concept of brain health being embedded within the strategy as a holistic approach to preventing dementia and promoting healthier lifestyles.
Through our work on brain health, we know that the actions that have a protective effect on your brain have wider health benefits too. For example, being physically active is good for your heart; staying sharp and keeping connected improve your mental health and reduce the harmful effects of social isolation.
Supporting brain health and reducing dementia risk is not only the right thing to do – it could also save money for the public purse. Preventing dementia by targeting just three specific risk factors – tackling high blood pressure, providing hearing aids, and helping people to quit smoking – could save the economy £1.9 billion per year and reduce the number of cases of dementia by nearly 10%.
But the prevention agenda isn’t the only opportunity that this strategy presents – we hope to see a focus on early detection and diagnosis too. It’s now imperative that the NHS evolves to be able to identify people at the earliest stages of dementia, allowing them to benefit as new treatments become available – which they surely will. Early detection, coupled to effective treatment, has been prioritised for conditions like cancer – we need a similar approach to also yield life-changing outcomes for people with dementia.
This strategy should also harness the relatively untapped power of GPs – who play a crucial role at various stages along the dementia diagnosis pathway. We want to see greater, more equitable access to new and emerging diagnostics that hold such promise for detecting diseases like Alzheimer’s at their earliest stages, whether that be innovative scans that use MRI and PET, or the rapid adoption of innovative blood tests once they are clinically proven.
Accelerating the arrival of new treatments
Few will have failed to notice the excitement generated last year by a new drug for early Alzheimer’s disease, lecanemab – the first to show meaningful benefit in clinical trials, and which has now been approved for use in the US. Lecanemab represents the beginning of a new wave of dementia therapies – behind it in the pipeline are more than 150 potential dementia drugs.
So alongside boosts to dementia prevention and diagnosis, this strategy needs to set out a plan to prepare the NHS for these new treatments – one that’s developed in tandem with the NHS Long Term Workforce Plan. We want to see a clear vision for how these drugs will be administered and patients monitored, including how cross-speciality teams of neurologists, psychiatrists, neuroradiologists and specialist nurse practitioners will come together to do this effectively.
To echo the new Secretary of State for Health and Care, Stephen Barclay’s sentiment – the successful delivery of this strategy will require coordinated efforts from government and the NHS, alongside social care, patient representatives, industry and partners across the health and care system. We’re particularly keen to see government departments beyond those responsible for health be involved too. For example, promoting brain health will mean improving housing, communities and education, to help people from all backgrounds to make positive lifestyle changes. The benefits would go beyond dementia, helping people reduce their risk of other diseases like cancer and heart disease too.
People with dementia – no matter where they live or their household income – need a plan that will make a difference for them. Alzheimer’s Research UK is ready to hold government to account until this new strategy sees the light of day. Heaven knows, we’ve all waited long enough.