BBC BLOGS - Mark Easton's UK
IN ASSOCIATION WITH
« Previous | Main | Next »

Map of the Week: Dementia

Post categories:

Mark Easton | 17:08 UK time, Thursday, 14 January 2010

I wouldn't want to be suffering from dementia in Berkshire. According to my analysis of official NHS stats, health managers in the county spend just a few pennies per patient on drugs that might benefit dementia sufferers. In North Lancashire, by contrast, they spend 40 times as much.

I worry about losing my marbles. When I can't remember the name of someone I have known for years, or I walk upstairs only to get there and wonder what I went up for, or when my memory of great chunks of my past fades to nothing, I wonder what I will be like if I live to be 80 or 90. These "senior moments", as a friend of mine describes them, frighten me.

I am not alone. As our society ages, dementia is going to become increasingly common in Britain and in 2007 the government responded to anxiety about the range of diseases defined by the term, announcing it was to be a "national priority" for the NHS.

Graph showing projected increase in the number of people with late-onset dementia in the UK by age group

Now ministers are accused of reneging on that pledge with the National Audit Office arguing that dementia "has not been given the levers or urgency normally expected for such a priority".

The structure of the NHS in England is founded on the concept of devolved power - localism in action. Primary care trusts are given control of their budgets, to decide the priorities in their local area and be responsive to local people rather than national politicians.

When it comes to dementia, the NAO finds that "primary care trusts, who are responsible for prioritising funding under the devolved delivery system, do not see it as a 'must do'."

Why not? National politicians have made it crystal clear that they believe dementia should be a priority for local health services. And yet, the NAO report finds big variation between prescribing levels of anti-dementia drugs in different English regions "suggesting that people in some parts of the country who might benefit from the drugs are not receiving them".

Graph showing prescription of anti-dementia drugs in England

Only around a third of people with dementia are formally diagnosed which means that most sufferers miss out on early intervention and specialist care. What this map does is identify what the NAO calls the "diagnosis gap" in each region, then factor in current prevalence and its expected rate of increase, to see which parts of the country are failing to give the issue the priority the auditors clearly believe it deserves.

Map showing regional breakdown of the diagnosis gap challenge

The regional picture may camouflage the local experience however. For individual patients, diagnosis and access to drugs will be down to the local PCT and GPs, so I have had a look at local prescribing rates for the range of pills which are thought to work best at treating dementia.

Now, there is more to dementia services than simply drugs. There are many different types of the disease, of which Alzheimer's disease is the most common. Symptoms include a decline in memory, reasoning and communication skills, leading to an inability to perform everyday tasks and eventually a need for 24-hour care.

There is no cure and drugs that slow its progress do not benefit everyone, but they have their place and a look at the spending per patient in different parts of England may offer a clue as to the importance different care trusts place upon treatment.

dementia data

I created this table (full figures here [40 Kb Excel spreadsheet]) from figures obtained from the NHS Information Centre (thanks to them for their help). I used published figures on the spending on clinically approved dementia drugs by each PCT and divided the last year's expenditure by the number of people on each trust's list.

Obviously, some places will have a higher proportion of elderly people than others but the difference in expenditure on these drugs is startling and goes well beyond any demographic explanation.

In Berkshire West, with a population of just under half a million people, they spent £34,000 on prescriptions for dementia sufferers. In North Lancashire, with a population of around 340,000, they spent more than £1m.

Local health managers are not only failing to prescribe the right drugs for dementia patients, a recent independent report for the Department of Health [832KB PDF], found that GPs were prescribing the wrong drugs - leading to "an additional 1,800 deaths per year on top of those that would be expected in this frail population".

The research warned ministers that, contrary to clinical guidelines, GPs "are treating 180,000 people with dementia with anti-psychotic medication across the country per year".

What the NAO appears to be arguing for is greater centralised control over local managers. "Empowered local leadership is important for delivering transformational change" in dementia care, the report insists, but then argues that Whitehall "should find a way of ensuring that Primary Care Trusts commission sufficient memory services".

The auditors point to "the lack of strong levers for improving dementia care" with the "risk that NHS and social care delivery organisations will not give it the priority status expected". As I have argued before, the inevitable side-effect of localism is variation in service - the post-code lottery. Devolving power means reducing influence and control.

There are 'levers' that ministers use to encourage local NHS managers and GPs to take account of centrally agreed priorities and standards - the so-called "vital signs" indicators [560KB PDF].

Triangle diagram showing national priorities for department of health

At the top of the triangle are a small list of "must-dos" against which local trust managers are performance managed by the department centrally. Dementia is not one of those. Tier 2 includes activities where "concerted effort" is requested and there is a degree of regional accountability. Dementia is not one of those. Tier 3 includes a list of areas from which local managers can choose their own priorities. Dementia is not among the options.
A full list can be found here [500KB PDF].

So the NAO's argument (and, of course, those interest groups demanding more attention and resources be applied to the condition) is that if central government says something is a priority then they should do more to get local officials to do their bidding.

In this case, it appears that those people in Whitehall wanting dementia to get "must-do" status, didn't get their finger out in time. The NAO notes that the Department of Health decision to make dementia a national priority "was too late for inclusion in vital signs".

However, if you really believe in local power rather than central control, you might resent politicians in Whitehall picking out their priorities. Currently, the list of Tier 1 indicators relates to cancer, stroke, hospital acquired infections and access to services. But it could be argued that devolving power should mean trusting health officials locally to decide how those issues should be prioritised.

If the health chiefs in Berkshire don't think it is worth spending a fortune buying drugs for dementia sufferers then that is their prerogative. Equally, their counterparts in North Lancashire must have spent less on a competing health demand in order to find the £1m they thought necessary to spend on prescribed dementia treatments. Should someone in Whitehall tell them any different?

Comments

or register to comment.

  • 1. At 5:50pm on 14 Jan 2010, John Ellis wrote:

    I have memory problems left over from my breakdown which can be realy frustrating the medication and a few strains of cannabis dont help any in maintaning it either, I know this but for me in maintaing a healthy mind and one that is not going to write me of in a fit of behaviour that causes myself and my family harm they are both nessasery evils.
    Now Mark you go on about the fear of not remembering through old age, an old age that sees many people prescribed the anti depressants and anti pshycotics that I have taken for many years so the thought realy is proment in my mind. How fast is the chemical clock being moved by such drugs how fast is the bodies abilty to resupply the chemical chain managed what happenes when this stops and slows and do they actualy further burn out the brain in there workings.

    Complain about this comment

  • 2. At 5:56pm on 14 Jan 2010, Wyrdtimes wrote:

    It would be interesting to see how this data (and access to drugs) compares with Scotland, Wales and Northern Ireland.

    I'll hazard a guess based on how England compares in nearly every other field - that England is the bottom of the pile.

    Complain about this comment

  • 3. At 6:22pm on 14 Jan 2010, John Ellis wrote:

    :) Mark Sorry :D
    um chemical resupply
    http://www.telegraph.co.uk/science/science-news/3485163/Marijuana-may-improve-memory-and-help-fight-Alzheimers.html

    http://alzheimers.about.com/b/2008/12/09/dude-can-marijuana-prevent-alzheimers-disease.htm
    for and against.
    http://medicalmarijuana.procon.org/viewanswers.asp?questionID=000130

    Complain about this comment

  • 4. At 8:27pm on 14 Jan 2010, CComment wrote:

    You wrote : "If the health chiefs in Berkshire don't think it is worth spending a fortune buying drugs for dementia sufferers then that is their prerogative".
    Sorry, but that just sums up the postcode lottery which renders the NATIONAL Health Service as anything but national. Standards should be uniform across the country. Caledonian Comment

    Complain about this comment

  • 5. At 8:33pm on 14 Jan 2010, TroyTempest44 wrote:

    To be fair you have alluded to this in your report but really using the numbers in the way you have could produce a less than clear picture. In order for the data to make any sense you need to first establish what the population at risk is in the area. Generally this will be older people so you would need to establish the number of people in the age group - say over 65. Then you would need to establish how many people have dementia (the prevalence) as this will affect how many people are prescribed the drugs.

    Area A may have fewer older people but a larger population.
    Area B may have more older people and a smaller population.

    Using your analysis both areas could have the same number of dementia sufferers receiving the same medicine but one will have a lower spend per head than the other. What you need to do is get the age standardised rates of dementia and marry this up with the expenditure data. This will then definately tell you whether it goes beyond any demographic differences.

    Complain about this comment

  • 6. At 10:43pm on 14 Jan 2010, greybunker44 wrote:

    You quote stats for people over 65. There are approx 15,000 people below this age with dementia in the UK and this a a growing trend that must be included in the action taken. My NHS Trust uses a bespoke community nurse for sufferers under 65 recognising that their needs are different from older people who also have other serious conditions

    Not sure were my NHS trust (Portsmouth)comes in your league table but I am pleased with the investigation and support provided to my wife.

    Complain about this comment

  • 7. At 11:02pm on 14 Jan 2010, watriler wrote:

    Yes of course it is analysis like this that makes one wonder what we mean by a National Health Service. There is the Tesco's model - delivering exactly the same portfolio and quality of services regardless of location v the relative autonomy/diversity of the present position. Perhaps in the latter case there is something to be said for a minimum provision and standard with published information showing the relative position of the PCT eg how far above or below average that PCT is. There was another point - I am sure it will come to me soon. Anyway is it an old photo Mark because you look far too young to have any kind of senior moment!

    Complain about this comment

  • 8. At 01:05am on 15 Jan 2010, Paul in Crawley wrote:

    My 85 year old father has mild memory impairment, which could be the early stages of dementia. His GP has recommended a healthy lifestyle and for him to keep up his interests. You seem to suggest in your article that there are drugs which could help his condition, but you must know that NICE has withdrawn its support for all the existing drugs on the grounds that they have not been shown to be cost effective. There are always drug companies ready to push their products in the media and through pressure groups, but aren't the local PCT's quite justified in following the advice from NICE, rather than bowing to other pressures. Surely, it is NICE that first needs to be convinced that the drugs work (if they really do) not the PCTs.

    Complain about this comment

  • 9. At 02:31am on 15 Jan 2010, John Ellis wrote:

    Paul quite right active and healthy life is very important so is social stimulation. The drugs I worry about mostly down to all the reading I end up doing posting babble here. Ive had a friend who died on these drugs of a heart attack age 34 ish was in and out of mental health wards getting meds changed left right and centre while trying to balance his odd behaviour came as quite a shock to us all wasn't to long after my break down so cant quite place full memories of it due to massive amounts of meds myself.
    Most of the drugs effect the CB proteins in there attempt to stabilise the brain function but provide no chemicals to fortify the chemical changes so end up weakening the brains CB signaling across an entire lobe which in turn leads to cell death in the brain and probably has a weakening effect on other CB sites in the immune systems of both the brain and the body.
    This is why i find it scary at my age were I have to take pharmaceutical drugs in order to maintain my mental health the same classes of drugs that kill old people with brain dysfunction. So I opt for the THC and CBD's which don't suppress the brains functioning anywhere near the levels of the prescribed medication, oh and it saves my local PCT loads in prescription costs, you know for the other med to fix the lack of sleep or the nausea the sexual dysfunction. god the implications of these drugs are horrible Mark..
    Never mind getting Old....

    Complain about this comment

  • 10. At 03:54am on 15 Jan 2010, stalinvlad wrote:

    @TroyTempest44
    Yes I agree without the extra analysis this report is somewhat mute
    I recall reading Eastbourne has/had the highest deaths per 1000 population simply because so many retire to that area, and then die

    On another note; on Digg and some other sites I can thumb up or down a comment
    But the BBC only invites complaint, playing into the hands of the Daily Mail again? why oh why?

    Complain about this comment

  • 11. At 07:46am on 15 Jan 2010, newshounduk wrote:

    Given that the final NHS bill is paid by the government and the trusts are a means of delivering the service I cannot see why we have a postcode lottery for any drugs except of course the massive cost.

    As part of upping their campaign to deal with dementia, the government could ensure a minimum ring-fenced level of dementia drug availability across the country which trusts are required to provide.

    Though we hear a lot about recognising symptoms of dementia, we seem to hear less about its causes and about measures we can all take to prevent it.

    Complain about this comment

  • 12. At 09:22am on 15 Jan 2010, Angel_in_Transit wrote:

    #5 TroyTempest44

    Thank you for making the same points I would have made.

    Late onset dementia has been a huge problem for decades especially amongst the poorest sectors. If you had managed to visit a workhouse you would have found out just why. By comparison pre-senile dementia, which afflicts across class bounds, has a much higher focus but is still largely incurable.

    We can all empathise with the "elderly moments" but they occur regardless of age and we do not, by a long way, know why. These moments do, in many cases, mean little and do not really echo what happens with real memory loss and its accompanying debilities. Society needs to spend a lot more of its research effort on the mind; but it will not do so as long as there are no quick wins.

    One thing is clear; we are far from knowing if drugs are the answer.

    Complain about this comment

  • 13. At 09:23am on 15 Jan 2010, jon112dk wrote:

    I accept your point about local comparisons, but I don't think it is the big story. The big issue here is the extent to which the NHS values old people.

    Other health issues are subject to the same localism, but whilst you quote authorities paying £0.07 for an old person, the same authorities will authorise (literally) £100s of thousands on one young person with 'mental health problems'.

    Cognitive enhancers are only one issue, and you mention the unjustified prescribing of anti-psychotics to old people. Don't forget: most of these people will be DEAD within one year of being admitted to a nursing home. Is this entirely accidental? Would it be accepted if this level of death was occuring in younger people?

    I would suggest that the NHS has a very clear culture of accepting lower standards and deaths in our old people. It is open to question is the NHS actually welcomes those deaths as a way of managing increasing costs. Frankly they just do not value old people. I welcome your article which can only help open this topic up to scrutiny and debate.

    Complain about this comment

  • 14. At 09:38am on 15 Jan 2010, bill wrote:

    There is a lot of discussion on dementia drugs, but nowhere near enough on dementia care.

    The overwhelming majority of doctors, nurses, carers and social workers in this country are untrained in dementia care; an absolutely appalling and unforgiveable oversight. A brief visit to any hospital or nursing home will confirm this beyond any doubt.

    I would suggest that better treatment for dementia could be more effectively achieved by addressing this issue, rather than concentrating on drugs.

    Complain about this comment

  • 15. At 09:57am on 15 Jan 2010, TroyTempest44 wrote:

    No13. jon112uk

    In a way you are falling into a similar trap - to say that most people admitted to a nursing home are dead within a year you would need to define two things. What do you mean by most and is this an artefact of the data. Sad as it is, older people by their very definition die more often than younger people. Therefore if you were admitting older people to nursing homes you would expect a higher proportion to die than in the younger population.

    Now if you carried out a comparison study which looked at the admission rate for those on anti-psychotic drugs v those who aren't, followed the two groups until they died, adjusted for any potential confounders and then carried out a hazard analysis, then you could identify whether this was actually a result of some other factor such as the drugs that are prescribed.

    Unfortunately what happens in the NHS is often a lot more complicated than is simply reported on in the media. Simple straight forward reporting of complex issues is no bad thing but there does need to be a bit of clear evidence based data behind it.

    Complain about this comment

  • 16. At 10:18am on 15 Jan 2010, busby2 wrote:

    Mark Easton wrote that a report "found that GPs were prescribing the wrong drugs - leading to "an additional 1,800 deaths per year on top of those that would be expected in this frail population".

    This is suggested as a tragedy but surely the real tragedy is not that they died, but that they suffered from senile dementia and were probably all in the advanced stages. In those cases, surely death was a merciful relief.

    Rather than seeking to prolong the ife of those with advanced dementia, we should be putting resources into preventing dementia and to delaying the onset of dementia.

    Complain about this comment

  • 17. At 10:40am on 15 Jan 2010, John Ellis wrote:

    Busby2 Also leads to 1600+ heart attacks and other cardiac events.

    here is some interesting stuff on stem cells and cell creation
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1919431/

    http://stemcells.nih.gov/info/scireport/chapter5.asp

    when the drugs don't work try a supplement :D

    More should be spent on one to one interaction as well not chemical cosh's

    Complain about this comment

  • 18. At 11:19am on 15 Jan 2010, jon112dk wrote:

    15. At 09:57am on 15 Jan 2010, TroyTempest44 wrote:

    Yes, I agree with most of what you say in terms of the studies/evidence needed. (I was only writing a comment, as opposed to to scholarly article!)

    Broadly, the research you suggest has been done. The hypothesis that the use of anti-psychotic drugs in dementia causes excess deaths is strongly supported by the evidence - hence the the report Mark refers to. (You can download it on the department of health website if you really wanted)

    The same research is pretty clear in saying the anti-psychotic drugs are being used for sedation ('chemical straight-jacket') and have no real therapeutic role in most cases of dementia. But they are still being used, often (usually) without the competent/informed consent of the patient.

    This is just one issue. There are others, for example equality of access to specialist treatment for strokes once people get older.

    Complain about this comment

  • 19. At 12:05pm on 15 Jan 2010, General_Jack_Ripper wrote:

    Caledonian Comment wrote:
    "Sorry, but that just sums up the postcode lottery which renders the NATIONAL Health Service as anything but national. Standards should be uniform across the country."


    I'm afraid I'll have to disagree with you on this one CC.
    Personally, I want my local branch of the NHS to deal with the problems that affect our local area and this would not be possible with uniform standards across the whole of the NHS.
    You've got the problem that some parts of the country have a totally different requirements than others, if you wanted uniform standards across the country then that would mean some areas wasting resources providing infrastructure and services that will be under-utilised while other services will be overstretched, for example;
    If an area has a very high proportion of pensioners and very few breeding age couples then why should they have to provide the same level of services as an area with very few pensioners and lots of breeding age couples ?
    You'd end up with row upon row of incubators and other infant specific equipment being left unused while the geriatric department were always running out of dialysis machines and other such things.

    Would you want the Kent health authority to have to provide a mountain rescue team or the Leicester health authority to provide maritime rescue services ?
    Of course you wouldn't because it would mean they have to remove funding from other essential services so that they could provide the universal standards you want, even though there is no need for them in their area.

    It would be pointless and lead to a lower overall standard of care with even more inefficiency than we have now.

    The postcode lottery is just another red herring thrown about by the press in an attempt to slander the NHS, given the choice I'd want my local health authority to have more powers to decide the sort of services they're going to provide to our area as they are the people who know the needs of our area best.
    The introduction of patient councils recently also means that local people are now able to have a big input into the decision making process to decide what services are provided in their area, this has lead to some improvements in our local NHS and I'm sure that over time it will continue to help improve the standard of health care we receive.
    Anyone can apply to join these groups, all you have to do is check your local NHS website and go along to the next meeting.

    Complain about this comment

  • 20. At 12:10pm on 15 Jan 2010, General_Jack_Ripper wrote:

    I'd recommend everyone watch the "Can Gerry Robinson Fix Dementia Care Homes ?" documentary that was on BBC2 recently.

    http://www.bbc.co.uk/programmes/b00pf0s2

    I will warn you that it is very upsetting.

    Complain about this comment

  • 21. At 12:29pm on 15 Jan 2010, Angel_in_Transit wrote:

    #18

    I think your use of "broadly" conjures the wrong image; surely the advocacy should be based on the "individual" and what may really be happening is a "line of best fit" which dominates medical thinking. It is crucial that we remember how resources are divided in the NHS, and how, throughout the "purge years" (to avoid making a political point) stress was placed on community care largely without the support essential to make this work.

    Compare this to the huge resources poured into children and young person care where the cost of bespoke placements often run into lottery size fortunes in just a few years. And we must also consider the "fixed income" argument which really narrows down diet and social opportunity, coupled with supermarkets "out of reach".

    Generic treatment of problems with any group of people is unlikely to be as effective as looking at all the options for each individual. The problem is that the options cost money and it is being spent elsewhere across a very wide range of considerations. Perhaps society has, for a long time, considered its elderly population, even when looking at close relatives, as a barrier to having a "better time".

    My reference to a workhouse, which I have seen the inside of, was to suggest that things may be worse now than they were for the unfortunates who made it to the upper floors of those god forsaken places.

    Complain about this comment

  • 22. At 12:42pm on 15 Jan 2010, John Ellis wrote:

    The Wife used to work for age concern before she gave up work to look after me GJR the improvements in cognitive approaches makes a great deal of difference. The centre she was in dealt with early onset dementia and the big A. She used to come home very upset with the whole system of medication as a lot of the clients came in drugged up and only after a few weeks or months of being there under supported communal living did they actually start to come out of themselves. the loss of a partner further aggravates this need to use chemical cosh methods which is wrong.

    Our local age concern has just built a respite centre for sufferers of advanced dementia and Alzheimer's. As Ive shown in previous posts some drug help is useful in regeneration of cells and the functioning of the brain. These are natural proteins that we don't have in our diets in any great amount, if you turn around what I have suggested it also implies that current medication which attempts to force mental health will have an adverse affect on the function of the brain and lead to further degeneration of proteins the body is able to use. We need to look at what gives us these chemical building blocks in order to better understand these type of illnesses of the body.
    Dietary supplements are important and just because one is controversial should not mean its ignored.

    Treatment for any of the dementia illness should be standardized and cognitive approaches put first the 'use it or loose it approach'.

    Complain about this comment

  • 23. At 12:46pm on 15 Jan 2010, John Ellis wrote:

    GJR seen it very good program and highlight the systemic failure to interact and treat people like people. Steven Fry's secret life of a manic depressive also very good.

    http://www.bbc.co.uk/health/tv_and_radio/secretlife_documentary.shtml

    Complain about this comment

  • 24. At 1:16pm on 15 Jan 2010, General_Jack_Ripper wrote:

    CommunityCriminal wrote:
    "Steven Fry's secret life of a manic depressive also very good."

    I agree, it was very informative.

    While we're on the subject of TV shows, "Kevin McCloud: Slumming it", was on Chanel 4 last night with part 2 being on tonight and it is well worth a watch to see how people live in the slums of Mumbai. One of the things that really separates us from people in Asia seems to be the family unit, in India several generations of the same family live together in a family home and this appears to bring a lot of benefits.
    Older people are kept active within the family and continue to play an important role throughout their whole lives, I've often wondered if this is a part of the reason they have fewer mental health problems later in life as instead of spending their twilight years sat at home with very little contact with the outside world they continue to take part in almost every aspect of family and community life.

    We all know the brain is a muscle and I wonder what role this constant stimulation has on keeping mental health problems away.

    There's also the issue of "out of sight, out of mind", in the UK we're happy to dump our old people into nursing homes and then just leave it to the nursing staff to look after them, if these people were still living in a family home then the family would continue to take an active role in their healthcare that could well have advantages too.

    Complain about this comment

  • 25. At 1:33pm on 15 Jan 2010, sugarboy wrote:

    This is a very interesting piece as are most of the comments. I have a family member suffering from Alzheimers. Having followed the debate about how society deals with the looming cloud of dementia, I think there are two challenges: how medication is developed, allocated and prescribed, but equally, how the healthcare community deals with the disease. Personally I am sceptical we will make any significant strides in the short to medium term in dealing with the disease, leaving us with the immediate issue of how to treat sufferers. My family member was recently admitted to hospital. It has already been admitted that hospital staff have no training for dealing with dementia sufferers. Our 'experience' demonstrated that perfectly. All the staff we encountered are frighteningly clueless, and I imagine that unless you are in less than perfect mental health, being in such a place alone is a dreadful experience. Is this really the best we can do?? Interested to know how much is spent nationally on drugs/research versus training in care for current sufferers. Anyone know?

    Complain about this comment

  • 26. At 1:47pm on 15 Jan 2010, jon112dk wrote:

    21. At 12:29pm on 15 Jan 2010, Angel_in_Transit wrote:
    #18

    I think your use of "broadly" conjures the wrong image; surely the advocacy should be based on the "individual"....
    ==========================

    By 'broadly' in #18, I meant that the research, in general, suggests a particular point. I'm not suggesting everyone should be treated the same.

    I understand your argument. How do we value evidence - randomised controlled trials vs personal experience. It is a common position, particularly in 'mental health'

    I don't it's a good line here. If we give anti-psychotics to lots of old people and (a) the ones who get the anti-psychotics die sooner (b) we can't even see a positive difference in terms of reducing the challenging behaviour the drugs are supposed be managing, then that sounds quite important to me. They don't work, and they cause people to die. I don't think we can ignore that, even if someones personal opinion says different.

    The official reports do acknowledge that in a small number of individual cases there may be a benefit from anti-psychotics, but certainly not from the wide scale prescribing we see at the moment.

    (It might interest you to know that many years ago when the same client group was cared for in the big old mental hospitals, the prescribing of anti-psychotics was actually LOWER. Perhaps different skills in the staff and/or a greater tolerance of 'odd' behaviour. The curent situation is not exactly progress.)

    Complain about this comment

  • 27. At 3:20pm on 15 Jan 2010, CarolineOfBrunswick wrote:

    What information do you think the Department should collect from PCTs regarding dementia (through Vital Signs)?
    They will already be able to get primary care prescribing data through the IC, and do you think that measuring performance based on levels of spending should be encouraged?
    Also, is the data on spending by PCT only based on GP prescriptions? Does differing dementia services by Mental Health Trusts impact on this?

    Complain about this comment

  • 28. At 4:25pm on 15 Jan 2010, chrisbucks wrote:

    Mark Easton says “Obviously, some places will have a higher proportion of elderly people than others but the difference in expenditure on these drugs is startling and goes well beyond any demographic explanation”. A 30-40 fold difference would override the variations, certainly. Unfortunately, there is also the issue around a formal diagnosis, where some GP’s are reluctant even to consider referral to memory clinics, and by so doing, deny that person with dementia the few social support services that they may be entitled to, while making him or her “invisible” to medical services. It is very disappointing too, that the National Dementia Strategy put forward by an All Party Parliamentary Group, has not translated into a priority for local authorities. Maybe the increase in recorded cases that that Strategy would throw up, is too inconvenient for a government in a period of recession…

    Complain about this comment

  • 29. At 5:03pm on 15 Jan 2010, Angel_in_Transit wrote:

    #26

    Thank you for that Jon.

    I hate that word "broadly" as it masks a lot of sins, but your explanation allays my fears.

    I think we agree that the "drug fest" may do the pharmaceuticals a lot of good but it is hardly an appropriate way of improving the quality of life for many of our senior citizens, or indeed many of our citizens, period.

    Complain about this comment

  • 30. At 1:12pm on 16 Jan 2010, freespeechoneeach wrote:

    The Government doesn't want to protect us from dementia. If dementia had anything approaching the priority it deserves; alcohol- which directly causes dementia- would be classified.

    http://en.wikipedia.org/wiki/Alcohol_dementia

    Complain about this comment

  • 31. At 2:04pm on 16 Jan 2010, yellowsandydog wrote:

    My father lived in Berkshire until his death in February 2009 and I think the standard of drug therapy for dementia he received was very good. He was regularly assessed by a psychiatrist to check the progress of his illness and the effectiveness of the medication. Drugs like Rivastigmine were a big help in slowing his illness down.

    Complain about this comment

  • 32. At 2:08pm on 16 Jan 2010, John Ellis wrote:

    30# FSOE this is well documented in alcohol use. But as I've said on previous posts Cannabis users are lucky the government make sure we are aware of the health implications of our use of what is described as a LETHAL drug. My LETHAL drug of choice fixes the problems of Alcohol damage to most if not all parts of the body.

    So warning of dementia through alcohol is pointless in this day and age the consumer is so blinded to its use and has no long term care for the effects on them as most of them are end of life scenario's so why bother worrying.

    If the government was truly worried by alcohol dementia then it would be a Class A substance with strict controls on consumption times of consumption. Sale of alcohol would be evened out and the price fixed at public house prices even for off licence and Supermarket sales. With No 2 for 1 or reduced price sales allowed.

    People will say but pubs need staff so it should be more expensive..... hospitals also need staff and equipment to treat the abuses and accidents of alcohol use. A fair way to do this would to be cost 100 pubs and work out the average cost of sale and apply the difference as a tax on supermarkets and offlicenes to pay for the health services required by their irresponsable sales of alcohol. My cannabis supplier's would receive custodial punishments for their supposed part in the ill health of the nation. I once wrote to government about such a tax on local sales to pay for children and young peoples leisure services in the area. Got told we have a positive strategy for youth programs (not facilities) and a very sound policy on alcohol use. In other words were not interested in fixing problems of social drinking and under age drinking I only asked for 3% of the profit for Youth services from EVERY off licence and alcohol outlet selling cheap alcohol.

    Complain about this comment

  • 33. At 2:25pm on 16 Jan 2010, freespeechoneeach wrote:

    Hi CommunityCriminal, Thanks for replying!

    If only protecting public health really was motivating the drugs laws! How many lives could be saved?

    To will the cause is to will the consequence. The Government wants us all to drink. So they must also want the dementia (and everything else) that inevitably follows.

    Complain about this comment

  • 34. At 2:39pm on 16 Jan 2010, John Ellis wrote:

    Well it depends on how you see life and on which side of the maths your on.
    With the average citizen contributing full taxes until the are 65 ish there health and social well being is important and mostly pays for itself.
    Once past 65 citizens are a burden on the state and system unless they have great wealth and so can afford private health care.

    We also have the fact that we can only support a percentage of the population with current resources, this leads to political shaping of care and the 'disposable population'. Damn were a commodity now.

    Shallow but very true on Paper.

    Complain about this comment

  • 35. At 11:52pm on 16 Jan 2010, John Ellis wrote:

    33# according to the white paper here many many lives could be saved and length of life extended without harm.

    http://www.cannabisscience.com/

    Complain about this comment

  • 36. At 06:16am on 17 Jan 2010, clamdip lobster claws wrote:

    Mark,
    You're not losing your marbles, you're just stressed out. Isn't dementia caused by a lack of folic acid (green leafy vegetables)? Like Popeye's wife, Olive Oil, your wife just needs to serve you more spinach....Yuck! Yuck! Yuck!

    Complain about this comment

  • 37. At 06:49am on 17 Jan 2010, clamdip lobster claws wrote:

    The lack of early detection and treatment of dementia could be planned due to the cost of specialized nursing services needed to care for dementia patients. It's a cost the government doesn't want to be strapped with as many patients will end up in residential care. This issue will be a crisis in the future. In America, excellent residential care can cost upwards of $10,000/month compared to the cost of keeping a loved one in their own home. Residential treatment for dementia patients requires nursing care and most regular households don't have the medical expertise or ability to take care of this vulnerable section of the population. As money dwindles and healthcare becomes completely overwhelmed as they already are, this issue will become a crisis.
    Its easy to take care of an ambulatory parent without Alzheimers. Imagine taking care of a parent who can't walk, dress or have control of their bowel functions. These issues are too stressful for any regular family to take care of with little support and government help. Specialized nursing home care can better deal with Alzheimer patients because they have three different shifts of specially trained nurses and all the equipment and support available. You can try to be a saviour to your loved one but you'll quickly burn out. This issue is a looming crisis of monumental proportions.

    Complain about this comment

  • 38. At 09:19am on 17 Jan 2010, bill wrote:

    @ clamdip lobster claws

    Adequate residential dementia nursing care is available in the UK for around £800 a week; care at home including living expenses will require 24 hour dementia nursing cover, which would cost around three times as much. This is well beyond the financial resources of most people.

    However, most people in dementia care have paid tax and national insurance throughout their lives, on the promise that they will be cared for at the end of their lives. The government is obliged to honour this obligation, and funding should be available.

    There are about 700000 dementia sufferers in the UK; which indicates the scale of the problem. If they were all in residential care it would cost around 700000 x 40000 = £28bn a year.

    This is a worst case scenario, so clearly the funding is available out of a £500bn annual budget if other less necessary expenditure is curtailed.

    Complain about this comment

  • 39. At 10:17am on 17 Jan 2010, Angel_in_Transit wrote:

    #38

    "However, most people in dementia care have paid tax and national insurance throughout their lives, on the promise that they will be cared for at the end of their lives. The government is obliged to honour this obligation, and funding should be available."

    I applaud your honest statement about the Government's obligations within the auspices of the National Assistance Acts. It would seem however that our politicians are more concerned with "insuring" the health of our banks rather than the health of their citizens and misappropriate funds from national insurance payments as if the money belongs to them.

    It is often stated that there are pets who are treated better than huge droves of people, especially in the third world, and it saddens me to continue to watch the once great British way of life squandered to "corporate" greed. The USA already has its own domestic "third world" and the UK is rapidly catching up; how long before doctors will be saying to their patients (or their loved ones) "he/she/you is/are better off dead"?

    Complain about this comment

  • 40. At 1:15pm on 17 Jan 2010, John Ellis wrote:

    This comment was removed because the moderators found it broke the House Rules.

  • 41. At 5:27pm on 17 Jan 2010, copperDolomite wrote:

    Yes, memory problems often seem to afflict the journalists working at the BBC.
    Mark, you've forgotten that England is not Britain, it is only part of it, or is this the EBC?

    Complain about this comment

  • 42. At 6:21pm on 17 Jan 2010, I-Hate-People wrote:

    I would just like to say that for a demented corporation the BBC is amazing...

    Complain about this comment

  • 43. At 6:37pm on 17 Jan 2010, I-Hate-People wrote:

    ...ly corrupt in its filtering of peoples comments.

    Stop it you childish fools or expect more puerile comments from disgruntled licence-fee payers.

    Complain about this comment

  • 44. At 6:50pm on 17 Jan 2010, I-Hate-People wrote:

    Map of the Week: Dementia - Main address: Wood Lane, London, W12

    Complain about this comment

  • 45. At 6:54pm on 17 Jan 2010, clamdip lobster claws wrote:

    Bill and Angel in Transit,
    I totally agree because the government uses taxpayer funds to subsidize big companies and banks as if we were their private piggy bank. Essentially, telling older people its 'best if they die' is already happening because Obama's health care plan is scaling back on operations for the elderly. The poor are also affected as they can wait up to 6-12 months to get life saving surgery. We are in a looming healthcare crisis and so probably is England but its citizen's just don't know it yet.

    Complain about this comment

  • 46. At 7:15pm on 17 Jan 2010, clamdip lobster claws wrote:

    Bill,
    Thank you and you bring up another excellent point regarding the high cost of quality residential care. Considering the fact that the elderly sleep a great part of the day or feed the birds. Apart from therapy, occasional excursions and professional nursing care and entertainment which is usually voluntary, I don't understand why it costs so much? To me, its a lot of fluff and profit because its obvious that the money isn't going into the nurses pockets. I'm thinking these facilities are highly profitable but I'm not sure.

    Complain about this comment

  • 47. At 09:26am on 18 Jan 2010, The Trough wrote:

    Mark your report is interesting particularly as I may face the issue with my parents in due course. However it would be more valuable still if you were able to include Scotland in the statistics which I assume would be availble for the NHSiS.
    Indeed the differences between the government approach to healthcare provision may well add an interesting aspect to the differences locally as you have shown.
    As a general comment. When reports such as this ignore Scotland they add weight to programme production in Scotland and to division. That would be a loss to us all I believe.

    Complain about this comment

  • 48. At 10:12am on 18 Jan 2010, oobuc5 wrote:

    The gov said of BSE/ BIRDflue/ SHEEP varient/ AND PIG flue , NONE OF THESE CAN CROSS OVER THE HUMANS, [they said ] ,
    and back when bse was rife they found out diferent but kept quiet about it,
    And now we have the results of this ,the gov wont come clean about the figures ,but they have been gathering information about peoples conditions since the bse incident and keeping it quiet [people in the nhs know this ]but i doubt if the true figures will ever come out !





    Complain about this comment

  • 49. At 12:18pm on 18 Jan 2010, John Ellis wrote:

    Re 40# Popeye and spinach really don't understand why you would remove the history of this cartoon..

    CL Claws wrong type of green leaf ..

    the mistake
    http://health.learninginfo.org/spinach-facts.htm

    The influence
    http://www.cannabisculture.com/articles/3568.html

    Complain about this comment

  • 50. At 1:36pm on 18 Jan 2010, WolfiePeters wrote:

    I believe that health authorities have a financial interest in not diagnosing or recognising dementia. If they do, the old people who need care because of it need care for medical reasons and the cost falls on the health authority. However, if old people need care for non-mendical reasons (I know that only a 'public servant' could conceive of the possibility), then the cost falls on the unfortunate individual in need of the care.

    Personally, the discussion scares the hell out of me.

    Complain about this comment

  • 51. At 2:51pm on 18 Jan 2010, busby2 wrote:

    "Its easy to take care of an ambulatory parent without Alzheimers. Imagine taking care of a parent who can't walk, dress or have control of their bowel functions. These issues are too stressful for any regular family to take care of with little support and government help".

    Alzheimers is a tragedy but to extend life, when the advanced stage is reached, is simply to prolong the tragedy for all concerned (ie the victim and the family) and for what purpose or benefit?

    We should not therefore be looking to spend more money on looking after Alzheimer sufferers but on spending money on how to prevent or delay the onset of Alzeheimers. In that way the number of advanced sufferers would be greatly reduced because potential victims would be far more likely to die from other natural causes before advanced Alzheimers could take hold.

    Complain about this comment

  • 52. At 4:26pm on 18 Jan 2010, clamdip lobster claws wrote:

    busby2,
    There are people who have lost their ability to care for themselves but still have the will to live. If so, we should honor that and likewise, if an older person who has lead a good life and is ready and wants to die, we should honor that too. I agree that money would be well spent on finding a cure but that could takes years, in the meantime, the reality is that people will suffer from dementia and will need quality treatment. We need a health care system that can manage this looming crisis.

    Complain about this comment

  • 53. At 5:14pm on 18 Jan 2010, busby2 wrote:

    "busby2, There are people who have lost their ability to care for themselves but still have the will to live".

    I agree entirely but I was referring to those with advanced Alzheimers who cannot make any decisions for themselves. This is the difficult group, not those who need a great deal of care with active minds who can make decisions for themselves.

    But what should we spend on looking after those with advanced Alzeheimers and what should we forego to fund it? That is why it is so important that we should be spending far more on prevention and the delay of the onset of Alzeheimers.


    Complain about this comment

  • 54. At 10:27pm on 19 Jan 2010, clamdip lobster claws wrote:

    Busby2,
    People with advanced Alzheimers need a system of protection even more so. I would spend less on gang related drug and knife deaths if the victim is a known gang member or has gang affiliations. How much of the healthcare budget is spent on these people causing so much mayhem in our communities? Most people in Los Angeles won't go to an emergency room on a Friday-Sunday because they know they will never get treated in a reasonable time because beds are taken up by gang victims. That's my solution.

    Complain about this comment

  • 55. At 9:04pm on 20 Jan 2010, Tim Winch wrote:

    Hello, Mark My fear, bourne out of some experience in prescribing the drugs that you mention, is that Dementia isn't a great example to illustrate the structural problems with the NHS that you describe. This is as,I expect,you instinctively feel that the value of dementia drugs (to patients ) is more than it actually is. Indeed, areas of low spend might just be areas stuffed with wise clinicians and savvy managers. Berkshire, perhaps? These drugs, provided for us by some of the world's most powerful multinationals, give minimal benefit to a minority of early cases. The money might be better spent on non-drug support for patients and carers. Thank you for your article. Tim Winch

    Complain about this comment

  • 56. At 7:24pm on 22 Jan 2010, beezy wrote:

    Worrying certainly and I dont see the nhs improving over the years but I dont think you need to single out dementia, the same problems are felt caring for most people with terminal illnesses. For example, mnd is a rare terminal illness but incredibly cruel you lose all physical functions but maintain full mental functions what can be worse? I think emphasis needs to be on preventation and a serious debate about making euthanasia legal.

    Complain about this comment

  • 57. At 12:35pm on 23 Jan 2010, John Ellis wrote:

    This is interesting on mental health diagnosis..
    http://news.bbc.co.uk/1/hi/sci/tech/8470258.stm

    maybe we are now on a road to more selective treatments with correct diagnosis of conditions and not just guess at the dissorder suffered.

    Complain about this comment

  • 58. At 4:48pm on 23 Jan 2010, Luke Addis wrote:

    My Nan suffered from Dementia for the past 3 years and died 2 weeks ago. I agree with some of the comments posted by various people. I would like to shift the line of thinking a little. Why is it in England that the answer to most illnesses, pysiological/psychological states comes down to simply diagnosing and writing out a prescription for some cocktail of drugs? We are lucky to have access to the particular meds being mentioned here but nothing has been said for the psychological factors that may need to be addressed for brain deterioration. The same can be said for heroin addicts. With an increasing heroin availability in Britain, people should be more focussed on using therapy, counselling psychological assistance alongside the medications being prescribed. Somebody that may be easily addicted to a trend, may just find what we call the 'treatment', becomes the new dilemma(subutex, methodone). And of course it should not matter where you live in Britain, there should be a national standard provided by the NHS. It just raises too many if's, when's and why's. This issue of dementia/alzheimers needs to be addressed and i find it quite absurd that your access to medication will be dependent on an independent decision made by an area. The urgency of this should not come down to a matter of opinion about how urgent care is for these people. None of us are that special and i feel we must get our priorities ironed out a little. This is urgent so please get on with the obvious and dont wait until one of your loved ones is affected and you see them decline in physical and mental health, losing all dignity they might have one day had. Another thought might be to look at social factors and for once compare the English line of thought with another nation outside of The British Isles. We may learn more.

    Complain about this comment

  • 59. At 2:42pm on 24 Jan 2010, SueLiz wrote:

    When my memory started to 'go on the blink', my sympathetic teenaged son would refer to them as 'senior moments' (cheeky so-and-so!).

    Then I had a conversation with a friend, who had begun the same medication I've had for several years. She, too, had noticed a speedy detereoration in her memory. I researched our joint medication and found that two of my meds are reknowned for causing memory loss (Fluoxetine and Lipitor).

    I spoke with my doctor at the time of discovery, but she could offer no solution. So, memory blanks continue, even mid-sentence and I now write copious lists and notes as reminders (keeping the Post-It company solvent for at least the next five years!)

    Complain about this comment

  • 60. At 09:42am on 26 Jan 2010, EBAYTKMAX wrote:

    I work in a care home a client there has dementia, it is heartbreaking! We the staff didnt know this client before moved in to the home, client is double incontinent, tries to bite us when we give medication, becomes angry for no reason, we the staff offer the very best, this client really needs one-to-staff but this isnt always possible as there are many other clients to help & care for. My friend told me she works in a home where ALL the clients there have Dementia, there, I wouldnt choose to work, when this 1 client needs all our help, all of the time. For the good homes that do a fantastic job, like we do, well done! Lets hope the bad nursing homes get foundout very soon!

    Complain about this comment

  • 61. At 09:46am on 26 Jan 2010, EBAYTKMAX wrote:

    I certainly wouldnt like it to happen to me! Having looked after a client at work. This client doesnt know anything that is happening in our world. I think home carers too are fantastic, we need to get behind them & more support offered!

    Complain about this comment

View these comments in RSS

BBC iD

Sign in

BBC navigation

BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.