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The Health Foundation (Nightingale & Merrifield) recently criticised the Government as showing a “dangerous pattern on action for health.” Recent announcement that the health disparities white paper will not be published exposes a pattern of delay and dashed hopes. A similar pattern appears to be the case for dementia policy; we have been waiting for a refresh of the national dementia strategy and now we have heard that dementia policy will be incorporated into ‘major conditions strategy’ (Government action on major conditions and diseases).

The authors comment that COVID times highlighted the need to address health inequality. Similarly for dementia, we might have thought that the challenges faced during lockdown(s) might have shone a light on the desperate needs of people in communities. We have seen in the news media the distress experienced by people living in care homes, many living with dementia. Similarly people living in their own homes have had care and support withdrawn and care partners have noticed deterioration in cognition during lockdown.

As with the health disparities white paper, the promised dementia strategy refresh has been rolled into a major conditions’ strategy. Indeed, the policy change was noted at the Health Select Committee’s meeting of 21^st Feb on ‘preventative healthcare’ where James Morris MP questioned whether the progress of the mental health 10 year view would be maintained as it was being ‘folded into’ the ‘major conditions strategy’ (BBC Parliament).

Nightingale & Merrifield comment in their Health Foundation blog:

“…history shows us that focusing on medical conditions means activity gravitates towards early diagnosis and treatment within the NHS.”

What are the parallels for dementia policy? For over a decade we have had two major ‘arms’: Living well with dementia: a national strategy 2009 (including early diagnosis), Prime Minister’s dementia challenge 2012 (describing dementia-friendly community). The former is partly a response to the needs of biomedical research – we think the best chance of a new drug being effective is by targeting early elements in the disease process, therefore researchers need more people diagnosed early who can participate in these studies. Therefore we need better techniques to diagnose people earlier (which are usually referred to as biomarkers).

This change in policy direction from a detailed multi-faceted strategy, to being wrapped up in a ‘major condition’ policy is very likely to focus on hospital-based episodes of care, and to biomedical resources: biomarkers and drug development. It is likely to deprioritise care in people’s own homes and maintaining independence.

These latter two aspects relate to the second ‘arm’ of dementia policy mentioned above – dementia-friendly communities. This approach aims to tackle the stigma against dementia in our communities; to reduce the exclusion that people with dementia feel due to negative attitudes to dementia. It could be argued that this approach is more important to people in earlier stages of their dementia journey and is less of a priority for people at late stage of dementia. However, considering the policy-push for early diagnosis (the first of the two policy arms mentioned above) – we anticipate a greater number of people to be receiving a diagnosis and to be living many more years with this diagnosis. The lack of renewal of the national dementia strategy policy may indicate a lack of policy emphasis and investment in dementia care and support in the community.

In summary, this policy change is concerning because it implies a stepping back from a positive health (salutogenic) approach and reversion to a disease orientated (pathogenic) approach.