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April 9, 2015

Private Eye Issue 1388
Filed under: Private Eye — Dr. Phil @ 9:46 pm

Dementia Time Bomb

David Cameron’s reluctance to contest a third term or talk about the NHS is entirely understandable given the state it’s likely to be in whenever he leaves office. Last week, the Kings Fund reported that performance has regressed to 1990’s levels. NHS funding needs to increase year on year not just because people are living longer, but because they are living longer with multiple diseases, and particularly dementia. When the NHS was founded in 1948, half the population didn’t make it to 65. Now one in three people in the UK are likely to live to a hundred, and the person who lives to 150 may already have been born.

Between 1948 and 2011, NHS annual funding growth averaged 4%. From 2011-2015 it was 0.9%, and the target growth 2015-2020 is 1.5%. If Cameron wins the election, and even if he loses, the NHS is likely to be stretched beyond repair in five years. NHS England gets very excited about the efficiency savings from new models of working (Vanguard locality commissioning has now replaced GP Pathfinder commissioning on the bullshit bingo cards), but the biggest challenges to the NHS remain inequality, poor self-care and frailty. The difference in disability-free life expectancy at birth between the richest and poorest parts of the UK is nearly 20 years. A quarter of the population (over 15 million people) have a long-term condition such as diabetes, depression or dementia– and they account for 50 percent of all GP appointments and 70 percent of days in a hospital bed.

The number of older people likely to require care is predicted to rise by over 60 percent by 2030. And yet local authority spending on social care for older people has fallen in real terms by 17 per cent during Cameron’s first term. In that time, the number of older people aged 85 and over rose by almost 9 per cent. The number of people able to get publicly funded social care has fallen by 25 per cent since 2009 (from 1.7 million to 1.3 million) and in 90 per cent of local authorities only those with ‘substantial’ or ‘critical’ needs get publicly funded services.

The buck at present stops with unpaid often elderly carers. 32 percent of carers aged 65 to 74 are providing 50 or more hours of unpaid care a week, and 55 percent of carers aged 85 and over – many of whom are in bad health themselves. The number of carers aged 65 and over has risen by 35 percent since 2001 to 1.2 million, and 90,000 are over 85. For dementia alone, there are currently 850,000 people in the UK who have been diagnosed, costing the UK £26 billion a year. Two-thirds (£17.4 billion) of the cost of dementia is paid by patients and their families, either in unpaid care (£11.6 billion) or in paying for private social care. This is in contrast to other conditions, such as heart disease and cancer, where the NHS provides care that is free at the point of use.

The King’s Fund predicts that the financial cost of dementia in England will rise from £14.8 billion in 2007 to £34.8 billion in 2026. Research suggests that this cost could be significantly reduced by improvements in diagnosis, treatment and support for people with dementia and their carers to help avoid future admissions and improve clinical management. However, that would require a substantial investment in services. Currently only 43% with the condition get a diagnosis, and so 57% are denied the treatment and support they need.

By the age of 80 about one in six of us will have dementia, and one in three people in the UK will have dementia by the time they die. It is a progressive condition that gets worse over time and sufferers increasingly rely on carers as it advances. There is currently no cure although there are treatments that can slow the progression of some types of the condition in some cases. Usually, only about one in three people show a positive response to such drugs. The longer we live, the more of us will get dementia and – for all the government’s focus on the illness – the NHS and social care system simply doesn’t have the funds to care for those most in need, and it’s going to get a lot worse. No wonder Cameron – who put the NHS centre stage 5 years ago – doesn’t want to hang around to see it.

MD’s book – ‘Staying Alive – How to Get the Best from the NHS’ is published by Quercus