Asked by
To ask His Majesty’s Government what assessment they have made of
the recommendations in the Alzheimer’s Society report Improving
access to a timely and accurate diagnosis in England, Wales and
Northern Ireland, published in May, on ways to improve and
futureproof the system for dementia diagnosis.
(Con)
My Lords, while no formal assessment has been made of the
Alzheimer’s Society report, we welcome research that will help us
to improve and future-proof the system for dementia diagnosis.
NHS England remains committed to the national ambition of
diagnosing two-thirds of people over 65 years of age who are
estimated to have dementia. Timely diagnosis of dementia is vital
to ensure access to advice, information, care and support to help
persons live well with dementia.
(DUP)
I thank the Minister for his response. There has been some
hopeful news regarding dementia in recent months that suggests
that we are potentially on the cusp of new treatments that, while
not curing dementia, could help delay or at least reduce the
level of significance of the disease. But that is effective as a
form of treatment only if it is not too late in the progression
of the disease for the individual. In light of the report that
suggests that a lot more work needs to be done on dementia
diagnosis, can the Minister outline what specific steps the
Government are taking to improve early diagnosis for dementia?
(Con)
I thank the noble Lord for his question and pay tribute to his
work on the APPG on Dementia. Timely diagnosis of dementia is
vital to ensure that a person with dementia can access advice,
information, care and support to help them live well with the
condition and remain independent for as long as possible. NHS
England is committed to increasing dementia diagnosis rates. NHS
England’s 2023/24 Priorities and Operational Planning Guidance
provides a clear direction for ICBs to support the delivery of
timely diagnosis with systems.
(Lab)
My Lords, will the Minister tell the House what has happened to
the pilots that were announced, due to start earlier in the year,
about the identification of dementia? In particular, will they
deal with the very large variation in diagnosis rates across the
country?
(Con)
The noble Lord raises a very important point. He is right that
there is substantial variation across integrated care boards in
dementia diagnosis rates. NHS England has commissioned a dementia
intelligence network to develop a resource to investigate that
very issue. It is important that we learn from the very best so
that we can put in place an industry-standard best practice to
make sure that we get the very best across the country.
(LD)
My Lords, is the Minister concerned that there may be
misdiagnosis of Alzheimer’s in people who do not speak English as
their first language because of the use of verbal cognitive
function tests? What are the Government doing to ensure that
appropriate tests are available for people from all the different
linguistic groups that have a significant presence in the United
Kingdom?
(Con)
We try to diagnose right first time, but the noble Lord mentioned
the important point of different languages. I do not have a
specific answer on what we are doing about that, so I will write
to him.
(Lab)
My Lords, timely and accurate diagnosis of dementia is also
important to the families of such patients, who are often
providing care in very difficult circumstances. While commitment
to patient confidentiality is of course important, does the
Minister agree that such information must be shared as soon as
possible with the families who are providing care?
(Con)
The noble Baroness is entirely correct. We want a society where
every person with dementia and their families and carers receive
high-quality, compassionate care from diagnosis through to the
end of life. NHS England is committed to delivering high-quality
care and support for every person with dementia, and central to
that is the provision of personalised care and support, with
planning for post-diagnostic support. This is a terrible disease
and not one hat fits all, so, as the noble Baroness points out,
we have to personalise it wherever we can.
The Lord
My Lords, I am grateful to the Minister for his answers on the
diagnosis of dementia. Will he also outline what is being done to
measurably improve the structures of support for those diagnosed
with dementia, not least in the early stages, given the
increasing social isolation that sufferers experience and the
onerous costs they must often bear? This is increasingly evident
in our parishes, in our wider communities, in the experience of
clergy up and down the land and in my own diocese of Southwark.
(Con)
The right reverend Prelate raises a very important point. I refer
him to my previous answer, but he is absolutely right to point
out his diocese and parishes across the land. The NHS can do only
so much, but it is important to have communities coming together.
In my experience, the Church does a fantastic job, including the
community groups that church organisations and others have at the
very local level. Not everything can be done by the NHS, but
people in communities can help carers, families and those with
dementia to a very high level, in my experience.
(CB)
My Lords, people with learning disabilities are more likely to
develop dementia, but particularly in complex cases of learning
disabilities the symptoms are very often masked. What can be done
to help those who care for people with learning disabilities to
spot symptoms early on, so that diagnosis can take place and
treatment can begin?
(Con)
The noble Baroness is exactly right. She raises a point about
carers. Carers are not professional people; they are loving
partners who vary in their experience and knowledge of this
disease. I do not have a specific answer to her question other
than to say that, generally, carers are far more recognised than
they used to be and do a fantastic job. In fact, we would not be
able to look after those 600,000 people in the country without
those individual carers. I will write to her with a more specific
answer, but she is absolutely right that carers are key to the
care of people with dementia.
(Con)
Is not the key word “timely”? In relation to that word, is it not
time that the junior doctors throughout the United Kingdom
recognised that timeliness in relation to many conditions is
being jeopardised, so long as they continue to go on strike week
after week? Should they not recognise the Hippocratic oath that
they took in the first place to do no harm to their patients?
(Con)
My noble friend raises a very important point. It is important
that junior doctors and others come to some agreement and do not
continue with their strikes. I understand that there are strong
feelings on all sides, but we all have to work together—carers
and healthcare professionals—to do what we can for people
suffering from this dreadful disease.
(Lab)
My Lords, one of the important points that emerged from the
report was on the importance of workforce training. In many
instances, the first point of contact for anybody with such
symptoms is their GP. Can the Minister outline what steps the
Government can take to ensure that GPs are trained to identify
dementia symptoms and differentiate between types of dementia?
(Con)
The noble Baroness is absolutely right. There are different types
of dementia at different stages depending on the individual and
their age. Unfortunately, it can start very early on, in their
30s and 40s. In my experience, GPs and their practices are very
well trained and knowledgeable in such matters. If the noble
Baroness has any specific concerns in her area I can certainly
look into them, but GP services do a very good job overall. We
also have on our high streets things such as dementia awareness,
where retailers and other public services recognise the early
signs of dementia to make sure that people get the services they
require.
(CB)
My Lords, the Minister may recall that I asked a Question about
dementia palliative care teams before the Summer Recess. Can he
give the House an update on the progress in rolling these out
around the country?
(Con)
I do recall the noble Lord asking that Question, but I do not
have that information to hand. I cannot update him in person, but
I will certainly write to him in detail.
(LD)
My Lords, we know that there is a national shortage of care
homes, but when people have dementia, getting into a care home
becomes even more difficult because many care homes do not cater
for patients and people with dementia. Will the Minister
acknowledge that this is an additional problem to the care home
problem that this country has, and tell us what his department is
doing to address the drastic shortage of care home places for
people with dementia?
(Con)
That issue varies around the country. In some areas, there
certainly are shortages; we all know of examples where there is a
shortage of beds for dementia services. Some areas are better
than others and more can certainly be done, but the noble Lord
highlights a very good point. Most families will agree that it is
very important to keep dementia sufferers in their own home. That
brings us on to the point about carers and communities working
with families to keep those dementia sufferers in their own home
for as long as possible.
(Lab)
The Minister has recognised that dementia diagnosis rates vary
significantly across the country, but we are less sure about
exactly why. Does the Minister agree that, without this key
information, it is impossible to address the current diagnosis
postcode lottery? What steps are the Government taking to bring
the diagnosis pathway up to the required standards everywhere,
and what consideration have they given to the introduction of
culturally relevant assessment tools to support this?
(Con)
NHS England is taking several actions to improve diagnosis rates.
In the financial year 2021-22 the Government allocated £17
million to the NHS to address dementia waiting lists and increase
the number of diagnoses. NHS England is sharing learning on good
practice with dementia clinical networks. There is a substantial
variation of ICBs throughout the country, as I said previously,
and the Government have recognised that. That is why they have
commissioned the dementia intelligence network to investigate
this and report back.
