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Health reforms put dementia care in jeopardy

new study by ippr highlights the risk that new commissioning models will not meet the challenge of the growing need for dementia care. There are currently around 700,000 people in England with dementia – and that number is set to double in the next 30 years.

The study of services in London, commissioned by the City of London Corporation’s City Bridge Trust, reveals that the capital is facing a number of serious problems in the future provision of care for dementia patients:

  • Less than a third of GPs in the capital say they are able to diagnose dementia or to provide sufficient help for dementia sufferers
  • Dementia care is particularly poor for the over-80s in London who receive a worse service than people with early-onset dementia
  • The number of black, minority and ethnic (BME) Londoners over 80 is projected to triple in the next 20 years – and there is a serious lack of dementia services tailored to meet their needs
  • Failures of integration between health and social care services.

The report, Dementia care in London, warns that proposed health reforms could make things worse unless safeguards are introduced as a matter of urgency.

In particular, systems need to be put in place to strengthen the links between health and social care to ensure a more integrated service and a seamless care pathway for people with dementia. The report makes a number of recommendations:

  • The new Health and Wellbeing Boards should make dementia a priority
  • Co-location of health and social care services needs to be rolled out to ensure closer working between GPs and other providers
  • Local authorities need to retain a role in scrutinising dementia care provision
  • Dementia patients, and their carers, should hold their own personal budgets to pay for services
  • The NHS Commissioning Board should ensure that the quality of dementia care is included in the new outcomes framework by which GP consortia will be held to account.
  • One of the new ‘pathfinder’ GP consortia should pilot an early intervention approach to dementia care. This could provide the necessary evidence base to reassure future consortia that commissioning dementia services will make savings down the line.

Rick Muir, ippr's Associate Director for Public Service Reform, said:

'The extent and the quality of dementia care in London is clearly inadequate – particularly for the over-80s and for London’s fast-growing population of elderly people from ethnic minorities. At the same time, GPs admit that they do not have the skills to deal with this growing care crisis.

'The health reforms which bring in new commissioning arrangements are an opportunity to ensure that the wedge between health and social care doesn’t grow – leaving dementia sufferers stuck in the middle with inappropriate or inadequate levels of care. But at the moment it is far from clear that changes will rise to the challenge. 

'It’s essential under the new commissioning framework that both GPs and social care commissioners are held truly accountable, that good practice is driven forward and that joint working is supported. If this doesn’t happen many vulnerable elderly people will not get the care they need.'

Clare Thomas, Chief Grants Officer of the City of London’s City Bridge Trust, said:

'Dementia care has been a Cinderella service in London. It’s vital that we plan for the future now. The situation will worsen unless we act now and plan for more integrated services.'

Notes to editors 

Download Dementia care in London.

The City Bridge Trust, stewarded by the City of London Corporation, builds bridges across diverse communities through charitable grant-making. With the City at our heart, we promote social cohesion and address disadvantage throughout Greater London. With a strong track record in bringing overlooked problems to a wider audience, we ensure long-standing practical change. The City Bridge Trust is the grant-making arm of Bridge House Estates which maintains Blackfriars, Southwark, London, Tower and Millennium Bridge at no cost to the taxpayer. Surplus funds from the upkeep of the bridges are awarded in charitable grants to benefit Londoners. The sole trustee is the City of London Corporation. Since 1995 a total of £240 million has been awarded to charitable causes.


Tim Finch, Director of Communications, ippr: 0207 470 6110 / 07595 920 899 /

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