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New Statesman
19-05-2025
- Health
- New Statesman
Better dementia diagnoses can lessen waiting list pressures
Dementia, the UK's biggest killer, puts massive pressure on our health and social care system – especially when it's undiagnosed. The King's Fund argues that delivering improvements on dementia is a litmus test for the success of integrated care systems to address system-wide challenges. Getting dementia right and going further and faster on diagnosis could therefore be a massive enabler to achieving the Government's three key shifts in healthcare and meeting its targets on 18-week waiting times, against which impressive progress has already been made. Ensuring this continues requires decisive action on dementia, which isn't getting the attention it needs. A third of people living with dementia in England don't have a diagnosis. For those that do, people live with symptoms for an average of 3.5 years before getting diagnosed. Waiting times for dementia diagnosis are also steadily increasing, from 13 weeks in 2019 to 22 weeks by 2023, according to latest available figures. Some integrated care boards have told Alzheimer's Society that improving dementia diagnosis rates in their areas will be less of a priority since it was removed from the 2025/26 NHSE operational planning guidance. People with dementia need an early and accurate diagnosis. Often, this will have to be confirmed via an MRI, CT or PET scan, or a lumbar puncture. But scan waiting times are rising, too. There's also huge variation in access to a diagnosis, with the number of patients at memory assessment services who have a scan varying from 0-90 per cent. The Government's pledge to double the number of CT and MRI scanners could help address these challenges, but we need to see additional capacity specifically used to support this. Although around one million people in the UK live with dementia, it's never been prioritised as it should be. When we consider the burden that dementia represents for the system and the economy, it can be difficult to understand why. In 2024, dementia cost the UK economy £42bn. Without action, this is set to rise to £90bn by 2040. People with dementia occupy one in every six hospital beds, make around one million A&E visits each year, and account for over 36 million contacts across primary, secondary, specialist and mental health care services annually. Earlier and better diagnosis could help reduce the enormous impact that dementia is having on the system. For example, evidence commissioned by Alzheimer's Society shows a lack of diagnosis risks increasing healthcare use. Undiagnosed people are 1.5 times more likely to go to A&E than someone with mild, moderate or even severe dementia. The same research found that, on average, someone with severe dementia who has an unplanned admission stays in hospital for a month. By focussing on getting more people a dementia diagnosis, we have huge potential to free up hospital beds and avoid emergency hospital admissions altogether. That means reduced pressure on the NHS, and a significant step towards moving care from hospitals to communities. Subscribe to The New Statesman today from only £8.99 per month Subscribe The Institute for Fiscal Studies has said that 'the government will more likely than not miss this 18-week waiting time target.' To reach its goal, the UK government must ensure more people with dementia get a diagnosis, so they can access help and maintain independence for longer in the community, away from hospital settings. In contrast, failing to address the impacts of undiagnosed dementia, and dementia as a whole, will make it far harder for government to achieve its goals on healthcare. As well as helping people access care, a diagnosis also means they can plan for the future. It provides the simple dignity of clarity for the people affected. Evidence shows the support unlocked by a diagnosis can keep people with dementia out of crisis, out of hospital and living in their own homes, freeing up beds. In turn, this will help with reducing waiting times across the NHS. By prioritising dementia diagnosis, we are also helping to ready the healthcare system for new disease-modifying treatments. These can slow progression of Alzheimer's disease, but they rely on early and accurate diagnosis. At the World Dementia Council Summit 2025, Patrick Vallance, Minister for Science, Research and Innovation, spoke about the opportunity to align the 10-Year Health Plan with the Life Science Healthcare Goals. If the government wants to be a leader in dementia, and prioritise the condition relative to its impact, it's key the system is ready for such breakthrough treatments. The current target timeframe for a dementia diagnosis is six weeks from the point of referral, but this only happens for 10 per cent of patients at memory assessment services Meanwhile, just 1.4 per cent of all dementia healthcare spend currently goes on diagnosis and treatment. The government's efforts on elective care show what can be achieved when there is focus and drive on a specific issue. Chief Medical Officer for England, Chris Whitty, argues that early dementia diagnosis 'helps to avoid unnecessary admission to a care home or hospital', providing 'substantial savings on long-term care costs.' By investing in diagnosis now, and ensuring new scanning capacity is utilised for dementia, we could see more people diagnosed early and accurately, which benefits both the person and the healthcare system at large. In the future, blood tests could also be used for diagnosis on the NHS – Alzheimer's Society is proud to be co-funding work to make that a reality sooner – but we need the government's help to drive the action that's needed. Right now, we have a target that two-thirds of people living with dementia in England should get a diagnosis. But with prevalence on the rise, that's just not ambitious enough. We need to see bolder targets, from ensuring all diagnoses include dementia type and happen early in disease progression as long as the patient chooses it, to empowering clinicians through better access to imaging and staff who are trained to read scans. A situation where so many people don't get a dementia diagnosis is not good for them or the NHS. Waiting times are falling, but to maintain and accelerate progress, there must be action on dementia too. We can't leave people with dementia waiting. It's time to make dementia a priority. Doing so could be the missing piece of the puzzle that enables the Health Secretary to meet his targets. This article first appeared in our Spotlight Healthcare: Parity of esteem supplement of 16 May 2025 Kieran Winterburn is Alzheimer's Society's head of national influencing Related
The Guardian
08-04-2025
- Health
- The Guardian
The Guardian view on staffing the NHS: Wes Streeting needs a plan for its people
Responding to the first NHS long-term workforce plan, in 2023, the King's Fund thinktank described staff shortages and gaps in England as amounting to a 'deeply entrenched crisis'. That document was meant to be the start of something. Under the Conservatives, parliament rejected the idea that NHS England's jobs strategy should be subject to independent scrutiny. But given the initial estimate of a 260,000 shortfall in England's health workforce (including doctors and nurses), there was a promise to review the position in two years. That date is fast approaching. Fixing the workforce should be among the big themes of Labour's 10-year plan for the health service, when it is published in June. Attention in recent weeks has focused on the centre, following the announcement that NHS England would be scrapped and its functions, along with around half of its 15,000 staff, brought back inhouse to the Department of Health and Social Care. Manoeuvring at the highest level continues, with Sir Chris Whitty filling the role of permanent secretary on an interim basis. But what of the changes on the frontline that will be needed if the government is to succeed? The deployment of community health and wellbeing workers to 13 more areas, following a successful pilot, is one clue to what lies ahead. While not clinically trained, like health visitors, these workers are responsible for checks on households in a given area that are known to need support, and can help with housing or other practical issues as well as health. Early results are promising. This kind of holistic outreach looks consistent with the government's aim of pivoting towards prevention in the community, and reducing the proportion of health budgets spent in hospitals. But developing new roles and projects like these while simultaneously slashing budgets and jobs will be challenging, to say the least. Instructions to NHS trusts to cut by 50% the cost of their corporate functions, such as HR and communications, could lead to the loss of 100,000 posts in total – and a huge redundancy bill. Integrated care boards are also under instructions to slim down and focus on commissioning. At the health select committee on Tuesday, Wes Streeting depicted himself as a warrior against bureaucratic bloat. Far from a power grab, he told MPs, the merger with NHS England is intended to push decision-making down the line to neighbourhoods. On the reduction of centralised targets, he stuck to his guns. Ministers want more 'doers' and fewer 'checkers'. Will community and primary care services be able to deliver what is asked of them? However the 10-year plan is framed, this looks like being a key question over the next few years. How to reconcile a commitment to local innovation with demands for fairness is another. On waiting lists, and GP numbers, there is modest progress to report. The risk is that cuts and reorganisation cause more problems than they solve. Talking up the importance of 'doers' is one thing. But staff morale and patient satisfaction are both at worryingly low levels, with further strikes a strong possibility. The entrenched crisis in the NHS workforce is ongoing.
The Guardian
02-04-2025
- Health
- The Guardian
Could antibiotics stop working? Yes – but the biggest danger isn't prescription-happy GPs
If the antibiotics we use to treat infections ever stopped working, the consequences would be catastrophic. It is estimated that the use of antibiotics adds about 20 years of life expectancy for every person worldwide (on average). As the King's Fund put it, if we lose antibiotics, 'we would lose modern medicine as we know it'. Doctors, public health experts and governments take the threat of antimicrobial resistance (AMR) very seriously, yet the problem appears to be getting worse. A report from the National Audit Office in February finds that out of five domestic targets set in 2019 to tackle AMR, only one has been met – to reduce antibiotic use in food-producing animals. Others, such as the target to reduce drug-resistant infections in humans by 10%, haven't made much progress; in fact, these infections have actually increased by 13% since 2018. AMR is often misunderstood. I have often heard people say 'I'm afraid of taking antibiotics and becoming resistant to them.' But AMR isn't about individuals becoming resistant to antibiotics. It's about pathogens – most often bacterial infections but also viruses, fungi and parasites – evolving to become resistant to our current drugs, so that the infections they cause become untreatable. Think of ear, urinary tract and chest infections, or procedures such as C-sections and other routine surgeries, becoming life threatening because the drugs we use to treat infections or to prevent them after medical procedures don't work. However, I despair at Britain beating itself with yet another stick. The country has actually been fairly good at tackling AMR. In 2023, our research team led by Jay Patel published an analysis in the Lancet Infectious Diseases journal measuring the global response to AMR in 114 countries. The UK made the top three 'best performing' countries with only the US and Norway ahead, followed by Sweden, Denmark, Germany and Japan. The credit in the UK largely sits with Dame Sally Davies, the chief medical officer for England from 2011 to 2019, who made it a priority during her tenure and continues to lead as the UK special envoy on AMR. The UK government has led on national guidelines and oversight in human and animal health in conjunction with the EU. We may worry about doctors overprescribing antibiotics in the NHS, needlessly exposing pathogens to these drugs and allowing them to evolve resistance. But having worked on AMR governance before, my take is that the biggest threat is the rise of resistant pathogens emerging in countries using huge amounts of antibiotics in their animals for growth and cheap meat. Think of pigs, chickens and cattle in China, Brazil, India and, even until recently, the US. Livestock alone is estimated to consume 50% to 80% of the antibiotics produced in high- and middle-income countries. These resistant pathogens develop in animals, which are given antibiotics as a prophylactic even when they're healthy. They then infect a human, who may travel and spread it to other humans. It is a straightforward formula. Antibiotics in animals plus farm workers plus air travel equals drug-resistant infections in the UK, and elsewhere. It is not just theoretical. In 2018, a study in Nature found that widespread colistin-resistant bacteria, including in hospitals in London, could be traced to a single event in 2006 in China when a bacteria jumped from pigs into humans. Colistin is a last-line antibiotic for certain infections, meaning it is given after other drugs have failed, yet it was used heavily for growth promotion in pig farming in China. Since these findings, the Chinese government, as well as India and Japan, banned colistin in animal feed. This probably will have a larger impact on reducing AMR than anything being done in UK clinics and with human prescribing practices. The UK is best protected from drug-resistant infections by working with other countries to regulate the use of antibiotics, especially in animals. Davies has tried hard to push this agenda globally, bringing together human health, agricultural and vet experts to agree on standards and regulations that are a universal good. However, there is a clear conflict with those who argue that boosting animal production, including of cheap and available meat, is the priority, especially in middle-income countries with large populations. Why can't we just develop new antibiotics if our current ones become ineffective? Simple question and tough answer. These are technically difficult drugs to develop and we have made very slow progress. Developing similar versions to existing antibiotics isn't enough because they won't be as effective against pathogens that have developed resistance: we need totally new classes of drugs. And a recent World Health Organization report noted that since 2017, while 13 new antibiotics have obtained authorisation, only two represent a new chemical class. Our best to shot to tackle AMR is to protect our current arsenal of drugs and make sure they remain effective. This means working with other countries on a shared approach to how and when drugs are used in humans and animals. This is an ongoing challenge, especially in a world where cooperation is breaking down and isolationist approaches are on the rise. Yes, we can blame the UK government for many things, but on the issue of AMR it is a standout country and a global leader. Prof Devi Sridhar is chair of global public health at the University of Edinburgh, and the author of How Not to Die (Too Soon)
The Independent
01-04-2025
- Health
- The Independent
Six in 10 people unhappy with NHS, poll reveals amid ‘startling collapse' in public satisfaction with health service
Almost two-thirds of people are dissatisfied with the NHS, according to a major new poll which reveals a 'startling collapse' in the public's view of the health service. The British Social Attitudes (BSA) survey of more than 10,000 adults across England, Wales and Scotland found that 59 per cent of people said that they were either 'quite' or 'very' dissatisfied with the way the NHS runs – the highest level of dissatisfaction reported since the survey began in 1983. Nearly one in 10 people also reported they have been harmed by the health service in recent years, with the highest levels of harm reports in hospitals. The survey, which was carried out in autumn 2024 and has been published by the Nuffield Trust and the King's Fund, shows sharp drops in satisfaction with particular services, including A&E, GPs and dentistry. However, the findings suggest people still believe in the founding principles of the NHS and the majority believe it needs more money and staff. Healthcare bosses warned the findings were a 'wake-up call' for the NHS. The survey found that 9.7 per cent reported that they had been caused harm by the NHS in the last three years. This includes 6.2 per cent who reported harm as a result of treatment or care and 3.5 per cent who said that lack of access to care had caused them harm, according to the survey, which took place in late 2021 and early 2022. Of the 988 who reported physical or emotional harm, 37.6 per cent reported a 'moderate impact' and 44.8 per cent said they had suffered a 'severe impact' as a result. The report authors said the last time the Labour Party was in office, public satisfaction stood at 70 per cent. They said that level of satisfaction 'feels almost unreachable in today's more pessimistic times' and added the public's pessimism was reflected in the government's proclamation just weeks before the survey that the NHS was 'broken'. Interim chief executive of NHS Providers, which represents NHS hospitals, Saffron Cordery said: 'These figures must be a wake-up call for the NHS. 'While public support for the fundamental principles of the NHS is still rock solid, it's clear radical action is needed across the board to restore the public's faith in the NHS and turn the tide on falling patient satisfaction.' The news comes following announcements by the government that it will abolish NHS England, the organisation responsible for the health service in England since 2010. Bea Taylor, Fellow at The Nuffield Trust, one of the report's authors, said: 'Just five years after the British public were called on to 'Protect the NHS' at the start of the pandemic, these findings reveal just how dismayed they are about the state of the NHS today. 'The government says the NHS is broken, and the public agreed. But support for the core principles of the NHS – free at the point of use, available to all and funded by taxation – endures despite the collapse in satisfaction.' Responding to the survey, Scottish Health Secretary Neil Gray said: "Patient safety is paramount and we are committed to ensuring all health and care is safe, effective and patient-centred. "When things go wrong we expect NHS Boards to fulfil their statutory duty to be open with patients about what happened and to learn lessons to prevent it happening again." A Welsh Government spokesperson added: "We want any harm or concerns about care provided by the NHS in Wales to be reported so that it can be investigated thoroughly and openly. "We are making the complaint process simpler so that the NHS can respond quickly to feedback, learn when things go wrong, and continuously improve the quality of care provided." A spokesperson for the Department of Health and Social Care in England said: 'When things go wrong in healthcare, the NHS must learn from it and provide compassionate support for those affected, particularly the most disadvantaged or vulnerable.' An NHS England spokesperson said: 'The NHS has made significant progress in strengthening patient safety – including a nationwide programme of training and education – and we recognise there is still more to do to improve care for patients by providing better access to services and reducing health inequalities.'
The Guardian
01-04-2025
- Health
- The Guardian
Patient satisfaction with NHS has hit record low of 21%, survey finds
Public satisfaction with the NHS is at a record low and dissatisfaction is at its highest, with the deepest discontent about A&E, GP and dental care. Just 21% of adults in Britain are satisfied with how the health service runs, down from 24% a year before, while 59% are dissatisfied, up from 52%, the latest annual survey of patients found. Satisfaction has fallen dramatically from the 70% recorded in 2010, the year the last Labour government left office, and the 60% found in 2019, the year before the Covid-19 pandemic. Mark Dayan, a policy analyst at the Nuffield Trust thinktank, which analysed the data alongside the King's Fund, said the years since 2019 have seen 'a startling collapse in NHS satisfaction. 'It is by far the most dramatic loss of confidence in how the NHS runs that we have seen in 40 years of this survey.' A&E is the NHS service the public is least happy about. Satisfaction fell from 31% in 2023 to just 19% last year – the lowest proportion in the 41 years the British Social Attitudes (BSA) survey of the views of patients in England, Scotland and Wales has been carried out. Satisfaction with NHS dentistry has collapsed, too, from 60% as recently as 2019 to just 20% last year. More people (55%) are dissatisfied with dental care than with any other service. Similarly, fewer than a third (31%) of adults are satisfied with GP services. 'The latest results lay bare the extent of the problems faced by the NHS and the size of the challenge for the government', said Dan Wellings, a senior fellow at the King's Fund. 'For too many people, the NHS has become too difficult to access. How can you be satisfied with a service you can't get into?' The collapse in satisfaction from 70% to 21% in 14 years had been 'extraordinary', he said, adding that people should not be scared about going to A&E, or that an ambulance will not come quickly after dialling 999 or that they may have to get themselves to hospital some other way. 'People are sad and angry at the place we've got to.' A generational divide is also emerging. Over-65s are more likely to be satisfied, though the figure is still only 27%. But satisfaction among under-65s has fallen from 24% to just 19%. More positively, a narrow majority (51%) are satisfied with the quality of the NHS care they receive when they manage to access services. And there remains overwhelming support for its founding principle that it should be available to everyone free at the point of use and funded through taxation. Wes Streeting, the health and social care secretary, said: 'We inherited a broken NHS and this survey shows patients agree. Ever-longer waiting lists, widespread corridor treatment and a regular struggle to see your GP have led to these record levels of dissatisfaction with the health service.' Since the survey was undertaken in September and October, the government had 'taken the NHS off life support', pledged an extra £26bn in investment over the next two years and was drawing up a 10-year plan to make the service once again 'fit for the future', he added. Meanwhile, a separate study has found that almost one in 10 (9.7%) people in Britain have been harmed by either NHS treatment or a delay in obtaining help in the past three years. In 45% of cases, the harm the person suffered had a severe impact and in 38% of cases a moderate impact. But those from disadvantaged groups – such as people with a disability, from poorer backgrounds or with a long-term health condition – were more likely to be harmed and suffer serious harm. Researchers, whose findings are published on Wednesday in the journal BMJ Quality and Safety, surveyed more than 10,000 people in Britain between November 2021 and May 2022. They were asked about their experience of NHS adverse events, which included the medical or physical consequences of treatment, and also the psychological damage involved and harm caused by lack of access to care. 'Our study confirms that disparities in rates of NHS harm for socially disadvantaged groups exist and impacts are more severe,' said Dr Michele Peters, an associate professor at Oxford Population Health and an author of the study. 'These groups may find it harder to have their needs met within a difficult-to-navigate system with a culture that is less able to hear more vulnerable people.'
