NHS: Dementia Treatment Trials

Question

Asked by

To ask His Majesty’s Government what steps they are taking to assess and prioritise investment in trials of new dementia treatments in the NHS.

My Lords, across the last five financial years, the Government have spent more than £555 million on dementia research, including into dementia diagnostics and trials of potential treatments. We are working for Britain to be at the forefront of transforming treatments and a world leader in dementia trials expertise. We are prioritising that through investment in the UK Dementia Trials Network and the Dementia Trials Accelerator.

I am very grateful to the Minister for that update. Dementia is now the most prevalent mental disorder in the country and the leading cause of death in women. I think she will agree with me that, at the moment, only 30% of dementia cases ever get diagnosed. If we are to benefit from some of the new developments in treatments, which I recognise are not yet as efficacious as we would like, there has to be some more investment in ensuring that people get an early diagnosis, so that patients can not only be linked into trials as they come up but get the help and social support that they—and their families, of course—will need. Does the Minister have any plans to increase the dementia diagnosis rate?

We do indeed, and I certainly agree with the noble Baroness. A timely diagnosis is absolutely vital to make sure that people with dementia can access everything they need, live well and remain independent for as long as possible. We are committed to recovering the dementia diagnosis rate to the national figure of 66.7%, and as of 31 March the figure stood at 66.3%. That is an increase from the time before and we will continue, through developing the modern service framework, to drive that upwards.

My Lords, dementia is projected to reach 1.4 million people by 2040, yet Alzheimer’s Research UK reports that up to 45% of dementia cases could be prevented or delayed. Will the Government commit to a national dementia public awareness campaign to support risk reduction and healthier ageing?

Encouraging people to age well and healthily is indeed part of our whole drive in terms of prevention and moving away from sickness. As part of this, it is absolutely crucial that we have the NIHR and UKRI, which are the relevant arms of our health service where we are investing in that dementia research. Causes, diagnostics and prevention in order to get treatment, care and support, as the noble Baroness says, are absolutely crucial. I would include carers in that too.

My Lords, while accepting the importance of early diagnosis and the improvements that are being made, does my noble friend agree that families—and she has mentioned carers—are often reluctant to seek a diagnosis? They think that these are only small symptoms of confusion and do not want to go for the full diagnosis on dementia. Would the public awareness campaign, mentioned from the other Benches, also include encouragement to families and carers to seek that diagnosis?

My noble friend is right: we want to encourage people to come forward for diagnosis and care. On the point that my noble friend and the noble Baroness, Lady Pidgeon, made about an awareness campaign, I will raise that with the Minister for Care.

My Lords, NHS England has said that implementing some of the new, promising drugs that exist, when they get clearance from NICE, is going to be one of the biggest challenges the NHS has faced in its 75 years. Is the Minister confident that the steps that she has set out for improving diagnosis are up to that challenge, so that we can reduce the proportion of dementia patients who do not receive a diagnosis—around a third—to much smaller levels?

Yes, indeed. I am feeling positive about the way we are moving forward, about increasing research and about developing a frailty and dementia modern service framework by the end of this year, as the noble Baroness, Lady Casey, has called for. On the question of drugs, to which the noble Lord has referred, I can confirm that NICE is currently evaluating two licensed disease-modifying treatments for Alzheimer’s disease; it will meet to consider that on 8 July.

My Lords, if our intention is to increase the diagnosis rate of early dementia, normally what we would do is to find a screening test that would identify people at risk of any disease. There is one called Mini-Cog; it takes three minutes to administer and uses word registration and recall and a clock to diagnose early dementia. Why do we not use that as a screening test, easily implemented by trained people to increase the rate of diagnosis of dementia?

That will be considered. We have the Dame Barbara Windsor dementia goals programme, which very much aims to speed up the development of new treatments for dementia and neurodegenerative conditions by accelerating innovations, including in clinical trials. I agree that we need diagnosis that is effective and thorough, and the point that the noble Lord raises will of course be considered in all that.

My Lords, Wes Streeting was absolutely right when he said that prevention is better than cure. The onset of dementia can be delayed by regular exercise and eating healthily, but the facts are that one in three adults is not taking the recommended NHS guidelines for exercise. Ultra-processed foods provide more than half the total energy intake in UK adults, and the National Institute on Aging has suggested that what we eat, such as fruit, vegetables and whole grains,

“affects the aging brain’s ability to think and remember”.

Fixing this will not only make the population healthier, saving the NHS tens of billions of pounds, but prevent the onset of dementia. Surely it is time to act at pace.

I believe that we have upped the pace. It is very important, as I know the noble Earl is aware, to go with evidence-based solutions. Indeed, when I speak to the point about an evidence base, that is why we have several research initiatives, including, as I mentioned, the dementia trials network and the trials accelerator. Both of those are speeding up the set-up of early and late-phase clinical trials. We have already gone well under our ambition of 150 days to set up, at 122. We are positioning ourselves well to be a global leader in a way that I am sure the noble Earl would want us to be.

My Lords, does the Minister agree with me that, while the noble Lord, Lord Patel, is quite keen on screening tests, we can both agree that screening tests have all sorts of major disadvantages, such as false diagnosis or unclear diagnosis? If we are not careful and do not have a test that is really reliable, we could end up with much more unnecessary worry for people who, for all sorts of reasons, believe that they have dementia when actually they are simply being a bit forgetful. That is important for health.

My noble friend makes a very fair observation that probably applies to many situations. When we talk about diagnosis, we are talking about getting the right people diagnosed, and quickly. That is why the modern service framework, as I mentioned earlier, will be developed and is being developed with partners and those with a particular interest. That will make sure that any interventions not only improve dementia care but improve diagnosis and the waiting times for diagnosis.