Brighton and Hove’s family doctors need to get better at spotting patients with dementia, according to a report by councillors.
The prescription is one of 14 which comes in a warning about the ageing population placing a greater strain on local health services.
The report says: “There is little effective early diagnosis of dementia … it is estimated that only around 30 per cent of people with dementia ever have their condition diagnosed.
“This means that the majority of dementia sufferers and their carers are left to cope without the most appropriate support.
“It also means that the cost of dementia care is increased as late diagnosis is strongly correlated with heavier use of residential care services which tend to be considerably more expensive than community support.”
The report is due to be presented today to the Overview and Scrutiny Committee of Brighton and Hove City Council by its cross-party Select Committee on Dementia. It can be read here.
It is intended to help shape thinking about how the council and the NHS locally will deal with the expected rise in demand for care from the growing number of dementia sufferers.
The select committee held an inquiry into dementia diagnosis and care and the likely future demands.
The report asks why diagnosis rates are so low and acknowledges that the stigma attached to dementia, including conditions like Alzheimer’s disease, are part of the problem.
It adds: “In part it may also be because the principal contact that most people have with the medical profession is with their GPs, and there are problems with GP diagnosis of dementia.
“These problems include the length of GP appointments.
“These have actually increased in recent years, but still average less than 15 minutes, which is clearly not long enough to do much other than to deal with the ostensible problem with which the patient is presenting.”
The dementia committee, chaired by Pat Hawkes, the Labour councillor for Hollingdean and Stanmer, also says that most GP appointments take place in surgeries rather than patients’ homes.
“It is generally held to be easier to make an accurate assessment of someone’s mental health when seeing them in their own home, as many people find the process of visiting a doctor highly stressful and may act in atypical ways, whether or not they have any underlying mental health condition.”
The report says that patients and their partners or carers sometimes try to conceal cognitive or memory problems from doctors or simply avoid seeing a doctor at all.
It also says: “Older people and especially the ‘old old’, ie, 80 plus, may quite naturally evince some of the symptoms of dementia, eg, occasional confusion, forgetfulness, etc, while generally being in full control of their faculties.
“Finally, it maybe that GPs simply tend not to be as good as they might be at diagnosing dementia.
“Although a high percentage of a GP’s caseload is likely to feature mental health problems, many GPs have traditionally not been as well versed in mental health matters as they are in general health.”
The committee asked Brighton and Hove City Teaching Primary Care Trust (PCT) – also known as NHS Brighton and Hove – to invite GPs from the area to give evidence to the inquiry.
The report says: “No GP came forward, and committee members were told that this may have been because no city GP was comfortable with presenting themselves as an ‘authority’ on dementia.
“It is a matter of concern that there appears to be no city GP with a specialism or even a particular expertise in the field of dementia.”
It called on the PCT – now chaired by the council’s former chief executive Alan McCarthy – to encourage family doctors to be better informed in this area.
The report also identifies problems with hospital beds for dementia sufferers.
While many will be cared for in nursing homes, the report says there is a need to maintain a relatively small number of specialist mental health in-patient beds for acutely ill patients with dementia.
“In Brighton and Hove these beds are currently provided by Sussex Partnership NHS Foundation Trust at the Nevill Hospital in Hove.
“It has long been apparent that there are problems with the location of this service.”
Sussex Partnership does not own the Nevill Hospital site and, the report says: “Lease arrangements make it expensive to run.
“In addition, although the Nevill is not a particularly old hospital, it is a far from ideal environment for people with dementia.”
The report adds: “It is clear that the city’s other acute mental health hospital, Mill View, would not be an appropriate location for these beds.”
It urged health chiefs to find ways of caring patients as close to their families as possible though.
The committee said that its report was the start of the process of overseeing this area of need – not its last word on the matter.
The report says: “It is evident that this is a time of considerable flux for mental health services.
“On the one hand, we are entering into a period when it seems very likely that there will be extreme pressures on health and social care budgets, with most commentators predicting a long period of austerity.
“Healthcare commissioners will inevitably have to react to real-terms reductions in funding by looking very carefully at the services they commission.
“The Sussex Partnership NHS Foundation Trust is also undertaking a major review of all its activity, and is expected to make significant changes to the way in which it provides services, potentially including services for dementia.
“These changes are likely to focus on providing value for money, but also on shifting the focus of mental health care from the use of acute hospital beds to a more community-based service.
“Demographic change is likely to see an explosion in demand for dementia services across most of the country.
“Although the effects may not be as severely felt in Brighton and Hove as in East or West Sussex, there is bound to be sharply increasing demand for services in the near future.”
