Poor health arises from living with a least one of six major health conditions: cancer, cardiovascular diseases (including stroke and diabetes), chronic respiratory diseases, dementia, mental ill health and musculoskeletal disorders.
Many of these conditions do not exist alone and people experience multiple morbidity of two or more of these. The Major Conditions Strategy (MCS) proposes a five-year plan to improve health service for these six health conditions as they place the most strain on the NHS (Department of Health and Social Care, 2023); the final version is expected in 2024.
The MCS aims to focus on treatment and prevention to help people to stay in better health for longer, thus reducing the burden to the NHS. This will require activities and interventions along a life course.
This is an ambitious strategy in many respects, not least in that each of these conditions have had an individual focus thus far, each with their strategies and plans, each of considerable size and ambition.
“The recognition, treatment and care of other conditions when a person has a diagnosis of dementia still fall short of what should be expected”
The MCS generally is to be welcomed on several counts, not least that conditions experienced more widely by the population will have a central focus. However, when considering dementia there are concerns about whether there will be parity with the other included conditions, such as cancer which has had a central focus for health and social care for many decades.
There is, at last, recognition that often these conditions do not ‘travel alone’ – often people experience more than one of these major conditions at any one time. Historically, the delivery of NHS care has been in condition-specific ‘silos’, with little attention given to the impact of comorbidity and multimorbidity.
This brings us back to parity; people with dementia experience multimorbidity of greater proportions than in many other conditions, with over 60% likely to have at least three comorbid conditions, many of them major as identified in the MCS (Scrutton and Brancati, 2016). Sadly, the recognition, treatment and care of other conditions when a person has a diagnosis of dementia still fall short of what should be expected.
The MCS aims for early diagnosis, intervention, and access to high-quality treatment, proposing that early identification will lead to better outcomes and their negative impact on a person’s life being much reduced. These ambitions have long been the aim in dementia, with policy historically calling for its early recognition and diagnosis.
It is now 15 years since the first dementia strategy made early diagnosis its primary recommendation. Despite this, diagnosis rates still fall woefully short of targets so how will the MCS enable people with dementia to gain a timely diagnosis? This is an area of significant concern in the field of dementia care and will require reassurances that the MCS will provide parity with the other five major conditions in setting targets for investigation and diagnosis.
The MCS aims for the NHS to better manage the six conditions to maintain the employability of the population – to keep them in the workforce or get them back into it as soon as possible, through prevention work.
This is a fine aim but of all the six conditions, dementia largely affects an older population who may have already retired (with the exception of those affected by young onset dementia (Carter et al, 2018).
This may also result in a lack of parity for dementia. What should have importance here, however, is the significant numbers of family carers who support people with dementia and the need to maintain their health and employability.
One in two of us will be affected by dementia, either through being diagnosed with it or in supporting a family member or friend (Holland, 2023). Unpaid carers have the right to receive support for their contribution in delivering care to people with dementia.
The MCS needs to consider not just the people diagnosed with the six conditions but also the army of unpaid family carers and friends who are their supporters if we are to maintain their employability and visibility in the workforce. Ensuring they remain a fit and active group within the workforce is essential to realising the outcomes of the MCS.
Karen Harrison Dening is head of research and publications, Dementia UK, and honorary professor of dementia nursing at De Montfort University, Leicester.
References
Carter JE et al (2018) Young-onset dementia and the need for specialist care: a national and international perspective. Aging and Mental Health; 22: 4, 468-473.
Department of Health and Social Care (2023) Major conditions strategy: case for change and our strategic framework. DHSC.
Holland G (2023) How we calculated our ‘one in two’ dementia statistic – and what we will do about it. Alzheimer’s Research UK.
Scrutton J, Brancati CU (2016) Dementia and Co-morbidities: Ensuring Parity of Care. ILCUK.
