Monday, 27 October 2014

Cash for diagnosis won’t help people sailing into the darkness of dementia or their families.

Under a plan put forward by NHS England last week GPs could be paid £55 for every patient they diagnose with dementia. This, it is hoped, will help to reduce the 90,000 or more people currently living with the debilitating condition who have not been given an official diagnosis.

The money will go towards providing improved care for suffers, Dr Martin Mc Shane, national director for long term conditions for NHS England, told the BBC ‘We know that more needs to be done across the health service to ensure that people living with dementia are identified so they can get the tailored care and support they need.’

He denied the proposal was ‘payment for diagnosis’ and said that it was ‘part of a larger range of measures to support GPs in their work tackling dementia.’

These measures include £42million available to help GP practices carry out assessment of people with suspected memory problems and a further £31million to provide appropriate care.

Criticism of the plan has come from the Patients Association; chief executive Katherine Murphy called it a ‘step too far’, saying that it would place a ‘bounty on the head’ of certain patients. Good GP practices, she told the BBC, would ‘be diagnosing their dementia patients already. This seems to be rewarding poor GPs.’

Professor Sir Simon Wessley of the Royal College of Psychiatrists said, also speaking to the BBC, the government had ‘done well’ when it came to improving awareness and funding for dementia care. However, he added, at present ‘evidence favours either improving social care, or investing in research to find new treatments that actually modify the course of the disease. Until that happens I can see little point in this exercise.’

Having spent the last two years watching my father sail into the darkness of dementia I welcome any initiative that raises the profile of a sadly ignored and stigmatised condition. This plan though goes too far down a route we shouldn’t even be considering.

Caring for someone with dementia is a lonely and terrifying experience; actually having dementia must be a thousand times worse. At no stage along the associated trail of tears can I imagine anyone saying that what would make things better would be for medical professionals to be incentivised like used car salespeople.

What patients and carers alike want is quicker diagnosis, the remaining sentience someone with dementia has is precious and passes so swiftly, knowing they’re ill allows them and carers to make plans and say their goodbyes. A system of social care that doesn’t make vulnerable people into participants in a bureaucratic obstacle race would be helpful too.

Neither of those objectives will be achieved by loading yet more perverse incentives onto the already tottering NHS. As Katherine Murphy rightly says cash for diagnosis will just provide the handful of lazy GPs with another system to game, whilst grinding out of the responsible majority the idealistic desire to help others that brought them into medicine in the first place.

That such a suggestion is even being considered is all too sadly symptomatic of a political system that has become witlessly enthralled to the idea that for every problem there must be a market based solution. There are many things the market does brilliantly; delivering healthcare isn’t one of them.

The result of bringing the market in to solve healthcare problems is at best a two tier system that is the unfair antithesis of everything the NHS stands for; the worst case scenario is the sort of target driven madness that destroyed Stafford hospital. If your answer to the problems of the NHS is more marketisation, then you’re asking the wrong questions.

What is needed is a concerted effort to remove the stigma surrounding dementia and other mental health problems. This won’t be an easy sell, unlike with cancer it is impossible to construct a ‘narrative’ about a heroic battle against adversity that can be won through effort. There may be a cure someday, but for now it is all about making the time sufferers have left a little less grim.

A whole lot more respect for carers, both paid and unpaid would be welcome too, they deserve the best support for their own needs as much as those of their loved one; sadly what they get all too often is ignored and left to worry themselves to rags in isolation.

Next year is an election year; expect the three ghost brands that used to trade as Labour, the Tories and the Lib Dems to trot out the same tired platitudes about how only they can be trusted with the NHS, whilst all the time they plan to carry on doing the same destructive things for the same old muddled reasons.

Personally I’d rather see the future of the NHS in the hands of people who don’t think an adding machine is a piece of medical equipment.

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