The Department of Health and Social Care published a consultation on the proposed Major Conditions Strategy in May, and the NCF has submitted a response to the call for evidence via the online survey. The survey structure was rigid, and we had a number of key points about the scope/content of the strategy that the survey constrained us from fully expressing. Below we have detailed some key aspects of our response, for the full response to the survey click here .
Scope of the Strategy
We understand the intention of bringing both dementia and mental health services into an overarching strategy – and appreciate the attempt to give them both parity with some of the other major conditions that have previously enjoyed significant focus and investment. However, we remain concerned that this may, inadvertently, reduce the focus on both dementia and mental health (a focus that a standalone strategy would enable).
As well as limiting the degree to which major conditions such as dementia can be consulted on, this call for evidence restricts the degree to which major conditions that aren’t “the big six” can be addressed. The rationale behind an all-encompassing overarching strategy would be to conceptualise major conditions in a person-centred, holistic way. The scope of the proposed strategy does not seem to deliver on this and doesn’t make use of what is an opportunity to discuss the connectedness and interdependencies between major conditions.
Old age and frailty
The consultation fails to discuss frailty and old age which we feel is an oversight. The landscape of public health has changed in recent decades; advances in medicine and people living healthier lives has led to an ageing population. With an ageing population comes complexity, and many of us are living longer with multiple long-term conditions, requiring ever more complex care in later life. The strategy does not account for this, we think it should. The planning of care needs for major conditions should be nuanced, holistic and person centred – at present there is concern that the current approach would not sufficiently meet such criteria.
Learning Disability and Autism
The call for Evidence mentions very little around disability and autism. As demonstrated by LeDeR (2021), people with a learning disability and autistic people die earlier than the general public, and all too often do not receive the same health care outcomes as those without a learning disability or who are not autistic. More needs to be done to improve outcomes for this portion of the population and the strategy offers a vehicle through which to do this. In particular, we argue the government should do more to follow through on its commitments in the Building the Right Support Action Plan (2022), and support the implementation of the Oliver McGowan Mandatory Training with social care sector specific funding and tailored support.
Given the significant impact of dementia on so many people, families, and communities, it is unfortunate that the consultation seems to offer little space and consideration to managing and supporting people with dementia – this is a worrying and significant gap.
There is little opportunity to highlight the very important aspects of what joined up, supportive, and timely care and treatment looks like for people with dementia, and their families. For many of the other conditions, there seems to be clearer care and treatment pathways – this is often missing for those receiving a diagnosis of dementia. People tell us they leave a clinic with a leaflet, not an appropriate pathway.
The silence of the consultation on the importance of social care and support rather amplifies this gap in relation to dementia. We remain concerned that the current approach may, inadvertently, reduce the focus on both dementia and mental health (a focus that a standalone strategy would enable).
Increasing early diagnosis for dementia is essential: NHS digital data (2023) indicates that only 63.1% of people with dementia have a diagnosis and the process of getting a diagnosis can take around 18 months (Alzheimer’s Society, 2022). There should also be a wider societal and governmental push to reduce social stigma and increase people’s understanding of what it means to live with dementia.
In our response we argue that early diagnosis for dementia is essential. We also called for more joined up, supportive, and timely care and treatment for people with dementia and their families. There must also be a standalone carers strategy. This should cover carer identification, carers’ rights, and detail how tailored support can be accessed at every stage of a carer’s journey.
As an active member of the Community Rehabilitation Alliance, the NCF promotes the argument that care and rehabilitation needs to be shifted away from outpatient departments, and towards a more integrated and holistic approach. We recommend that the strategy incorporates the recently published standards for community rehabilitation that the NCF was instrumental in shaping. The standards were published, co-developed and endorsed by 55+ professional bodies and national charities in England. It should particularly note the following recommendations. Each ICS must appoint a rehabilitation director at executive level within the integrated care system and each system should establish a local provider rehabilitation network to include primary, secondary, tertiary health care, mental health, social care, independent and third sector providers.
Data, technology, and research
Digital innovation and research is advancing at pace; as such, the NCF believes data, intelligence and technology will be a key factor in the success of any strategy. The strategy should be forward looking, and account for the future – recognising the key opportunities that come with digital innovation. However, it should also look at the key ethical questions, barriers to implementation, and challenges that come with digital innovation in health and social care. Key to the successful use of data, intelligence and technology will be a deep understanding of the social care sector, knowing what data exists, what the current burdens are on the sector, and what the key challenges to digital uptake will be.