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Marching on

The tireless, often heroic efforts of carers continue to go unrecognised by government

A group of ants carrying leaves that say 'DEMENTIA'Dementia now costs the UK economy twice as much as cancer but gets a fraction of the funding, at least that's what the Alzheimer's Research Trust says. In the foreseeable future the number of Alzheimer's sufferers will reach 1.4 million; that's equivalent to the population of Dubai.

The government's response is a National Dementia Strategy. It has three strands, and aims to: increase awareness, improve diagnosis and define a 'pathway' of care for better treatment and support. Yeah, well...

There will be an unimaginable number of potential sufferers; where will they be cared for, who will pay and can we stop the disease in its tracks? There are four things that need to be done urgently. Of themselves they are not a cure, yet taken together, they might make the inevitable more manageable. 

Firstly, places: the care home infrastructure that provides care for dementia sufferers is a worrying hotchpotch of venture capital-funded companies that see a lucrative market, counterbalanced by what is little more than Mamma–Pappa shops run by a mixture of entrepreneurs, former NHS staff and well intended amateurs. 

The credit crunch has worrying implications for them all. The venture capitalists will want their money back and smaller care homes will see their revenues squeezed by social services struggling to cope with cuts in public spending and banks anxious to restrict overdraft borrowing. The prospects are not looking good.

The market needs consolidation. This is no place for companies that are as vulnerable as their residents. The government must respond by making the care home sector a priority and an attractive business opportunity. In the same way that it is encouraging the new 'green' industry, it should encourage a 'grey' industry. 

Tax incentives that encourage the sale of the smaller homes to larger operators are a good place to start. Make the tax on the capital gain on the first sale no more than 2 per cent; this would encourage the smaller operators out of the market. For the operators that remain: reduce corporation tax to a level that makes investment worthwhile – no more than 5 per cent. 

Consolidation would improve quality, keep a lever on costs and create a sector robust enough to pay to be licensed by the Care Quality Commission; it would withstand proper inspection and the demands of modern care. It would also have the effect of creating jobs: jobs that for a large part of the workforce require skills and dementia training but not necessarily professional qualifications. Just the types of jobs that will help reduce unemployment and stimulate the economy. 

Next, paying for care: it is impossible for government to bear the full costs – they are overwhelming, with weekly costs exceeding £800. Saga says that for the past three years fees have risen at 1.5 per cent more than the retail price index.

Individuals and families will have to contribute. The syndication of costs, among family members, to help pay the cost of Granny's nursing home care should be incentivised through tax-breaks for the individuals participating. Make it worthwhile and tax efficient for families to come together to bear the costs. Indeed, why stop at family members? Close friends could be included and it is not impossible to imagine the inclusion of charitable giving. A family paying is cheaper than social services bearing the cost. In some cases a partnership deal might be possible: social services and families working together, with tax-breaks making it a worthwhile proposition.

Thirdly, it is the people who care. In 2007, researchers at Leeds University calculated the value of care provided by unpaid relatives: the figures revealed that carers now save the state £87bn a year. This is a rise of 52 per cent across the UK, an increase of £30bn since 2002. The value of care is almost as much as the annual budget for the NHS.

Where nursing home care is the last choice; elderly relatives are often cared for at home. Some carers are little short of heroic but go unrecognised by the government. If a family member is willing to give up work, undergo simple training and take on the care of an elderly relative, the commitment should be recognised. 

The state could expect to pay for this service (relieving itself of the responsibility in the interim, if not permanently), by paying the carer two-thirds of the income (tax-free) they have sacrificed, by giving up work. This would leave some headroom for the government to pay for respite care, in a contract with the principle family carer. It would also create an opportunity for domiciliary care providers to come in with packages of support care: doing the work that the home carer cannot cope with, such as; incontinence care, laundry and respite care in the home setting.

Finally, what can pharma do? The industry works in secret with new drugs to protect. We know several major pharma companies are working in the dementia sector and they must be duplicating research. Is not this the point at which the government should step in to make change happen? Pharma needs to align its R&D with the needs of its customer; in this case the government, which is desperate for a drug deal for the treatment of dementia.

The government could create a 'pharma priority' and provide a secure, independent and safe research review facility, where pharma R&D was deposited and analysed for duplication. Where overlapping research is discovered the companies would be encouraged to pool their knowledge and work together.

A solution might be nearer than we think. Often, hopeful pharma research is abandoned as a fruitful pathway runs out. It is very likely the 'missing part' of the research is in the hands of a competitor but they simply just don't know it. The government could create an opportunity for 'blind-gossip' where companies would talk to each other but they wouldn't know which company they were talking to until meaningful dialogue develops.

The pharma industry is already well treated by the government; however, such is the scale of the problem it must be worthwhile for the government to incentivise research in the dementia sector even further.

Like most problems, there is no silver bullet; the nation faces a huge problem. However, there might just be enough silver buckshot, to make the unmanageable, manageable.

The Author
Roy Lilley is a (sometimes controversial) healthcare author and broadcaster.

To comment on this article, email

17th March 2010


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