Who really wants to face up to dementia? It’s one of those illnesses that, despite its prevalence, most of us would rather not think about, much less entertain the prospect of developing it. I’d wager that more of us are comfortable with thinking about our own deaths than we are contemplating what might come before. It’s hardly a slim risk, though, is it. There are currently around 900,000 people in the UK with dementia, and by the age of 90, around a third of people have the condition.
The odds aren’t getting better, either. This week, a study by University College London warned that by 2040, the number of people with dementia will nearly double to 1.7 million. This was a new study that put the forecast of future cases 42 per cent higher than previously predicted, and its lead author Dr Yuntao Chen warned that as well as the devastation that dementia causes in families, “it will also put a considerably larger burden on health and social care than current forecasts predict”.
It’s not as though policymakers have been doing much about the current forecasts, though. The health and social care systems are manifestly not coping with the current number of sufferers. Diagnosis of the specific type of dementia can take up to two years, meaning people with worrying symptoms are left in the dark about their prognosis. Then, sufferers are often just handed a leaflet with some information on, and left to get on with it – or not – themselves.
If they can’t cope by themselves, or with the help of family, then people with dementia end up in a system that can be more bewildering and frustration than their actual condition: social care.
We do not have an accurate picture of how well councils are meeting the demand in their areas, because they are not required to collect the data. The Association of Directors of Adult Social Services says 430,000 people were waiting for care, with three quarters of its members saying they “aren’t confident” about being able to meet the minimum level of support – even though it is required by law.
There have been some small boosts to social care funding, including the £600m announced in the summer for workforce funding over the next two years, and the rest going to local authorities under the most pressure.
But this government has not reformed social care funding and provision, and will not do it before the next election. Neither will Labour: Keir Starmer admitted to me in an interview at the start of this year that full reform would be a second-term issue, and the party may well leave it out of its manifesto.
Both Conservatives and Labour prefer to talk about the importance of preventive healthcare, something I’ve covered a fair bit in this column before. It’s a great idea, but it’s also not clear from either party what it would actually entail.
The rise in dementia cases could, according to the UCL team, be driven in part by the “epidemic” of obesity and type 2 diabetes, which are risk factors for the illness. But once again, politicians don’t really want to engage with what this means, because whenever they make a half-hearted attempt to talk about a healthy society, they tie themselves in knots.
Often, they really just mean moving things around in the NHS, which is all very well and good, but prevention that really works would have to go far beyond the health service and into wider society. Too often debates about obesity end up with politicians fretting that they are suggesting people don’t have enough willpower to maintain a healthy weight – without wondering whether it might be that society is making it increasingly difficult to be healthy.
It might be the way the planning system doesn’t encourage active travel within or between places, and still suggests that the world is ruled by cars that need lots of public land to recline on, rather than people with bodies that need to move. It might be the way we think a “sugar tax” will make a blind bit of difference to the fact that the modern diet has become so palatable and highly calorific that it is quite hard work to consume food that doesn’t take you over your energy needs. It might be that for many adults, calories have become such an emotionally-charged expression of energy needs that they don’t want to see them on menus, even while they’re perfectly keen to see how much the food costs to buy.
Government interventions are about as half-hearted as our own efforts to confront what might happen in our own old age. Westminster seems content to bury its head even deeper in the sand. But as those on the waiting lists for dementia care know, pretending a problem isn’t really there doesn’t make it go away.