Dementia 2020 Challenge

The challenge on Dementia 2020 contains over 50 commitments that together aspire to make England the best country in the world for dementia care and support, for people with dementia to live; and to conduct dementia research. The 50 commitments are split across four themes: risk reduction, health and care, awareness and social action, and research.

Implementing the Challenge
13th of April 2017
Royal Society of Medicine, London

The Implementation Plan published on 6th March 2016 sets out how these commitments will be met. It sets out priority actions and the organisation responsible, across 4 themes:

Risk reduction

  • Health and care
  • Awareness and social action
  • Research

The 2020 Challenge spans five years and has two clear phases:

  1. Up to 2018 – this covers the immediate actions both Government and delivery partners will take over the next 12-18 months to improve dementia care and support, awareness and research.
  2. 2018-2020 – this covers longer term actions that will deliver all of the 2020 Challenge commitments.

Progress in both phases will be monitored by the Dementia Programme Board, chaired by Jane Ellison MP, Parliamentary under Secretary of State for Public Health, and comprising senior leaders from many of the partner organisations involved in the 2020 Challenge.

In addition, the Government, working with key delivery partners, will establish a Citizens’ Panel of people with dementia and carers to regularly review the progress.

Dementia
A full formal review of the Implementation Plan will take place in 2018, using the findings of the Citizens’ Panel, wider engagement and range of data and measures.

This conference will review and assess the actions included in the Implementation plan, providing the necessary transparency to ensure that its actions – and later updates – make a real and lasting difference to people with dementia, their families and their carers.

Through our inaugural conference in London and the accompanying Northern version, we have ensured that the leading stakeholders are convened to discuss the progressions to date. These activities have empowered hundreds of health and care professionals with valuable insight on future policy aspirations for 2020 and beyond. The huge success of these conferences also enabled Govconnect to utilise its social status and reinvest back into many community projects and national charities.

This Implementation Plan was agreed by each delivery partner, and signed off by the Dementia Programme Board and Ministers. However, engagement with delivery partners was only part of the process.

There was extensive engagement, with people with dementia and carers, the engagement sessions were focused on what people living with dementia and carers felt were the key priorities in the 2020 Challenge that will make the biggest difference to them. The following priorities were identified:

  • Better support for people with dementia and their carers following diagnosis.
  • People with dementia being able to live in their own home independently for longer.
  • Improved waiting times for diagnosis, applied consistently and country-wide.
  • GPs ensuring continuity of care.
  • All people with dementia being given the opportunity to plan ahead at the right time through advanced care planning.

Govconnect recognise the importance of engaging with service users; dedicated breakout sessions during the conference coordinated by Dementia UK, and the DEEP and Tide networks will allow attendees from NHS, Local Government and community care settings to engage with people living with dementia and carers.

Now in its second year Govconnects Dementia 2020 series of conferences continue to develop a nationwide community of conference delegates, online users and wider stakeholders who together strive to create a society by 2020 where England is the leading country in the world for dementia care and support, for undertaking research into dementia, other neurodegenerative diseases and for people with dementia, their carers and families to live.

The NHS Five Year Forward View – Summary

The NHS Five Year Forward View was published on 23 October 2014 and sets out a new shared vision for the future of the NHS based around the new models of care. It has been developed by the partner organisations that deliver and oversee health and care services including Care Quality Commission, Public Health England and NHS Improvement (previously Monitor and National Trust Development Authority).

Summary

  1. The NHS has dramatically improved over the past fifteen years. Cancer and cardiac outcomes are better; waits are shorter; patient satisfaction much higher. Progress has continued even during global recession and austerity thanks to protected funding and the commitment of NHS staff. But quality of care can be variable, preventable illness is widespread, health inequalities deep-rooted. Our patients’ needs are changing, new treatment options are emerging, and we face particular challenges in areas such as mental health, cancer and support for frail older patients. Service pressures are building.
  2. Fortunately there is now quite broad consensus on what a better future should be. This ‘Forward View’ sets out a clear direction for the NHS – showing why change is needed and what it will look like. Some of what is needed can be brought about by the NHS itself. Other actions require new  partnerships with local communities, local authorities and employers. Some critical decisions – for example on investment, on various public health measures, and on local service changes – will need explicit support from the next government.
  3. The first argument we make in this Forward View is that the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgradein prevention and public health. Twelve years ago Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded – and the NHS is on the hook for the consequences.
  4. The NHS will therefore now back hard-hitting national action on obesity, smoking, alcohol and other major health risks. We will help develop and support new workplace incentives to promote employee health and cut sickness-related unemployment. And we will advocate for stronger public health-related powers for local government and elected mayors.
  5. Second, when people do need health services, patients will gain far greater control of their own care – including the option of shared budgets combining health and social care. The 1.4 million full time unpaid carers in England will get new support, and the NHS will become a better partner with voluntary organisations and local communities.
  6. Third, the NHS will take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care. The future will see far more care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases.
  7. England is too diverse for a ‘one size fits all’ care model to apply everywhere. But nor is the answer simply to let ‘a thousand flowers bloom’. Different local health communities will instead be supported by the NHS’ national leadership to choose from amongst a small number of radical new care delivery options, and then given the resources and support to implement them where that makes sense.
  8. One new option will permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of-hospital care – the Multispecialty Community Provider. Early versions of these models are emerging in different parts of the country, but they generally do not yet employ hospital consultants, have admitting rights to hospital beds, run community hospitals or take delegated control of the NHS budget.
  9. A further new option will be the integrated hospital and primary care provider – Primary and Acute Care Systems – combining for the first time general practice and hospital services, similar to the Accountable Care Organisations now developing in other countries too.
  10. Across the NHS, urgent and emergency care services will be redesigned to integrate between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Smaller hospitals will have new options to help them remain viable, including forming partnerships with other hospitals further afield, and partnering with specialist hospitals to provide more local services. Midwives will have new options to take charge of the maternity services they offer. The NHS will provide more support for frail older people living in care homes.
  11. The foundation of NHS care will remain list-based primary care. Given the pressures they are under, we need a ‘new deal’ for GPs. Over the next five years the NHS will invest more in primary care, while stabilising core funding for general practice nationally over the next two years. GP-led Clinical Commissioning Groups will have the option of more control over the wider NHS budget, enabling a shift in investment from acute to primary and community services. The number of GPs in training needs to be increased as fast as possible, with new options to encourage retention.
  12. In order to support these changes, the national leadership of the NHS will need to act coherently together, and provide meaningful local flexibility in the way payment rules, regulatory requirements and other mechanisms are applied. We will back diverse solutions and local leadership, in place of the distraction of further national structural reorganisation. We will invest in new options for our workforce, and raise our game on health technology – radically improving patients’ experience of interacting with the NHS. We will improve the NHS’ ability to undertake research and apply innovation – including by developing new ‘test bed’ sites for worldwide innovators, and new ‘green field’ sites where completely new NHS services will be designed from scratch.
  13. In order to provide the comprehensive and high quality care the people of England clearly want, Monitor, NHS England and independent analysts have previously calculated that a combination of growing demand if met by no further annual efficiencies and flat real terms funding would produce a mismatch between resources and patient needs of nearly £30 billion a year by 2020/21. So to sustain a comprehensive high-quality NHS, action will be needed on all three fronts – demand, efficiency and funding. Less impact on any one of them will require compensating action on the other two.
  14. The NHS’ long run performance has been efficiency of 0.8% annually, but nearer to 1.5%-2% in recent years. For the NHS repeatedly to achieve an extra 2% net efficiency/demand saving across its whole funding base each year for the rest of the decade would represent a strong performance – compared with the NHS’ own past, compared with the wider UK economy, and with other countries’ health systems. We believe it is possible – perhaps rising to as high as 3% by the end of the period – provided we take action on prevention, invest in new care models, sustain social care services, and over time see a bigger share of the efficiency coming from wider system improvements.
  15. On funding scenarios, flat real terms NHS spending overall would represent a continuation of current budget protection. Flat real terms NHS spending per person would take account of population growth. Flat NHS spending as a share of GDP would differ from the long term trend in which health spending in industrialised countries tends to rise as a share of national income.
  16. Depending on the combined efficiency and funding option pursued, the effect is to close the £30 billion gap by one third, one half, or all the way. Delivering on the transformational changes set out in this Forward View and the resulting annual efficiencies could – if matched by staged funding increases as the economy allows – close the £30 billion gap by 2020/21. Decisions on these options will be for the next Parliament and government, and will need to be updated and adjusted over the course of the five year period. However nothing in the analysis above suggests that continuing with a comprehensive taxfunded NHS is intrinsically un-doable. Instead it suggests that there are viable options for sustaining and improving the NHS over the next five years, provided that the NHS does its part, allied with the support of government, and of our other partners, both national and local.

“It suggests there are winners and losers using NHS services. We can only hope the new models of care makes more winners”