Chris Whitty: NHS and Government need to do more to plan for rise in dementia cases

Prof Sir Chris Whitty - Chris Whitty: NHS needs to do more to plan for rise in dementia cases
Prof Sir Chris Whitty is worried the demand will outstrip support for those with dementia in rural areas where older people tend to live - Alamy/Mark Thomas

The NHS and the Government are “not properly planning” for an increase in dementia cases, Prof Sir Chris Whitty has said.

The Government’s top doctor warned that an ageing population that will be concentrated in rural areas would pose “a very serious challenge to the NHS and care services” in the coming years.

Sir Chris told the Alzheimer’s Society annual conference that demand would outstrip support in rural areas where older people tend to live, warning health services were not prepared for the shift in population dynamics.

There are currently around one million people living with dementia in the UK, but this is set to rise to 1.6 million by 2040 as people live for longer.

The chief medical officer said the majority of these cases would be in rural areas, which will “age at a much faster rate” than the average, while cities would “stay forever young”, creating a barrier to the staffing of support services.

“The increasing concentration of older people in peripheral areas is going to provide a very serious challenge to the NHS and care services, and I personally do not think we are properly planning for it,” Sir Chris said.

“I think we’re planning for a world of disease now rather than the world as it is inevitably going to be in 20 or 30 years time,” he added.

Prof Whitty later clarified that he felt the burden was not just with the NHS, but that the nation as a whole needed to do more, including national and local government, and civil society.

‘It will get harder to deliver services’

Sir Chris said health services already had “trouble attracting care workers, nurses and other workers into areas where there are older populations” and that this would “be exacerbated by the so-called age support ratio – the number of working-age people to people over 70”.

“We’re going to move steadily through the rest of this century in an adverse direction where the number of people working age compared to the number of people in their 70s is going to go down and steadily down for the next, certainly 80 years,” he said.

He said it would get “harder to deliver services” in rural areas and the “problem from a purely operational point of view is going to get substantially more difficult”.

“There’s no point hiding that that is a reality we have to respond to. Because if we ignore it, we’re going to end up with a problem that’s even greater than that inevitably leads us to,” he said.

Hope thanks to new drugs

The NHS has previously been criticised by leading Alzheimer’s charities for its lack of preparedness to roll out two cutting-edge new drugs: lecanemab and donanemab.

Both are going through regulatory approvals and in trials have proven they can slow down the progression of the disease in patients with an early stage of Alzheimer’s by breaking down the build up of a specific protein in the brain linked to the disease’s development.

There were questions about the health service’s ability to roll out the drugs to the around 280,000 patients who could be eligible at short notice, as well as concern about the capacity to diagnose patients early enough to allow them to benefit.

Research published on Tuesday by the Alzheimer’s Society found that one in three dementia patients had to wait more than six months to get a diagnosis.

NHS England has set up a dedicated team to ensure the drugs can be rolled out quickly if and when they receive UK approval, and are working “in lockstep” with regulators to make this happen, according to officials.

But Sir Chris urged caution about the hope of the new drugs in a field that was still in its “infancy”. He said they “undoubtedly” would benefit some but have “significant side effects” for others and did not expect drugs to become the principal treatment for dementia in the next decade.

Question marks over early diagnosis

He also called for a “twin track” diagnosis, which would provide early diagnoses for those that wanted it, but respect that “there are some people who genuinely would prefer not to have an early diagnosis if it’s not affecting their life seriously”, and warned against diagnosing babies with genetic tests.

“The reason I wanted to put the counter argument was partly about choice, but there was talk for example of doing early diagnosis at birth. People hear all the diseases you’re going to get. ‘Congratulations on the birth of your child, they’ll get Alzheimer’s at 50’ does not strike me as a useful way for us to move forward as a society,” he said.

The NHS has said that diagnosis rates are at their highest in three years as services have recovered from the pandemic, but it is still estimated that one in three people with dementia do not have a formal diagnosis.