Introduction

This document shows the geographical distribution of the dementia surveillance data as a snapshot in March 2024. It accompanies the monthly dementia surveillance, which show the ongoing area performance. The surveillance data illustrates the disparities that exist across England in relation to the diagnosis of people with dementia and the care they receive. It is aimed at informing national and local policy development, and for local commissioners to help in planning services around the needs of people with dementia.

  • The 2023 Chief Medical Officer’s annual report: health in an ageing society notes that ‘people move out of cities and large towns before older age, concentrating geographically in coastal, semi-rural or peripheral areas, often with relatively sparse services and transport links’.
  • The maps presenting dementia data aim to help the commissioners visualise geographically the spatial distribution of the dementia-related population and need.
  • They show statistical comparisons (rates and percentages) for the health geography in England, the Integrated Care Boards (ICB) and their sub locations which were established in July 2022.

Geography

There are 42 Integrated Care Boards in England which plan services for their population’s health as part of the NHS Integrated Care System. Of these, 26 contain exactly one sub location while 16 are split into multiple sub locations creating a more granular health geography with 106 areas. Data is mapped for both, ICB and sub location, to give the commissioners a choice of looking at higher or lower geography level. The first 2 maps are a reference to the specific areas and show where each ICB and sub location is by displaying their organisation code on the map. These reference maps can be accessed at any point in the document via the left-hand-side menu.

Maps showing health geography in England: Integrated Care Boards (ICB) and sub locations

ICB

Sub location

People with dementia

Diagnosis rates

A timely diagnosis enables people living with dementia, their carers and healthcare staff to plan and work together to improve health and care outcomes. The Estimated Dementia Diagnosis Rate (EDDR) measures the diagnosis levels as a rate of people diagnosed with dementia per 100 people estimated to have dementia. It looks at the population aged 65 and over. The maps show the relevant data:

Maps showing Estimated Dementia Diagnosis across Integrated Care Boards (ICB) and sub locations

ICB comparator

Sub location comparator

ICB rate

Sub location rate

Diagnosed prevalence

Diagnosed prevalence describes the frequency of existing cases of dementia in a defined population at a given point in time. Here measured as a rate of people with a formal diagnosis of dementia on their primary care record per 10,000 of those registered with the primary care practices. While dementia is often considered a disease of the older population (with over 466,000 diagnoses on the primary care register for people aged 65 and over), England also has over 15,000 people under the age of 65 diagnosed with dementia. Commissioners will need to provide services tailored to them and any comorbidities they might develop as they get older.

Maps showing prevalence of people aged 65 years or older diagnosed with dementia across Integrated Care Boards (ICB) and sub locations

ICB rate

Sub location rate

Maps showing prevalence of people aged 64 years or under diagnosed with dementia across Integrated Care Boards (ICB) and sub locations

ICB rate

Sub location rate

Services

Ensuring dementia patients receive a high quality of care is one of the aspirations outlined in the Prime Minister’s challenge on dementia 2020. The services should be delivered in places where the patients need them and should ideally not incur extensive travel times. They should moreover address the whole cycle of living with dementia from diagnosis through care planning, treatment and support to (once other options are exhausted) medical management of symptoms and end of life care. This collection of maps illustrates 3 different services for people of all ages with a record of dementia diagnosis:
  • referrals from primary care to memory clinics as an example of services supporting the diagnosis process
  • planning and reviewing the care of patients as an example of post diagnostic services
  • and antipsychotic prescribing as an example of crisis interventions

Memory assessment services

The majority of formal diagnoses of dementia are provided by specialist clinicians at memory assessment services (memory clinics). To receive a referral to a memory clinic from primary care, an individual should be first assessed to eliminate any potential underlying causes that may be contributing to memory and welfare issues. Good access to memory clinics is crucial in delivering that service and the clinic locations should align with diagnostic need based on the age-distribution of the population. Areas with a relatively younger population, like most cities, will have less need for them.

It is difficult to obtain a comprehensive list of dementia services. The presented map shows the best information available at the time as supplied by the Royal College of Psychiatrists (RCPSYCH), which runs a Memory Services National Accreditation Programme (MSNAP). It is a quality improvement and accreditation network for services that assess, diagnose and treat dementia in the UK. The map presented here shows the 87 services accredited in England.

Maps showing memory referrals and accredited dementia services across Integrated Care Boards (ICB) and sub locations

ICB %

Sub location %

Dementia memory services

Care plans

Following a diagnosis of dementia, a care plan should be put in place as soon as possible. This plan should set out the care needed by the person and those caring for them and it should be reviewed regularly. If a care plan is not current, there could be unmet needs for the individual leading to the deterioration of their health and wellbeing. The dementia care pathway full implementation guidance recommends that the care plan should be reviewed within at least 12 months of being agreed, then reviewed every 12 months in accordance with changes in the person’s needs. There will be geographical differences in what team provides care plans and reviews, as different local services develop care plans in different parts of the country. Alzheimer’s Society online search engine provides a list of dementia-related community services.

Maps showing care plans and care plan reviews across Integrated Care Boards (ICB) and sub locations

ICB %

Sub location %

Antipsychotic prescribing

People with dementia may develop behavioural and psychological symptoms (BPSD) including agitation, aggression, distress, and psychosis. If these symptoms cannot be managed otherwise, patients may be prescribed antipsychotic medication to help. The National Institute for Health and Care Excellence (NICE) guidance recommends prescription of antipsychotics should be undertaken with serious consideration due to the wide range of adverse effects they can cause. High levels of antipsychotic prescribing may suggest breakdowns in care pathways leading to more crisis interventions being needed.

Maps showing antipsychotic medication prescribing across Integrated Care Boards (ICB) and sub locations

ICB %

Sub location %

How to use this document

Each map shows the geographical variance of one data aspect. Its interpretation cannot be done in isolation but by looking across the range of maps as well as external population and geographical analysis underpinned by local insight.

For example, the EDDR, prevalence and population maps show that one ICB and 9 sub locations across England achieved estimated dementia diagnosis rates statistically above the 66.7% aspiration in March 2024. A question presents itself, are they doing something different to areas not achieving the aspiration? However, the 9 sub locations are some of the smallest areas analysed, both in terms of geographical and population size, placed in the lowest 2 quintiles by patient list size for those aged 65 and over. On the other hand, they are placed in the top most 2 quintiles with some of the highest prevalence rates of diagnosed dementia per 10,000 people registered in primary care practice. So perhaps these locations face a different set of challenges and requirements and service planning in these areas will be different to areas with higher levels of registered and estimated dementia diagnosis or larger and older populations.

The maps presented in this document allow to form these questions and comparisons but only local knowledge can answer them and help improve service provision for patients with dementia and their families.

About this document

This document was created by National Dementia Intelligence team (NDI), part of Clinical Epidemiology in the Department of Health and Social Care (DHSC) on 17 September 2024. Data used in this publication is available via the dementia surveillance part of the Dementia Profile. Enquiries:

Data sources

This document is using Primary Care Dementia Data from March 2024 published by NHS England. Office for National Statistics (ONS) boundary files and places provided the base geography boundaries and points. The Royal College of Psychiatrists (RPSYCH) provided a list of accredited memory services.

Map symbology

Most of the maps show the data divided into 5 groups (quintiles), each containing similar number of areas with a value in that quintile’s range as described by the map legend. Others show unique values or a gradient of values as defined in map legends or point locations of health units. The maps were created in Esri ArcGIS Pro under the UK Health Security Agency (formerly Public Health England) licensing agreement and used the inbuild statistical quintile distribution functionality.

External resources

The Office for National Statistics, government, academia and charities provide additional population based graphical products which can support the geographical analysis of age related population needs: