Dementia surveillance illustrates the disparities that exist across England in relation to the diagnosis of people with dementia and subsequent 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. This document concentrates on Cambridgeshire and Peterborough, one of the 42 Integrated Care Boards (ICB) compared to England national and East of England regional data. Cambridgeshire and Peterborough ICB has one sub location (06H), which has the same data as the ICB and is therefore not analysed separately. The data runs from April 2023 to March 2024.
The national aspiration is that two-thirds (66.7%) of people estimated to be living with dementia should have a formal diagnosis recorded in their primary care notes. This reflects the 2015 prime minister’s challenge to increase the numbers with a formal diagnosis of dementia. A timely diagnosis enables people living with dementia, their carers and healthcare staff to plan accordingly and work together to improve health and care outcomes. The 2 sections below present data on dementia diagnosis rates and diagnosed prevalence.
NHS England measure compliance with the national aspiration of dementia diagnosis levels using the estimated dementia diagnosis rate (EDDR). The EDDR is calculated as the number of people with a formal diagnosis of dementia divided by the number of people in the locality, aged 65 years and older, who are estimated to have dementia using the Cognitive & Function Assessment Study (CFAS II) prevalence rates. It is illustrated below as the rate of people diagnosed with dementia per 100 people expected to have dementia aged 65 and over.
The interactive chart in figure 1 shows the monthly value for EDDR as trend lines for England, East of England region and Cambridgeshire and Peterborough ICB against the national diagnosis aspiration line of 66.7%.
Figure 1
In March 2024, there were 10,973 people aged 65 and over estimated to have dementia in Cambridgeshire and Peterborough ICB. Of these, 6,507 have been formally diagnosed and added to the dementia register making the EDDR for the ICB 59.3%. This was significantly below the 66.7% aspiration, below the England value of 64.8% and not significantly different from the East of England regional value of 63.3%. The ICB rate varied over the reporting time between 55.4% and 59.3%.
Prevalence describes the frequency of existing cases in a defined population at a given point in time. Measuring prevalence can be particularly helpful in assessing the need for preventive action and the planning of health services. Prevalence illustrated below is the number of people with a formal diagnosis of dementia on their primary care record, as a percentage of those registered with the primary care practices. The population it measures is aged 65 years and older.
The interactive chart in figure 2 shows the monthly prevalence for those with a formal diagnosis of dementia as trend lines for England, East of England region and Cambridgeshire and Peterborough ICB.
Figure 2
In March 2024, the diagnosed dementia prevalence in people aged 65 and over for Cambridgeshire and Peterborough ICB was 3.8% of the 169.6 thousand registered patients. It was significantly below the national England value of 4.2% and below the East of England regional value of 4.2%.
Ensuring dementia patients receive a high quality of care is one of the aspirations outlined in the Prime Minister’s challenge on dementia 2020. This section illustrates data on memory clinic referrals, antipsychotic prescribing and planning care for people of all ages with a record of dementia diagnosis.
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. Since March 2020, the COVID19 pandemic has affected the provision of the usual health services in England, limiting access to memory assessment services.
The interactive bar chart in figure 3 shows the referrals to memory clinics as a percentage of all individuals receiving an assessment for dementia since 1 April 2023 for England, East of England region and Cambridgeshire and Peterborough ICB. The memory clinic referrals data is cumulative and resets in April each year.
Figure 3
Between April 2023 and March 2024 there were 480 referrals to specialist memory assessment services in Cambridgeshire and Peterborough. This was 13.6% of the dementia assessments provided in that ICB. This percentage was not significantly different from the national England value of 13.3% and below the East of England regional value of 18.4%.
People with dementia may develop behavioural and psychological symptoms (BPSD) including agitation, aggression, distress, and psychosis. They are often prescribed antipsychotic medication. The National Institute for Health and Care Excellence (NICE) guidance recommends prescription of antipsychotics should be undertaken with serious consideration.
The interactive chart in figure 4 shows the number of people with dementia receiving a prescription for antipsychotic medication in the preceding 6 week period, as a percentage of all individuals with a formal diagnosis of dementia. It displays the England, East of England region and Cambridgeshire and Peterborough ICB trend lines.
Figure 4
In March 2024, 9.6% of people with a diagnosis of dementia also received a prescription for antipsychotic medication in the preceding 6 week period in Cambridgeshire and Peterborough ICB. The ICB levels of antipsychotic prescribing were not significantly different from the England value of 9% and not statistically different from the East of England regional value of 10.3%.
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.
The interactive bar chart in figure 5 shows the number of people with dementia who have received a care plan or care plan review in the preceding 12 month period as a percentage of all individuals with a formal diagnosis of dementia. This data is cumulative and the monthly values can be used as a performance measure to indicate progress in the given area but they are not suitable for comparisons over time. Annual trends can be seen in Dementia Profile by comparing data collected at the end of March each year.
Figure 5
In March 2024, there were 6,730 people with a dementia diagnosis in Cambridgeshire and Peterborough ICB. Of these, 5,068 had a care plan or care plan review recorded in the past 12 months (75.3%). This was not statistically different from the England value of 75.1% and above the East of England regional value of 73.9%.
This document was created by Neurology and Dementia Intelligence team (NDI), part of Clinical Epidemiology in the Department of Health and Social Care (DHSC) on 16 May 2024. Data points represent extracts at the last day of the month. Data used in this publication is available via the Surveillance Factsheet part of the Dementia Profile. Underlying data, caveats and metadata are provided by the NHS. Enquiries: ndi@dhsc.gov.uk
This document is using Primary Care Dementia Data, which replaced the Recorded Dementia Diagnosis data in October 2022. The latter has been analysed in previous Dementia Surveillance Factsheet which reflects geographies from before July 2022. Geography changes are detailed by the data provider.
In the new Primary Care Dementia Data the primary care practice coverage was relatively low to start with, while practices were signing up to the new data collection system. That number has recovered to over 95% in March 2023 but still had incomplete data due to one of the Integrated Care Boards not submitting any data at all. From April 2023 all the ICB submit data and the coverage rises above 98%, which is why that date is the first reported in this factsheet. The latest coverage in March 2024 is 98.7%.
Statistical data comparisons have been made using 95% confidence intervals. If the area’s confidence interval contains the comparator value of the higher geography, the values for both areas are not significantly statistically different from each other. These values are described as ‘not different’ in the factsheet. If the whole confidence interval is above the comparator value, the area’s value is significantly statistically higher than the comparator. These values are described as ‘higher’ or ‘above’. If the whole confidence interval is below the comparator value, the area’s value is significantly statistically lower than the comparator. These values are described as ‘below’ or ‘lower’.