The significance of the #juniordoctors dispute is far greater than the #juniorcontract


The main rule of the game is simple. No main political party in the UK will wish to enter a general election stating an intention to privatise the NHS. Jeremy Hunt has even laughed away on many occasions the notion the NHS is being privatised, despite overwhelming evidence to the contrary.

The tragedy about the fact that some doctors want to go to Australia is that this possibly will help the vision of the NHS to be dragged out of the public sector kicking and screaming.

I would be very surprised if Jeremy Hunt wished to negotiate on behalf of the Department of Health about the current contract. The fact that Hunt does not particularly care about resolving the current pay dispute is graphic in his absence in the House of Commons this week to make a statement on the issue.

Love him or loathe him, Jeremy Hunt is in a long line of Secretaries of State for health who has seen (and, indeed, exacerebrated) the unwinding of the National Health Service from proper funding by general taxation in the public sector to private sector beneficiaries. This process is otherwise known as privatisation.

In as much as there are a number of ways to skin a cat (and of course I should never  wish to do due to my love of cats), there are a number of ways to shoo-in the private sector into the running of the NHS.

One might be to have the private sector involved in aspects of procurement. The defence of the privatisation of NHS Logistics by a previous Labour government was magnificently tried by Andy Burnham in front of Iain Dale in one of the LBC election debates. Indeed, that news was at the time, 2006, reported as “Privatisation sparks biggest NHS strike in nearly 20 years”.

This was roughly the same time as the alleged gaffe by the now Lord Warner, also of the Labour brotherhood, presenting a £64bn NHS Privatisation Plan.

Other ways include the private finance initiative, originally worked up under the John Major government at about 1993 but fully torpedoed by the Tony Blair government following his election thereafter. The NHS Trusts saddled with colossal debt are a testament to this legacy, ably continued by subsequent governments.

In ‘balancing the books’, in what is referred to erroneously as ‘lack of sustainability’ (meaning in fact the Government no longer prioritises a well funded NHS and social care), corporate-sympathetic think tanks have largely pointed at the need to cut staff costs to solve the ‘productivity challenge’. The alternative, of course, would be to do something altogether more fundamental: that is, value and invest in staff, and renegotiate the crippling PFI loans. The NHS cannot burn off all bridges of sources of capital for the future.

‘Privatising’ the NHS is unlikely to be achieved in a ‘Tell Sid’ type flotation (initial public offering) in the City. There are no adverts on the telly for you to buy shares in the NHS. Jeremy Hunt and his minions are well aware of that.

But outsourcing the NHS is of course the Trojan Horse par excellence, as Oliver Letwin well knows.

But transferring entities within the NHS comes with its own legal considerations, such as ensuring the employment conditions of outsourced employees do not suffer. TUPE (2006) is the Act of parliament which is supposed to take care of that, harmonised through the corresponding EU directive.

I wouldn’t be at all surprised if Jeremy Hunt simply wants to tear up the current contract, and build from scratch his “privatisation-friendly contract”. NHS employees will want to protect their pensions, derogatively called ‘gold plated pensions’ by others. Current legislation will protect the pension rights of current employees being outsourced to the private sector, but it is possible HM Treasury will want to reduce this pension load by a legal carve out in a new NHS contract.

In other words, even though it would be vehemently opposed by the BMA and Royal Colleges, Jeremy Hunt could somehow impose a brand new contract by effectively making the entire workforce redundant and getting the workforce to apply for new jobs. This would be politically dynamite, as the recent solidarity of the BMA poll confirms, but technically possible if (a) Jeremy Hunt really does not care about his or his government’s popularity (in the face of a possibly weak Corbyn-led opposition), (b) Jeremy Hunt gets ‘reshuffled’ sideways onto something different (no SoS health has ever gone to lead his or her political party, to my knowledge) (c) parliament votes through the legislation for brand new NHS contracts.

Despite all the noise from Baroness Williams recently, the Liberal Democrats were instrumental in voting through the disaster-laden Health and Social Care Bill/Act. A possible and likely interpretation of this is that introducing competition promoted privatised markets consistent with a neoliberal interpretation of the doctrine of free movement of capital.

But why would Jeremy Hunt want to change fundamentally the NHS contract? Jeremy Hunt, following the well rehearsed principles of massive corporate restructuring programmes for ‘large scale transformation’, presumably will argue that the new contract is necessary to implement a 24/7 service. His rationale for that, to promote patient safety, has been consistently been rubbished by specialists in the area. The General Medical Council will of course give a ringing endorsement to any move to promote patient safety, consistent with their statutory duty, but legally must have due regard to whether the NHS is being properly the correct resources to do the new 24/7 job.

See, for example, this clause of the doctors’ code of conduct GMC ‘Duties of a Doctor':


Ironically, the current ‘mood music’ from the NHS “change gurus” is to encourage disruptive change through change platforms, including Facebook, Twitter or even Pinterest, than large scale bulky costly ‘large scale transformations’. This is consistent with international advice from the leading management consultants McKinseys, for example.

As a Doctor, I have complete solidarity with my colleagues in the medical profession, but I feel instinctively the contract is a bit of a decoy for a much wider agenda. Nothing would make me happier than to be proved wrong, of course.


Redistributing the flour into a few number of bags for less money is #notsafenotfair. The clinical regulator should have this as their prime concern.



Jeremy Hunt MP addresses the Conservative Party conference 2015

Good afternoon.

I’m sorry I’m not the most interesting Jeremy in British politics right now – but I do have the most interesting job, and there is no greater privilege in government than being responsible for our NHS.

To do that I’m supported by a fantastic ministerial team.

So let me start by thanking Alistair Burt for his avuncular kindness, Ben Gummer for his youthful energy, Jane Ellison for her good-natured calmness, George Freeman for his great passion, and David Prior for his worldly wisdom – what a team and I am lucky to have them.

My day as Health Secretary usually starts the same way.

When I arrive in the office there’s a pink folder waiting for me on my desk.

It contains a letter from a member of the public about something that’s gone wrong in the NHS.

Of course these letters are not typical of much brilliant care that happens every day in our hospitals and surgeries.

But I know that if I ignore the things that go wrong, others will too.

I’ll never forget one letter.

A lady wrote to me about her brother who worked as a call centre manager.

He went to hospital for an operation because his back was in agony from a pinched nerve.

Things didn’t go well, including a feeding tube inserted incorrectly, a catheter left blocked for 2 days and cries for help left unanswered in what ended up being a horrible last two weeks of his life.

As Health Secretary you have a very simple choice.

Do you ignore these problems and try to sweep them under the carpet or do we confront them head on and sort them out?

It’s a political choice, too.

Because it’s never comfortable for any government to admit when things go wrong.

But if you care for something – as David Cameron always has for our NHS – you want it to be the best.

I’ll tell you someone else who wanted it to be the best. Nye Bevan, the Labour Welsh firebrand who set up the NHS in 1948 – four years after a Conservative Health Minister suggested it.

Now Bevan would probably turn in his grave if he knew he was being quoted at a Conservative Conference.

But he used a good phrase to explain what he was trying to do.

He said he wanted to ‘universalise the best.’

If the NHS is about equity, it has to be about excellence.

If someone wealthy lives near a hospital with problems, they have alternatives.

But everyone else depends on that hospital.

And if we don’t do everything in our power to improve the quality of that hospital we betray them – and we betray the founding vision of the NHS which says that however fraught your life, however frail your voice our society has not forgotten you because we have an NHS.

The vision of Nye Bevan before.

The vision of a one-nation Conservative Party today.

But a vision that, in office, the modern Labour party forgot.

Their pride in having set up the NHS blinded them to the dangers of ignoring poor care.

Targets mattered more than people.

Good news mattered more than good care.

So when we faced up to the problems of Mid Staffs – which happened on Labour’s watch – they said we were ‘running down the NHS.’

They even tried to vote down the law that set up an independent Chief Inspector of Hospitals.

The true party of the NHS insists on high standards for patients in every corner of the NHS, however tough and challenging that might be.

And although there is much still to do, the results so far speak for themselves.

24 major hospitals have been put into special measures in the two years since the Francis Report into Mid Staffs.

People said no one would want to work at those hospitals.

That they would sink in a spiral of decline. That things would go from bad to worse.

Instead those Trusts changed their boards, recruited hundreds of doctors and nurses, and transformed the care they give. 9 have already come out of special measures and according to one study up to 450 lives are being saved every year as a result.

So let’s recognise the brilliant work of the doctors and nurses  at Basildon, Tameside, King’s Lynn, East Lancashire, George Eliott, Bucks, Goole, Lincoln and Heatherwood and Wexham Park who have worked so hard to turn their Trusts round.

Across the NHS the effort to learn those lessons and improve care has never been higher. And I want to pay tribute to some of the achievements in the last 5 years.

Record numbers of doctors and nurses.

MRSA and CDiff rates halved.

Mixed sex wards eliminated.

Cancer survival rates at a record high.

Maximum waiting times introduced for mental health.

A million more operations every year.

And public satisfaction going up, now at near record levels.

Last year the independent Commonwealth Fund said that under the Coalition our NHS had become the best healthcare system in the world – better than France, better than Germany, better than the US – and here’s something for rugby fans – better than Australia! – so let’s hear it for all 1.3 million NHS staff working so hard in such challenging circumstances – the nurses, cooks, surgeons, cleaners, clinicians, physiotherapists, mental health professionals, porters and volunteers.

We are proud of every single one of you.

And not just the NHS – let’s recognise those working for local authorities to support our vital social care sector and public health programmes.

As you struggle with the pressures of a rapidly ageing population, you too have had many successes.

Integrated care finally becoming a reality thanks to the Better Care Fund.

Smoking rates at an all-time low.

Teenage drinking down and drug use halved in decade.

Teenage pregnancies at a 40 year low.

Yes the gaps between richer and poorer areas are still too high but we are making progress – and Conservative governments and Conservative Councils will never allow young people to have their future taken away by accidents of birth, or debt, or dependency, or addictions which destroy their dreams and take years off their lives.

I have a simple plan.

I want our party, the Conservative Party, to be the party of the NHS.

Some people listen to our opponents and think differently.

So we have to prove it.

And we are.

For two elections in a row, David Cameron and George Osborne promised more money for the NHS than any other party.

The extra £10 billion we have committed to the NHS this parliament is a massive commitment in the face of the worst deficit in our peacetime history.

But what Conservatives know is that a strong NHS needs a strong economy.

We also know high quality public services are not just about what taxpayers put in – they are about what the public gets out.

That whether it’s schools, or police, or hospitals the truly progressive party is the one that fights for higher standards and tackles problems head on.

Like the issue of people who die when they shouldn’t because they are admitted to hospital over a weekend.

When we said in our manifesto, we were committed to 7 day services, it wasn’t just about the convenience of evening and weekend GP appointments, important though that is.

It was to end the scandal of 11,000 excess deaths each year because of what is known as the ‘weekend effect’ in hospitals.

We are not asking junior doctors to work longer hours – that wouldn’t be safe.

Nor is it our intention to cut doctors’ pay – and it is utterly irresponsible to try and scare people into believing we are.

But we do want to support the many doctors who do work weekends with properly staffed shifts, safe working hours and 7 day diagnostic services so that patients are not put at risk.

So I say to those people working very hard right now on the frontline, stand beside us as we address this.

What’s good for patients is good for doctors, so be our partners in building the safest, highest quality healthcare system in the world.

Now safe care is not just about weekend services.

How many of you know that there are around 200 deaths in our hospitals that could have been avoided every week?

We’re no better or worse than other countries – but that’s like a plane crash a week because of mistakes we shouldn’t be making.

Part of the reason is that across the world, often the culture in hospitals is wrong.

Put simply we make it too difficult for doctors and nurses to speak out about poor care.

Too many worry that if they own up to making a mistake or blow the whistle on poor care they will be fired – as they sometimes are.

As a result not only do we cause patients and families untold anguish as they search for the truth, we lose the chance to learn from those mistakes.

In our hospitals we need an honesty culture not a blame culture – which is why I asked Sir Robert Francis to do the first ever independent review into whistleblowing.

Some people say we don’t have enough money in the NHS to deliver the high standards of care we all want.

But it isn’t a choice between standards or money.

If someone catches MRSA in hospital, they stay in hospital for longer costing the NHS more money.

Safer care costs less, not more.

So let’s eliminate the waste from unsafe care and like the rest of the public sector make efficiencies and raise standards at the same time.

Our best hospitals like the Salford Royal down the road, Frimley in Surrey and Northumbria show us it can be done, so let’s learn from them and never waver in our commitment to high quality care in every corner of the NHS.

Now I want to talk about GPs.

Let me tell you about a wonderful GP in Essex.

Every week he asks his practice nurses to write the names of any patients they are worried about on post-it notes.

He then personally calls them to check up how they are.

We have many GPs like him.

But many more who want to be like him, but find they simply can’t deliver that kind of personal care because of targets and tick-boxes and rising appointment lists.

That kind of personal, proactive care should not be a relic of a bygone age.

It’s how we’ll make the NHS sustainable by keeping people healthy and happy at home without needing expensive hospital treatment.

So on Sunday we set out plans for a new contract that will support GPs to deliver evening and weekend care by working with other local surgeries and clinical staff.

We also announced a £750m scheme to improve primary care premises and technology to allow surgeries to expand and modernise their services.

And it’s why we are backing the NHS England Five Year Forward View which will connect the services offered by GPs, local hospitals and social care system to offer integrated care closer to home.

Right for GPs, right for the NHS and the social care system – and most importantly right for the patients.

Let me finish with a point about the culture in the NHS, perhaps the most important point of all.

If we’re going to change the culture to make it more focused on patients, governments too are going to have to change the way they run it.

The NHS is the fifth largest organisation in the world – only beaten in size by McDonalds (now you weren’t expecting the Health Secretary to mention McDonalds were you?), and also Walmart, the Red Army and the US Department of Defense.

Faced with such a large bureaucracy, health secretaries of all parties – quite understandably – have tried to make changes by introducing targets.

Individually those targets have worked – bringing down waiting times, speeding up A & Es, improving cancer care and so on – but collectively they have undermined the professionalism and sense of vocation that should be at the heart of medicine.

Now I’m not going to scrap every target because patients should never have to wait too long for treatment.

But we do believe peer-review, transparency and openness about performance is a better way to drive up standards than endless new targets.

So last year I launched a new website, MyNHS, where we publish more information about NHS performance than any other healthcare system in the world.

You can see how safe your local hospital is;

how good the food is;

how good your local GP surgery or care home is;

the mortality rate for your surgeon

and over 693,000 other pieces of data.

From next May we will go further with assessments on MyNHS about the overall quality of mental health and cancer care, area by area,

and because we still have too many avoidable deaths we’ll also publish avoidable death rates hospital by hospital.

Some people have criticised this as ‘naming and shaming’ – but there are no sanctions or punishments for those with low scores, just the opportunity to improve.

Transparency for patients, not targets for politicians.

A new culture where patients always come first.

Conference, our healthcare system has always faced challenges.

And our strongest weapon in the face of those challenges has always been our willingness to innovate.

We discovered penicillin, we pioneered anaesthetics, we made the first hip replacements possible and we unravelled DNA.

We gave Britain the NHS – and the world its first universal healthcare system.

And we’re not stopping.

We will soon be a world leader in curing rare diseases with our genomics programme;

a world leader in using transparency to drive up clinical standards;

a world leader in improving hospital safety.

All backed with the resources of a strong economy only a Conservative government can deliver.

Some say with pressures mounting and money so tight, we need to rein back our ambitions.

But I say the only way to meet the challenges we face is to raise our ambitions, face the storms and draw strength from the wonderful commitment of NHS staff and the British people who stand foursquare behind them.

Because with a one nation Conservative government, for our NHS the best is yet to come.

Thank you.


And here was the reaction of Richard Humphries, Director at the King’s Fund:


Could the “social impact bond” help to improve services in dementia care?

It’s impossible to ignore the occasional spate of reports of ‘care home scandals’, including Winterbourne View and Orchid View.

Whilst a direction of travel might be to advance people living ‘successfully’ as long as possible independently, there’ll be some people for whom a care home might be appropriate. There are particular aims of policy designed to support living well with dementia, such as combating loneliness and providing meaningful leisure activities, which can possibly be achieved through high quality care homes.

It’s pretty often that you hear of social care being “on its knees”, due to drastic chronic underfunding. A concern about attracting investment from the private sector is that this will help to accelerate the lack of financial resource allocation from the State. And yet this is the opposite to the argument of resources ‘leeching’ out of the public sector into the private sector.

In terms of the ‘business model’, there are concerns that, to maximise shareholder dividend, staff will not be incentivised to ‘care well’, if they are barely meeting the requirements of the national minimum wage. Whilst the employer emphasises ‘flexibility’ of zero hours contracts, for many such contracts are symbolic of a lack of commitment for sustained employment by the employer.

So the idea of bonds being used to prop up dementia care, currently one of the three big arms of the Prime Minister’s Dementia Challenge, has gained some momentum, for example here. Bonds are effectively “IOUs“, and concerns remain for them as in the private finance initiative – such as who actually benefits, the prolonged threat of penalty for not being able to meet your loan repayments, the issue of who decides the outcomes by which performance will be assessed, and who actually manages or controls the enterprise.

Social Impact Bonds (SIBs) are depicted as “a way of enabling innovation, creating flexible contracts around social outcomes and providing linked investment“. But for some, they are a vehicle for enabling ‘privatisation by stealth’.

The current Labour opposition officially is trying to distance itself from any mechanisms promoting the privatisation of the NHS, and yet it is known Chris Ham and Norman Lamb wish to publish a report imminently on the possible use of SIBs in policy under the auspices of the King’s Fund.

This is the title slide of Hazel Blears’ presentation for the Alzheimer’s Show on Friday.


And here is a section of her talk.

[apologies for the sound quality]

Hazel has a strong personal attachment to campaigning on dementia, and is particularly interested and influential in the direction of travel, not least in her rôle as Vice Chair of the All Party Parliamentary Group on dementia, a cross party group made up of MPs and Peers with an interest in dementia.

Andy Burnham MP, Shadow Secretary of State for Health, has made it clear that it is his firm and settled intention to repeal the Health and Social Care Act (2012). The current Prime Minister’s Dementia Challenge is to come to an end officially in March 2015.

Dementia UK set up some time ago its innovative ‘Admiral Nurses’ scheme, to provide specialist nurses who could help people with dementia and family carers to improve the quality of life of people with dementia and family carers.

Burnham has also let it be known that he intends to subsume social care within the NHS under the construct of ‘whole person care’. Whichever various formulations of ‘whole person care’ you look at, you tend to find a ‘care coordinator’ somewhere. The exact job description of the care coordinator, nor indeed which specialisms might be best suited to accomplish this rôle, is somewhat unclear presently.

But it is all too common to hear of people being diagnosed with dementia being ‘lost in the system’, sometimes for years without follow up.

A “care coordinator” might help to boost access to the following services: emotional support, enable short breaks for people with dementia and anyone in a caring role, promote nutritious meals, ensure medications are given on time, ensure the correct medications have been subscribed (for example avoiding antipsychotic medications in individuals who might be unsuited to these), advice about suitable housing (including downsizing), ensure all physical commodities are properly medically managed; and so the list goes on.

I feel it’s pretty likely there’ll be a ‘first mover advantage‘ effect for any entity which takes up this coordination rôle in dementia care. But the tension between this and the Opposition’s policy is palpable: one cannot talk of this entity being ‘the first to enter the market’, as many wish (and expect) Labour to abolish the internal market in health care.

Such a coordinating entity could well be a recipient of a SIB – but is this like the PFI of social care? PFI by and large has an incredibly negative press amongst members of the general public.

But on the other hand, is it vindictive to prevent a social enterprise from pitching from such a service? If that entity has the technical ‘know how’ to run operations nationally competently and at a reasonable price, would that be preferable to the State running such services when projects such as NHS IT and universal credit have not gone terribly well?

In our jurisdiction, private companies can hide easily being a corporate veil, and are for example currently not readily accountable through freedom of information legislation. This is despite numerous requests to Jeremy Hunt in parliament about parity in disclosure requirements from both private and public providers.

And the track record of some outsourcing companies in the private sector, it is said, has been terrible.

Jeremy Hunt and Norman Lamb are currently in control of NHS and care policy, but there might be a fundamental change in direction from the next Government.

Or there might not be.

A person newly diagnosed with dementia has a question for primary care, and primary care should know the answer

GP seeing his patient

Picture this.

It’s a busy GP morning surgery in London.

A patient in his 50s, newly diagnosed with Alzheimer’s disease, a condition which causes a progressive decline in structure and function of the brain, has a simple question off his GP.

“Now that I know that I have Alzheimer’s disease, how best can I look after my condition?”

A change in emphasis of the NHS towards proactive care is now long overdue.

At this point, the patient, in a busy office job in Clapham, has some worsening problems with his short term memory, but has no other outward features of his disease.

His social interactions are otherwise normal.

A GP thus far might have been tempted to reach for her prescription pad.

A small slug of donepezil – to be prescribed by someone – after all might produce some benefit in memory and attention in the short term, but the GP warns her patient that the drug will not ultimately slow down progression consistent with NICE guidelines.

It’s clear to me that primary care must have a decent answer to this common question.

Living well is a philosophy of life. It is not achieved through the magic bullet of a pill.

This means that that the GP’s patient, while the dementia may not have advanced much in the years to come, can know what adaptations or assistive technologies might be available.

A GP will have to be confident in her knowledge of the dementias. This is an operational issue for NHS England to sort out.

He might become aware of how his own house can best be designed. Disorientation, due to problems in spatial memory and/or attention, can be a prominent feature of early Alzheimer’s disease. So there are positive things a person with dementia might be able to do, say regarding signage, in his own home.

This might be further reflected in the environment of any hospital setting which the patient may later encounter.

Training for the current GP is likely to differ somewhat from the training of the GP in future.

I think the compulsory stints in hospital will have to go to make way for training that reflects a GP being able to identify the needs of the person newly diagnosed with dementia in the community.

People will need to receive a more holistic level of support, with all their physical, mental and social needs taken into account, rather than being treated separately for each condition.

Therefore the patient becomes a person – not a collection of medical problem lists to be treated with different drugs.

Instead of people being pushed from pillar to post within the system, repeating information and investigations countless times, services will need to be much better organised around the beliefs, concerns, expectations or needs of the person.

There are operational ways of doing this. A great way to do this would be to appoint a named professional to coordinate their care and same day telephone consultations if needed. Political parties may differ on how they might deliver this, but the idea – and it is a very powerful one – is substantially the same.

One can easily appreciate that people want to set goals for their care and to be supported to understand the care proposed for them.

But think about that GP’s patient newly diagnosed with dementia.

It turns out he wants to focus on keeping well and maintaining his own particular independence and dignity.

He wants to stay close to his families and friends.

He wants to play an active part in his community.

Even if a person is diagnosed with exactly the same condition or disability as someone else, what that means for those two people can be very different.

Once you’ve met one person with dementia, you’ve done exactly that: you happen to have met one person with dementia.

Care and support plans should truly reflect the full range of individuals’ needs and goals, bringing together the knowledge and expertise of both the professional and the person. It’s going to be, further, important to be aware of those individuals’ relationships with the rest of the community and society. People are always stronger together.

And technology should’t be necessarily feared.

Hopefully a future NHS which is comprehensive, universal and free at the point of need will be able to cope, especially as technology gets more sophisticated, and cheaper.

Improvements in information and technology  could support people to take control their own care, providing people with easier access to their own medical information, online booking of appointments and ordering repeat prescriptions.

That GP could herself be supported to enable this, working with other services including district nurses and other community nurses.

And note that this person with dementia is not particularly old.

The ability of the GP to be able to answer that question on how best her patient can lead his life cannot be a reflection of the so-called ‘burden’ of older people on society.

Times are definitely changing.

Primary care is undergoing a silent transformation allowing people to live well with dementia.

And note one thing.

I never told you once which party the patient voted for, and who is currently in Government at the time of this scenario.

Bring it on, I say.

Jeremy Hunt’s message on dementia should have been ‘screened’ for damaging myths

My presumption is that I wish to be extremely positive about HM Government’s own volition about leading the G8 with the subject of dementia.

Also, the “Prime Minister’s Dementia Challenge”, which sets out a roadmap for dementia for this year and next, has been a success which I much admire.

David Cameron and Jeremy Hunt, and their team, must rightly be applauded.

However, some accidental problems with the latest message appear to have crept in unfortunately.

The article in the Telegraph says that, “Health Secretary Jeremy Hunt says it is “utterly shocking” that only half of people suffering from dementia are being formally diagnosed.”

You can watch the video here.

Recently in English policy a skirmish over screening has been temporarily staved off by certain stakeholders avoiding ‘the S word’.

They have decided to plump for the ‘C-word instead’.


But in fairness Jeremy Hunt MP, Secretary of State for Health, in the actual “piece to camera” does not use the word “suffering”.

This is particularly ironic as Hunt later says, “”We’ve got to overcome the stigma.”

A major thrust of dementia must be to destigmatise dementia, by emphasise the myriad of things which can be done to help individuals living with dementia, like improvements of the house and the outside environment, non-statutory advocacy or dementia friendly communities.

Hunt’s attempts to overcome the stigma are, unfortunately, somewhat mitigated by his claim that,

“Dementia is a really horrible condition.”

Hunt mentions that “This is not surprisingly because memory is an intrinsic part of all of this.”

The meme that memory problems are synonymous with dementia remains a persistent toxic misrepresentation.

Not all memory problems are dementia (depression can cause profound memory problems.)

Not all dementia presents with memory problems. One of the most common forms of dementia in the age group below 60 is the behavioural variant of frontotemporal dementia.

This presents typically with an insidious change in behaviour and personality, often not noticed by the person himself or herself (but noticed by somebody close by.)

Even some of such individuals can present with plum-normal brain scans.

Advanced MRI brain scans

This small fact would aggravate hugely physics experts to sit on dementia clinical steering groups perhaps, if they knew.

A number of parliamentarians have recently emphasised the need for prevention.

This is indeed a worthy claim.

“You can change your lifestyle to help to stave off the diagnosis.”

However the evidence for this claim is extremely scant.

Non-clinicians in policy must not give false hope to members of society.

This is extremely irresponsible.

Hunt continues, “GPs have been reluctant to give a diagnosis as they’ve thought that ‘nothing is really going to happen'”

There has been in recent years a language depicting war, between GPs and persons with a possible diagnosis of dementia.

There is a very damaging myth, perpetuated by some influential people in the third sector, that GPs are actively withholding a dementia diagnosis in some people.

This claim undermines the credibility and probity of medical professionals, but GPs are relatively defenceless against such a slur.

Hunt says, “If people are worried, come and talk to your GP.”

A moral dementia policy is giving correct support including non-pharmacological interventions to support people living with dementia, as well as support for carers who often experience significant pressures in caring themselves.

People need to be accurately diagnosed with dementia. A wrong ‘label’ of dementia, for a person with no dementia, can do much harm.

Nonetheless, the idea of identifying correctly new people with dementia such that they can be given the right support is a commendable one.

It’s essential though that we do not enmesh this with this policy goal becoming targets, and clinicians being thrown off track by perverse incentives which are not directly beneficial to patients of the NHS.