Creating one national health board and giving people access to their own medical records could accelerate Scotland’s “world-leading” reputation in dementia prevention, an expert in the disease has said.
Professor Craig Ritchie said the country had set a standard, globally with the launch of a national, government-funded centre, hosted by Alzheimer Scotland that aims
to reduce incidence with clinics focused on maintaining brain health.
It is widely known the diseases that lead to dementia start in midlife and that lifestyle changes can cut the risk, such as reducing alcohol intake, eating a balanced, Mediterranean-style diet and managing stress. One study found up to 40 per cent of cases could be prevented or delayed by individual or policy changes.
Prof Ritchie said progress in introducing preventative clinics across Scotland was being delayed by the “structural layers of numerous health boards”.
He said there was some frustration that Scotland’s “enviable position” in dementia research, prevention and treatment was “slow to be picked up from some agencies within Scottish Government and the NHS”.
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He said the NHS should be moving towards a system that prioritises “health maintenance” over the treatment of illness and said efforts to prevent disease such as dementia were being halted by a system that “waits until people are sick”.
He said the pandemic had led to “transformative” change within
the NHS by giving people access to their own vaccine status and suggested widening this out to medical records could empower people to take ownership of their own health.
Mr Ritchie, who is Professor of the Psychiatry of Ageing at the University of Edinburgh, said he was in favour of opening up health services to other qualified providers while maintaining the NHS’s “free at the point of delivery” founding principle and said it was an approach Brain Health Scotland was keen to explore under his leadership.
He said: “Although there are several entities within government dedicated to this work – the fact we have numerous health boards and other structural layers can make translating this envied position globally into a real difference in the lives of people at high risk of developing dementia, when in fact the opposite should
be true.
“In the future, I think the public and people working in the NHS need to set new, more ambitious targets and demands for what excellence in healthcare looks like and be motivated to achieve this.
“In Brain Health Scotland, we are committed to having brain health services available for everyone in Scotland by 2025, in doing so we will take a major step forward in preventing dementia across the country.
"National service delivery, which is innovative and transformative though has to be filtered currently by local health boards, and such national initiatives would really benefit if we had a dynamic, single national health board providing leadership with local boards tasked to deliver on these nationally agreed pathways.”
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He said the relationship between the NHS and the public had been “fundamentally changed” by the pandemic through vaccine certification and this could be expanded in other areas to improve health.
He said: “When the NHS was founded in 1948 a top-down, paternalistic model of healthcare was a reflection of hundreds if not thousands of years of medical practice, but now, with knowledge at virtually everyone’s fingertips, the relationship between health care provider and the public is fundamentally changing.
“In brain health service that is grounded in health maintenance not management of symptomatic disease, the person will be very much in charge, starting with owning their own medical information.
“It was a subtle but actually transformative moment when we each had our own detailed vaccine information on an app on our phones. I hope that is just the start of having your entire medical record at our fingertips.”
He said health boards were set up around hospitals with “huge gravitational pull for resources” adding, “the reality is that we want to move towards undertaking much more healthcare via digital solutions that have no boundaries geographically.”
“This doesn’t mean to say we throw out the baby with the bathwater because people like to be seen face to face by their nurse, pharmacist, doctor, etc – but so much health information can be collected both actively and passively from remote testing on smart phones or computers and be provided to the practitioner ahead of their appointment.
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“21st century healthcare has to be leading a digital revolution and get to the forefront of the use of data sciences and Artificial Intelligence, which have until now been dominated by the financial, military, retail and social media world.”
He said Scotland was the only country working on all three programmes of a new global initiative set up by the World Economic Forum that aims to better understand the earliest stages of dementia.
The first brain health clinic was launched in Edinburgh before the pandemic struck and also gives patients access to new drug trials.
Kevin Stewart, Minister for Social Care, said: “The Scottish Government is providing funding to Brain Health Scotland to take a national role to ensure that optimal brain health is part of public health policy, clinical research and clinical practice to reduce the risk of developing or preventing some forms of dementia and consequently help reduce incidence and prevalence.
“We are working with Brain Health Scotland and others to establish pilot brain health services within the NHS.
"We continue to support NHS boards and local partners to improve dementia care and are working to implement the commitments in the Dementia Covid-19 Recovery Plan.
“Recent figures for 2019/20 on the percentage of those referred for dementia
post-diagnostic support who received a minimum of one year’s support show a welcome improvement nationally.
“We want everyone who is entitled to post-diagnostic support to be offered a referral.
"That’s why we are allocating an additional, ring-fenced sum of £3.5 million
last financial year and this new financial year, and so that we can meet the service shortfall and address variation across health boards.”
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