Long-standing followers of this blog will remember that I started to take a special interest in healthcare and particularly dementia after my father started to decline towards what was eventually diagnosed as frontotemporal dementia. I was so shocked by what I discovered that I made the feature-length investigative documentary You must be nuts! – The business of dementia. So, even though the topic of the day remains security, I will turn my attention in this post to an issue which came up much earlier in the election campaign: the dementia tax and the state of the NHS.
What emerged from my research into how best to treat my father was so distressing that I included animated sequences to ensure that viewers would make it to the end of the film! Over 8,000 people have watched it so far on YouTube, after around 1,000 had watched its initial appearance on Vimeo. Thanks to the contacts I made when making my film, I now find myself among an active but occasionally frustrated community of scientists and researchers who have joined the quest for a holistic approach to healthcare.
If you have been watching the ‘Doctor in the House’ series on BBC 1, you will know that my namesake Dr Rangan Chatterjee uses such an approach to treat families after visiting them in their homes and experiencing their lifestyles. You may also have seen cardiologist Dr Aseem Malhotra on TV. Dr David Unwin is a GP who became the first to publish a paper demonstrating how lifestyle changes could reverse Type 2 diabetes and have saved £20,000 per year in diabetes medication costs in his practice. He recently argued in a paper in the British Medical Journal that GP practices should be able to keep the money saved from putting patients on a low carbohydrate diet.
So what is stopping the NHS adopting a holistic approach to healthcare? Unfortunately, this is where you need to ‘follow the money’. I detailed my concerns and called for a formal investigation in a letter to the Chair of the Commons Health Select Committee in February 2015. I have given up hope of ever receiving a reply, let alone seeing a formal investigation. As others who had raised similar issues before me have found as well, the problems I identified seem to lead right to Jeremy Hunt, Secretary of State for Health since 2012.
In essence, I believe that certain Government policies may have increased the risk of dementia and other modern chronic diseases (cardiovascular disease, obesity, diabetes and cancer). Over several decades, under successive Labour and Conservative Governments, the NHS has been pursuing unscientific practices such as:
Meanwhile, since 2012, the city of Amsterdam has reduced child obesity by 12% by banning fast food sponsorship and fruit juice at schools while encouraging parents to allow their children to get enough sleep. In contrast, child obesity in the UK is rising.
The third problem area is the reluctance to regulate the widespread use of pesticides and herbicides on crops and indeed domestic gardens. Each of us can try to protect ourselves from this by buying organic and eating only real, unprocessed food. Still, it does raise the question of why the consequences of poor nutrition and dietary advice are being ignored while the NHS suffers increasing costs of treating the resulting illness.
As if this was not enough for the NHS to cope with, thanks to the ‘people-have-decided’ anti-immigrant mantra of the Brexiteers, there is also the imminent potential departure of tens of thousands of non-British EU nationals working in the NHS who now feel unwelcome in the UK since last year’s Referendum result. Nick Clegg highlights this in the video above.
Almost all of my father’s carers were non-British EU nationals. We gathered that British carers preferred to stay on benefits rather than continue as carers and earn only marginally more – it is a very tough but low-paid job.
This brings me to the ‘dementia tax’. In the UK, the NHS looks after treating people who are ill while local councils are responsible for social care – as they were before the creation of the NHS. Based on our experience with my father, this setup is totally dysfunctional. Elderly patients are often left for weeks occupying hospital beds while the doctors treating them remain to be convinced that their patients will be able to survive with the care they will get after they leave. Moreover, hospital doctors have different IT systems from community health practitioners such as GPs. In my father’s case, that meant that, although a hospital doctor had signed a paper advising that my father should not be resuscitated in case of breathing problems, this meant nothing to ambulance staff and paramedics without his GP signing a similar paper!
In case you had not realised, local councils have very tight budgets. Social care funding is means tested, although based on their disposable income, not their total assets. This already gives local councils an interest in assessing elderly people as ‘self-funders’. A few weeks ago, Theresa May announced a manifesto commitment to include the cost of people’s homes in this calculation. According to the announcement, their homes would not need to be sold until after their deaths.
However, this seems to be unlikely in practice if the system continues to work as it did when I was managing my father’s carers. He was a ‘self funder’, which meant that he received a monthly contribution from the local council towards his care costs but it was he who was liable to pay the care agency/carers – not the local council.
Under Theresa May’s proposal, his share of our house would have been included in the calculations, presumably reducing considerably the monthly contribution made by the local council. Nonetheless, he would still need to pay the care agency/carers. At £15 per hour, this adds up very quickly – especially if care agencies insist that their carers cannot attend the person alone and need to have two carers in attendance (which is very disorientating for anyone with dementia).
Even with a cap on care costs that was eventually extracted from Theresa May after an outcry by other political parties, the carers have to be paid each week and, somehow, the councils need to find the money to fund the difference. I cannot imagine how an elderly person would avoid having to sell their house during their lifetime (and hence move into a care home) to pay the care bills if the value of their house is included in the means testing assessment.
From what we have seen, there are ways for the NHS to save money provided people are given the right (non-commercially-funded) dietary advice and treated holistically by their GPs (instead of doctors and medical journals being sponsored to encourage daily drugs being prescribed for the rest of people’s lives). In addition, it would be useful if the Government would ban two processed foods which are known to increase the risk of heart disease (margarine and highly processed vegetable oils, such as sunflower oil), as well as glyphosate – the key component of the most popular domestic and industrial weedkiller which is known to be an endocrine disruptor.
However, this would need politicians with the guts to take on Big Food, Big Pharma and Big Ag. Given his performance over the past 5 years, Jeremy Hunt doesn’t seem to be one of them.