Provision of drugs to treat Alzheimer’s disease

Conclusions of NICE review

On 22nd November 2006 the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) published a clinical guideline on the care and treatment of people with dementia, alongside NICE's technology appraisal on drugs for Alzheimer's disease. This was the result of a long consultation and review process. The key conclusions of this review are set out in the letter posted below.

What provision is available for Alzheimer's sufferers?

Many people have contacted me about the treatment of patients suffering from Alzheimer’s disease and NHS funding of care for people with dementia and other conditions.

I am sure you will be aware that NICE was set up to independently assess the effectiveness of all drugs – the decisions they make are not political, they are scientifically based. Therefore it would probably be helpful to study the full detail of the NICE findings on this issue, as it appears the Alzheimer’s Society themselves recognise the shortcomings of these drugs. However I do understand your concerns and that this is a matter many people feel strongly about.

In its recent review of guidance on the use of drugs for Alzheimer’s disease, NICE suggest that the use of the Alzheimer’s drugs covered by their 2001 guidance is no longer cost-effective. The draft technology appraisal produced by NICE and issued on 1st March is a consultation document. Consultation runs until 22 March.

The reason for the proposed change of view is because of the availability of more recent evidence on cost-effectiveness. NICE will carefully consider all responses to their consultation before making a final decision. Until then, the original 2001 guidance should be adhered to and patients currently being prescribed Alzheimer’s drugs should continue to receive them.

I know that health ministers will be asking a number of questions of NICE when it responds to NICE’s consultation on its draft proposals. These questions will be published on NICE’s website along with other comments.

It is open to anybody to offer evidence and views during the consultation period on the draft proposals, and this consultation period ends later this month.

Health ministers do not give instructions to NICE on how they do their evaluations, as reported by some national newspapers.

It is important that we respect the independence of NICE. However, in view of the public concern over the draft proposals, I think it is also important to ensure that all aspects have been fully considered. That is why the Department of Health will be asking NICE whether the wider social implications of not approving the drugs' use

have been fully taken into account, especially the benefits and costs to carers as well as patients.

You also call for the NHS to fund personal care. It may be helpful if I clarify the distinction between personal care and nursing care. Personal care is the term used to describe the help someone needs in order to carry out personal activities such as bathing, dressing and undressing, eating and using the lavatory. It may also cover advice, encouragement and supervision in these activities. Personal care costs are met either by the recipient or by the local authority on a means-tested basis so there may be a charge for this aspect of an individual’s care.

Personal care does not include the cost of food and board. So, even in Scotland where personal care is not means tested, people will have to contribute to these costs if they are in residential care.

Nursing care refers to any action taken by a registered nurse in providing, planning and supervising a person’s health care. In October 2001, we delivered on our commitment set out in the NHS Plan to provide free nursing care for people in care homes and other settings. NHS funded nursing care is assessed solely on the grounds of an individual’s medical needs.

Where an individual's assessed continuing medical needs are of a certain level, as defined by the strategic health authority's eligibility criteria, then the individual's package of care is fully funded by the NHS. This is described as fully funded NHS continuing care. People with dementia are as entitled to fully funded NHS continuing care as those with other conditions if they meet local eligibility criteria.

Fully funded continuing care can be provided in a hospital, in a person’s own home, or in a care home. Where the NHS provides continuing health care in a hospital or care home, all care is free, including the cost of food and accommodation.

We do not believe that making personal care free for everyone is the best use of limited resources. Making personal care free for everyone carries a very substantial cost and it would consume most of the additional resources we are making available for older people.

We believe our alternative proposals to improve standards of care and ensure fair access to services will generate more important benefits for all older people. We have invested money in a range of new initiatives and these include:

• free NHS nursing care in all settings since October 2001;
• substantial investment in intermediate care;
• property being disregarded from the means-test for residential accommodation for the first twelve weeks of a permanent move into a care home;

• deferred payments scheme, whereby people can delay selling their homes in order to meet care costs. Councils have been given a grant to help them introduce this scheme;
• raising the capital limits below which individuals will receive financial assistance to pay towards their care; and
• implementation of Fair Access to Care Guidance which will promote access to care services based on an evaluation of an individual's assessed needs and likely risks, including both immediate needs and needs which are likely to become more intensive.

In July 2002 the Government announced an additional billion pounds for social services over three years from 2003/04 to 2005/06. With this money we are investing in a range of initiatives to improve care for all older people. Some of these initiatives are:

• removing social services' ability to charge for community equipment and intermediate care services. Services will now be free of charge and this removes a barrier to local councils providing these services jointly with the NHS;
• making it an obligation for every local council to offer older people a direct payment to purchase care that best suits their individual needs;
• increasing the amount of money to support carers. The Carers Grant was introduced in 1999 to support local councils in arranging short breaks services for carers and was worth £125million in 2004/05. Next year the Grant will be worth £185million;
• speeding up assessments. As of the end of 2004, all assessments for social care services will begin within 48 hours and will be completed within four weeks. Following assessment the services people need will be in place within four weeks; and
• agreeing to make £70million available by 2006 to support training for social care staff.

These benefits are not available in those parts of the UK that made personal care free.

It is also important to stress that in England no one need sell their home if they enter residential care. Every council has been given funding to allow them to put a charge on a person’s property and to recover any money owed to them after a person dies.

Free personal care does not help the poorest people or the sickest as the care of these people is already funded. It would divert resources from schemes that help all older people and in particular would divert money that we use to help people maintain their independence and stay longer in their own home.

Finally, one of the key standards in the National Service Framework (NSF) for Older People aims to ensure that older people who have mental health problems have access to integrated mental health services, provided by the NHS and councils, to ensure effective treatment and support. Early milestones in the NSF require local NHS bodies and councils to review current arrangements for the management of depression and dementia for older people. They are required to agree and implement local protocols across primary care and specialist services, including social care. In time, this should be extended to cover all mental health problems in older people. This review will help to identify gaps in provision which need to be addressed, and in the long term, help to alleviate pressure on existing services.