The government’s new vision for dementia diagnosis is ambitious: by 2029, more than 92 per cent of patients could receive a diagnosis within 18 weeks of referral, up from fewer than half today.
Backed by £5m in research funding, it’s a bold statement of intent. However, these ambitions risk falling flat if innovation is only viewed through the lens of what’s coming next, not what’s already within reach.
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This failure to utilise currently available tools means around one in three people with dementia in the UK don’t have a diagnosis. For them, the science of the future offers little comfort. They need answers now.
There is no single diagnostic test that determines the different causes of dementia, the most common being Alzheimer’s disease. Combining the results of several different investigations helps doctors provide an accurate diagnosis. For most patients, that still means pen-and-paper tests that have remained largely unchanged for decades. Meanwhile, only 2 per cent currently receive a “gold standard” test – either a specialist PET brain scan or a lumbar puncture to collect and analyse cerebrospinal fluid (CSF).
Despite the National Institute for Health and Care Excellence (NICE) updating its guidance in 2018 to recommend CSF analysis where appropriate, access in the UK remains extremely limited and leaves patients facing long waits and uncertainty. Across Europe, in countries including Ireland, Germany, and Sweden, CSF testing is routine.
The barrier to patients being given access to this test is not scientific; it’s systemic. There’s a lingering perception that lumbar punctures are invasive and painful, when in reality they are well-tolerated. The bigger issue lies in how diagnostic pathways are structured, with patients often moved from pillar to post and left to fall through the cracks.
The NHS Medium Term Planning Framework provides an opportunity to change this. It includes an explicit mandate for the full utilisation and extended operating hours of community diagnostic centres (CDCs). These centres could be home to Alzheimer’s testing, including the use of blood tests to triage patients with mild cognitive impairment, and CSF analysis to confirm an early diagnosis in those where Alzheimer’s is likely the cause of their symptoms. There are already proven models for NHS-funded procedures, such as cataract surgery, being delivered safely in community or independent settings. With the right commissioning, governance and workforce training, CDCs and other community settings could become hubs for enabling more people to get a dementia diagnosis, without the need for significant investment.
We should also remember that during the pandemic, the UK demonstrated its ability to accelerate access to diagnostics at pace and scale. Processes were streamlined, partnerships strengthened, and infrastructure rapidly deployed. We didn’t lower standards – we aligned priorities, acted decisively and all pulled in the same direction. That drive and sense of urgency seem to have faded.
The government has a clear and laudable ambition to make the NHS fit for the future. However, innovation is not just about discovery; it’s about delivery, and we risk leaving thousands of patients behind if, by focusing too heavily on what’s coming next, we ignore what’s possible now.
