Modern Service Framework for Dementia and Frailty

Lord Kamall Excerpts

Thursday 9th July 2026 Grand Committee

[Lord Kamall (Con)]

My Lords, I, too, thank the noble Lord, Lord Weir of Ballyholme, for securing this important debate. I also thank all those who sent us briefings, as well as all noble Lords who have spoken in this debate.

Dementia remains one of the greatest health and social care challenges facing our country. As the noble Baroness, Lady Pidgeon, rightly said, and as other noble Lords agreed, dementia is said to be the leading cause of death in the UK, with nearly 1 million people in the UK currently living with dementia, a figure that is expected to rise significantly over coming decades as our population ages. As the noble Lord, Lord Weir, said, this is a condition that touches most, if not all, families. My noble friend Lady Wyld spoke movingly about her experience. I have started to experience it in my own family because my mother is in the early stages; I have to fly over every so often to give her some sort of respite, as it were.

That demonstrates that behind every diagnosis is not only the individual but their families, their friends and their carers, whose lives are profoundly affected. As my noble friend Lady Wyld said, it calls for a whole view of the person as much as a whole view of the system. Against that backdrop, I think we all welcome the modern service framework and see it as an important opportunity. However, for it to succeed, it must do more than simply list aspirations. It must provide a practical road map on, first, improving diagnosis, secondly, strengthening the evidence base, and, thirdly, ensuring that the NHS and other healthcare providers are prepared to adopt new innovations as they emerge.

If we look at the current state of diagnosis, we find that around one in three people living with dementia remains undiagnosed. Even when someone receives a diagnosis, the precise type of dementia—such as Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia or any other rare type of dementia—is often unspecified. That makes a huge difference because it helps you determine the most appropriate treatments. How can you do that if the type of dementia is not diagnosed?

Early diagnosis not only allows patients and their families to plan and access support sooner; thanks to the continuous advances in research, about which noble Lords have spoken, it will allow patients to access treatments that could possibly slow disease progression. Can the Minister tell us how the modern service framework will support more consistent diagnostic pathways across England? Given the significant regional variation that currently exists, how will resources be targeted to those areas with lower dementia diagnosis rates? What role does the Minister’s department see community diagnostic centres, neighbourhood health centres and primary care playing in this early diagnosis?

I turn to the evidence base, which is the crux of the Question from the noble Lord, Lord Weir. It refers to

“robust and acceptable clinical data and performance metrics”,

which will be key to improving prevention, diagnosis and treatment. Without good-quality, consistent data, we cannot know whether patients are receiving appropriate care, where services are improving or where additional support is needed. Can the Minister tell the Committee how the modern service framework will establish a consistent national approach to collecting dementia data? Will it include meaningful outcome measures that reflect patients’ experiences as well as clinical activity? How will that data be used to drive improvement, rather than being simply about reporting requirements?

I turn to innovation. As other noble Lords have said, we are entering a transformative period in dementia research. Scientific understanding has advanced considerably in recent years, with disease-modifying treatments emerging and more therapies under investigation. This gives us cause for some optimism, particularly when it comes to prevention. Growing evidence suggests that around 45% of dementia cases may be preventable or delayed by addressing modifiable risk factors. Given the mantra “from sickness to prevention”, with which all noble Lords would agree, can the Minister explain how the modern service framework will embed brain health and dementia prevention across our system of healthcare, whether through NHS health checks or other public health initiatives? It would be useful for us to know which particular initiatives will play a role.

As the Minister will be aware, preventing or delaying dementia where possible would improve quality of life for individuals. It would also reduce pressure on not only them and their families but our systems of health and social care. Can the Minister explain how the modern service framework will prepare the NHS, first, to adopt new diagnostic tests and innovative treatments as the evidence develops; and, secondly, to try to reduce those delays as much as possible while maintaining safety?

We know that innovation is driven by research. The Secretary of State has accepted the recommendation of the noble Baroness, Lady Casey, to increase participation in dementia clinical trials to 2,000 people over the next few years. That is welcome but, as other noble Lords have said, participation in dementia research remains strikingly low despite the growing number of clinical trials now under way internationally. I was very much struck by the comments of the noble Baroness, Lady Nargund, who spoke about the underrepresentation of women in clinical trials. We must also do more to understand the links between dementia and other conditions, which are interesting; one mentioned by the noble Baroness is that between the menopause and dementia. Can the Minister say how the Government intend not only to achieve the target of 2,000 trialists but to create a generally research-ready, research-led system of healthcare?

The UK is already a leader in some areas of health research, but, in recent meetings with life sciences companies, I have heard some of them talk about how much more difficult it is becoming to conduct clinical trials in this country. The UK is still a leader, but we must always look behind us as well as looking ahead because, clearly, there are some concerns among life sciences companies. If the United Kingdom is to realise its ambition of becoming a world leader in dementia research, participation in clinical trials cannot be viewed as an optional extra; it must become an integral part of high-quality dementia care.

While we are here, I ask the Minister for her views, as the noble Lord, Lord Weir, said, on NICE’s health technology assessments, including whether there is a way in which we could start to consider the contribution that a treatment could make to society and others. I understand that we had a separate debate and that there were some concerns from the Government, but I would like to hear the Minister’s views on this.

The challenge of dementia extends far beyond healthcare alone. It affects social care, housing, research and innovation, and it is itself affected by these factors. At the human level, it affects not only the individual but their families every single day. The modern service framework is an important opportunity to ensure that our health system is ready for the remarkable scientific advances that are beginning to emerge.

I realise that, in my usual Socratic way, I have asked the Minister many questions, some of which will be answered today, and others which she will diligently respond to in writing. But the gist of all these questions from me and other noble Lords is to remind her that the framework will be judged not simply by its ambitions but by whether research gives us better understanding of prevention and treatment. It will be judged by whether more people receive an earlier diagnosis and gain faster access to innovative treatments—and by whether people in England diagnosed with or at risk of dementia will one day be able to live longer lives in good health.