Modern Service Framework for Dementia and Frailty

My Lords, I welcome the opportunity to raise what is both an important and timely issue. There is a truism which certainly affects my family, indeed most families: many years ago, it would have been said that the terrible scourge of cancer had touched pretty much every family in the country and that most had lost at least one loved one. With dementia now being the single largest cause of death in the United Kingdom, that truism about cancer is becoming more and more relevant and accurate for describing dementia as well. Given what I think is the universal nature of the dementia issue, we should all be on the same side and the same page on this, and I believe that we are. To that extent, the modern service framework offers a golden opportunity to set the strategic direction, and its practical implementation, for the future of dementia services within the United Kingdom. I am encouraged to learn of a number of groups with which there has been co-operation from the department in drawing up that document. It would be helpful for the Minister to give us a little more detail today of the extent of the co-design of the modern service framework, and to update the Committee on the timescale for the interim and final reports of the framework. It is therefore important that we get this right, because none of us want to see the modern service framework become a missed opportunity. That is why the details need to be right. In the brief time available to me today, I will touch on four areas which are critical to the modern service framework. First, there is reduction of risk. A recent survey carried out by Alzheimer’s Research UK indicated that 84% of people wanted to know more about what they could do to reduce the risk of dementia, but, in that same poll, only 8% had any level of confidence that anything they could do could help to avoid or delay it. We know from international global studies that, currently, about 14 risk factors have been identified. I think this will become more and more relevant as our medical knowledge develops over the years to come. It is important that reduction of risk is built into the modern service framework. That means looking at practical steps and at what is being done to try to identify high-risk groups—for example, how we will incorporate positive brain-health messaging into NHS health checks—and at how we can increase access to secondary prevention, through methodologies such as the memory assessment services and emerging brain health clinics, and integrate these with neighbourhood health centres. Reducing risk therefore has a critical role. Secondly, there is the critical issue of diagnosis. We know it is estimated that perhaps a little over one-third of people with dementia are as yet undiagnosed. When we delve into that for early-onset dementia, the figures fall to probably less than half currently being diagnosed. There is a wide variety—a very patchy provision—across the country in the speed and extent of diagnosis. For example, if we look at early-onset dementia, the time taken for diagnosis is, generally speaking, about twice the length of time as for anybody else with dementia. There is also an issue about the quality of the data generated from that diagnosis and the specificity that is able to be provided in the diagnosis. Therefore, it is important that the modern service framework looks at what the pre-existing options are for diagnosing Alzheimer’s. For example, if we look at PET scans and CSF testing, how can we embed those more and then embrace the next-generation technology of blood tests? Having commitments to that within the MSF is important, but it is also the case that we need to standardise coding across health and care settings, so that we can have standardised data in that regard. I say to the Government that it is important that they look, through the modern service framework, towards increasing the rate of diagnosis and ensuring that there is a greater level of consistency of diagnosis across the country. Thirdly, and related to that, is the issue of research. We know that research and diagnosis in many ways go hand in hand, because if we do not have the volume of people being diagnosed, or if it is slower, that obviously impacts on the ability for clinical trials but will also impact the individual’s ability to get that early intervention as quickly as possible. Many of us see a golden opportunity in the years ahead. We are hopefully at the cusp or dawn of a new era of medical advances as regards dementia, which could either delay or even at some stage, we hope, prevent dementia in many cases. I commend to the Government the very recent publication of Ready for the Cure, which has been produced by the Alzheimer’s Research Society. I urge them to look at it. Within that, we need to learn how the Government see additional commitment to research through the modern service framework. Will it be focused on strengthening the research pipeline, and perhaps on creating a national dementia innovation team and national dementia datasets, so that we do not have a wide variety of those? There is also a challenge, when looking at treatments, with the current position of NICE. There is a concern that its cost-benefit analysis does not take fully into account the extent of the burden on carers, even from the financial point of view. That needs to be fed a lot better into the system. As part of that, we need to ensure that not only do we get the research, but that the NHS is research-ready, so that whenever we have it available it can be implemented quickly. Finally, I want to touch on the issue of pathways. Obviously, diagnosis is just the start rather than the end of a journey. Again, we have somewhat patchy quality in the pathways across the country. We need to standardise that and create a pathway applicable to everyone, probably with a level of variation—we would need something slightly different for those with early-onset dementia. Arising out of that, we will need to address gaps in infrastructure and staffing levels. In looking at pathways, we should not forget end-of-life palliative care and how we can invest in that. I welcome the debate and look forward to the contributions of others and the response of the Minister.

My Lords, I am grateful to the noble Lord, Lord Weir of Ballyholme, for securing this important debate, and I welcome the Government’s commitment to delivering the modern service framework for dementia and frailty. Dementia is not gender neutral. We may not have a cure at the moment, but we can cure the inequity in access to research, clinical trials, early diagnosis and effective treatments. In England, more than 500,000 people now have a recorded diagnosis of dementia, and nearly two-thirds of them are women. Dementia and Alzheimer’s disease have been the leading cause of death for women in England and Wales since 2011. Almost two-thirds of unpaid carers for people with dementia are also women. Women live longer, but longevity alone does not explain this disparity. The APOE4 gene increases women’s risk of Alzheimer’s disease more than men’s. The emerging evidence suggests that the hormonal changes associated with menopause may increase vulnerability. The hormone oestrogen is vital for memory formation, as it is essential for effective communication between neurons in the part of the brain involved in memory. The link between dementia and menopause extends beyond misdiagnosis, yet until recently, the relationship between menopause and dementia received remarkably little scientific attention. We need more research about the risks of developing dementia in women who undergo early or premature menopause. As the noble Lord, Lord Weir, mentioned, we need to work on reducing risk and, where possible, identify who is at high risk of developing dementia. Part of that involves identifying the risk in women going through early or premature menopause. This has a human cost. Karen Barber from Essex devoted more than a decade of her life to public service at HM Passport Office and HMRC. In her 50s, her memory and organisational skills began to deteriorate. Her symptoms were repeatedly attributed to menopause and stress. She was repeatedly told that her symptoms were “in her mind”. Without a diagnosis, she was dismissed from her job for poor performance. More than 10 years later, and only after paying privately for a specialist assessment, she was finally diagnosed with young-onset dementia. Karen’s story is not simply one of illness; it is a story of delayed diagnosis, lost employment, financial hardship for the family and a system that failed to recognise the disease at the time. For too long, medicine has been built around a male standard. Women’s underrepresentation in research and the failure to analyse differences between the sexes have left important gaps in our understanding of dementia. As we have known for a long time, studies show that women are underrepresented in dementia clinical trials relative to the burden of disease they bear. One review found that, among 118 dementia trials, only eight reported outcomes separately for women and men. In several studies, treatment benefits appeared greater in men, reminding us that biological sex may influence how medicines work. If we do not measure these differences, we cannot deliver gender-based care and the truly personalised, precision medicine that everyone deserves. I therefore warmly welcome the framework’s commitment to expanding dementia clinical trials, which is absolutely necessary and urgent, and the confirmation that participation will increase to 2,000 people over the next five years. Innovation reduces inequalities only if it is designed for everyone. This is not only a health challenge for women, it is also an economic one. Women already face a substantial gender pension gap, and many leave the workforce prematurely because of caring responsibilities or their own ill health. For women with young-onset dementia, like Karen Barber, years of lost earnings, delayed diagnosis and interrupted careers compound lifetime financial disadvantage. Preventing dementia becoming a pathway into poverty should be part of our national ambition. Women bear a double burden when it comes to dementia, as I said earlier—I repeat it. They constitute the majority of those living with dementia and the majority of those caring for people with dementia. Too often, they also constitute the majority of those overlooked by research, clinical trials and clinicians. If this modern service framework is truly to be once in a generation, it must place women not at the margins but at its very heart when it comes to clinical trials and early diagnosis. As the noble Lord, Lord Weir, said, this is a huge opportunity to achieve that. Can my noble friend the Minister assure the Committee that sex and gender differences will be embedded throughout the modern service framework, from research funding and clinical trial design to the adoption of new diagnostics and treatments with proportionate representation of women? That includes ethnic minority women, because there are some differences in clinical trials and mandatory reporting of sex-disaggregated outcomes. If we are serious about precision medicine, which we should be, it must be precision medicine for all women.

My Lords, I too thank the noble Lord, Lord Weir of Ballyholme, for securing this debate and for setting out the issues, as he did so comprehensively and with great expertise. We are very grateful to him. Like so many people up and down the country—and, as I know, in your Lordships’ House—I too have experience of helping to care for relatives with dementia. The first time was over 20 years ago, and now our family joins many others in trying to navigate the challenge of a recent diagnosis. I have been reflecting on what has changed since I first tried to help a relative over 20 years ago, and I want to start on an optimistic note, because the medical landscape is different. As we have heard, we have entered an era where the first disease-modifying therapies have been licensed. Innovation in diagnostics is enabling us to accurately identify disease earlier in the trajectory, and blood tests in NHS trials could make the diagnostic pathway easier. So, recent breakthroughs have at last delivered hope, if we build a healthcare and research system that is ready to adopt and deliver these innovations at scale as soon as they become available. I am grateful for the briefings I have received. The joint letter from Dementia UK, Alzheimer’s Research UK and the Alzheimer’s Society in the very helpful Library briefing confirmed that there is “a clear opportunity to change the trajectory of dementia—if the system is ready to act”. However, it also stressed that “we must recognise that the health and care system is failing to deliver the outcomes that people with dementia deserve today”. The contrast between scientific progress and the daily reality faced by many patients can be jarring. Every dementia experience is of course unique to the individual, but the vast majority of families face similar hurdles: the emotional toll, the labyrinth of health and social care services and the struggle to access specialised support. It can be a very lonely journey, and I know that for many families, it takes a crisis for help to arrive, so I ask the Government to ensure that the framework is built on a true understanding of the experience of patients and carers. In a debate on Alzheimer’s in October 2025, the Minister described the framework as taking “a whole view”. My hope is that this means it will take a whole view of the person and indeed of the system. The title of the report from Alzheimer’s Research UK, which the noble Lord, Lord Weir, rightly referred to, is Ready for the Cure. It also highlights that dementia is one of the most feared health conditions, as we have heard. Yet we may also have a once-in-a-generation chance to move to a more preventive treatment model. We must ensure that the UK’s scientific excellence is translated into impact for patients and their families. I would be most grateful if the noble Baroness could set out how she envisages the framework achieving this. We have so many strengths in the UK: there has been political will from past Governments and from this Government and many global leaders in the field are based here. As part of the 2012 Prime Minister’s challenge on dementia, the UK established the UK Dementia Research Institute, a beacon of scientific innovation, and the last Government established the Dame Barbara Windsor Dementia Goals programme. We are also gaining a better understanding of prevention. The Lancet commission suggested that 45% of cases of dementia are preventable, as the noble Lord, Lord Weir, referred to. We know that it is about managing risks where we can through lifestyle interventions—what is good for the heart is good for the head—and through better health system management, particularly of conditions such as diabetes. I also want to flag that recent successive studies have shown that people who have had the shingles vaccine have a low incidence of dementia. The shingles vaccine is one of a number of vaccines where studies have suggested some preventive cognitive benefit. Understanding the science behind this better will help shape future vaccine advice, and I wonder whether the Government have thought about this as part of the strategy and whether the Minister can comment. Finally, but most importantly, let us remember the importance of kindness and empathy. I think about the number of people I have known who have sat in a room to hear a diagnosis and, indeed, the times when I have heard news about a family member. Each time, the reaction has been: where do we go next and who can help us? The Secretary of State has set out the importance of enabling patients to live well in their own neighbourhoods. This relies on a properly resourced workforce across health and social care, with the skills and kindness to help patients and their families manage a heartbreaking disease. Navigating post-diagnostic support is difficult, even with an advocate. I hope the Minister will be able to comment on the Government’s approach to care plans. This framework must move us away from a fragmented approach which too often let-down patients and families. We stand at an inflection point. I hope the Government recognise the urgency, because decisions taken now will shape how millions of people experience the hardest chapter of their lives. I look forward to the Minister’s response.

My Lords, I am grateful to the noble Lord, Lord Weir of Ballyholme, for tabling this Question for Short Debate and for his comprehensive opening words which set the tone for this short but perfectly formed debate, giving us the opportunity to consider what the modern service framework for dementia and frailty needs to deliver. If it is to succeed, it should set clear national standards backed by funding and accountability so that a diagnosis opens the door to real support and access to new treatments as they become available. As we have heard, dementia is the UK’s leading cause of death, with almost 1 million people currently living with the condition. This is projected to rise to 1.4 million by 2040. The noble Baroness, Lady Nargund, pointed out that two-thirds of them are women and referred to the interesting research on hormonal changes, the menopause and its links to developing dementia. That is important and something that we need to consider. Research is advancing rapidly. There are, I understand, 158 drugs in 192 clinical trials globally. The first disease-modifying treatments are now licensed in the UK. However, people can access trials for innovative treatments only when they are diagnosed early—making diagnosis at the earliest stages increasingly important. It would be good to hear from the Minister what work the Government are undertaking to ensure easier access to trials. Alzheimer’s Research UK estimates that close to one-third of people over 65 living with dementia in England still do not have a recorded diagnosis, so closing that diagnostic gap is critical. A UCL-led trial—supported by the Alzheimer’s Society, Alzheimer’s Research UK, the National Institute for Health and Care Research, Gates Ventures and players of the Postcode Lottery—began testing a blood test for Alzheimer’s disease in NHS memory services last year, offering a simpler, less invasive route to diagnosis than current methods. If this proves reliable, the framework should be ready to support its rollout across the NHS. As we have heard, Alzheimer’s Research UK has launched a new policy report today, Ready for the Cure: A Blueprint for UK Leadership in Dementia Research, which sets out a series of recommendations to address the key structural barriers to advancing dementia research. I hope to hear, perhaps, an initial reflection on that report when we hear from the Minister. However, a diagnosis on its own is not enough. NHS England’s data shows that more than one-quarter of people living with a dementia diagnosis did not receive a care plan in the past year and that specialist support, such as Admiral nurses, remains patchy and dependent on where someone lives. That gap matters most in the weeks after diagnosis, when families are trying to understand what has changed and what support is available to them. The noble Baroness, Lady Wyld, set out her family’s personal experience. As for others, with that diagnosis of dementia, the question is: where should we turn? What happens next? It is a picture about which we hear so often from many families. Dementia UK and others have called for specialist dementia nursing to be part of every neighbourhood health team. If the framework is genuinely to modernise dementia care, diagnosis, treatment, care planning and support for carers, which is so important, it must be designed and funded as a single pathway. As the ageing population grows and new dementia treatments emerge, the demand for diagnosis will inevitably rise. The forthcoming framework presents a clear opportunity for standardising the pathways for referral, assessment and treatment, for robust data capture and reporting and for reducing the variation in service across the country, which we hear about so often. As the noble Lord, Lord Weir, rightly stressed, we need to get this right. Our discussion on prevention is also an important part of this. I turn to frailty, which makes up the other half of this framework. Around one in 10 people over 65 live with it, and the figure rises to as many as half of those aged over 85. Last month, the Commons Public Accounts Committee reported that only 17% of patients aged over 65 had had a frailty assessment recorded by their GP in the past year, well short of what is needed to ensure that those living with frailty have access to treatment. For those already identified as being most at risk, only 16% had had a medication review and 18% had had a falls risk assessment. This is in a service that is meant to reach everyone in that group. If frailty is to sit alongside dementia in the framework, it deserves the same focus on early identification, consistent standards and timely intervention. Bringing these two conditions together in one framework creates a real opportunity to establish common principles across both. If the framework is going to achieve everything, it must make a meaningful difference to people living with dementia and frailty, as well as to their families and the support networks that care for them. I look forward to the Minister’s reply to this debate and hope to hear of a timescale and resource commitment to this important area.

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.

My Lords, I start by congratulating the noble Lord, Lord Weir, on securing this debate. It has clearly engaged so many and I, for one, am pleased about the positive reaction. He mentioned at the outset that we are all agreed. I am sure that this outbreak of unanimity is always helpful when trying to make progress. A number of noble Lords, including the noble Baroness, Lady Wyld, and the noble Lord, Lord Kamall, just now, spoke about the personal impact—as did the noble Lord, Lord Weir, and all other noble Lords—on the person but also on their families, their communities and those around them. That is very much at the core of the modern service framework. The noble Baroness, Lady Wyld, described the challenge of a lonely, crisis-driven system. That is not how it should be, and it is not serving as it should. I want to set out at the beginning that everyone with dementia and frailty, and their loved ones, deserves high-quality, compassionate, joined-up care and support. Indeed, I say to the noble Baroness, Lady Wyld, that the framework will take a view of the whole person and the whole system. That is the way in which we will deliver. I am grateful, not just for the welcome but for the description of this as a golden opportunity, which the noble Lord, Lord Weir, talked about, and as a once-in-a-generation opportunity, as the noble Baroness, Lady Wyld, said. We absolutely recognise the points being raised by all noble Lords because the system we have has to, and will, change. That is why we are developing and will deliver the first ever modern service framework for frailty and dementia. It will be all about the outcomes—to pick up some of the points asked. It will be a blueprint for how we develop that shift that we are all seeking. It will also work across both health and care settings, which is absolutely crucial. It is important that the MSF is delivered in this way because it acknowledges that dementia and frailty so often coexist. They are hard to distinguish and there is no need to do so. The MSF will also outline, when we look to the future, how we harness the innovations that have the potential to transform care. I say to the noble Lord, Lord Weir, that I am grateful for the engagement that we have had with such a wide range of stakeholders, including those with lived experience, and carers, without whom we could not develop this in the right way. They also include clinicians, adult social care, the NHS and charity partners. As noble Lords will have seen, the immediate findings from the noble Baroness, Lady Casey, on social care made some immediate recommendations on dementia, and we have embraced them straight away. That includes the establishment of a new dementia leadership role in the department with the power to drive action forward. I agree with the noble Lord, Lord Kamall, on the tests that he set; I am totally on board with those. It is only by action, outcomes and change for the better that we will be able to judge it. Otherwise, it is just a piece of paper, and there is no point in doing that. On the question about timelines from the noble Lord, Lord Weir, we seek to publish the full modern service framework by the end of the year, as recommended by the noble Baroness, Lady Casey; we are glad to accept that. To answer the question from the noble Lord, Lord Kamall, it will set national standards and redirect NHS priorities, because we cannot pretend that we can do this as things are. There has rightly been a discussion about clinical data, which the noble Lord, Lord Kamall, raised, and performance matrix. There are many interventions to consider as we improve dementia and frailty care. That is why we are considering all options—I emphasise that. We want to look at the interventions with the best evidence and outcomes. Through the MSF, we will set standards, so we can measure against them, on how interventions should be used, and we will review the metrics and performance data necessary to monitor these standards. I turn to the question of timely and accurate diagnosis, which we know is vital to delivering excellent care. It is, in effect, a gateway to vital advice, information and support. That is why we are committed to recovering the dementia diagnosis rate to the national figure of 66.7%. Importantly, that includes a validated diagnosis of dementia subtype—it is important not to just lump everything together. The framework will look at how we improve diagnosis waiting times, which are too long in many areas, as well as addressing unwanted variation in dementia diagnosis rates across the country and across different groups, as raised by the noble Lord, Lord Kamall, and my noble friend Lady Nargund. The noble Lord, Lord Weir, referred to the Ready for the Cure report, which deals with research and access to treatments and is very pertinent to the immediate recommendations of the noble Baroness, Lady Casey. I can say in response that, through government funders such as NIHR, we continue to invest in dementia research, including speeding up the development of potential treatments, which was also much called for in today’s debate. The noble Lord, Lord Weir, rightly raised the risk factors and the noble Baroness, Lady Wyld, talked about the Lancet commission, which has been very helpful in identifying global risk factors for dementia and the extent to which they are reducible. The NIHR-funded dementia and neurodegeneration policy research units are supporting the development of our understanding of where we have an opportunity to reduce risk. I will be pleased to keep updating the House on that ongoing work. The noble Baroness, Lady Pidgeon, asked about easier access to trials. We are working to fast-track clinical trials, because we want to drive global investment in life sciences as well as provide opportunities for individuals. I have spoken about the acceleration of the development of medicines. I say to the noble Lord, Lord Kamall, that we have made the UK an infinitely more attractive place for clinical trials, not least by stripping out bureaucracy and unnecessary obstacles. We have reduced the period to way below the 150-day ambition that we set. We are ensuring, as my noble friend Lady Nargund asked, that research opportunities are available, irrespective of who people are and where they live. The women’s health strategy makes particular reference to the point she raised on the link between menopause and dementia. The NIHR continues to work on funding for applications for research into any aspect of human health and care, including that link. Our investment continues. We have already adopted the target of 2,000 people participating in dementia trials within the next five years; it currently stands at 377. I believe that by improving the UK’s attractiveness for dementia trials, we will be able to drive forward improvements beyond what we have currently. There was a number of particular points, and I will be very pleased to write to noble Lords on specifics. All the specifics raised today are key to how we improve the potential of the MSF, and we are keen to continue to work on that. The Government absolutely recognise, and are with noble Lords on, the need to improve diagnosis and to have that robust data and the access to innovative treatments. I believe that the modern service framework will deliver that and drive them forward, as well as the other provisions, in a way that we do not have access to now. It is a time to be positive, and I am glad noble Lords spoke in that way, because I, too, share that feeling.