The thinking behind PicaPal

There is a stretch of the dementia journey that begins long before any diagnosis.

It is crowded, quiet and under-supported.

On average, it now takes three and a half years from when symptoms are first noticed to a diagnosis (UCL, 2025). Three and a half years in which a person is still at home, still themselves, still holding the thread of ordinary days - with memory or confidence quietly becoming less reliable, and little formal support designed to meet those everyday moments.

That stretch matters.

Just 1.4% of dementia healthcare costs go on diagnosis and treatment (Alzheimer's Society, 2024). The practical support that comes before diagnosis is thinner still. And people living with dementia and their families shoulder 63% of the entire £42 billion annual cost of dementia in the UK themselves.

None of this is anyone's fault.

Funding, understandably, gathers where there is something formal to respond to - a diagnosis, a care package, a trial, a treatment pathway.

The years before that belong to the person and the people who love them, often alone.

I am not asking for a single pound less to be spent on care, or on the search for a cure. Both matter, and I am glad serious people give their time to them.

I am asking a quieter question:

if need begins before the system can formally name it, why does so little practical support begin at this point?

Support that arrives earlier need not add to the load further down the road.

It can ease it.

It can help someone stay genuinely themselves for longer - which is worth a great deal to them, to their family, and to a system already carrying so much.

That is the space PicaPal is being built for.

Help that does not wait.

In cognitive change, much of what our system offers responds once difficulty is already visible.

Diagnosis may name it. Formal care steps in once someone is in the system. Telecare and response services provide a dependable safety net, helping people live more safely and independently when risk is visible or support is needed.

Each is vital. But each often begins after the need has already started to form.

What about the quiet stretch before that?

When someone's memory, confidence or daily continuity is starting to feel less reliable, yet they are still living independently and very much themselves - no formal care package, no crisis. Just an appointment forgotten, a familiar task that suddenly feels harder, the next step momentarily out of reach.

At that point, there is still too little practical support designed specifically for that earlier, still-independent stage.

Here is the thought I keep coming back to.

The pressure on social care is structural and growing. Age UK estimates around 2 million older people in England already have unmet care needs. Skills for Care estimates that 470,000 additional adult social care posts may be needed by 2040 to keep pace with the ageing population.

If the system needs hundreds of thousands more care roles it has no clear way to fill, then anything that helps people stay independent for longer should be a welcome, complementary layer - one that works upstream of, and alongside, the services already carrying so much of the load.

What if support that arrived earlier did not add to that load, but eased it?

What if helping someone stay genuinely independent for longer meant formal care became necessary later, and at a more appropriate stage?

Not replacing what already works. Sitting in front of it. Easing the quiet moments before they become incidents.

I'm not a neutral observer. I've spent months designing PicaPal for exactly this stage, so I hold this with conviction.

I think it is a question worth asking out loud: are we building enough for the years before the need becomes a crisis?

A moment of confusion. A flash of anxiety or frustration. A familiar action that suddenly feels less familiar. A memory that is just too far out of reach.

Families notice because they know the person.

They care. They reassure. They explain. They step in when they can.

But they cannot be in every room, at every moment.

And in the earlier stage of cognitive change, often before diagnosis or formal care, no one may yet be expected to be there.

That is the quiet gap.

The person is still independent. Still themselves. Still living ordinary daily life. But there are moments when the next step becomes harder to find.

That is what PicaPal is being built for.

Not to replace family. But to help when help is useful.

To offer calm, practical support when it matters.

Recent UCL research puts it at three and a half years, on average, from the first symptoms of dementia to a diagnosis.

Three and a half years.

And that clock only starts when someone asks. Many wait longer still before asking at all - quietly, and for very human reasons. Not wanting a label. Not wanting to worry the family. Not wanting to find out what the answer might change.

Speeding up diagnosis is vital work, and I am glad serious people are fighting for it. But life does not pause for those years.

The person is still at home. Still making breakfast, still going to the shops, still holding the thread of ordinary days, with memory or confidence becoming quietly less reliable, and often no support yet able to meet those everyday moments. The system is not failing them out of neglect. It simply is not designed to begin until there is something formal to respond to.

So those years belong to the person and their family. Far too often, alone.

And this is not only about dementia. That same quiet stage touches many lives and many causes, whatever the diagnosis or none. The need is wider than any single label.

Shortening the wait matters. Making those years more liveable matters too - practical, dignified support for the ordinary moments, before formal support has begun.

That is the space PicaPal is being built for.

One should not have to wait for the other.

There is a small device on the ceiling of almost every home in Britain.

It is always there. It asks for nothing. It does not want your attention, your conversation or your time. It will never interrupt a good day. Most of the time you forget it exists - and that is exactly how it should be.

But in the one moment it is needed, it speaks. Clearly, immediately, and only for as long as it takes. Then it goes quiet again, and life carries on.

Nobody has a relationship with their smoke alarm. Nobody looks to it for company. And yet it is one of the most trusted objects we own - trusted precisely because it wants nothing from us.

I think about this a great deal, because I am building technology for one of the most sensitive stages in a person's life: the earlier stage of cognitive change, when memory or daily confidence is just starting to feel less reliable, but the person is still independent and still themselves.

At that stage, what someone needs is not more to manage, more to learn, or something else asking for their attention.

They need the opposite.

Help that is content to be unremarkable. Help that does its small, practical job - a gentle prompt, a steadying word at the right moment - and then steps back.

Help that leaves the person more capable, not more reliant. More themselves, not less.

That is the standard I hold PicaPal to. If it ever asked to be the centre of someone's day, it would have failed. Its job is to sit quietly at the edge of life, useful in the moment that matters, and unobtrusive the rest of the time.

Because the measure of good support is not how much someone comes to need it.

It is how much of their own life it quietly hands back.

Most formal help wants to know what is wrong first.

That makes sense in a hospital environment where a diagnosis can point to a treatment, and a formal name for a problem can open the right door.

But there is a stretch of life where a person is finding some things harder than they used to - still themselves, still living independently - who, for any number of reasons, does not yet have a diagnosis.

In that stretch, the most useful kind of help does not wait.

It does not begin by asking what is wrong.

It asks a simpler question: what would help you live well today?

That is the principle I am building PicaPal around.

Whatever the underlying reason, the support should stay attached to the person, without waiting for a formal diagnosis to be made. I think of it as help that does not wait.

Because the thing that matters most is not the name of what someone is facing.

It is that they are living their own life - and good support should meet them exactly there.