Conclusions and Recommendations
1. There are over 560,000 people in the UK
with dementia, costing the economy some £14 billion a year,
yet dementia has not been a NHS priority. In
response to the C&AG's report the Department is now developing
a National Dementia Strategy. The Strategy should have a clear
timetable for implementation, and should include criteria for
evaluation and reporting progress and addressing areas of underperformance
such as poor diagnosis or availability of interventions recommended
by NICE. It will also require an effective communication strategy
to engage patient groups, health and social care professionals,
the Royal Colleges, health and social care inspectorates, and
the voluntary sector, all of whom are essential to improving care
for people with dementia.
2. Unlike cancer and coronary heart disease
there is no single individual with responsibility or accountability
for improving dementia services. Without
clear leadership there is a risk that dementia care will continue
to lack priority. The Department should appoint a Senior Responsible
Officer to drive through the dementia strategy, learning from
the model used for cancer services.
3. Between a half and two-thirds of people
with dementia never receive a formal diagnosis. Diagnosis
should always be made, regardless of whether interventions are
available. The rate of diagnosis could be significantly improved
by GP practices receiving greater support from mental health services;
by the Royal College of Psychiatrists and the Royal College of
GPs developing a dementia care pathway including guidance on the
importance of early diagnosis; and by the Institute of Innovation
and Improvement promulgating good diagnostic practice.
4. There is poor awareness amongst the public
and some professionals of dementia and what can be done to help
people with the disease. The Department
should commission a dementia awareness campaign to increase understanding
of the symptoms of dementia, emphasising that there are interventions
and treatments which can slow the progress of the disease and
help people with dementia and their carers lead independent lives
for longer.
5. People with dementia require support from
multiple health and social care providers but this is often difficult
to manage. On diagnosis, people with dementia
and their carers should be given a single health or social care
professional contact point to improve the co-ordination of care
between the various services and professionals. This contact point
could be a social worker or a community psychiatric nurse, for
example.
6. Between a half and two thirds of all carers
do not receive the carer's assessment to which they are entitled.
Carers often struggle to cope with caring
for a relative with dementia at home, particularly if the person
with dementia has challenging behaviour, leading to costly admission
to a care home or hospital. The Department should emphasise to
local health organisations and their social care partners that
they need to develop an action plan which gives priority to assessing
and meeting the needs of carers. The Department should develop
a commissioning toolkit to help demonstrate the cost benefits
of the different options for providing support, including respite
and domiciliary care.
7. 62% of care home residents are currently
estimated to have dementia but less than 28% of care home places
are registered to provide specialist dementia care. Few
care home staff have specialist nursing qualifications or have
been trained in dementia care. There is high turnover in staff
and high vacancy levels and some staff do not have English as
a first language. Poor standards of care have resulted in instances
of inappropriate medicines management and complaints that people
are not afforded sufficient dignity and respect. The Commission
for Social Care Inspection should assess staff qualifications
and training as part of its review of the quality of care for
people with dementia, and local mental health services should
use the findings when allocating resources to community psychiatric
teams so they can provide adequate out-reach services to support
care homes.
8. Hospital care for people with dementia
is often not well managed, increasing the risk of longer stays,
admission to a care home and deterioration in the patient's health.
Hospital staff generally focus on the physical reason for admission
and can fail to identify or deal with dementia as a disease, resulting
in longer stays and poorer outcomes than for people who are psychiatrically
well. To improve the cost effectiveness of acute care, families
or carers of people with dementia should hold a copy of the care
record so that paramedics will be able to make an informed decision
whether the person needs to be taken into hospital or can be treated
at home. For older patients admitted and known or suspected to
have cognitive impairment, hospitals should routinely undertake
a mental health assessment.
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