Supplementary memorandum from the Department
At the Public Accounts hearing on 25 January,
Committee members asked for notes from the Department of Health
on a number of topics. This note sets out my response to those
Questions 63-64 (Mr Burstow): Social
In 2007, the latest year for which data is available,
just over 66% of care workers said they had obtained the equivalent
of an NVQ level 2 or higher, while around one-third had not
obtained a level 2 qualification. This compares with 2006 when
fewer than 60% of care workers said they had obtained the equivalent
of an NVQ level 2 or higher.
As at November 2008, there were 81,323 registered
social workers in England. All registered social workers have
a social work degree or equivalent professional qualification.
Over 12,000 qualified social workers have a post-qualifying
award of some description. There are 14,185 social work students
training in England.
Questions 79-82 (Angela Browning): Dementia
Champions in Hospital
We want to see a senior clinician identified
in every general hospital to take the lead for quality improvement
in dementia care with hospitals. We identified this as a priority
objective in the Dementia Implementation Plan. We want to see
this happening as soon as possible and would support the NAO recommendation
that this happens by 31 March 2010.
Information on the number of dementia clinical
leads in general hospitals, is not currently collected centrally
by the Department but is an area that we are looking at as part
of the audit which we are in the process of commissioning.
Question 145 (Mr Burstow): Managing
The Department's National Dementia Strategy
Implementation Programme Board has identified, and is managing,
the following high-level risks for the National Dementia Strategy:
The need to ensure that the Strategy
has adequate funding in years three, four and five of the Strategy
NHS & Local Authorities do not prioritise
implementation of the Strategy.
Departmental business planning does not
afford sufficient resources for the central implementation team.
These risks, and mitigating actions, are regularly
reviewed as part of the governance of the National Dementia Strategy
Implementation Programme Board.
It is the responsibility of individual NHS Organisations
to set and manage risks locally, in line with local circumstances
Question 145 (Mr Burstow): Costs of
NHS Continuing Healthcare
The Regulatory Impact Assessment Based which
accompanied the National Framework for NHS Continuing Healthcare
and NHS funded Nursing Care in England (2007), estimated,
based on existing data about the costs of care, the overall cost
of implementing the new Framework to the NHS in the first full
year as £219 million. This included an allowance for
PCTs to continue paying the high band RNCC to all those receiving
it, until they have chance to review the cases individually: the
costs in subsequent years would therefore be projected to be lower
The costs of implementation will include a cost
shift from Local Authority budgets, where Social Services have
previously funded individuals who may become eligible for NHS
funding under the National Framework. However, any saving to LAs
is likely to be minimised by general demographic and financial
Question 158 (Chairman): Lincolnshire
The National Audit Office commissioned the Balance
of Care group to undertake a bed usage survey across Lincolnshire
to identify alternatives to hospital for people with dementia.
The central focus of the project was a survey of 863 adult
inpatient case notes, which took place across Lincolnshire on
29 November 2006. The survey found that, on the on the day
of the survey the majority of acute hospital patients with dementia
(68%) did not met criteria for needing an inpatient bed as assessed
by the Appropriateness Evaluation Protocol.
Following the Balance of Care report NHS Lincolnshire
has invested £1.2 million in three new dementia teams:
acute hospital liaison, intermediate care in reach and community
case management teams. The service has now been operational for
12 months. The key learning up to now is that:
There is no evidence as yet that any
of the services have resulted in measurable reductions in admissions
or length of stay. NHS Lincolnshire plan to undertake a much more
detailed evaluation in 2010-11 before they feel able to advocate
a sound business case for rolling out the model as a Quality and
Productivity Challenge initiative in other localities.
Up to now the gains have been on quality
and patient and carer experience.
The acute hospital in reach service has
assessed and identified 650 new individuals with dementia
in a five month sampling period, representing a significant increase
in detection rates (at the time of the NAO study 111 patients
(13%) had a documented diagnosis of dementia).
Mental Health assessment times have been
reduced from seven days to 24 hours: a key quality indicator
for the project.
The biggest challenge identified is to
improve the community based management of those people who have
both dementia and other co-morbidities, as this is the group who
make up the bulk of the resource usage in the acute sector.
Questions 112-119 (Mr Mitchell): Prescribing
of dementia drugs
The table shows the number of defined daily
doses (DDDs) of dementia drugs, (donepezil, galantamine, rivastigmine
and memantine, these are cholinesterase inhibitors than can slow
the progress of dementia), per Strategic Health Authority in England.
|Total DDDs||Patients with|
a diagnosis of
|EAST OF ENGLAND||4,307,548
|SOUTH EAST COAST||3,461,513
|YORKSHIRE AND THE HUMBER||4,469,687
|UNIDENTIFIED DEPUTISING SERVICES||534
Source: NHS Information Centre
I trust that this information will meet with the Committee
1 March 2010