Improving Dementia Services in England - an Interim Report - Public Accounts Committee Contents

Supplementary memorandum from the Department of Health

  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 requests.

Questions 63-64 (Mr Burstow):   Social Care Qualifications

  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 Risks

  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 (2011-14).

    — 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 and priorities.

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 than this.

  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 pressures.

Question 158 (Chairman):   Lincolnshire whole—system approach

  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 DDDsPatients with
a diagnosis of
DDDs per

2,854,515 20,089142.1
EAST OF ENGLAND4,307,548 25,315170.2
LONDON3,725,12924,859 149.9
NORTH EAST2,132,224 13,198161.6
NORTH WEST5,542,313 34,057162.7
SOUTH CENTRAL3,322,580 18,840176.4
SOUTH EAST COAST3,461,513 21,442161.4
SOUTH WEST3,675,320 25,920141.8
WEST MIDLANDS2,972,342 23,866124.5
YORKSHIRE AND THE HUMBER4,469,687 24,844179.9
Grand Total36,484,493 232,430157.0

Source: NHS Information Centre

  I trust that this information will meet with the Committee members' requests.

1 March 2010

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