Conclusions and recommendations
1 Although the Department said dementia would
be a national priority, it has not afforded it the same status
as other national priorities such as cancer and stroke.
The Department should give dementia the same priority status as
cancer and stroke in its key communications with the NHS including,
if relevant, the next NHS operating framework. The Department
should also work with Strategic Health Authorities to explore
the feasibility of pooling health and social care resources in
order to develop local dementia budgets; and require Strategic
Health Authorities to agree with each Primary Care Trust a local
dementia implementation plan, comprising costed actions and a
timetable, by July 2010. The Department should establish a process
for monitoring annual progress, similar to that for End of Life
Care, and provide a progress report on the first two years to
the Committee by October 2011.
2 Dementia is like cancer in the 1950s, still
very much a hidden disease. There is a
need for a massive campaign to promote openness and debate on
this important and challenging issue.
3 The Department does not know how the first
£60 million of dementia funding has been spent by Primary
Care Trusts. The Department has only recently
commissioned an audit of costs of dementia services which is expected
to be completed in summer 2010. The Department should provide
us with a copy of its audit of costs and details of how the first
£60 million of funding has been spent. It should also include
in the October 2011 progress report to the Committee the results
of reporting from Primary Care Trusts to Strategic Health Authorities
on how they spend the further £90 million of dementia funding
provided for 2010-11.
4 The implementation of the Strategy is dependent
on achieving £1.9 billion of efficiency savings by increasing
care in the community and reducing reliance on care provided in
care homes and acute hospitals. The Department
should write to all NHS Chief Executives setting out the good
practice examples of the various ways in which it expects cost
savings and improvements in care to be achieved. This should include
an immediate requirement for acute hospitals to have an older
people's mental health liaison team in place to ensure that unnecessary
admissions are avoided and that discharge to appropriate care
is as swift as possible.
5 Early diagnosis of dementia is crucial in
providing timely and appropriate care and in preventing more costly
hospital or residential care. The Department
should work with Primary Care Trusts to ensure they urgently commission
good quality and effective memory services. Improvements in diagnosis
and care would be further improved by including the study of dementia
in undergraduate training and accredited continuing professional
development for GPs and health care staff in hospitals.
6 There is unacceptable regional variation
in access to diagnostic services for dementia and in access to
dementia drugs. The Department should
build on the work of the new dementia metrics and the quality
standards being developed by the National Institute of Health
and Clinical Excellence to develop a set of health and social
care minimum standards for dementia which Primary Care Trusts
should incorporate in their implementation plans. Strategic Health
Authorities should measure progress against these standards.
7 Local leadership is still lacking in NHS
hospitals, in primary care and in the social care and care home
sectors. The Department should ensure
every acute hospital has identified a senior clinical leader by
31 March 2010 and work with the new Care Homes Champion to develop
dementia 'Champions' across the care home sector. The Department
should also identify a similar Champion or Ambassador in the domiciliary
care sector to improve providers engagement in the Strategy and
improve the quality of care provided.
8 Most people with dementia receive their
day-to-day care from domiciliary carers or care home staff, who
have little understanding of dementia, which therefore puts at
risk the quality of care and safety of some of the most vulnerable
people in society. After six years of debate and discussion, plans
to introduce registration of social care staff, many of whom are
without qualifications, appears to have been abandoned. As a result
these staff will remain unregulated for some time to come.
As the Department has now estimated what proportion of the social
care workforce is without any qualification it should require
PCTs and local authorities to use their commissioning powers to
drive improvements in training and qualification rates by only
letting/renewing contracts with providers who have a robust approach
to training, or who employ suitably trained staff.
9 There is inappropriate and excessive prescribing
of anti-psychotic drugs for people with dementia, particularly
those living in care homes, which has contributed to up to 1,800
additional deaths each year. The Department
should establish as a clinical governance priority the requirement
that every Primary Care Trust should set as a local performance
target, the need to reduce such prescribing by two-thirds within
two years.
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