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

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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Prepared 16 March 2010