2 Driving and monitoring change in
services for people with dementia
10. Those leading the implementation of the Strategy
had failed to ignite passion, pace and drive at the frontline.
Instead, the Strategy's implementation had been process-driven
and therefore had yet to actively engage the health and social
care staff who actually delivered care to people with dementia.[25]
This was demonstrated by the scepticism amongst Consultant Old
Age Psychiatrists and GPs that the Strategy could be successfully
implemented within five years.[26]
11. The Department failed to appoint National
Clinical Directors for dementia and older people until the eve
of our hearing in January 2010. These Directors could have played
a pivotal role in driving forward the Strategy, but their appointment
almost a year after the Strategy's launch meant the first year
of the Strategy's implementation had been wasted.[27]
Figure
3: An effective and efficient memory service
A memory service is a service for GPs and others to refer people to if they are suspected of having dementia, for example because they have problems with failing memory or changes in behaviour or personality that may be attributable to dementia. The service is designed to generate as accurate a diagnosis as possible, as early as possible, in those with mild to moderate dementia. An effective memory service should have the capacity to work for all of the population of a PCT that might develop dementia and should do three things:
1, Make the diagnosis well;
2. Break that diagnosis well to people with dementia and their carers, and
3. Provide the immediate treatment, care and support that is needed for people with dementia and their carers.
A memory service does not have to operate out of a particular clinic setting. It can be provided in a variety of different places, including in people's own homes, and the emphasis should be on accessibility. An efficient and effective memory service should therefore be able to see approximately 20 referrals a week. A PCT with around 50,000 people over the age of 65 might typically expect to have 900-1,000 new cases of dementia a year, and should be able to commission a memory service to cover the needs of this population for between £650,000 and £1 million per year. The team to operate this level of service would comprise a multi-disciplinary team of 10 staff including health and social care professionals with a half-time consultant psychiatrist and a full-time specialist grade doctor, with nurses, psychology and the input of the local Alzheimer's Society.
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Source: Qq 21 and 42-44; Evidence given by Professor
Sube Banerjee
12. Early diagnosis is essential to enable people
with dementia and carers to make choices about the future and
to help prevent harm. However, usually only around one-third of
people with dementia are formally diagnosed and late diagnosis
means that the majority miss out on early intervention and timely
specialist care which can enable them to live well.[28]
Vital to enabling early diagnosis is access to memory services
(Figure 3), which is currently inequitable.[29]
If PCTs had spent their allocation of funding on dementia care
as intended, every PCT would have been able to afford a memory
service along the lines described in Figure 3.[30]
13. Having a memory service to refer patients
with possible dementia to, had a positive effect on GPs' awareness
of and attitudes towards the disease. This could be improved further
if combined with better undergraduate and continuing professional
development training.[31]
Memory services are key to improving care for people with dementia
and they are crucial not just at the diagnosis stage, but throughout
the disease progression for people with dementia, carers and professionals
alike. Therefore, if swift progress is made on making memory services
accessible for all who need it, this will help drive the entire
Strategy forward. [32]
Figure
4: Regional breakdown of the diagnosis gap challenge in England
Note: The 'challenge' is reflected by an index which
has been calculated taking into consideration the diagnosis gap
that exists at present in each region and the expected increase
in future prevalence. The higher the index, the greater the challenge
for the SHA to reduce the diagnosis gap in their region.
Source: C&AG's Report (2010)
14. Much variation exists in terms of the diagnosis
gap[33] across regions
and this is exacerbated when it is considered in light of the
expected increase in future prevalence, as Figure 4 demonstrates.
The regions facing the biggest challenge due to their current
diagnosis gap and expected increase in prevalence were the South
West and East Midlands (Figure 3).[34]
There was also much regional variation in terms of service provision
and drug prescription across England with the experiences of people
with dementia varying on the basis of where they live.[35]
15. Research is acknowledged as a vital component
in improving dementia care, yet there was a 7% fall in dementia
research funding in the year following our previous hearing in
October 2007. The Department explained that its research programme
was determined several years in advance and therefore it took
time to influence the distribution of such funding. But in recognition
of the importance of research, it held a dementia research summit
in July 2009 to encourage research in the field of dementia and
it expected to see plans coming forward for research with a consequent
increase in funding in 2011-12 and 2012-13.[36]
25 Qq 73 and 82 Back
26
Qq 95-98; C&AG's Report, para 2.7 and Figure 10 Back
27
Qq 12-15 and 33-38 Back
28
Qq 100, 106, 120 and 123; C&AG's Report, para 1.5 Back
29
Q 20 Back
30
Q 42 Back
31
Qq 101-102 and 142 Back
32
Qq 21, 100-102, 106, and 142-143 Back
33
Diagnosis gap is the difference between the expected dementia
prevalence in a given area and the actual numbers diagnosed. Back
34
Q 93; C&AG's Report, para 1.5 and Figure 6 Back
35
Qq 77, 103, 109, and 111-113; C&AG's Report, para 1.6 Back
36
Qq 71 and 72 Back
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