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

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.

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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