3 Delivering the Strategy at a local
level
16. Whilst national and regional leadership has
been strong, local leadership for improving dementia had still
to be put in place. The Department did not know how many dementia
champions there were in England or where they were located[37]
and only 21% of consultant old age psychiatrists were able to
confirm that a senior clinician had taken the lead for improving
dementia care in their general hospital.[38]
17. Engagement of frontline staff within acute
hospitals was particularly important since hospital stays can
increase confusion in people with dementia and speed up their
deterioration. Most healthcare workers came into contact with
people with dementia regularly, but there was no required dementia
training for generalist healthcare professionals and their awareness
of the disease was poor.[39]
A recent report by the Alzheimer's Society[40]
found that by discharging people with dementia (who no longer
had any medical needs) earlier from hospital, and reducing unnecessary
lengths of hospital stay, the NHS could save £86 million
in practice, as well as preventing the further deterioration of
these patients. The Department was looking at ways to reduce unnecessary
length of stay in hospitals and felt that some redesign in the
system was needed with better support for people at home.[41]
18. Most people with dementia received much of
their day-to-day care from domiciliary carers or care home staff.
These staff are currently unregistered and, despite six years
of discussion and planning for a new process of registration for
social care staff by the General Social Care Council, all plans
had been suspended and nothing had been achieved in this area.[42]
Many of the social care workforce did not have any type of training
or qualification.[43]
This general lack of training and poor level of qualifications,
coupled with the absence of registration with the General Social
Care Council, their professional body, meant that the quality
of care and safety of the vulnerable people they looked after
was being put at risk. This risk was compounded for people with
dementia as the lack of understanding of this complex condition
meant even lower standards of care.[44]
19. Another serious issue concerned the excessive
prescribing of anti-psychotic drugs for people with dementia,
particularly those living in care homes. An independent review[45]
commissioned by the Department, reported in November 2009 that
up to 150,000 people with dementia were inappropriately prescribed
anti-psychotic drugs, contrary to clinical guidelines, contributing
to up to 1,800 additional deaths each year. The level of prescribing
could be reduced by two-thirds within two years but to achieve
that Primary Care Trusts must acknowledge this issue as a clinical
governance priority.[46]
20. In July 2009, the Department appointed a
Champion/Ambassador for the independent sector to improve the
engagement of care homes in the Strategy and to help communicate
the findings of the above anti-psychotics review to help reduce
the prescribing of anti-psychotics as envisaged.[47]
21. In 2007, we expressed concern at the lack
of dementia training in social care, high staff turnover and vacancies.
The All Party Parliamentary Group on dementia's 2009 report highlighted
that these problems still hadn't been addressed. The stigma attached
to dementia was reflected in the low status society gave to this
work which reduced morale and motivation. Care homes told the
NAO that changes in employment rules and increasing NHS pay had
made recruitment and retention of care staff even more difficult.[48]
The Department had commissioned Skills for Care and Skills for
Health to map the training needs of the social care workforce
to identify gaps. This would conclude in March 2010 and would
inform the Department's workforce action plan.[49]
1.
37 Qq 79-82 Back
38
C&AG's Report, para 2.7 Back
39
C&AG's Report, paras 2.12 and 2.13 Back
40
Alzheimer's Society (2009), Counting the cost: caring for people
with dementia on hospital wards Back
41
Qq 74 and 75; C&AG's Report, Figure 17 Back
42
Qq 65-70; C&AG's Report, para 2.11 Back
43
Q 63 Back
44
The All Party Parliamentary Group on Dementia (2009), Prepared
to care: challenging the dementia skills gap Back
45
Q 54; Professor Sube Banerjee (2009), The use of anti-psychotic
medication for people with dementia: time for action Back
46
Qq 57-62 Back
47
Q 56; C&AG's Report, para 2.8 Back
48
C&AG's Report, para 2.10 Back
49
Q 85; C&AG's Report, para 2.14 Back
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