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


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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Prepared 16 March 2010