"The Department
of Health stated in October 2007 that dementia was a national
priority and brought forward a widely supported strategy in
February 2009 to transform the lives of people with dementia. The
action however, has not so far matched the rhetoric in terms of
urgency. At the moment this strategy lacks the mechanisms needed to
bring about large scale improvements and without these mechanisms
it is unlikely that the intended and much needed transformation of
services will be delivered within the strategy’s five year
timeframe"
Amyas Morse, head of the National Audit Office, 14 January
2010
The Department of Health has developed an
ambitious and comprehensive strategy for dementia. However, there
has not yet been a robust approach to implementation, according to
a National Audit Office report published today. Despite the
Department stating, since 2007, that dementia is now a national
priority, it has not been given the levers or urgency normally
expected for such a priority and there is a risk that value for
money will remain poor unless these weaknesses are addressed
urgently.
The strategy, Living Well with Dementia, was published
in February 2009. Because of the timing, dementia was not included
in the Department’s tier 1 Vital Signs indicators for the NHS,
through which it monitors performance. Other levers built into the
NHS’ devolved management arrangements, such as joined-up
commissioning and comprehensive performance information, are not
yet fully developed. Achieving transformation in the proposed five
years will be very challenging. Changes at a local level are taking
place slowly because local leadership on the issue has still to be
developed and there is no formal performance monitoring of progress
built into the system.
The Department does not have evidence on current and future
costs and benefits; the strategy is likely to cost much more than
the estimated £1.9 billion over ten years. The Department also
expects implementation of the strategy to be mostly funded through
efficiency savings arising from the acute hospital and long-term
care sectors. However, this will be difficult to achieve without
joined-up, well-informed commissioning and the actual releasing or
re-directing of resources from secondary to primary care, or from
NHS to social care is likely to be difficult to achieve in the
short to medium term, particularly in a time of financial
constraint.
There is as yet no basic training for healthcare professionals
on how to understand and work with people with dementia. Strong
leadership is also key to improving services, but this is not yet
in place in local NHS and social care delivery organisations. There
is not yet enough joined-up working between health and social care
services for people with dementia: for example, demand for care
homes is going to rise, but the independent care home sector feels
excluded from the strategy.
Today’s report points out that there are some examples of
excellent practice which could already be making a difference if
they were adopted across the country. But it is not clear that
services are making best use of money; it will not be clear until a
baseline audit is completed, how the first £60 million of
additional baseline funding for primary care trusts to implement
the dementia strategy has been spent, or whether it has actually
been spent on dementia.
Publication details:
HC: 82, 2009-10
ISBN: 9780102963328