Press Release - Improving services and support for people with
dementia
4 July 2007
Despite a steeply rising trend in cases of dementia, the
condition is being given too low a priority by health and social
services, according to a report out today by the National Audit
Office. Too few people are being diagnosed, or being diagnosed
early enough, and early interventions known to be cost-effective
are not being made widely available.
Dementia presents a significant and urgent challenge to health
and social care in terms of both numbers of people affected and the
costs. At least 560,000 people in England have dementia and,
because of an ageing population, the number of cases is predicted
to rise by over 30 per cent over the next 15 years. Dementia
accounts directly for three per cent of all deaths, but four times
as many people may die with dementia. Dementia costs the economy
14.3 billion a year, including direct costs to the NHS and social
care of 3.3 billion a year.
The report points out that dementia has not received the
priority status from the Department, the NHS or social care that it
deserves. It has suffered historically from poor awareness and
understanding; and there is a widely held perception that little
can be done and a lack of urgency attached to diagnosing and
treating the condition. Parallels can be drawn between dementia now
and cancer in the 1950s, when there were few treatments and
patients were commonly not told the diagnosis for fear of
distress.
Early diagnosis and intervention in cases of dementia is known
to be cost-effective. Yet only a third to a half of people with
dementia ever receive a formal diagnosis. The UK is in the bottom
third of countries in Europe in terms of the percentage of dementia
patients receiving anti-dementia drugs, and the average time taken
to diagnose patients in the UK is up to twice as long as in some
other countries.
Frontline staff often lack sufficient awareness and
understanding of dementia. Less than two thirds of GPs surveyed by
the NAO felt that it was important to look actively for early
symptoms of dementia and only 31 per cent felt they had enough
training to diagnose and manage the disease. Half of the Community
Mental Health Teams surveyed told the NAO that they felt acute
hospital nurses were inadequately trained in dementia needs.
Failure to diagnose or treat patients with dementia can extend
hospital stay, but diagnosis can, in itself, make it difficult to
find a suitable location to discharge the patient to. Indeed, older
people with dementia make up half of those whose discharge from
hospital is delayed. For example, in the case of elderly people
admitted to acute hospitals with a hip fracture, we found that
effective identification of dementia and more proactive,
co-ordinated management of their care and discharge could produce
savings of between 64 million and 102 million nationally.
Whilst the NAO identified a number of examples of good practice,
where people with dementia are receiving a high quality service,
for many people there are gaps in their ability to access
specialist skills and services in both the community and in care
homes. Indeed, two thirds of people with dementia live in the
community, largely looked after by the 476,000 or so informal
carers in England. Informal carers often enable a person with
dementia to continue living in their own home but these carers
often lack the support they need to enable them to continue to play
such a vital and cost-effective role.
Within the care home sector, less than 28 per cent of beds are a
registered specialist dementia bed, which creates a lack of
visibility of the need for specialist dementia training in care
home settings. Appropriate end of life care for people with
dementia is also very limited.
The report concludes that much needs to be done to improve
health and social care services for people with dementia and the
NAO has made a number of recommendations to address this. The
scale, cost and impact of dementia indicates that the Department
needs to actively champion and co-ordinate improvements in dementia
services as an explicit part of its approach to improving health
and social care, including providing strong and transparent
leadership for dementia management. The Department, the NHS, social
care and professional bodies need to work together to improve
understanding of the needs of people with dementia and to plan
services accordingly. More needs to be done to raise awareness of
dementia amongst health and social care professionals and to
improve diagnosis and early intervention. And all those
organisations responsible for the care of people with dementia need
to improve the management of services and support in the
community.
Head of the National Audit Office Sir John Bourn said
today:
"For too long dementia has not been treated as a high
priority. Today's report shines a light on how significant an issue
dementia is and how much scope there is to improve the way in which
people who suffer from dementia are treated.
"Our rapidly ageing population means that costs for
addressing dementia will continue to increase and, without
redesign, services for people with dementia are likely to become
increasingly inconsistent and unsustainable. Dementia can no longer
be set aside. The issues raised in this report need to be addressed
as a matter of urgency."
Notes for Editors:
- Press notices and reports are available from the date of
publication on the NAO website, which is at www.nao.org.uk. Hard
copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 850 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Press Notice 30/07
All enquiries to Donna Watson,
NAO Press Office: Tel: 020 7798 7038
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