Press Release - Improving dementia
services in England - an interim report
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.
Mr Amyas Morse, head of the National Audit Office, said
today:
"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."
Notes for Editors
- Dementia affects about 570,000 people in England. At the
current rate the number of people with dementia will double in the
next 30 years and the cost to the country will rise from £15.9
billion this year to £34.8 billion by 2026.
- The NAO previously reported on this subject in 2007 (the report
can be found at
http://www.nao.org.uk/publications/0607/dementia_services_and_support.aspx).
It found that dementia services in England were not providing value
for money in terms of the outcomes for people with dementia and
their families or the efficient use of taxpayers’ money. Too many
people were not being diagnosed, or diagnosed late and health and
social care services were often disjointed, of poor quality and
wasteful.
- The Committee of Public Accounts reported on dementia services
in 2008 and in response the Department developed the National
Dementia Strategy, Living Well with Dementia. The
Committee requested that the NAO report on progress within 12
months of the strategy’s launch.
- In December 2007, as part of its 2008-09 NHS Operating
Framework, the Department introduced "Vital Signs", a set of fixed
national and local priorities. Tier 1 Vital Signs set out five
"must-dos" decided and managed at national level.
- 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, Amyas Morse, is the head
of the National Audit Office which employs some 900 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 02/10
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