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Improving dementia services in England – an interim report

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.

"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

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 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 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.

PN: 02/10