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.