National dementia strategy at risk of failure, says NAO

The government’s national dementia strategy for England is at risk of failure because of a lack of leadership and mechanisms to deliver on change, a National Audit Office report warned today.

The public spending watchdog’s follow-up to its highly critical 2007 report on the issue found that the value for money of dementia services remained “poor”, with a lack of join-up between health and social care, leading to unnecessary hospital admissions and premature entry into residential care.

With the first anniversary of the strategy due next month, the NAO said the Department of Health’s plans were “ambitious and comprehensive” but had not been matched by mechanisms to deliver change, and progress had been slow.

Strong risk of failure

It concluded: “There is a strong risk that value for money will not be significantly improved within the strategy’s five-year implementation timetable.”

The strategy’s goals include providing early diagnosis and support for everyone with dementia, delaying entry into residential care, improving information for users and carers and enhancing the quality of care in hospitals and care homes.

Though the DH had provided additional funding for primary care trusts of £60m in 2009-10 and £90m in 2009-10 to support the strategy, it was not clear how the first year’s money had been spent or whether it had been spent on dementia, because local audits of dementia services were not due to be finalised until March 2010.

No targets

The NAO also said despite DH claims in November 2007 that dementia would be a national priority no targets were included in “Vital Signs” – the list of indicators that primary care trusts are measured against published in 2008 – nor were there specific local authority targets for dementia.

It said this meant PCTs did not see dementia as a “must do” area, while there also remained a lack of effective local leadership to drive change.

For instance, only 21% of consultant old-age psychiatrists questioned by the NAO felt a senior member of staff had taken a lead on improving dementia in their acute hospital and a further 44% were unsure. In addition care homes reported having had little communication about the strategy from national leaders or local partners.

Training criticised

Training also remained a problem with 47% of GPs saying they had sufficient training in dementia management, despite improving the quality of the workforce being one of the strategy’s objectives.

The NAO said the strategy would cost more than the £1.9bn over ten years estimated by the DH. It also questioned the DH’s assumption that the money could be found through efficiency savings released from reduced admissions to care homes and hospitals, particularly given the current funding climate.

Tories question commitment

Shadow health minister Stephen O’Brien said: “This report gives the lie to the government’s so-called commitment to dementia. It is clear that ministers think that warm words are enough, and have washed their hands of delivery.”

Care services minister Phil Hope was keen to point out that the field work for today’s study was done only five months after the national strategy’s publication. He said: “Change will not happen immediately. There is still much more to be done and we are working hard to put the plans outlined in the strategy into place.”

The NAO’s recommendations included:-

• Appointing dementia leads in every acute hospital and PCT commissioning department by March 2010.
• Instituting an accreditation scheme for all dementia healthcare professionals by the end of this year.
• For the DH to produce more robust calculations of savings as part of a new impact assessment due in 2010.

Dementia conference

Community Care is running a conference to mark the first anniversary of the national dementia strategy in central London on 11 February. Find out more and book your place.

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