Will the National Dementia Strategy targets be achieved by 2014?

The problems associated with dementia care have been well documented. So what are the chances of turning it around by 2014, the implementation date for the national dementia strategy? Vern Pitt examines the likelihood that the key objectives will be delivered

Good-quality early diagnosis and intervention for all

What is the current problem?

Only one-third of patients ever receive a formal diagnosis, and those who do often receive it too late to take effective action. GPs feel ill-equipped to diagnose.

What action is planned under the strategy?

Primary care trusts and councils should commission specialist services to provide early diagnosis and support (in the form of memory clinics), receiving referrals from other health and social care services.

What does success look like by 2014?

All people with dementia should have a timely specialist assessment, an accurate diagnosis, treatment, and care and support as needed following diagnosis. Fewer people will require residential care as a result, releasing savings that can be channelled back into early support.

What are the barriers?

Commissioners must find the money up-front to develop memory services at a time of resource scarcity. GPs are reluctant to refer to specialist services and stigma prevents people approaching GPs about possible dementia.

Chances of success

Moderate to good. Progress is dependent on improved training for GPs, and PCTs seeing the benefits and savings from commissioning specialist support. Action may be limited by the fact that dementia is not an NHS priority.

Improved community personal support services

What is the current problem?

Most dementia sufferers live in their own homes. But short home care visits, based on tasks not outcomes, are often found to be inadequate for dementia sufferers.

What action is planned under the strategy?

The DH wants to develop an evidence base for specialist home-based services for people with dementia, and commissioners will be called on to implement best practice emerging from this.

What does success look like by 2014?

All people with dementia in the community would have access to flexible and reliable services, ranging from early intervention to specialist support, which respond to their needs and are tailored to their family circumstances. This should reduce admissions to hospital and care homes.

What are the barriers?

Lack of dementia training and existing commissioning practices. Lucianne Sawyer, president of the United Kingdom Homecare Association, claims council commissioners focus on efficiency and reducing costs. She says the commissioning of short appointments must be “rigorously” discouraged.

Chances of success

Too early to tell. Personalisation has not made much progress for people with dementia and tight finances will make changing commissioning practice difficult.

Living well with dementia in care homes

What is the current problem?

The quality of care homes is variable; the Alzheimer’s Society often finds that activities, and interaction between residents and staff, are inadequate.

What action is planned under the strategy?

The appointment of senior staff members in care homes to lead dementia care improvements. Antipsychotic drugs to be used only where strictly necessary. The commissioning of specialist in-reach services.

What does success look like by 2014?

The quality of care improves. Homes have person-centred care planning and good staff training. They enable people with dementia to move around safely and provide purposeful activities based on individual preferences. Close relationships with families and close links with communities are nurtured.

What are the barriers?

Lack of staff training and commissioning. English Community Care Association head Martin Green says care homes could become centres of expertise for dementia care but says commissioners need to be more creative. He accepts that care homes need to develop innovative services as well.

Chances of success

Weak to moderate. Progress should be helped by the plan to reduce the use of antipsychotic drugs but it is questionable whether PCTs will find the money to commissioning in-reach services.

An informed and effective workforce

What is the current problem?

Primary care staff lack the skills to diagnose, and other professionals generally cannot adapt their practice to cater for people with the condition.

What action is planned under the strategy?

The Department of Health will agree core competencies for dementia staff with training bodies. Skills for Care is developing dementia specific training for care staff. Commissioners will have to specify dementia training in contracts with providers.

What does success look like by 2014?

All staff involved in the care of people who may have dementia would have the necessary skills to provide the best quality of care through effective basic training and continuous professional and vocational development in dementia.

What are the barriers?

Low status of social care workforce and lack of clarity about access to training funding. Simon Williams, dementia lead at the Association of Directors of Adult Social Services, says the key issue is changing assumptions and attitudes among staff, though believes resources will not be a problem.

Chances of success

Weak to moderate. Success will require action by several training bodies across health and social care and the spread of existing good practice on staff development.

A clear picture of research evidence and needs

What is the current problem?

The Alzheimer’s Research Trust says dementia costs the UK five times as much as cancer but research spending – £50m a year – is 12 times lower than for cancer.

What action is planned under the strategy?

The DH has set up a group dedicated to increasing the volume and impact of research into the causes, care and cure of dementia. It is due to guarantee funding for priority areas of dementia research from the government’s medical research budget.

What does success look like by 2014?

Advanced brain scans and blood tests could identify promising treatments allowing quicker diagnosis of patients and more effective development of drugs. The discovery of genes that play a role in the disease’s development could also help.

What are the barriers?

Simon Ridley, research manager at Alzheimer’s Research Trust, says lack of money stands in the way of success, both in terms of funding research and new treatments. The trust has called for annual research spending to be trebled. Other barriers include lack of public support for brain donation and regulation of research.

Chances of success

Good, though dependent on political will. Public spending is tight, but Ridley says increased competition for research funding could help boost the quality of research.

Useful links

Keep up with Community Care‘s dementia campaign

The dementia strategy in action in Croydon

Judith’s story

Can Gerry Robinson fix care homes?

National Dementia Strategy

Published in the 1 April 2009 issue of Community Care under the heading ‘Things can only get better’