Despite Department of Health assurances that dementia would be a national health priority, it has not been given the same status as cancer and stroke, and the Department does not know how the first £60 million of dementia funding has been spent, say MPs in a damning new report published today.
“There is a wide gulf between what the Department of Health keeps saying it is going to do about dementia services and what it actually does,” said Edward Leigh, chairman of the House of Commons Committee of Public Accounts, which has published the report. The Committee members feel “badly let down by the Department’s failure to act on the commitments it gave to us in 2007,” when they held their first evidence session on dementia and were told by Department officials “at least 10 times” that dementia would be a national priority – “but it still isn’t,” added Mr Leigh, Conservative MP for Gainsborough.
Dementia covers a range of progressive, terminal brain conditions which affect an estimated 600,000 people in England, a number which is rising rapidly, and those affected require a complex mix of health and social care, the report notes. Dementia costs £8.2 billion a year in direct health and social care costs but much of this is spent in response to crisis, in the later stages of the disease, it adds.
In February 2009, the Department launched an ambitious, comprehensive five-year National Strategy to raise the quality and priority of dementia care. However, in practice, it has failed to match these commitments with a robust approach to implementation, says the Committee. Describing dementia care as “this Cinderella service,” the MPs accuse the Department of failing “to ignite passion, pace and drive or to align leadership, funding, incentives and information to help deliver the Strategy,” and are highly critical of the fact that the appointment of a national clinical director, a role that has proved very effective in developing and implementing other national strategies, was delayed until this January.
Moreover, improvements which the MPs had in 2007 identified as urgently needed – some of which could have been adopted straightaway – have not been afforded the urgency and priority which they had been led to expect, they say. Nor does the Department know how the first £60 million of dementia funding has been spent by Primary Care Trusts (PCTs), having only recently commissioned an audit of costs of dementia services, which is due to be completed this summer.
The MPs are particularly concerned at the “unacceptable” regional variations in access to diagnostic services and drugs to treat dementia, and they call on the Department to build on the work of the new dementia metrics and the quality standards being developed by the National Institute for Health and Clinical Excellence (NICE) to develop a set of health and social care minimum standards for dementia, for PCTs to incorporate into their implementation plans.
They also condemn the “inappropriate and excessive” prescribing of antipsychotic drugs for people with dementia, particularly those living in care homes, pointing out that this has contributed to up to 1,800 additional deaths each year. As a clinical governance priority, the Department should require every PCT to set as a local performance target the need to reduce such prescribing by two-thirds within two years, they say.
The situation cannot continue, the report stresses. “If dementia services are to improve at the rate required and better value for money is to be achieved from the £8 billion or so that is spent each year on direct health and social care costs, then implementation of the National Strategy must be pursued with urgency and commitment. Good performance information, robust performance management and strong local leadership are all essential,” say the MPs.
