Committee of Public Accounts


Publication of the Committee's 19th Report, Session 2009-10

Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:

"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. This Committee feels badly let down by the Department's failure to act on the commitments it gave to us in 2007.

"Just over a year ago, it published a five-year national strategy to raise the quality and priority of dementia care. But the strategy lacks the tools to ensure effective implementation and make change happen. At an earlier hearing, the Department left us in no doubt that it was going to make dementia a national priority, in the same way that cancer and stroke are national priorities. But it still hasn't.

"This cannot continue. 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.

"Great progress would be made towards earlier diagnosis of dementia€”a crucial factor in improving care - if swift action were taken to make good quality memory services available around the country to all who need them. Another highly significant step would be to require generalist health and social care staff, whose awareness of dementia is often poor, to undertake training and continuing professional development in dementia care."

Mr Leigh was speaking as the Committee published its 19th Report of this Session which, on the basis of evidence from the Department of Health (the Department), examined understanding and responding to the scale and urgency of dementia; driving and monitoring change in services for people with dementia; and delivering the Strategy at local level.

Dementia covers a range of progressive, terminal brain conditions which affect an estimated 600,000 people in England and this number is rising rapidly. People with dementia require a complex mix of health and social care with patients regularly moving across organisational boundaries. The effectiveness of care depends on co-ordination and co-operation between the NHS; social services; care homes; and the voluntary sector. Stigma and negative attitudes towards mental illness and old age further exacerbate the problem. Dementia costs £8.2 billion a year in direct health and social care costs but much of this spend is in response to crisis, in the later stages of the disease.

We first took evidence on this important subject in October 2007 and raised serious concerns about the status of, and approach to, this Cinderella service. The Department assured us that dementia would become a national priority and that it would be developing a National Dementia Strategy.

In February 2009 the Department launched an ambitious and comprehensive five-year National Dementia Strategy aimed at helping people to live well with dementia. The Department estimated that the Strategy would cost £1.9 billion to implement over 10 years, and that this would be funded largely through efficiency savings. National and regional leadership was put in place and initial seed funding of £150 million was allocated to Primary Care Trusts (PCTs) to assist implementation over the first two years.

However, in practice, the Department has failed to match its commitments to raise the quality and priority of dementia care with a robust approach to implementation. It has failed to ignite passion, pace and drive or to align leadership, funding, incentives and information to help deliver the Strategy. It also delayed the appointment of a national clinical director, a role that has proved very effective in developing and implementing other national strategies, until January 2010. Furthermore, improvements that we identified in 2007 as urgently needed, some of which could have been adopted straight away, have not been afforded the urgency and priority that we had been led to expect. Whilst the Department now states that improving dementia services is the greatest health and social care challenge it faces, we feel badly let down by the Department's lack of urgency. Despite stating at least 10 times at our earlier hearing that Dementia would be a national priority€”it still isn't.