Are dementia plans failing?

One year into the dementia strategy, shortcomings are surfacing. Stephen Robinson reports.

Dementia damage on MRI scan
Dementia damage on MRI scan

England's five-year National Dementia Strategy (NDS), launched in February 2009, pledged to transform the quality of care for the 570,000 people living with dementia.

But in January this year, the National Audit Office (NAO) said dementia care was still failing to provide value for money.

In March, a report by the All-Party Parliamentary Group on Dementia claimed that two-thirds of PCTs were unable to account for NDS funding. This led NHS chief executive David Nicholson to remind PCTs that they were expected to produce action plans by 31 March, setting out how dementia services would be developed.

But a GP investigation has found that one in three PCTs had not completed this plan by the 31 March deadline.

In addition, despite repeated concerns over resource allocation, half of the 116 PCTs responding to GP's Freedom of Information Act request could not account for how they had spent their NDS funding.

Andrew Chidgey, head of policy and public affairs at the Alzheimer's Society, believes PCTs must be brought to account on this issue.

'We would certainly like to see far more explanation, and the requirement for explanation, about what is being done in relation to dementia,' he says.

Insufficient services
Confidence in the dementia services developed by PCTs is low among the GPs referring patients on, the Alzheimer's Society says.

'Quite a number of GPs have said they feel they do not have sufficient secondary services to refer on to,' says Mr Chidgey.

Buckinghamshire GP Dr Johnny Marshall, chairman of the National Association of Primary Care, believes GPs need to be at the centre of dementia care in future. 'Engaging GP commissioning with PCTs would be a much better way of pushing (the NDS) forward,' he says.

However, PCTs have no specific performance requirement to improve dementia care and no duty to allocate to dementia care their share of the £150 million provided to support rollout of the NDS.

David Stout, director of the NHS Confederation's PCT Network, says PCTs are doing exactly what is expected of them. Ultimately, he says, PCTs retain control over budgets and priorities for their population.

'Every PCT has to meet every health need in an area. I think PCTs understand their responsibilities within dementia.'

Mr Stout does not favour ring fencing funding, and says there are difficulties when central management tries to 'second guess' local needs. 'The acid test is holding PCTs to account in their local area and what they have done,' he says.

But Mr Chidgey says: 'PCTs will always make the case that they are the people who understand local need best and they need maximum flexibility to respond to local need. But I think you have to be much clearer about (spending).'

Whether PCTs like it or not, ring fencing may be the future. Before the general election, then shadow care minister Stephen O'Brien said the Conservatives would ring fence future NDS funds. But the DoH says it cannot confirm whether, in the climate of austerity facing the NHS, the government would fulfil this promise.

The Alzheimer's Society believes questions about the strategy's progress now need to be answered.

'Now we're starting to get to the point at which people have to bite the bullet and decide: are all the things that we said we need to do going to be done?' Mr Chidgey says: 'There are some good early signs of progress but we would agree with the NAO that it is not nearly fast enough.'

The NAO has announced that it is to re-examine progress of England's dementia strategy. Its report, due in 2011, may make uncomfortable reading for many PCTs.

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