Please find enclosed a list of questions that we believe need to be answered at the PAC hearing on Monday. We hope that it will be possible to put some of these to the Department of Health officials who will be attending. The questions are drafted in two groups titled "Looking back" and "Looking forward". Within those groups the questions are in priority order from the Alzheimer's Society perspective.

  The Alzheimer's Society fully supports the findings of the National Audit Office Report. In particular we support the view of the NAO that dementia services have failed up to now to provide the quality of care which people with dementia and their carers need and deserve.

  Dementia is estimated to cost the UK over £17 billion a year, yet our health and social care services continue to provide inefficient care, wasting money and failing to deliver a better quality of life to people with dementia and their carers.

  The Government has recently announced the development of a National Dementia Strategy and will be working closely with the Alzheimer's Society to achieve what the Department of Health has described as a "transformation plan" for dementia services by the summer of 2008. This is most welcome. But it must deliver solid commitments to change.

KEY QUESTIONS FOR THE PUBLIC ACCOUNTS COMMITTEE HEARING INTO THE NAO REPORT ON DEMENTIA SERVICES

A.   Looking back

  1.  The NAO Report states that dementia care is similar to cancer care in the 1950s[2] and the Care Services Minister Ivan Lewis has said that services have failed people with dementia in the past.[3] How can this have been allowed to happen for so long?

  2.  Dementia is a large and growing problem.[4] Why has dementia not been recognised as a significant health and social care challenge before? Why has there been no national plan as with cancer?

  3.  The report shows that public funding of dementia research is incredibly low compared to other countries.[5] Current commitments are to a small number of clinical trials and the Dendron clinical research network which is infrastructure rather than research funding. Why is UK public funding of dementia research funding so poor compared to other countries? Has the Department had discussions about how to improve research funding in the UK for dementia?

  4.  Community Mental Health Teams are accepted as a good service model.[6] Why are there not well developed CMHTs everywhere?

  5.  If early diagnosis is a stated policy priority for dementia why haven't memory clinics or memory assessment services been developed everywhere?

  6.  How can we expect better support in the community for people in the early stages of dementia as the NAO Report argues needs to happen when local authorities are all being forced to support only people judged to have critical or substantial needs?[7]

  7.  The NAO Report highlights the significant sums being spent on poor care which is producing poor outcomes. The Lincolnshire case study shows what can be achieved to change care.[8] Can't this be done everywhere?

B.   Looking forward

  8.  How are you going to make sure that this dementia strategy isn't just another piece of guidance that has no impact?

  9.  We may be a year away from launch of a full national dementia strategy. People with dementia and carers are struggling to cope now. What is the Department looking to do in the short term to improve public and professional awareness about dementia before the national strategy is published late next year?

  10.  The projections in the NAO Report show that the number of people with dementia in England will increase by over 40% in the next 15 years. This is going to require significant development of services and health and social care funding isn't it? Where will this money come from?

  11.  How will you make sure that local commissioners factor dementia into their planning?

  12.  Isn't the fundamental point that the NAO Report makes that dementia is not owned by any single part of the system, partly because it impacts on all parts of the system. As a result, isn't dementia a classic case where, even in an era of no top down targets there needs to be some clear central direction? If so, how far do you think that direction can go?

  13.  The NAO Report recognises the major burden for families which dementia causes and lack of support that family carers have to carry out their crucial role.[9] Do you think that the NHS and social care have failed to recognise the interdependency of people with dementia and their carers? What do you propose to do to improve access to planned respite care and peer support networks?

  14.  The NAO Report identifies that the financial burden of dementia on families who have to pay large sums towards dementia care is significant. 9 Do you agree?

Supplementary—will the green paper on the funding of social care next year look at proposals which seek to reduce the disproportionate impact of charging on people with dementia and their families?

  15.  The NAO Report states that only between a third and a half of people with dementia receive a formal diagnosis. There is currently a commitment in the GP contract to developing a dementia register. 10 How do you think this might be developed further?

  16.  Nurses often don't have the skills to support people with dementia11 meaning that people get bad and inefficient care. Shouldn't dementia care training be a core part of both the core nurse training curriculum and continuing professional development?

  17.  One of the major issues identified by the NAO is that people with dementia are rushed out of hospitals into inappropriate care homes. 12 Shouldn't local authorities take more responsibility for stimulating the provision of long-term specialist dementia care?

  18.  There is a lot of money being spent here. What are you going to do to improve the information available about what is spent on dementia services and what the most effective interventions are?

9  NAO, pp16-19

10  NAO, p32

11  NAO, p10, para 35

12  pp45-46

3   Speaking during a visit to a mental health centre for older people in North Kensington, Care Services Minister Ivan Lewis said: "The scale of our ambition must now meet the scale of the challenge as demographic realities mean dementia will impact on an increasing number of families in our society. The current system is failing too many dementia sufferers and their carers." Back

4   560,000 people with dementia today in England, projected to increase by over 40% in under 15 years, NAO Report, p7, para 8, from the Alzheimer's Society Dementia UK report Back

5   NAO, pp 67-68 Back

6   NAO, p33 Back

7   The State of Social Care in England, CSCI, 2007 Back

8   NAO, pp 60-66 Back

9   NAO, pp 19, 37-38 Back