This report, from the Committee of Public Accounts, follows on from an NAO report, (HC 604, session 2006-07, ISBN 9780102945614), and examines the prevalence and costs of dementia, diagnosis and early intervention, access to and quality of support services, and experiences of people with dementia in hospital and care homes. Dementia is a term for a range of progressive, terminal organic brain diseases. It affects about 560,000 people in England and costs the economy some £14 billion a year. The Committee has set out a number of conclusions and recommendations, including: that dementia has not been an NHS priority though, following the NAO report, the Department of Health is developing a National Dementia Strategy; that there is no single individual with responsibility or accountability for improving dementia services; that between a half and two-thirds of people with dementia never receive a formal diagnosis; that there is poor awareness amongst the public and some professionals of dementia; that people with dementia and their carers should be given a single health or social care professional contact point to improve the co-ordination of their care service; that between half and two-thirds of all carers do not receive the carer's assessment to which they are entitled; that 62 per cent of care home residents are currently estimated to have dementia, but less than 28 per cent of care home places are registered to provide specialist dementia care; that hospital care for people with dementai is often not well managed, increasing the risk of longer hospital stays, admission to a care home and a deterioration in the patient's health.

Dementia is a term for a range of progressive, terminal organic brain diseases, including Alzheimer's. Some 560,000 people in England are estimated to have dementia, with a steeply rising trend over the coming years. Some 476,000 people are unpaid carers of people with dementia. Direct costs to the NHS and social care are currently at least £3.3 billion a year, but the overall annual economic burden is estimated at £14.3 billion. This report examines what health and social care services are available for people with dementia and their unpaid carers in England and whether they are providing effective and good quality support. Until 2005 the Department of Health attached little priority to dementia, and progress was hampered by a lack of good quality data, by stigma, and by the low level of political and national focus on older people's mental health. The NAO conclude that services are not currently delivering value for money to taxpayers or people with dementia and their families. Whilst health and social care services are spending significantly on dementia, spending is late - too few people are being diagnosed or being diagnosed early enough. Early interventions that are known to be cost-effective, and which would improve quality of life, are not being made widely available. Services in the community, care homes and at the end of life are not delivering consistently or cost-effectively against the objective of supporting people to live independently as long as possible in the place of their choosing. The rapid ageing of the population means costs will rise and services are likely to become increasingly inconsistent and unsustainable without redesign. Recommendations cover: improving diagnosis and early intervention; improving management of services; gearing the system to respond to the major challenges of dementia in the future.

This report presents newly collected data on the quality of dementia care in OECD countries. By providing the most up-to-date and comprehensive cross-country assessment of dementia care, it can help countries to improve their care systems today, and better prepare for the challenges of tomorrow.

The Department of Health has developed an ambitious and comprehensive strategy for dementia, Living Well with Dementia (February 2009). Yet, despite the Department stating that dementia is now a national priority, it has not been given the levers or urgency normally expected for such a priority and there is a risk that value for money will remain poor unless these weaknesses are addressed urgently. Dementia was not included in the Department's tier 1 Vital Signs indicators for the NHS, through which it monitors performance. Other levers such as joined-up commissioning and comprehensive performance information, are not yet fully developed. Achieving transformation in the proposed five years will be very challenging. The Department does not have evidence on current and future costs and benefits; the strategy is likely to cost much more than the estimated £1.9 billion over ten years. The Department expects implementation of the strategy to be mostly funded through efficiency savings arising from the acute hospital and long-term care sectors, though the NAO foresees difficulties in achieving this. There is no basic training for healthcare professionals on how to understand and work with people with dementia. Strong leadership is also key to improving services, but this is not yet in place in local NHS and social care delivery organisations, nor is there enough joined-up working between health and social care services for people with dementia. The report points out that there are some examples of excellent practice which could already be making a difference if they were adopted across the country. But it is not clear that services are making best use of money.

Winner of the BMA 2011 book awards: psychiatry category Winner of the Australian Journal of Ageing book of the year award This definitive work on dementia and related disorders has been fully updated and revised to reflect recent advances in this fast-moving field. The incidence of dementia continues to rise as the population of the world ages, and the condition represents one of the most significant challenges facing societies and health professionals in the next half-century. In this, the most comprehensive single volume work available on the subject, the editors have met this challenge by assembling a team of the world's leading experts on all aspects of the condition, from history, epidemiology and social aspects to the latest neurobiological research and advanced therapeutic strategies.

The National Audit Office report on this topic was published as HCP 82, session 2009-10 (ISBN 9780102963328)

Commissioning : Written Evidence

Supportive Care for the person with dementia provides a broad and full perspective, drawing upon the experience and expertise of a wide range of internationally-based professionals to outline a model of supportive care that will provide good quality and holistic care for people with dementia.

What do national dementia strategies, constantly evolving policy and ongoing funding difficulties mean for people living well with dementia? Adopting a broad and inclusive approach, Shibley Rahman presents a thorough critical analysis of existing dementia policy, and tackles head-on current and controversial topics at the forefront of public and political debate, such as diagnosis in primary care, access to services for marginalised groups, stigma and discrimination, integrated care, personal health budgets, personalised medicine and the use of GPS tracking. Drawing on a wealth of diverse research, and including voices from all reaches of the globe, he identifies current policy challenges for living well with dementia, and highlights pockets of innovation and good practice to inform practical solutions for living better with dementia in the future. A unique and cohesive account of where dementia care practice and policy needs to head, and why, and how this can be achieved, this is crucial reading for dementia care professionals, service commissioners, public health officials and policy makers, as well as academics and students in these fields.

Practical Management of Dementia, Second Edition remains a comprehensive guide to identifying the challenges faced in caring for patients with dementia. Integrating new research into the diagnosis, detection and management of dementia, this book brings together a wealth of extensive practical experience and knowledge. It answers questions on medical, psychological and social management in an informative, evidence-based manner. Emphasising the need for a variety of pharmacological, psychological and social approaches that can be adapted for individual patients, it also encourages an understanding of the patients' spiritual needs. Reviews of the First Edition: 'This is a highly readable and useful resource.' NURSING STANDARD 'Comprehensive and valuable. Of merit to all healthcare team members from all care setting perspectives.' GERIATRICS TODAY 'Consistent and clear, well written and edited.' THE JOURNAL OF DEMENTIA CARE