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.
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