Variation in the quality of care means people living with dementia risk receiving poor care

A major review of dementia care by the Care Quality Commission (CQC) says the unacceptable gap in the quality of care means it is likely that someone living with dementia will experience poor care as they move between care homes and hospitals.

CQC inspected care in 129 care homes and 20 hospitals across England, looking at four areas: how people's care needs were assessed; how care was planned and delivered; how providers worked together and how the quality of care was monitored.

In about 29% of care homes and 56% of hospitals we inspected, we found assessments were not comprehensive in identifying all of a person's care needs. In about 34% of care homes and 42% of hospitals, we found aspects of variable or poor care regarding how the care met people's mental health, emotional and social needs.

The report says the variation in how care is assessed, planned, delivered and monitored by hospitals and care homes puts people living with dementia at risk of experiencing poor care.

It found when people are admitted to hospital via A&E there is too much focus on a person's physical health needs. There is also poor sharing of information between health professionals, people living with dementia in care homes and hospitals may not be able to tell staff about their pain and there is a lack of understanding and knowledge of dementia care by staff.

The report adds that supporting both the physical health and mental wellbeing of a person – as well as managing known risks such as falls and urinary tract infections– can help reduce avoidable admissions to hospital and unnecessary long stays in hospital.

Commenting on the findings, Andrea Sutcliffe, Chief Inspector of Adult Social Care, said: "People living with dementia, their families and carers have every right to be treated with respect, dignity and compassion. 

"Our review found some great care, delivered by committed, skilled and dedicated staff. But this is not the case everywhere or even within the same service meaning too many people are at risk of poor care. This has got to change. 

"A wealth of guidance exists to drive the delivery of excellent care for people living with dementia. We need to make sure that every care home and hospital achieves the high standard of care we see in the best services.

"Our new approach to the regulation and inspection of health and social care means that we can celebrate good care, identify where improvements are needed and take action where necessary so that people living with dementia, their families and carers can always be confident about the care they receive."

Health Secretary Jeremy Hunt said: "There can be no excuse, and no hiding place, for poor care within our NHS – we are focusing on improving the lives of dementia patients and their families as never before. That's why we've trained thousands of NHS staff to recognise the signs of dementia and invested in dementia friendly care homes and hospital wards.

"The CQC play a vital role in improving care through their tough new inspections and it's vital that they continue to shine a light on any poor practice so that we can drive up standards throughout the country."

Jeremy Hughes, Chief Executive at Alzheimer’s Society, said: "With a staggering 90 per cent of the care homes and hospitals inspected found to have aspects of variable or poor care, this report highlights the plight that many people with dementia face.

"The inconsistency of care found here means many people are rightly worried about being admitted to hospital or having to move into care. Carers have told us that their loved ones have gone for hours without food or water in hospital or that they were in pain but no one realised. Staff can also find communicating with people with dementia extremely challenging and wards and a new care home can be disorientating to navigate.

"However, we know there are many care homes and hospitals that are getting it right by training their staff in person centred care and making their homes and wards more dementia friendly. Developing staff and helping them understand the needs of people with dementia is vital if we are to improve the care people receive."

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said "It's vital that the excellent care highlighted in this report is replicated everywhere across the country. People with dementia deserve the best quality of life in their old age. With NICE's range of guidance available to all, there is no excuse for standards of care to fall short."

Some of the other findings of Cracks in the pathway include:

• In about 27% of care homes and 56% of hospitals we found aspects of variable or poor care regarding a lack of understanding and knowledge of dementia care by staff.
• In hospitals, there was limited evidence to show that staff considered the person's emotional and psychological needs, and how this affected their mental health and wellbeing.
• In about 27% of care homes and 22% of hospitals, we found aspects of variable or poor care in the arrangements for the sharing of information.
• Available guidance is not being used effectively and there is a failure to manage known risks such as falls, urinary tract infections and malnutrition.

 Following the report, CQC is committed to:

• appointing a new national specialist adviser for dementia care;
• training inspectors across all inspecting teams to understand what good dementia care looks like so that their judgements of the performance of providers are consistent and robust; and
• including a separate section in hospital inspection reports that shows how well the hospital cares for people living with dementia.

The findings of the themed dementia review are available here.

You can tweet your thoughts about dementia care using #dementiapathway.

For media enquiries about the Care Quality Commission, please call the CQC press office on 020 7448 9401 during office hours or out-of-hours on 07917 232 143. For general enquiries, please call 03000 61 61 61.