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The Royal College of Psychiatrists Improving the lives of people with mental illness

National Audit of Dementia

Background to the National Audit of Dementia (NAD)

In 2006 the Royal College of Psychiatrists was asked by the Healthcare Commission to look into priority areas for improvement of services for people with dementia. Following a literature review and 3 round consultation exercise, the report recommended an audit of the care of people with dementia in general hospitals.


The third round of NAD (NAD3) will examine the care provided to people with dementia in acute hospital settings in England and Wales.  A pilot phase for NAD3 will be conducted in 2015 and a parallel pilot will be carried out in community hospitals (feasibility study) to examine their inclusion in the main audit.



An ageing population means an increasing number of people with dementia in society. Evidence shows that a significant proportion of general hospital inpatients are people with dementia1. Important decisions about the future care of people with dementia, which maybe permanent, are often made while in general hospitals. Little is also known of how people with dementia and their carers' experience general hospital care1.

Important facts about the care of people with dementia:

  • Up to 70 percent of acute hospital beds are currently occupied by older people and up to one half of these may be people with cognitive impairment, including those with dementia and delirium. 2


  • People with dementia in general hospitals have worse outcomes in terms of length of stay, mortality and institutionalisation. 2


  • The National Audit Office has estimated the excess cost to be more than £6 million per year in an average general hospital. 2


  • The National Dementia Strategy launched in 2009 has identified improving the quality of care for people with dementia in general hospitals as one of its key objectives.2

Investment in care for people with dementia should result in improved quality of life, improved quality of death and reduced costs to society1. Hence, an audit on the care in general hospitals for those with dementia will help examine the effectiveness of services  as well as help explore patient and carer experience in general hospitals.  

Furthermore, a scoping and consultation exercise carried out by the Royal College of Psychiatrists at the request of the Healthcare Commission found that:

  • Admission to a general hospital ward is a time of high risk for people with dementia
  • Admission can lead to worsening of the condition and poor outcomes in general
  • There is a need for better consistency in standards of care on general hospital wards.

NAD is funded by NHS England and the Welsh Government, and  commissioned by the Healthcare Quality Improvement Partnership (HQIP).


1 Corbett, A. (2009). The Journal of Quality Research in Dementia Issue 8 (scientific version).

2  Living Well with Dementia: A National Dementia Strategy. Department of Health 2009.




Creating a national picture of care delivery

By participating in NAD, services will help to create a true picture of care delivery across the country. 


This will enable NHS England and the Welsh Government to develop realistic policies and targets to support service development, based on an accurate understanding of what is happening ‘in the field’.


The Healthcare Quality Improvement Partnership (HQIP) advises that:


clinicians, and their employing Trusts, should view a well designed and effective national audit programme as an essential tool for them to improve services and assess performance’.


Supporting local services

For individual organisations and services, participating in the national audit enables individual clinicians and teams to:


  • Benchmark their practice and performance against national standards and other sites participating in the national audit;
  • Identify areas in which they are performing well and areas for improvement;
  • Understand the views and experiences of those using their service.

Where next...


National Audit of Dementia,

21 Prescot Street, London, E1 8BB    

Fax: 020 3701 2761



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