New impetus for dementia strategy is welcome

While most of the political world is focused on Ed Miliband’s speech at the Labour Party conference today, the government has quietly made an announcement that should give renewed hope to people with dementia, their families and carers; a renewed focus for the National Dementia Strategy.

It seems a long time since the strategy was launched in February 2009 amid much fanfare and talk of how it would improve care for people with the condition. What followed that was, well, very little, it seemed. Indeed, the National Audit Office was heavily critical of the implementation of the strategy – or lack of it – back in January.

While some thought that criticism was premature – one year into a 5-year strategy – little progress seems to have been made since, hence the new government’s re-fresh of it.

The Department of Health document Quality outcomes for people with dementia: Building on the work of the National Dementia Strategy highlights 4 main priorities:

• Good-quality early diagnosis and intervention for all
• Improved quality of care in general hospitals
• Living well with dementia in care homes
• Reduced use of antipsychotic medication.

The DH adds that the improvement of community personal support services is integral to and underpins each of the 4 priorities.

I can’t argue against any of those priorities, but carers, care service professionals and campaigners have been saying this for years.

There is also talk of developing an ‘outcomes-focused approach’ to dementia. ‘Outcomes-focused’ is an increasingly used phrase in health and social care and is starting to grate – isn’t all health and social care geared to delivering an outcome? I.e. improving the life of the service user? Or is it meant to stand for ‘as opposed to target-driven approach of previous government’?

However, cynicism aside, this is a major and welcome commitment from the government. For too long dementia has not received the attention it deserves from successive governments and, as a growing number of people develop the condition, it becomes an ever more urgent priority.

This annoucement has also gone down well with organisations in the sector, with the Alzheimer’s Society, the English Community Care Association and Counsel and Care all coming out in support of this.

But we have all been here before and as the original dementia strategy shows, good words and plans are one thing, but it means nothing if it does not deliver results for service users and their families.

My worry with this is that this could happen all over again. There isn’t too much detail in the document on how this will be delivered, although this is in part because the delivery strategy will be linked into the wider reforms of the NHS and social care, which will be announced in the coming months.

So, there is much to commend the revisions to the dementia strategy, but, as ever, words and intentions are one thing, but the real indicator of success will be in the implementation of this and tangible results for service users. So I’ll reserve judgement on it until later when – or if – the results can be seen among service users.

Social care needs to be a priority for new government

Since the Conservative and Liberal Democrat coalition took power earlier in the week and started outlining its policies, one issue seems to have been conspicuous by its absence: social care.

As I have previously blogged, in the general election campaign social care seemed to disappear off the political radar, despite it being touted as a key issue in the run-up to it being called. Now post-election, it continues to be ignored in children’s and adults services; nowhere in the policy outline was social care mentioned.

Indeed, Michael Gove, the new head of the (swiftly renamed) Department for Education, has said in a letter to civil servants that education is the priority for the department, thus seemingly sidelining children’s services, although he added that this area will be strengthened and reformed, but didn’t elaborate on how.

Also, Andrew Lansley, the new health secretary, has spoken extensively of the plans for the NHS, while adult social care has garnered barely a mention.

This lack of attention is worrying; ask anyone within adult social care and they will say that reform – especially of the way it is funded – is urgently needed. Children’s services also need to be strengthened and supported. They can’t be left to drift as they have done for the past few years.

Leading social care organisations are also worried. Counsel & Care, a charity working with older people, their families and carers, have called for reform of social care to be made a priority by the new government.

Meanwhile, Carers UK’s director of policy and public affairs, Emily Holzhausen said; “We are deeply disappointed that the programme for Government published in the coalition agreement this week does not establish social care as a political priority.

“Clear plans must be brought forward as a matter of urgency, setting out a sustainable funding model for fair, universal, and transparent care services.”

However, despite the worries, I’m trying not to be too negative. It is still very early days for the government and we shouldn’t be too quick to judge – social care is a complicated issue and it may take more time to put together a policy.

Also, Paul Burstow, a Lib Dem MP with a history of championing issues such as social care funding, dementia and adult protection, has been appointed as a minister for state – the rung below cabinet – in the Department of Health. Having someone with in-depth knowledge of and a passion for the issues involved could ensure that they get the attention they need.

But until the government makes any policy announcements, as with everyone else blogging on this in the sector, everything is speculation and educated guesswork.

A final thought; in among all the speculation, there is one decision on social care that will have to be made soon – whether to pass Labour’s Personal Care at Home Bill. The Tories are against it, as are the Lib Dems, who would prefer to use the money for this to give carers extra short breaks, so I think we know what the result will be there.

Do you agree? Please let me know your thoughts below.

Little honesty in social care debate

So, the political mud-slinging has begun in earnest. As the Conservatives, Labour and Liberal Democrats all strive to tell you how bad the others are (or would be), reasoned debate goes out of the window.

The Tories have landed the first blow, accusing Labour of planning a £20,000 “Death Tax” to be levied on all estates after death.

To ram the point home, a new poster was revealed depicting a gravestone engraved with ‘RIP Off’ (see what they did there?) and the slogan: ‘Now Gordon wants £20,000 when you die.’

Health secretary Andy Burnham has rejected this accusation (or hinted that the party is planning it, depending on which paper you read), saying that “firm proposals” will be set out before the election – one assumes he means the White Paper on adult social care funding, which is still being promised, although time is fast running out if it is to appear before the election.

Currently, Labour is sticking to its line that it is considering the outcomes of the Big Care Debate, which took place last autumn after the release of the green paper on the future of adult social care funding.

The Conservatives have said even less, apart from their £8,000 voluntary insurance scheme.

Responding to this, another other related stories, Stephen Burke, chief executive of Counsel and Care, a charity that works with older people, their families and carers, has appealed for an “honest and serious” debate that recognises that better care will cost more, and that radical reform and proper funding is required.

While many people in the social care sector will agree wholeheartedly with that call, the chances of such a debate happening are virtually nil.

Also, any hopes of a cross-party consensus on the future of social care – something various social care commentators have called for – now appear dead and buried.

With the parties now getting into the swing of electioneering, everything they say will be geared to getting your vote. So a reasoned debate on the future of care funding will not happen, because it will require some tough – i.e. not popular – decisions to be made, if a crisis of care is to be averted. No politician is going to say anything that might lose them votes.

Paying for care still biggest concern for older people

How to pay for residential care is still the biggest worry for older people, their families and carers, according to a new report.

Older people’s charity Counsel & Care’s Care Concerns 2009 reported that 25% of calls to its advice line are about this.

Nothing new in this – it’s been a worry for years – but it shows that the issue will not go away and that reform is needed.

Indeed, the main concerns of older people are pretty much as they have been for years. Here are the top 5, according to Counsel & Care:

• Concerns about whether older relatives or friends starting to lose mental capacity are receiving the most appropriate and high quality care available in the setting of their choice
• Lack of available and meaningful information and advice for older people, their families and carers, particularly those who pay their care costs themselves
• Difficulty accessing the care and support system
• Difficulty navigating the complaints process if you experience poor quality care
• The ever-increasing costs of care and support.

Nevertheless, there are hopes that the government’s white paper on adult social care funding – promised to come out before the election – will address this.

While last summer’s green paper on the future of adult social care funding had some useful suggestions on providing better information for self funders, as well as making the care system easier to access and navigate, it still failed to address one of the most vexed points; people selling their houses to pay for care.

In addition, the government’s free personal care at home bill would go some way to addressing the concerns of older people paying for care, but it only helps those above the threshold for social care funding with high needs and who still live in their own home.

The green paper outlined several options to pay for care costs, from insurance to a mix of state and self funding, but none covered paying for the accommodation costs of residential care, which can still mount up if someone is in care for several years. In that situation, selling their house is still an option.

If nothing else, Counsel and Care’s report is a useful reminder of the main concerns of older people in the care industry and if the government does address these issues, it could leave a long-lasting positive legacy.

Keywords, however, are ‘if’ and ‘could’; if the white paper comes out before the election and if it makes it through parliament. Could, in that nobody knows yet what conclusions the government has come to.