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.

More funding needed for mental health research

While Homer Simpson may have said “people can come up with statistics to prove anything”, there are some occasions when bald numbers do tell their own story. Mental health funding is one of those.

For instance, according to a review by the Medical Research Council, mental health is estimated to cost £77 billion each year in England alone. It accounts for 15% of all disability due to disease and affects 16.7 million people in the UK at any one time. Yet only about 5% – £74 million – of medical research budgets are dedicated to it per year.

Professor Til Wykes from the Institute of Psychiatry at King’s College London hit the nail on the head in a recent BBC piece, saying that mental health research is “incredibly underfunded”

This seems especially so, given that mental health problems affect more people at any one time than cancer or heart disease – both of which receive more funding.

Given the statistics, it is hard to argue with Prof Wykes. Whether this relative lack of funding is down to stigma or the fact that mental health is not a “sexy” illness is debatable, but at least there are moves to challenge the situation.

For example, in its review, the MRC has outlined the priorities for the research community for the next 5-10 years:

• Focus on the prevention of mental disorders based on better understanding of causes, risk levels and new approaches to early preventive measures
• Accelerate research and development to provide new, more effective treatments for mental illness, and implement them more rapidly
• Expand the capacity for research in this area in the UK.

The MRC will work with funding agencies such as the Economic and Social Research Council, the National Institute of Health Research and the Health Departments of the devolved administrations on approaches to take forward these recommendations, but whether more funding will be forthcoming is debatable.

The logic for more funding is hard to argue against – basically, more research would lead to better and more effective ways of preventing and treating mental illness, thus reducing the burden to the country and saving money – but the financial state of the country may dictate what happens.

With the Department of Health looking for savings, research budgets look set to be slashed for many areas of healthcare – although not dementia – so any large increases may be out of the question, although an increase in real terms may be feasible. Whether that is enough is another matter – it may be another case of innovative work having to be done with fewer resources, which could hold back the pace of development – to everyone’s detriment.

Big Care Debate – any closer to a solution?

The Big Care Debate closed last Friday (the 13^th, ominously, for those of a superstitious bent) ending the consultation on the government’s green paper, Shaping the future of care together , which set out the government’s options for the future funding of adult social care.

Now, the Department of Health will go away and contemplate the results, before, in theory, coming back with a White Paper, possibly in early 2010.

But with an election looming, I wonder if any of it will actually get through and make it into law.  

A spokesperson from the DH told me earlier in the year that if there is no consensus from the Big Care Debate on the best way forward, then it may go to a further period of consultation.

Looking at the reactions to the green paper from various groups, there seems to be little consensus; there have been criticisms, notably from mental health and learning disability groups, that the green paper focused on too much on older people. Indeed, much of the media focus has been on old age care funding and people not having to sell their homes to pay for residential care costs.

But then, older people’s groups, such as the National Pensioners’ Convention, have also voiced dismay over the government’s dismissal of the option to pay for care from direct taxation.

This option also found favour in a Joseph Rowntree Foundation survey. But then other organisations have supported the partnership and comprehensive models of funding the government suggested, which involve insurance and some state provision or the creation of a National Care Service.

If this is reflected among the wider responses, then we could be in for further consultation, which neatly kicks the debate into election time, when nothing concrete will happen because every politician will be scrapping for votes.

So, it seems like the social care industry will be in limbo for some time to come. And all the while the current regime will continue to creak along, and the problems within it will continue to mount, and – crucially – service users will continue to suffer at the hands of a much-disliked and over-complicated funding system.

The end of the chemical cosh?

One from the file marked ‘at last’ today; the government has announced a “tough” (their word) new action plan to tackle the over-prescribing of antipsychotic drugs to people with dementia.

Anyone involved with social care – or who at least reads and writes a lot about it – over the past few years will be well aware of this problem. There have been numerous newspaper stories about people with dementia being drugged, as well as studies published on the mostly negative effects of it on patients.

Another example of how widespread this problem is is that some care homes even use the fact they don’t administer drugs to dementia patients as a selling point.

So the headline figure of 150,000 given inappropriate drugs is also no surprise, although having read a couple of responses to the Department of Health’s action plan, it is to some organisations. One wonders where they’ve been looking, then.

Leaving aside the theories on why dementia patients are given a ‘chemical cosh’ – from misunderstanding the nature of dementia to making care home staff’s life easier – it has been clear for years that it needed to be tackled and that government action was necessary.

Now it’s here, the action plan does have some good points; improving access to psychological therapy – many care homes see little of local psychotherapists – and ensuring health and social care professionals have the skills to care for sometimes difficult dementia patients.

For me, these are the keys to success. Other measures, such as implementing local targets to cut antipsychotic drug use and the appointment of a National Clinical Director for Dementia, seem rather superfluous; it has to be the expertise of those on the frontline to care for people with dementia and improving access to therapies that helps cut the use of drugs and the premature deaths of thousands each year.