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.

End of star ratings brings confusion

Amid the hubbub about the announcement of the coalition government’s plans – or lack of them – for social care last month, the Care Quality Commission’s announcement that it was scrapping its star ratings system for registered care services almost slipped under the radar – but it is an important decision and deserves more publicity than it has received so far.

But while the CQC is abandoning star ratings – 3 stars for an excellent service down to no stars for a poor one – it hasn’t got anything to replace it yet, and this has drawn criticism from some in the sector.

However, the passing of star ratings will not be much mourned. The system has been generally unpopular among care home operators ever since it was introduced 2 years ago by the then CSCI. Around the time it was introduced I was writing a lot about care homes, and to raise the subject of inspections – and the star rating the home received – to the manager often resulted in the sort of look that I’d get if I’d just sworn at them. Many objected to their rating and some were even prepared to go to court over it.

At the time, Frank Ursell, CEO of the Registered Nursing Home Association, voiced one of the major concerns – that a care home can receive a zero stars rating for being rated ‘poor’ in one of the three key areas involving safety and management, even if other areas are rated ‘excellent’.

The use of 3 stars, rather than the more common 5, was also queried as it was thought that it may confuse people trying to find care homes.

Getting rid of star ratings without having a replacement lined up has not gone down well either. Martin Green, chief executive of the English Community Care Association (ECCA) was unusually forthright on it:

“The CQC has told providers that it is interested in quality and yet… we have seen it bring forward the abolition of the star ratings system without a clearly defined timescale for its replacement,” he said. “The manner of this announcement, the lack of consultation, and the fact that CQC is not even adhering to its own published timescale gives us grave concern about its commitment to quality and its understanding and engagement with the social care sector.

“The CQC has been in existence for 13 months and it is becoming increasingly clear that it has little understanding of the social care sector, is administratively and bureaucratically shambolic, and lacks leadership and direction.”   

Harsh stuff, but if the head of the ECCA is saying it, imagine what those on the ground are.

The CQC says it is in talks with stakeholders to “discuss how a new system may work”. This can be seen as the regulator working with the sector to find a solution that suits everyone, or that it hasn’t got a clue what to replace star ratings with, depending on your view of the CQC.

But quite what they will come up with remains to be seen. In theory, star ratings should have been great to give an at-a-glance view of the quality of a home/service, but with the previously mentioned wrinkles in the system, this was not always the case.

Whatever does come from this consultation, the hope is that any new system is easy to understand, fair and remains in place for some time, rather than chopping and changing every couple of years.

This decision is crucial for the CQC, not only in terms of helping service users, carers etc navigate the system and find the right care, but for the body’s own credibility, which is seemingly on the line as well.

Improving dementia services will take time

When the National Dementia Strategy was launched amid much fanfare last February, the government said that dementia would become a priority and services would be improved. But nearly a year on, the rhetoric hasn’t been backed up by enough action, according to the National Audit Office.

In its interim report on improving dementia services in England the NAO was heavily critical of the implementation of the strategy – or lack of it.

Amyas Morse, head of the NAO, said; “At the moment this strategy lacks the mechanisms needed to bring about large scale improvements and without these mechanisms it is unlikely that the intended and much needed transformation of services will be delivered within the strategy’s 5-year timeframe.”

However, some feel that the NAO has jumped the gun with its criticism. For instance, Martin Green, chief executive of the English Community Care Association, called the report “somewhat premature”. He believes that while there is a lot more to be done to improve services, “the development of the strategy and the achievements so far represent a significant improvement in raising the profile of dementia services and giving some clear direction for the future of care and support.”

Green does have a point; it needs to be recognised that it takes time – especially in local authorities and the NHS – for change to happen. For instance, one of the main aims of the strategy is to give basic training in dementia to every health professional that comes into contact with someone with the condition. It takes time to set a project like that up and then complete it.

It is a 5-year strategy and shouldn’t be judged too harshly yet. But nevertheless the NAO’s report should serve as a kick up the behind for government, local authorities and the NHS to ensure that they do implement measures to improve dementia services or at least start putting the mechanisms in place to do so.

This agenda is evidently not going to be forgotten about, and organisations such as the NAO won’t be afraid to criticise if they see things aren’t going as well as they should be. This should ensure that the Dementia Strategy isn’t quietly swept under the carpet by the bodies involved – possibly tempting given the swingeing public sector funding cuts coming – and do, in time, deliver the standards of services required.

Pre-budget report pleases few in social care

If ever there was a pre-budget report that was going to be unpopular, it was this one. Chancellor Alastair Darling knew it and has pretty much admitted it too. Unfortunately for him, it seems he was right; finding anyone with much positive to say about it is tricky at best.

From a social care point of view, the PBR seems to have been attacked from all sides. While it is generally accepted that cuts to the public sector are necessary if the country is to dig itself out of the financial hole it is in, the size of these cuts is causing consernation.

For example, the drive to keep older people in their own homes and out of residential care by using preventative measures continues. While the government thinks £250 million can be saved this way, ADASS’ John Jackson has slammed these proposals as “naïve”. He says that most councils are already planning cuts of 4% in this area and to make more, without new initiatives designed to help local government or promote closer working and better resource utilisation between the NHS and local government, is unrealistic.

Elsewhere, the announcement of a cap of 1% on pay increases for public sector workers from 2011-13 has been met with dismay. With National Insurance set to go up by 1% in 2011 too, add in inflation – expected to rise to 3% next year – and that’s a pay cut for millions. However, many councils would have struggled to find money for pay increases in any case.

But as BASW’s chief executive Hilton Dawson has pointed out, this seems to fly in the face of the Social Work Task Force report’s recent recommendations on career structure and pay grades for social workers. He called it a “slap in the face for the profession”.

Public sector unions have also been critical of the plans to cap state contributions to local government employee pensions by 2012.

So, while the public sector is unhappy, is the private sector more welcoming? Err, no. The English Community Care Association, the representative body for the independent care sector, has also slammed the PBR. Chief executive Martin Green said that the; “report signals that the government is intent on protecting the statutory services at the expense of independent provision and putting dogma before need”.

But this criticism has come without anyone really knowing what the alternative is; the Conservatives have focused mainly on criticising Labour’s plans, rather than promoting their own. Ditto the Liberals.

Certain details have previously emerged – such as the Tories’ plans to make deep cuts quickly and freeze social work pay for a year – but nothing in the same detail as Labour.

Only when the other parties outline their plans in the same detail will everyone get a true sense of what may be to come for the social care sector and the country more widely on the other side of the general election.