Tag Archives: reform

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.

Leave a comment

Filed under adult social care, dementia, health care, social care

NHS reform – impact on social care

Andrew Lansley’s much-vaunted white paper on the future of the NHS was published yesterday afternoon, promising widespread reform, including the abolition of PCTs and SHAs and giving commissioning power to GP consortiums. But what will it mean for social care? Here are a few of my initial thoughts.

Firstly, there are concerns that the reforms focus on general services and that people with learning disabilities, mental health problems and dementia have been largely ignored – this came through strongly on Twitter yesterday, from what I saw.

To test this, I did a quick word search of the white paper to gauge how many times certain phrases were mentioned; mental health is mentioned 8 times in the 61-page document, Alzheimers or dementia receives one mention [as @seetheperson pointed out to me], and learning disability – or learning disabilities – never crops up.

To me, this is shocking. Considering that people with learning disabilities, dementia and mental health issues make up a significant chunk of those that use NHS services, the lack of attention given to them is a worrying omission.

Specialist services are often a lifeline or those who use them and an acknowledgement of this – and preferably a commitment to give them at least some degree of protection – would have been reassuring to the many service users who are already distinctly nervous about what government cuts will mean for services.

Hopefully the government is planning for learning disability and mental health services separately…

Also, do GPs, who will now have power over which services are commissioned in their area, have the specialist knowledge that is often required in MH/LD to be able to give an authoritative view on what sorts of services are needed? Mental health charity Mind’s chief executive Paul Farmer has already questioned this and called on them to talk to experts and “tap in to the personal knowledge of patients and mental health charities about what works.” 

There is also cynicism over whether GP commissioning will work from some within the profession. For example, the GP for hire blog gives a distinctly lukewarm reaction to the proposals, saying it will put more pressure on salaried and locum GPs, and could lead to divided interests for those doctors involved on a consortium.

Also, will GP consortiums not exacerbate the postcode lottery, which was supposed to be got rid of? If commissioning a service depends on the decision of the GP consortium – a group of individuals with their own opinions – surely there is the risk that one consortium would approve it, but the one next door would not.

It hardly improves patient choice if they find that their needs are rejected in one area but available in another.

But there were some good points in the white paper. For instance, it talks of promoting the joining-up of health and social care services and promoting preventative action. I can’t argue with that principle – health and social care are closely linked, so that is a no-brainer and could help to reduce duplication of information and bring about efficiencies. Also, preventative action is generally accepted to reduce the need for costlier, more complex services down the line.

The white paper also says that the government’s vision for adult social care will be outlined later this year, and indicate that it will be a continuation of the current personalisation drive towards choice and control for service users. A white paper will follow next year. Nothing new there, but it is good to have the timeline in place.

In conclusion, the government’s reforms are certainly ambitious, but they are also risky. Social policy think-tank Civitas has warned that considerable resources will be needed to enact the restructuring – I’m not sure how that sits with the aim of saving £20 billion by 2014 – and if it is got wrong it could lead to a dip in the NHS’ performance for at least a year.

That will be the acid test of these reforms – will it make services better for service users? I’m sceptical, but only time will tell, as ever with any reforms.

This white paper provides so many points for discussion so it is more than likely that I will blog on aspects of it again later in the week.

1 Comment

Filed under adult social care, health care, learning disabilities, Mental health, social care

Uncertainty in social care after election result

So, 3 days on since the election result was announced and we still don’t know who will form the next government. As a result, from a social care perspective, we still don’t know where the future direction of policy will go either.

So, nothing has changed there, then. It’s been like this for months as green papers and white papers have come and gone, with little changing on the ground.

The only certainty, in terms of policy, came with Labour and its plans for a National Care Service, as laid out in April’s White Paper. But many in the sector doubted it would ever make it to fruition, given their standings in the polls.

Indeed, at the time of writing, a Conservative-Liberal coalition is looking possible, which would mean the end of Labour’s ideas; the Conservatives did not sign up to it, and the Liberals rejected several elements of it.  

Their ideas for reforming social care have not been laid out in as much detail as Labour’s, so many are left wondering what will happen.

My hope is that if there is a coalition – be it Conservative-Liberal, Liberal-Labour or some other variation – it will give a chance for a consensus to emerge over future policy direction. If that happens then if there is another election in the near future, there is a chance that the policy might be consistent. But that’s a hope.

More realistically, my guess is that another commission will be formed to review social care and make recommendations from that – although what could be said differently to the results of last year’s Big Care Debate is unclear. The Liberals said they would do this in their manifesto, although the Conservatives are said to be against that as well.

So, as I write, it seems like the only things that are certain are: the social care industry will continue to do its best with the limited resources it has and a funding system that nobody likes – like it has done for years; and that nothing will change that situation in the immediate future.

1 Comment

Filed under social care

ADASS sets out social care challenges

On the day before the election, and with social care still conspicuous by its absence in the political debate – possibly because none of the 3 main parties wants to touch this controversial subject with a bargepole – it has been left to ADASS to bring the subject back up.

In a 12-page document catchily titled ‘All you need to know about adult social care’, ADASS sets out where social care is and where it needs to go in the coming years. It makes for interesting reading.

On the plus side, ADASS reveals that standards are have improved every year since 2002. In 2009 there were no councils assessed as ‘poor’ (for the sixth year running) and 95% were rated ‘good’ or ‘excellent’. Quality of care has also improved, with three quarters of services assessed as ‘good’ or ‘excellent’ in 2009.

So, in social care terms, we’ve never had it so good. Progress has been made and things are getting better. Good.

But this only tells part of the story – and the rest isn’t so rosy. For instance, it reveals that public spending on social care has increased by 53% in real terms since 1997. Taken on its own, that’s not too bad. But, when compared to the increase in spending other areas have had, such as the NHS (nearly 100% increase), education (60%) and transport (70%), it shows how much of a priority adult social care has been since Labour came to power.

ADASS also outlines the challenges facing the sector, such as how the number of people of people with dementia in the UK – about 700,000 currently – is set to double in the next 30 years. The report also reminds us that 75% of councils only provide services to people with ‘substantial’ needs at least – with the number of older people using services is falling at a time when the older population is rising.

The report concludes with the key issues that need to be addressed: reform of social care funding is “desperately” needed; the need for greater integration between health and social care; how social care should be more joined up with other services, such as housing and education; and securing a skilled, motivated and adequately remunerated workforce.

None of those will come as a surprise and how these issues will be addressed should have been a question put to politicians in recent weeks. As mentioned before, they haven’t, and it is those in social care – workforce and service users – who are set to lose out because of this.

For many people with disabilities, social care is a top priority and many feel ignored by the election debates, according to a survey by ComRes.  With some 1.8 million service users out there – and the election so finely balanced – have the politicians missed a crucial trick by ignoring them? Possibly, but we’ll never know.

Leave a comment

Filed under adult social care