Do “the right people” enable change in dementia care?


Whist it is pretty much universally accepted that funding has not kept up with demand in the NHS, yesterday’s capital cash injection for ‘successful pioneers’ for the sustainability and transformation plans was better than nothing, arguably.

My biggest concern for these plans is that they are being set up to fail, if they are not given sufficient financial resources. But I’ve always felt that they should be given a chance to work if two conditions are met. Firstly, that they are not driven by very short time horizons financially (the cost of initial investment initially is high nearly always). Secondly, they should be driven by arguments for better care from practitioners and professionals.

The Alzheimer’s Society is currently running a campaign called ‘Fix Dementia Care’ but it is not entirely clear to me how they intend to fix it.

They indeed call for three things:

1. All hospitals to publish an annual statement of dementia care.

2. Monitor and use the annual dementia statement as part of its Risk Assessment Framework to identify and take action in hospitals where dementia care is inadequate.

3. Care Quality Commission (CQC) to appoint a specialist dementia adviser and include dementia care indicators as part of its Intelligent Monitoring work to improve regulation of dementia services in hospital.

It is hard sometimes for me not to be deeply cynical about the nature of involvement of well meaning people in dementia policy. Around the inception of the Big Society, there was an aim that the third sector would ‘build up the capacity’ of services. Unfortunately, this coincided with austerity-driven cutbacks in public services, so the forging ahead of dementia friendly communities and friendly banking came with drastic cuts to day centres and domiciliary care on its knees.

The “Fix Dementia Care” solution could’ve been written by anyone without a background in dementia, which is what alarms me the most.

For me, it is not simply good enough to heckle loudly from the sidelines and think this is ‘job done’. Big Charity does a nice form of heckling, in that they are highly respected and influential, and very chummy to government. The same people sitting on the same boards, just with different names, running the same conferences, with the same speakers, and the same delegates. And their branding is expensive and nice.

But this is not to address the root of the problem for me. And it won’t in a million years produce ‘meaningful change’, akin to the “million chimpanzees argument”.

I accept the argument that is insufficient simply to ask for more money. However, having witnessed with my own eyes skeleton staff being asked to man hospitals in the name of ‘efficiency savings’, I do have to question the lack of questioning of stripping public services of adequate funding.

Secondly, it relates to the issue that weighing a pig every day does not make the pig fatter. I do not see how such a disproportionate emphasis on regulation, rather than performance management, is meant to be the panacea for dementia care.

It does not address also the need to see what models of care work – for example an important part of wellbeing is to improve the physical and mental health of people with dementia. But this will not always be appropriately through an acute hospital admission, especially if the habitual residence of a person living beyond a diagnosis of dementia is in a care home.

I think ‘speaking truth to power’ no longer is a case where we can reliably expect corporate-like charities to “tell the truth” about the state of the NHS and social care to our current Government. It’s well known that the money to be given to social care for three years, from yesterday’s budget, should have been given as a front-load for next year in itself.

“Speaking truth to power” has become a much underrated trait in these difficult times for dementia practitioners and professionals. There seems to be a somewhat corporate obsession to change, with well meaning people not having the slightest clue about what they’re changing from or to.

All of this is a long distance from the ‘real leaders’ and change catalysts in the NHS being ‘rebels and mavericks’, not people with PRINCE2 diplomas. The fact is that people running change in the main ARE the people with marketing ‘experience’ and PRINCE2 diplomas, and they’re doing the rest of us a massive disservice.  Sadly, the people with the most power tend to be the people with the most influence, even if, for dementia care, they are completely wrong.

I really do wonder whether the ‘right people’ are leading change – whether co-production is a social movement, in the civil rights sense, or just clever marketing producing an ‘offer’? This concerns me most about the brand of ‘dementia friendly communities’.

But I think we have to be brave, and cut our losses. We need to tell corporate-like charity that dementia care won’t be solved by professional brand ambassadors and expensive marketing, and successful e-petitions, but needs substantially more serious professional investment, for example in continuous professional development. Or else ‘policy’ becomes a sub-division of ‘marketing’.

Dementia is not a brand. Get over it.







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