Although never in the Coalition agreement, the Big Society was the ‘next big thing’ of the David Cameron government. Cameron boasted, at the start of that period of forced political marriage, that he wished his tenure of office to be judged by three things: Afghanistan, the reduction of the deficit, and ‘the Big Society’.
The Big Society never achieved traction despite many many launches and relaunches, lunches and re-lunches. Rather like Cameron himself, the idea was tolerated rather than loved. The Big Society, Cameron admitted, was not supposed to be an original idea but a rebadging of inherently worthy elements of society: in other words, devolution of purpose to members of society, a reduction in the top-down power of the State, and ‘social action’.
Irrespective of the nauseating graphics on Twitter, actually, social action has been done to death, along with call to actions. The ideological priority placed better customer service with a leading high street brand as a high priority in the dementia friendly community than improved human rights of residents in care homes.
It was always said that dementia friendly communities was ‘more than health and social care’, but the result always was nearly ubiquitously to expunge discussion of health and social care needs of people with dementia and carers out of the equation. Social care was diabolically addressed in the original 2012 Prime Minister Dementia Challenge, and the rest is history.
Well, relatively recent history to boot plays this out. At the weekend, the NHS was controversially called a ‘humanitarian crisis’ by the Red Cross, but putting aside the fairness of equating the NHS to Syria or Yemen it is undeniable that the 800,000 or so people with dementia with their complex comorbidities are amongst those caught up in waiting for hours to become admitted to NHS hospitals and amongst those to be stuck in hospitals without prompt care packages.
And the NHS crisis is not simply a crisis of the NHS. It is a crisis of the whole system, especially housing and social care, and whilst these continue to be neglected compared to leading high street brands and social enterprises specialising in dementia friendly gimmickry, the dementia friendly new world cannot materialise.
At around 2011 and 2012, Jeremy Hughes CBE, nearly appointed CEO of the Alzheimer’s Society, made numerous noises along with then Tory Minister for Civil Society Nick Hurd MP about how “dementia friends”, a call to action in dementia awareness, was a good example of how the third sector (no longer to be called the ‘voluntary sector’), the State and the community could all work together. This was apparently ‘the Big Society in action’.
Ideologically, this came at the time of wishing to liberalise the NHS market, while personal budgets continued to be rolled out through the back door in social care policy, through the Health and Social Care Act (2012). The ideological machinery was set up to outsource and sell off bits of the State in delivering dementia care through the dreaded section 75.
Cameron, in rolling his sleeves up, is thought to have been inspired by the talk of ‘little platoons’ of that other great Conservative (other than him) Edmund Burke. This referred to an army of little busybodies up and down the land who would, say, be able to buy their local refuse collection services to run them.
And the Dementia Friends Champions, run by Angela Rippon CBE, were the modern equivalents of the little platoons. And Dementia Tsar, Prof Alistair Burns CBE, would promote Dementia Friends and latterly see to fruition a NHS Transformation Network which omitted caring well.
The lack of ‘caring well’ in the ‘living with dementia’ network is, make no mistake about it, a national disgrace. It is a very loud insult to the million or so unpaid family carers of dementia. It is a disgrace to respite care services. It is a disgrace to home care services. It is a disgrace to clinical specialist nurses, consistently and comprehensively given short shrift from the “dementia friendly community” despite robust agreement on their enormous clinical volume.
And, at the weekend, the new Conservative Prime Minister, Theresa May MP confirmed in both an article in the Sunday Telegraph and an interview with Sophy Ridge for Sky, that she wished to see a ‘sharing society’ rather than a ‘big society’. I quipped with Sir David Nicholson, former CEO of the NHS, that sharing of risk was of course what enabled the provision of universal health care – and David said in a tweet ‘that is at the heart of it’.
I tweeted that the shared society was if the work by Phillip Blond in the think tank Respublica, though to have heavily influenced the Big Society, had never happened. Blond responded also back in a tweet that one couldn’t be so sure.
From what little we do know about May’s new vision, and we do know she doesn’t like giving a ‘running commentary’ on anything, the shared society is less about the rights of individuals but their collective responsibilities, in which the State might possibly intervene to fix injustices.
At the moment, there are thousands of people with dementia and carers suffering from poor or no care, completely untouched by the little platoons of the Dementia Friends brigade. The ‘Care Connect’ offering of 2012 in care homes never quite happened. The vision of someone with a forget-me-not badge would help out somebody fumbling with change in Sainsbury’s, or be able to make a new diagnosis of dementia in Tescos, did not quite happen (and good thing, many would argue, too).
Unfortunately, resource allocation in services is a zero sum gain, and the millions pumped into Dementia Friends have seen sacrifices elsewhere. The gravy train of Dementia Friends, with a less than enthusiastic ‘social movement’ some conscripted online out of desperation, needs to give way to the shared society of better State intervention on enhancing health and wellbeing in dementia, particularly through more and more highly trained social care practitioners, more AHPs, more Doctors and more specialist clinical nurses.
The Big Society is dead. The dementia ‘awareness’ has been a very good thing – but it is time for the Dementia Friends to make way too.