The breaking point of dementia care. Time for fewer bandwagons and more real action.

How many times do we all need to say that the NHS and social care are at ‘breaking point’?

The King’s Fund confirmed today the broad sentiment of this year’s Care Quality Commission State of Care (CQC) report. There have been a few more social media bandwagons compared to last year, with a few more social movements aka marketing audiences. But the fundamentals are essentially unchanged, as we knew they would be.

Nigel Farage is not the only one with a ‘breaking point’. As it happens, his breaking point, now turned into Brexit, not only has an effect on the availability of Marmite, Surf and Ben and Jerry’s online from Tesco, but also has a bearing on whether the number of available workers in social care will implode on itself.

The sobering part of this morning’s CQC report was that all of this was going wrong ahead of the Brexit decision. There was nothing to stop years or decades of relative underinvestment in the NHS and social care apart from politics. The reason the NHS is suddenly ‘underfunded, underdoctored and overstretched‘ is not due to decades of Asian immigrant staff helping to prop up the system.

Prof Sube Banerjee makes a striking observation about what we might expect in the near future from certain innovations in dementia in his foreword to my book ‘Enhancing health and care in dementia: a person-centred integrated care approach’.

“In the provision of services for people with dementia we are at the stage of ‘a hundred flowers’ blooming with as many models of care as there are Clinical Commissioning Groups. While some of the flowers may be wonderful, some are likely to be frankly poisonous and we do not know which is which at the moment.”

It is comforting to put your faith in the future of dementia care from mythical figures on the side of a bus, or the myriad of hashtags on Twitter, but, unless Chris Hopson’s fundamental concern is addressed, we cannot move much further forward.

Chris Hopson is the fairly bubbly CEO of @NHSProviders who is not afraid to speak his mind politely.

Hopson was this week appearing in front of the Health Select Committee, sat to the right of the Rt Hon Stephen Dorrell MP one of the most accomplished and experienced Health Secretaries.

This is what Ed Miliband MP used to warn about as ‘overpromising and underdelivering’. Hopson mooted whether some of the sustainability and transformation plans would live up to quality expectations given their financial projections.

And Hopson mooted exactly what many of us feel.

At worst, there is a strange form of intense denial at the top echelons of Government. However, some decision will have to be taken at the time of the Autumn Statement by the current Chancellor of the Exchequer.

Sir David Nicholson famously remarked that making long term plans for the NHS tended to be scuppered by short-termism, echoed by Hopson more graphically earlier this week.

I don’t need to rehearse the ways in which the NHS and social care outcomes are consistently breached by pressure points in the NHS, including delayed transfers of care, crisis in mental health provision, funding inadequacy, A&E delays, and so on. These are well known.

But while the intense denial continues, this means a lack of adequate funding grand plans for an integrated care pathway for people with dementia and carers. Every where you look, despite some excellent care, there are massive problems, like the inequity in provision of adequate health services in care home, delays in organising care packages for older patients in hospital, chaotic care planning, inadequate sharing of health and care records.

The point is – these are not new problems. We don’t need to spend a year producing more infograms and hashtags, and more campaigns and more conferences, for the same ‘in crowd’ to do nothing about the burning problems.

For all the talk of collective or distributed leadership, and there is a lot of it, it is clear leadership is not up to scratch either in the NHS or social care. Paul Burstow MP famously likens social care to ‘Baywatch’, where a lot more effort could be put into teaching people how to swim, rather than having a coastguard hub with an unsafe number and mix of lifeguards.

For the care of dementia, there could be, for example, some financial assistance in allowing people to live at home with the correct assistive technology support, or even robots or pets, or even ‘hospital at home’. But because the system is so fracked we’re not anywhere near that level of debate.

It’s the repeated failure stupid.

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