The national dementia strategy, published last week, presents some critical challenges to the social care workforce.
By 2014 services are expected to be able to support early diagnosis and intervention, and enable everyone to “live well with dementia”. Yet evidence from the Department of Health’s consultation on the strategy showed that the quality of care is being undermined by a major skills shortage.
Annie Stevenson, head of older people’s services at the Social Care Institute for Excellence, says the skills and knowledge gaps are huge, particularly among residential and home care workers. Many social care workers are failing to recognise and identify different forms of dementia, she says.
One third in care homes
There are 700,000 people with the condition in the UK – one-third of whom live in care homes – which is expected to double in 30 years. Two-thirds of care home residents have a form of dementia, according to Alzheimer’s Society statistics.
Andrew Chidgey, head of policy and campaigns at the Alzheimer’s Society, says workforce development could save much of the £7bn spent on care home placement of people with dementia in the UK each year.”If we get this right there’s a potential to save significant sums, which can be re-invested into services,” he says.
The strategy, which covers England, says the need for workforce development is a “priority that runs across all the themes in the strategy”.
John Nawrockyi, member of the workforce development policy network at the Association of Directors of Adult Social Services, says the 100 types of dementia pose unique challenges to social care workers.
Nawrockyi, who is also director of adult services at the London Borough of Greenwich, says: “Skills are needed in personalisation, advocacy, safeguarding, mental capacity, carers’ support, and dealing with challenging behaviour.”
These will form the basis of the “core competences” or skills in dementia care that the strategy recommends local authorities develop for unqualified staff over the next two years. This should be done with local partners in order to commission “a trained and competent workforce”.
Some councils are already acting on this. Birmingham Council has launched a review of training and continuing education programmes it commissions for people working with dementia.
Meanwhile, Skills for Care is working on a set of “dementia-specific” qualifications for care workers that conform to the new qualification credit framework, a standardised way of awarding credits for completed courses, due to be launched next year.
Stevenson says the sector needs to become more creative in delivering training, and should use new approaches such as e-learning. “Current one-day training courses are not sufficient in preparing the workforce and the quality of the training we provide should match the complexity of the condition.”
Diane Bennett, centre co-ordinator at Tutorcare, a Hampshire training provider, warns that the availability of training in dementia care is patchy, particularly among providers’ own in-house training. “It varies from staff being required to watch a 30-minute video to the procurement of the services of an experience occupationally competent trainer for a whole day,” she says.
The strategy also points to a lack of quality assurance for training programmes. The new National Skills Academy for Social Care, which will be launched in the autumn, is to start work on an accreditation scheme that would fulfil this requirement – Chidgey says this would be an “incredibly important step forward”.
But Stevenson acknowledges that there are “pockets of excellence”. Four Seasons Healthcare, which has 164 care units for people with dementia, invests heavily in its workforce. Caroline Baker, dementia services director, says £600,000 it spends each year on dementia training for staff is paying dividends.
Use of drugs declined
A study of seven Four Seasons homes showed the use of anti-psychotropic drugs fell significantly after staff completed the in-house training programmes in dementia care.
In social work, all degree courses include awareness of dementia, under the core subject areas of human growth and development, and mental health and disability. To boost learning, a long-term pledge of the strategy is to upgrade the degree and post-qualifying awards to include specific modules on dementia.
Heather Wing, director of regulation at the General Social Care Council, says all degree courses will incorporate an understanding of the dementia strategy. But she emphasises that this training must be “consolidated in practice” by greater take-up of specialist post qualifying awards.
Keith Brown, director of Bournemouth University’s centre for post-qualifying social work agrees that “tweaking” the social work degree will not deliver the person-centred care that the dementia strategy demands.
Brown wants to see at least 1,000 recently qualified social workers taking the specialist post-qualifying award in adult social work in England every year, requiring additional investment of £3m to cover the tuition fees. At present, only about 250 social workers take it each year.
Reforms on horizon
“When you qualify you have to engage in specialist training to develop the skills you need to work with complex cases,” Brown says.
Other reform programmes are on the horizon. The DH promises to ensure the adult social care workforce strategy, published later this year, will reflect the dementia strategy. The Social Work Taskforce will examine all forms of social work training. Last week, MPs in the all-party parliamentary group for dementia announced an inquiry into the readiness of the social care workforce to provide high-quality dementia care (see Website Extra).
The strategy leaves providers in no doubt that workforce development cannot be ignored.
Dementia strategy key aims:
● Improvement programme for care home services for dementia.
● A national awareness campaign to tackle stigma.
● A new inspection regime to monitor implementation.
● Primary care trusts to launch “memory clinics” in every town and city to ensure early diagnosis and intervention.
Contribute to inquiry
Last week, MPs in the all-party parliamentary group for dementia announced an inquiry into the readiness of the social care workforce to provide high-quality dementia care. To contribute click here
Community Care is running a conference, Dementia Dignity and the Challenge of an Ageing Society, in London on 26 February. It features Professor Sube Banerjee, co-lead of the national dementia strategy working group.