Community Care’s exclusive survey of views on the dementia strategy

Community Care is calling for a full debate on dementia care during the general election campaign given the problems identified by its exclusive survey. Mithran Samuel reports

If there’s one message from Community Care‘s exclusive survey about dementia care it’s that insufficient priority is being given nationally and locally to improving the care given to sufferers.

The readers who responded are in the frontline of the battle to tackle the current problems with services – the failure to diagnose dementia, the lack of early and ongoing support, the concentration on acute forms of care – and the challenge of rising demographically driven demand.

Nine out of 10 respondents work with people with dementia in areas including assessment and advice, mental health teams, and in residential, domiciliary or acute hospital care.

Their verdict is that:

● Dementia is too small a priority for government (89% of respondents)

● The dementia strategy for England has had little or no impact in their area (66%)

● The quality of dementia care in their areas is poor (42%).

With 12% of the sample of 108 coming from Scotland, the results deliver a strong message to its political and dementia care leaders, ahead of next month’s publication of a strategy for the condition.

For England, the results add to a growing weight of evidence that the five-year national strategy, published in February 2009, has had limited impact.

It follows critical reports this year from the National Audit Office (NAO), which found that the strategy could fail because of a lack of priority given to dementia care nationally and locally, and the all-party parliamentary group on dementia. The latter’s report, published this month, found two-thirds of primary care trusts could not account for their spending or planned use of £150m in dedicated resources for the strategy for 2009-11.

The NHS comes in for criticism in our survey, with 86% of respondents believing the health service in their area has not sufficiently prioritised dementia.

Martin Green, head of the English Community Care Association says: “The NHS is in denial about this condition.”

Ruth Cartwright, joint manager for England at the British Association of Social Workers, says: “People with dementia and their carers are let down, mainly by health services. Some doctors are still reluctant to diagnose because of a view that nothing can be done, which leaves people without essential support.”

Interestingly, diagnosis – a key priority under the strategy – is an area where survey respondents were positive, with 58% believing that the early diagnosis of people with dementia was improving.

Whatever the criticisms of the NHS, improvements in dementia care, and its efficiency, are dependent on joint-working between health and social care, given the need for sufferers to receive multi-agency support and co-ordinated care.

On this point, our respondents were not impressed, with most saying joint working on dementia between PCTs and councils was not improving.

This also chimes with the NAO’s findings. Care home providers and other practitioners it spoke to highlighted an unwillingness by health and social care organisations to pool costs and savings.

And just one in nine consultant psychiatrists the NAO interviewed could point to a joint health and social care pathway for people with dementia in their area.

Another of the strategy’s priorities is to establish “an informed and effective workforce”, amid concerns over the readiness of primary healthcare professionals to diagnose, poor care in hospitals and a lack of specialised support in social care settings.

Nevertheless, 45% of our survey respondents said training in their areas was not improving.

A number of people specifically commented on the inadequacy of training across health and social care. One practitioner, who worked in a hospital in Yorkshire and the Humber, criticised the quality of home care for people with dementia, saying: “Many agency workers have little or no knowledge of what’s needed other than the basic washing and dressing and are given too many service users to attend to.”

Simon Williams, dementia lead at the Association of Directors of Adult Social Services, says this past year has been a “baseline year” for the strategy, with councils and PCTs drawing up local plans for improvements based on analyses of need.

These must be completed by the end of this month. With less than four years to go on the strategy, Williams warns: “We would be disappointed if these plans were not beginning to make a difference in a year’s time.”

Stark facts on dementia

● One in six people over 80 have a form of dementia.

● 820,000 people have dementia in the UK.

● Dementia costs the UK economy £23bn a year including £9bn in social care and £12.4bn in informal care.

● At least 1.7 million people are expected to have dementia by 2051.

Sources: Dementia 2010 by the Alzheimer’s Research Trust. Dementia UK by Alzheimer’s Society, King’s College and London School of Economics

Useful links

 The dementia strategy in action in Croydon

 Judith’s story

 Dementia care homes, plus more useful links