The UK is ageing rapidly, which is heralding a big increase in the number of people with dementia. Yet a new report argues we are ill-equipped to face the care challenge this will create. Mithran Samuel reports
Government, councils, providers and users are in agreement that the next few decades will bring severe new pressures for the social care system, particularly as the population ages.
At the heart of this challenge is dementia, since it mainly affects the over-65s and its prevalence increases with age.
An Alzheimer’s Society-commissioned study this week outlines the scale of the challenge. It reports that more than 680,000 people have dementia in the UK, costing about £17bn a year in formal and informal care. It estimates numbers will rise to almost 950,000 by 2021, and more than 1.7 million by 2051, although it says calculating future costs involves too many assumptions.
Nevertheless, the society’s head of policy and campaigns, Andrew Chidgey (pictured left), says: “With the number of people with dementia increasing rapidly the cost will increase rapidly as well.”
The study, by academics from the London School of Economics and King’s College London, is not just about future cost, but also the state of services, about which it is scathing. “Despite areas of good practice, the UK’s current health and social care system is characterised by a widespread failure to support people with dementia and their families,” it states.
The charge sheet starts with a lack of priority given to the condition by the Department of Health. It moves on to highlight the failure by councils and primary care trusts to commission the right services and secure a sufficiently trained workforce and describes a lack of support for carers.
The study recommends a new national strategy for dementia. This, says Chidgey, “should have targets and [recognise] the need to put significant expenditure into services”.
There is no shortage of policy on dementia. The 2001 National Service Framework for Older People devotes a section to the condition as part of the mental health standard, but Chidgey says this failed to set measurable dementia-specific targets.
Christabel Shawcross, lead on older people’s mental health at the Association of Directors of Social Services, says there has been much good work on dementia since the NSF but “more needs to be done to ensure the consistency of services across the country”.
She says there are concerns that cuts being made by primary care trusts may disproportionately affect people with dementia, for instance through restrictions to NHS continuing care.
The Alzheimer’s Society and others have long complained that eligibility for continuing care has been both tight overall and skewed towards physical conditions.
The report is highly critical about the state of dementia training. It says people with dementia stay in hospital twice as long as other people for a given procedure, due to health staff ’s lack of understanding of their condition.
Chidgey adds that two-thirds of care home residents have the condition: “It’s unacceptable for care staff not to be trained in dementia.”
The report calls for planned revisions this year to the national minimum standards for older people’s care homes to include mandatory dementia training for staff.
But Andrea Rowe, chief executive of Skills for Care, says this is unlikely, given that the standards are set to become more outcome-focused as a result of the review, and move away from requiring inputs, such as specific training.
A “knowledge set”, showing expected training outcomes for staff working in dementia, was produced by Skills for Care in 2005
This includes understanding relevant legislation, the signs and symptoms of dementia and good principles of care.
Rowe says: “They are for people to develop in-house training and learning models. Social care staff have been involved in difficult cases without having the skills and training.”
She says awareness of the knowledge set remains low, and Skills for Care is planning to “showcase” it in every English region from April onwards, and adds: “I don’t think take-up would be very great at the moment. My feeling is that people haven’t got familiar with it.”
Rowe says individual care workers should have to acquire the training as a condition of re-registration with the General Social Care Council, which will open its register to domiciliary care workers in either late 2007 or early 2008, and residential care workers thereafter.
The report estimates that carers for people with dementia save the Treasury £7bn a year. But it says existing policy for carers is “very weak and needs revision”, without which increasing numbers will be unable to continue caring.
Chidgey says last week’s DH announcement, which confirmed a £33m package of support promised in last year’s health and social care white paper and promised a review of the 1999 Carers’ Strategy, does not go far enough.
He says the £25m set aside respite care “amounts to £5 per carer in this country”.
He adds that the government should signal its commitment to dementia in this year’s comprehensive spending review.
The realistic view is that the CSR will not deliver much for social care, with the smart money on a real terms funding freeze for local government.
But the Alzheimer’s Society report makes clear that the challenges posed by dementia will only grow and that failing to deal with them now may at best be delaying the inevitable, and at worst storing up significant problems for the future.
The report describes it as “a collection of symptoms, including a decline in memory, reasoning and communication skills, and a gradual loss of skills needed to carry out daily activities… caused by structural and chemical changes in the brain”.
‘I couldn’t just send her away’
George Russell, 73, from Shipley, West Yorkshire, has been caring for his wife Enid, 71, since she was diagnosed with Alzheimer’s disease 11 years ago. With the help of family, the local Alzheimer’s Society branch and the drug Aricept, he says they have tried to live as normal a life as possible. He says that her condition is now bordering on severe: “She’s got to the stage now where I have to do everything in the house. It’s a seven-day-a-week, 24-hour caring situation.”
Before Christmas, he says he became very low and is now on a mild anti-depressant which has improved matters. He has arranged for a home carer to bathe Enid, and Bradford Council has arranged for her to go to a day centre three days a week. “That’s a help it gets me a bit of time on my own.” But when overnight respite care was suggested by a social worker, he says: “Her face really dropped. I just couldn’t send her away.” He says the government needs to improve support to keep people with dementia in their own homes, saying money is a barrier to the family being able to increase support for Enid.The numbers
● £17bn is spent on care and informal care on dementia every year in the UK.
● More than 680,000 people have the condition, increasing to more than 1.7 million by 2051.
● Sixty-eight per cent of people with dementia are aged over 80.
● Thirty-six per cent live in residential care.
● Just £7 of public funding per citizen is spent on dementia research per year compared with £52 in the US.