Dementia champion Martin Green: How commissioners hinder staff

Independent sector dementia champion Martin Green says staff need more time to spend with sufferers but commissioners prevent this from happening. Vern Pitt reports

English Community Care Association chief executive Martin Green has been busy collecting dementia sufferers’ stories and the experience has changed his perceptions of care.

One woman he met was desperately unhappy despite being in a new, clean care home where she said the staff were great. Green couldn’t understand what the problem was, remarking that it was like a five-star hotel. “Yes, but I never did feel very comfortable in five-star hotels either,” she said. Retelling it, Green smiles: “[Residents] are often good at crystallising the issues.”

Green has been visiting dementia services run by ECCA members in his capacity as dementia champion for the independent sector, a government appointment designed to help raise the profile of the dementia strategy among independent care providers.

He has also been using these stories to help inform policy development within government, as well as identify good practice.

“It has been an uplifting experience,” he says. “It has really underlined the importance of the relationship base to care.”

Many of the examples of good care which Green has seen have involved staff going the extra mile to understand service users.

He applauds the efforts of staff at one home where a woman had developed a fixation with keys and was constantly locking doors. “The staff at the home did a lot of work researching her history with the family but that didn’t give them any clues as to the root of the problem. Then one member of staff talked to a friend of the woman and found out that this lady had had a job during the war working in a prison. She felt she had to secure the building,” he says. The solution was to give her a set of locks and a big set of keys which she locked every time she left her room and this instantly brought her anxiety and agitation down.

However, Green is afraid that at present the care system is not set up to engender this kind of working. “It’s never acknowledged in the commissioning process that staff have to spend more time talking to the patient to obtain that information,” he says.

Nowhere is this more acute than in his experience of visiting domiciliary care providers where time is often commissioned in 15-minute slots. One woman he met, who received 30 minutes of help with getting up each morning, asked Green how long it took him to get ready each day.

“I said it took an hour. ‘Exactly,’ she laughed. She told me, ‘the only way they can get me up that fast is if they do everything for me’. Enablement cannot be done on 15-minute time slots.”

It’s an issue which Green would like to see the Care Quality Commission clamping down on. He says the localised system of delivery hampers the success of the government’s dementia strategy. “What is government’s role when we encounter real blocks in the system for delivering outcomes?” he asks. “At the moment there doesn’t seem to be any mechanism at all.”

He says this is where the CQC needs to step in. “I’ll be interested to see what they will do when they see appalling commissioning. If they find appalling provision in a provider they close it down. What’s going to be their response to poor quality service in a local authority?” he asks.

Green, who supports Community Care’s dementia campaign to make dementia a priority for debate during the election, raises concern about the NHS’s performance on the issue.

He says the NHS does not understand that most of its patients are older people and it needs to work with care providers to meet their needs. Green adds that the national dementia strategy has missed an opportunity to engender this. “There is an emphasis on early diagnosis and then nothing until there is a crisis. Care providers can fill that gap.”

Before they will get the chance there is an election to get through. Green remains optimistic that all the major political parties understand the challenges of dementia, even if they don’t agree on the solutions. Whichever party wins, Green will continue to fight for his vision of better dementia care and to fix the issues he has seen first-hand. “If they had wanted a yes man they wouldn’t have appointed me,” he says.

➔ Find out more about Community Care‘s campaign to make dementia an election priority

➔ More on dementia care in care homes

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This article is published in the 8 April 2010 edition of Community Care under the headline “If they wanted a yes man I’m the wrong guy”