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Blog: Improving dementia commissioning

15 September 2014

Attitudes to dementia are changing, but Ewan King says that only through integrated commissioning can we improve care

Attitudes to dementia are changing, but Ewan King says that only through integrated commissioning can we improve care
Last week we heard in the news that it’s possible to die of a broken heart. Apparently, bereavement can have an effect on the immune system for older people. Not so my colleague’s grandmother, who died twenty-three years ago, shortly after her husband; in her case she lay down on a cold kitchen floor and froze. It turns out she had dementia, but in 1991 there was a massive lack of awareness of the condition. 
Also in the news last week; caring for people with dementia costs the UK the equivalent of £26 billion per year. Our friends at Alzheimer's Society are reported as saying that, on average, the equivalent of £32,000 a year is spent on care per person with the condition. Dementia is affecting more of us but how are commissioners addressing this situation? 
Dementia is one of those issues that crosses the health and social care divide. However, multi-disciplinary teams aren’t always in place to get the likes of social workers and clinical care staff to work together effectively. Not only do we need an honest and open debate about funding a truly integrated system, as suggested in the recent Barker Commission report, but both social care and health can work together to make the experience of care better for people living with dementia. So, there has to be a bigger focus on integrated commissioning. 
It would be easy to respond to the Barker Commission with a council of despair; that it’s too big a problem and we can’t afford it to fix it. But we shouldn’t use the report’s conclusions, brutally honest as they are, as an excuse for inaction when it comes to improving the quality of people’s care. In 2014, we all have a lot more to offer people like my colleague’s grandmother than in the past. 
Our chair at the Social Care Institute for Excellence, Lord Michael Bichard, was on the commission that produced the report, and made the central point that current systems have been designed over decades from a professional, bureaucratic and organisational perspective, and that it’s long overdue to simplify arrangements from the service user’s and patient’s perspective. So it’s not about whether to address the issue, but how. As local authorities prepare for implementing the duties of the Care Act 2014, they will need to work closely with their partners in clinical commissioning groups to think creatively about joining up the commissioning of services around the person.
Because attitudes are changing. In 1991, it would have perhaps been difficult to suggest that because cancer care is free (on the NHS), perhaps dementia care should also be free, but Alzheimer’s Society made just that point last week, and it was made clearly by proponents of better dementia care through the  mainstream media. Prime Minister David Cameron recently captured this changing mood on dementia, calling for us to “think about every aspect of life (for people with dementia) – from helping people access bank accounts to using public transport”. Now really is the time to commission better and more integrated dementia care. 
One of our recent guides is on commissioning homecare. This is an increasing option for people with dementia. We’ve come full circle. My colleague’s grandmother died at home, not because she wanted to, but because her dementia was undiagnosed. These days people with dementia may well be at home, but with a sense of purpose, things to do in the day and as meaningful a life as possible. Our guide says that to improve the quality and value of services, commissioners should look at all areas of the commissioning cycle, from assessment through planning and delivery to review. 
Another area that joint commissioners can take a look at is creating dementia-friendly environments at home and in residential and health settings. We say in our Dementia Gateway that if commissioners hear and respond to the views of people with dementia, they may develop and plan services that make a difference, and that offer value-for-money.
We’ve come a long way since my colleague’s grandmother died. These days, iPads are used regularly in care homes, for instance, to help people to access their memories and to help those who support them to understand their needs much more. It’s not a perfect world, but at least in 2014, compared to 1991, we have more awareness of dementia. However, many challenges remain about the condition. Commissioners play a vital role and an increasing focus on integrated commissioning will help to address how this is done. 
Ewan King is director of business development and delivery at the Social Care Institute for Excellence (SCIE).

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