Beyond the rhetoric

The highest standards in English dementia policy will not be achieved by political smoke and mirrors, where the rhetoric requires a unachievable leap with reality.

In this current term of parliament, where the aim should not have been plugging holes in the roof (the NHS deficits) but the aim should have been a rollout of a care system fit for purpose, social care is on its knees. It hasn’t been ringfenced since 2010, and on top of that national debt has concomitantly gone through the roof. The state of the national finances are in a parlour state.

Whilst the intention of the Labour Party had been to roll out ‘whole person care’, there was never any operational meat on the aspiration bones. People were left guessing whether personal unified budgets would remain optional, and how pooled budgets could be achieved such that the universal healthcare system could be bolted onto a means-tested social care system.

Social care has had its well published challenges. The rhetoric of key parts of the law in operation, including the Mental Capacity Act and Deprivation of Liberty Safeguards, has not occasionally been matched with the reality. There have even been high level problems as to whether our law is now consistent with European law.

In “dementia friendly communities”, we have the absurd situation of very few paid staff or consultants, living with dementia or carers, on the personnel of major charities in dementia. Invariably, speakers at the conference are the same, presenting the same unbalanced biased script on the purported successes of research and drug trials when the actual picture is far bleaker.

The success of ‘Dementia Friends’ has absolutely nothing to do with the number of friends achieved. One ‘friend’ is a success if that means that that friend knows more about dementia than he did previously. But likewise amassing friends through a quick online application is not really ‘mission accomplished’ by any stretch of the imagination.

There are too many talks I attend where speakers boast of ‘Dementia Friends’ as pitched as training. Under no stretch of the imagination, likewise, is Dementia Friends training. It is certainly no where nearly adequate for the purposes of providing care, and it is a sad testament to the lack of ability of some commissioners that they are totally unaware of this.

Clinical commissioning groups are nothing other accounting machines, budgeting, assessing and identifying risk in spending for populations. They are statutory insurance bodies, in place for the eventual privatisation of the NHS. It is no accident they’ve been introduced by Andrew Lansley who felt he had learnt lessons from the privatisation of the utilities. The major heavy lifting of breaking up the NHS into manageable parts which could be later transferred to private insurance, or sold, is not accidental.

The term ‘person centred care’ has been misused around the world, although there are brilliant examples of such care. Life stories are used as an administrative checklist exercise, without engaging in the real ethos of seeing the person’s identity. Activities, marketed as ‘meaningful’, are administered like drug rounds. Person centred care is supposedly delivered by staff who have not been treated in a person-centred way themselves, often, with breaches of the national minimum wage and insecure zero hour contracts.

The surge in dementia diagnosis rates is not a ‘result’ if so much effort is put into recoding possible dementia into primary care rather than diagnosing ‘real dementia’. We still have no idea how much of this dementia is actually mild cognitive impairment in reality, and we have set some people up for a fall, by telling them they have dementia when they haven’t. This is abhorrent and inexcusable. There have been nothing other than smoke and mirrors when any of us ask legitimate questions about extra funding for GPs to enable them to feel confident in diagnosing young onset dementia, often not heralded by memory problems, below the age of 65. There’s about 30,000 of them out of 850,000 currently in the UK.

Of course, this was of course masterfully masterminded by Big Charity, government and the media, who are superb at the rhetoric and less capable on the reality. This annually repackaged garbage has got to stop in England.

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