Wednesday, February 04, 2009

Improving NHS dementia care

Emma Dent from HSJ's version of dementia strategy. Good to point out that programme of support and counselling at diagnosis can be helpful, although have to be a bit careful about using reduction in institutional care as outcome. The point of the strategy shouldn't just be about reducing number of beds. Relatives may well need respite and even permanent residential and nursing care for demented person considering the burden of care.

How much do care homes make? Are there any figures on this? The government had a choice years ago whether to develop its own provision and chose instead using the profit motive to get enough provision. There's no going back here, but some care owners seem to do quite well out of it. Perhaps they should, but elderly care is not about exploitation.

And I wouldn't like people just to concentrate on information. Looking after someone with dementia has a physical side which must not be ignored. Input is not just about information but also practical help if it's asked for. Dementia care isn't just about advice. Calling people advisors means they may say that's all they can do. What's wrong with calling them consultants? - oh, that's monopolised by the doctors.

Sube Banerjee is right that people do worry they are becoming demented, if that's what he is saying. But it's not just because they really are becoming demented. Information can increase as well as decrease fear, particularly if the problem is incorrectly assessed.

I'm not totally convinced about the resources argument. We have seen a pretty dramatic increase in provision. OK, but so has the rest of medicine as well. As with any mental health care, so much depends on how well it is organised and how good the staff are at understanding what's going on.

I'm not against drop in services. We're supposed to be having them in every local NHS anyway. Are the memory clinics supposed to be part of that set-up? This is getting a bit muddled. I will get to the actual strategy publication soon.

(To be continued)

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