United front

Devolution offers the best chance we have to integrate health and social care for those with dementia, writes Hazel Blears

For the first time dementia has overtaken cancer and heart disease as the greatest single cause of death in the UK. More than 800,000 people are living with this terrible disease and the number is predicted to rise to more than a million by 2021.

Those stark statistics tell little of the story of the lives of people with dementia and their friends, carers and families as they struggle to come to terms with the changes in their physical and mental health, their bewilderment about what has happened and their fears for the future.

Dementia is a disease which affects almost every family, including my own, and yet until relatively recently it was rarely discussed, dramatically under-diagnosed, attracted tiny amounts of research funding and was subject to massive stigma.

Some of that, thankfully, has changed but there is still a long way to go to ensure that people with dementia can live stimulating and happy lives in the community and receive first-class health and social care support.

Dementia is a classic example of a condition which spans a huge range of public service responsibilities and so exposes the dysfunctionality of the very system that is supposed to care for people at this most vulnerable time of their lives.

People with dementia spend twice as long in hospital for the same condition as those without dementia, they are readmitted twice as often and disproportionately die in hospital rather than at home. All of that is damaging for the individuals and their families and it is also extremely costly.

Good health care is of course essential, but a hospital stay can be one of the most damaging events for people with dementia, reducing their independence, aggravating confusion and hastening physical and intellectual decline.

The divide between a nationally funded NHS and social care funded by local authorities has made it almost impossible for central government to create the muchheralded integrated system that would promote prevention, care and support and reduce the need for admission to residential and acute hospital care.

Devolution provides the best opportunity we have to integrate our commissioning and our provision for health and social care, to support people’s independence and the ability to live satisfying lives with friends and families in the community they know and understand.

In Greater Manchester we have a devolved health and social care budget of £6.6bn. It sounds a lot but in reality we need around £8bn to stand still, so fundamental changes in what we do are essential.

We currently have about 30,000 people living with dementia across our 10 boroughs and spend £221m a year on their health and social care. By 2021 there will be 40,000 people and the costs will rise to £376m.

We have now established a bold and ambitious programme to transform services over the next five years. We will drive up diagnosis rates and levels of community support, reduce avoidable admissions to hospital and residential care and provide excellent standardised care in hospital when it is needed.

Dementia United has brought together people with dementia and their families and those working across health, housing, social care, police, fire, and importantly social sector organisations which provide brilliant innovative services to improve the quality of people’s lives.

We have five pledges in our programme: to improve the quality of the lived experience of people with dementia, their carers and families; to reduce the variation of commissioning across Greater Manchester; to have a common standard for post-diagnosis support; to co-produce and redesign health and care with people and their carers and to adopt new technology.

Throughout my time in government, we faced the constant challenge of transforming our system from one which prioritises acute treatment to one which expands upfront support and prevention in the community.

The usual explanation for failure to achieve this is that there is never enough funding to do ‘double running’ – ie to support both parts of the system while the necessary shift of resources takes place.

This is where I believe social investment can play a part in supporting change. We can bring in funds to significantly scale up community support and activities such as exercise, music, art, gardening and befriending – all areas where there is growing evidence of their value in improving cognitive health and slowing the acceleration of dementia. We can then track the reduction in excess bed days spent in the acute sector and use the savings achieved to repay the social investment.

It sounds simple but we need to continue to develop the metrics and modelling to demonstrate that our approach works and we have been working with commissioners over the last 18 months to make it happen.

All of this matters to the thousands of families living every day with dementia. Until a cure can be found we must redouble our efforts to help people to live safe, fulfilling and stimulating lives with their carers, families and friends, supported by a system which genuinely works with them.

Image: Minette Layne