Uniting health and social care to give dementia patients improved services

Last week the Institute for Public Policy Research (IPPR), supported by the City of London Corporation’s City Bridge Trust, released a new report highlighting the challenge of providing support for the ever increasing numbers of people with dementia – many of whom require both health and social care services.

There are currently around 700,000 people in England with dementia, although this number is expected to double in the next 30 years as the population ages. The report found that GPs are failing to diagnose people with dementia, and a lack of joint working across health and social care means that people with dementia get overlooked. The report also highlighted care and support gaps for the over-80 age group and for people with dementia from black, minority and ethnic communities.

These findings are particularly important in light of major changes to health and social care that are currently being proposed by the coalition government.

Criticism of the reforms has been fierce, notably from the British Medical Association, who declared last week that the scale and nature of the reforms are “hugely risky and, potentially, highly damaging”. But whether or not the health reforms go ahead, and in what guise, it is essential that steps are put in place to work at creating a health and social care service that is truly accountable and more joined up. IPPR’s report makes a number of recommendations to ensure a more seamless care pathway for people with dementia:

• Embedding advice services in surgeries will help GPs to signpost patients towards services provided by local authorities and the third sector. This would provide a much needed link between health and care services;
• The new Health and Wellbeing Boards should include dementia as a priority in their local Joint Health and Wellbeing strategies;Community organisations supporting people with dementia should engage with the Health and Wellbeing Boards to make sure dementia is made a priority locally;
• Co-location of health and social care in the same buildings has been achieved in some parts of the country. This needs to be rolled out further to ensure greater information sharing and close working between practitioners.

IPPR’s report also highlights a major concern that less than a third (just 31 per cent) of GPs in London feel that they have received adequate training to diagnose dementia. If GPs are to take on a greater role in commissioning the following measures will need to be taken into account:

• Training on dementia needs to be embedded early in medical training;
• Voluntary and community groups should offer ongoing training packages to GPs, to provide an insight into local needs and services;
• GPs should issue ‘information prescriptions’ to ensure people are channelled towards the relevant advice;
• The NHS Commissioning Board should ensure that the quality of dementia care is included in the new outcomes framework by which GP consortia will be held to account;
• One of the new ‘pathfinder’ GP consortia should pilot an early-intervention approach to dementia care. This could provide the necessary evidence base to reassure future consortia that commissioning dementia services is a worthwhile investment, which can result in savings further down the line.

All commissioners need to be held truly accountable for the services they provide. Beyond the criticisms levelled at the reforms from the BMA around fragmentation of care, there is also a danger that too much focus on “power and freedom” for commissioners will be at the expense of scrutiny and ensuring that there are measures in place to drive good practice and joint working across both health and social care services.

At present there is a persistent disconnect in the way that health and social care is delivered – the sharp increase in projections of people ageing, and acquiring conditions like dementia, will only place an even greater burden on services and result in more people falling through the gaps.