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Honey, I shrunk the dementia-friendly State

“I think most people thought the Big Society was utter drivel.”

Those were the words of Ian Birrell, journalist and political commentator.

The election result for David Cameron MP was disappointing. He had the opportunity of a lifetime to win a resounding majority for the Conservatives, despite the undoubted unpopularity of Gordon Brown as Prime Minister – and he blew it.

The 2010 manifesto for the Conservatives, unusually, was a big hardback book, acting as an ‘invitation for government’.

The Big Society was the theme which ran all the way through it, but it was an innovation which didn’t get adopted. The strands through it were devolution and localism, radical public service reform and social action. Voluntarism was important.

What’s there not to get excited about? Dementia friendly Manchester, personal budgets, Dementia Friends. Some winners have taken all.

The multimillion pound Dementia Friends project was a magnificent opportunistic brilliance from the Alzheimer’s Society, as they were able to secure money for dementia ‘knowledge and awareness’ which fitted in nicely with the Big Society.

It fitted in with the sweeping Lansley reforms, later known to be disastrous, which surrounded the Health and Social Care Act (2012), which Baroness Shirley Williams was critical in aiding and abetting despite initial reservations. This staple gunned private market competition and commissioning onto an already sick private market in health and social  care.

Nick Clegg MP also had a natural anti-state liberal sympathy, which fitted in nicely with the strongly ideological thrust of David Cameron’s ideas, camouflaged in a compassionate soft shell. The community would take the place of the State – and it work for the dementia friendly community too…

Many people resented the idea of the State delivering health and care, in the name of people reaching into their pocket to be ‘public spirited’. This could mean donating time for Dementia Friends, or donating money to boost Alzheimer’s disease drug research.

The idea that Britain stopped being a nation but being a burgeoning welfare state has of course been capitalised by UKIP to much success, which arguably helped to precipitate a win for #Brexit.

The spending cuts accompanied the re-invention of the State, and this was seen as an opportunity by the Coalition government 2010-5. Social care was no longer ring fenced, and it became clear despite public noises to the contrary from David Cameron and Theresa May later that NHS spending did not match the increase in demand.

These cuts immediately got in the way of what the Big Society was meant to achieve. The same thing is happening now. With cuts in NHS and social care, patients with dementia cannot be discharged from hospital due to social care cuts – care packages aren’t ready, which means that patients cannot be admitted to hospital. Despite all the multimillion pounds spent on Dementia Friends, dementia care has never been in such a parlour state.

Nowhere is this seen more clearly than in the airbrushing of ‘caring well’ from the NHS England Transformation path for ‘Well pathway for Dementia’.

dementia-well-pathway

Austerity was a political choice, not an economic one as is clearly seen from the fact that national debt has gone through the roof between 2010 and 2016 – further squeezing the ability of the State to deliver dementia care.

The Coalition government did not actually re-distribute the power to the society, nor did they improve democratic representation, leaving civil democracy untouched. So the entire thing had the look and feel of a trite marketing brand – and this is exactly what the English dementia policy sadly now has become.

With the disappearance of the State, respite care, domiciliary care and the capacity for clinical specialist nurses have all been sidelined as a low priority compared to getting a plastic ‘Dementia Friends’ badge for your lapel – this is, of course, a crying shame.

This year’s Autumn Statement was one of the final nails in the coffin. There was no mention of the additional money needed to make the Better Care Fund work; not even that, the ‘precept’ and the Better Care Fund were heralded as reasons by the Government for why social care has never had it so good.  With the Conservative majority government now delivering ‘Brexit’, and likely to campaign on in 2020 with the ‘let’s finish the job we’ve started’ mantra, and with SNP retaining Scotland, and UKIP chipping away at some Labour votes, it is not inconceivable there’ll be another Conservative majority government in 2020.

Dementia policy has become deeply ideological politically – and this is a total disgrace.

And with that you can say a final goodbye to the dementia friendly State, a policy which has scant regard for huge swathes from clinical specialists, social care practitioners to hospices. But fear not – there’ll be only five years to wait for one of the many cures for dementia on the horizon.

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