Rarely have politicians – of all colours – been more united. With experts projecting that the UK will run out of money for social care by 2020, everyone agrees on the need for a new funding package. The only question is how much? Party spokesmen vie for our votes, promising to outspend each other – before adding their normal pragmatic caveat … But these are difficult times.
We have a different question. Not How Much, but What For? If the point of social care is to improve wellbeing, are we sure we’re getting what we pay for? Is our care system in crisis because it lacks funds, or because it lacks imagination?
If you want to win you need to spend. That’s what we’ve come to believe, whether it’s winning at football or winning at business – or for that matter providing a winning health service.
But while we applaud winners, history celebrates game-changers. People like Gutenberg, who changed the way we read and learn. Stevenson, who changed the way we travel. Henry Ford, who changed the way we manufacture. The key for them was imagination, to see that we could do things differently. Their success didn’t depend on big money, but big ideas. Ideas that saved time and money.
Let’s talk about dementia in the UK. Dementia is the cuckoo in our health and social care nest, consuming a significant proportion of the £20 million budget for adult social care, taking up space in our surgeries and hospitals, and turning many family carers from revenue generators into benefits recipients.
* At least 25% of NHS hospital beds are occupied by people with dementia. In the over-65 age group, the average hospital stay is twice as long as people with dementia than those with other illnesses – in some hospitals they stay up to seven times longer, often because there is no care package available to support them when they leave. (Source: Alzheimer’s Society)
* In 2017 there were 50,000 avoidable emergency admissions of over-65s with dementia. The Alzheimer’s Society report suggests that inadequate social care is leaving them unprotected from falls and infections. (Source: Alzheimer’s Society)
* The cost to the economy of informal unpaid care is reckoned to be £11.6 billion per year. (Source: Alzheimer’s Research UK)
* We spend £10.3 billion on social care for people with dementia – yet 68% of them report that they feel socially isolated. 63.5% of family caregivers say that they have had no or not enough support. (Sources: Alzheimer’s Research UK)
Should we really be investing in a system that’s clearly not working? Or is it time for a big idea?
So what is the big idea?
Let me start by asking a different question. Suppose the government announced that they were cancelling schools. They’d decided that kids would get a better education with one-to-one coaching, so teachers would now come to the family home, a couple of times a day for about an hour in total, to deliver their lessons.
For all sorts of reasons this would be a stupid idea. There might conceivably be some who’d argue that children would learn more in an hour of private coaching than they do in six hours of classroom learning. But what about the other benefits of school – learning to live in a community, building friendships ..? Think about the extra strain it would put on parents, obliged to stay at home, unable to work. And how many more teachers would we need to employ? Where would we find them and how much would it cost?
Stupid … and yet that’s exactly the way domiciliary care works for people living at home with dementia. One-to-one care, for about an hour a day. Or, because there simply aren’t enough professional carers, no care at all.
So what is our big idea? To start thinking about dementia care the way we think of schools. To create spaces where people with dementia spend the working-hours every day. Not to be parked, as they so often are in ‘care’ facilities, but to get involved in meaningful, worthwhile, enjoyable activities, as kids are ( – at least in the best schools). In the hands of care professionals who are as well trained and rewarded as our teachers. Giving hundreds of thousands of unpaid carers the opportunity to take back their old lives. And potentially saving the country billions, as the wellbeing of all those affected by dementia gets a boost.
What do we call this big idea? The Bine.
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