National Dementia Strategy

Greaves and Jolley¹ challenge the architects of the National Dementia Strategy and the army of builders trying to turn plans into a reality. Provocatively (to continue the building analogy) they query whether the ‘right’ buildings are under construction. Constructing a memory service for early recognition of dementia, repairing care homes, and re-fashioning hospital care to make it ‘dementia friendly’ all require equal attention and careful surveying; not least because the former may overshadow the latter. The possible creation of a National Care Service makes predictions of need at population level essential.

However, although the pay levels of care home staff are low and their skills are often taken for granted, it is also a matter of planning (or lack of it) that has erected fences — or sometimes dug moats — between this provision and other health and care services. While high turnover of frontline workers, and especially managers in care homes may cause problems in many areas, the greater problem is the isolation of the care home sector from primary care, voluntary, and community provision. What role does it play in the training of GPs, for instance, and why is ‘institutionalisation’ (a terrible word) so often seen as simply a negative option?

Greaves and Jolley are some of the few doctors working in the community to engage with this subject. Social care interest groups welcome their contribution to a debate that is about the building of a National Care Service, not just the strategy for people with dementia. Social care, like general practice, knows that most people with dementia have multiple disabilities. Strategies can be blueprints but they should not build higher walls around clinical conditions and imprison specialists in ivory towers.