Times are changing. Allegedly. Although maybe not changing an awful lot, since our PCT 'fessed up today that the money the SHA has given them for the implementation of the National Dementia Strategy, not being ring fenced, has been swallowed up by other stuff and spent on other things. So it goes.
Cash that could have been used to improve dementia care therefore's evaporated and the acute Trust down the road grumbles along, despite the national picture reported by the Alzheimer's Society showing that, well, it's all a bit shabby.
Is there any hope, then? Locally, the acute Trust is working with us and is keen to improve. There's a lot of work to be done, though. For example, the DoH have accepted Prof Banerjee's report and recommendations around antipsychotic prescribing in dementia care. 180 000 patients with dementia on such drugs with only 36 000 getting benefit rightly raises concern that prescribing practice needs to be more robust. How're things to improve? Exceptionally and very hearteningly, there's no requirement for more committees and no desire for more management. The report requires that Medical Directors and existing governance structures deliver on this. Deliver on what? Just one bit of one recommendation is that the Trust has to ensure good practice in initiating medication. And ensure good practice if it's maintained (e.g. a patient comes in on it and the hospital ward continues to administer it to them). And ensure good practice in discontinuing medication. All sensible stuff.
What's intrigues me more is that in addition to the clinical quality improving, there Trust has to ensure this is done. So just bashing out some protocols or care pathways or policies or naming a couple Dementia Champions or Medicines Management Champions or Lead Practitioners or having a standard operating procedure or drafting guidance ain't enough. They need to ensure that the system works. First the clinical care has to improve, then evidence of this meaningful implementation needs to be generated. Without more managers or committees or nonsense.
Having met with PCT and LA and colleagues today, I am hopeful. But the acute Trust having to do this, with no new cash 'cause the PCT snaffled it . . . somehow this seems less than ideal.