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17th September 2015

The Challenges of Dementia Service Provision in Wales

scottish_care_dementiaWelfare Provision and Older Adults

The UK welfare-burden, in respect of long term support (LTS) for older adults with cognitive impairment, is set to increase dramatically, as the number of over 85’s in the UK is predicted to double by 2035. This will inevitably lead to more people experiencing dementia and requiring LTS, with projections suggesting a doubling of LTS expenditure between 2002 and 2031.

So how can we best respond to this LTS welfare challenge?

In Wales, we are going for a system designed to promote strengths and resilience and develop existing personal and family support-networks. This is known as the Social Services and Wellbeing Act, under which individuals and families will be expected to do what they can, but for those in need of additional professional support there will be the following; 

  • ‘Information, Advice and Assistance’, to signpost people towards the help they need. 
  • Fully managed LTS packages for the most vulnerable, delivered by the Local Authority and its third-sector partners. 
  • Provision for informal carers (family members) to have an assessment of their needs. 
  • Work done by the Alzheimer’s disease Society and other countless smaller local groups, as a mainstay of provision.

Challenges posed by Dementia under the SSWA

It has now been 10 years since I was last professionally involved as an RMN, caring for individuals with dementia. This was in a nursing home setting, and I don’t mind admitting, I found it a tough assignment! Well steeped in academic nursing-theory and principles of ‘advanced practice’ (I was lecturing in mental health nursing, and working towards my PhD at the time) I was struggling to complete a drug-round in under 90 mins and offer any kind of effective leadership to my colleagues. Care was humane but still largely institutional. The Social Services and Wellbeing Act requires something different: To work towards 'well-being'...which is not easy!

  • ‘Well-being’ within the Act assumes ‘person-hood,’ i.e. an awareness of self, and the 'volitional' ability to make choices (see previous article on the ‘well-being’ concept)’. Of course, these are the very same properties which are eroded by dementia and the cognitive impairment it involves.
  • There is also the issue of 'diagnosis versus person-centeredness'. Medically-focussed interventions based upon diagnosis can undermine the uniqueness of personalised-support. Until recently, the routine of over-prescription of sedative-drugs to individuals with dementia is an example of this. 
  • On the other hand, practice can be compromised, if it is not contextualised within the 'signs and symptoms' of a disease-process. For example, this might lead to a failure to understand the nature of cognitive impairment in dementia, and therefore to utilise the relative resilience of long-term memory within interventions. We need a diagnosis as a gateway to appropriate service-provision.

These issues have serious implications for the practice required of us by the SSWA. Delivering high-quality support with an individual, particularly in later stages of dementia, IS challenging. But this is what services working with older adults with dementia will need to do. In my next blog, I will therefore discuss some of the dementia relevant policy and care models. 

Paul Rees - QCS Expert Welsh Care Contributor

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