Manchester University Institute for Dementia are pushing the boundaries out to bring about new innovative thinking to improve the lives of people who suffer with dementia.
Imagine a pub designed for people with dementia, complete with old beer adverts, games of dominoes and darts, a DJ playing a selection of music from the 50’s and regular live entertainment, where people with the diagnosis can feel welcome and those who look after them can receive support.
A pop-up pub like this was set up in Salford recently by the university’s Institute for Dementia as part of Dementia United – the Greater Manchester partnership whose five-year improvement plan aims by 2020 to make Greater Manchester the “best place in the world” for its 30,000 residents with Alzheimer’s and similar conditions. It also wants to reduce dependence on health and care services.
This pub experiment is one of a number of innovations under the umbrella of Dementia United, led by the health and social care trusts enjoying their newly devolved status, and the Alzheimer’s Society. Its 41 partners, including charities, sports organisations and three universities, are working out how to tackle dementia from the perspective of those who live with it.
Maxine Power, director of Dementia United, says: “This is a once-in-a-lifetime opportunity. Dementia is an area with a huge amount of activity, but it is like an orchestra without a conductor. Devolution brings clarity and a focus on care for people in the places where they live, rather than on organisations. Culturally that is a massive shift for our system.”
Dementia United goes way beyond pubs. It is about rejecting a model of care that health professionals agree is neither fit for purpose nor financially viable, and the opportunity to create a new one. Greater Manchester spends £270m a year treating and caring for people with dementia. The figure has not decreased in the past five years, despite many attempts to improve dementia care, and there are 20,000 hospital admissions for the 30,000 people in the area with dementia.
This is outrageous, says Power. She is adamant that in five years Dementia United will reduce that figure – mainly associated with unplanned hospital admissions and admissions to care homes – by 20%.
This will be guided by five pledges, to be implemented by 2021: improving the lives of dementia patients and their carers by questioning them about their individual needs; reducing variation in care quality (and a diagnosis rate difference between 63% and 90% across the city); the introduction of a key worker for each person with dementia; the redesign of services around users; and access to the best assistive technology.
Dementia United was set up in late 2015 as an “early win” under the devolution of Greater Manchester’s health and social care.
There is dementia knowledge in Manchester to back it. Its three universities formed a dementia research consortium in May 2016 and Prof Alistair Burns, the national clinical director for dementia, is based at Manchester.
Progress is being made. A measurement tool of “lived experience” has been developed, including numerical and qualitative measures of how people live their lives, which can be shared across Greater Manchester’s health systems. Work is under way on a dementia “dashboard” to allow inter-area comparisons and set standards. External evaluation methods of Dementia United are being developed jointly by the universities of Salford and Manchester.
Discussions are going on with Social Finance – a not-for-profit organisation bringing together government, the social sector and the financial community to tackle social problems – to build in additional financial support.
Assistive technology is advancing apace, with Manchester University’s dementia platform evaluating devices, such as watches with accelerometers to measure movement, to establish value for money. Everything in Dementia United must be supported by a business case.
George McNamara, head of policy for the Alzheimer’s Society, is working with Dementia United to make it a reality across Greater Manchester and is receiving inquiries from politicians worldwide, particularly the US. He says: “We are seeing the devolution of powers and funding on an unprecedented scale. What is significant is the scale and the marrying together of a number of political objectives and cultures into one vision.”
Patrick Hall, a fellow in social care policy for the King’s Fund, admires the ambition of Dementia United, but is concerned about its sustainability given the financial climate.
He says: “The locality focus in Dementia United is very welcome and anything that gives impetus to that for the care of people with dementia would be looked on by the King’s Fund very positively. However, it is being set up in the context of unprecedented cuts in social care and a decline in the number of community nurses. Only time will tell whether Greater Manchester has got the model right.”
Dementia services need innovation as an alternative to some of the existing practice This innovative approach to improving the lives of people with dementia is to be applauded. Especially, the pub experiment which offers the opportunity for people to continue as far as practical with a ‘normal life’.
It is sound practice to evaluate the experiment and share the learning with other services within the sector. Patrick Hall, a fellow in social care policy for the King’s Fund is right to add a note of caution. The proof of the pudding is the sustainability of any new innovation.
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy