The late, great film director Alfred Hitchcock was fond of describing suspense in the form of two people, sitting at a table talking, attending to trivial matters whilst unaware that underneath their table was a bomb, visible to everyone aside from its soon to be victims.
I mention this because it seems a pretty apt metaphor for the crisis facing our health and social care system. There’s a difference, though.
Our leaders are fully aware the bomb is there. You might argue they collectively placed it under the table. And yet like in Hitchcock’s metaphor, they’re too busy arguing over the table to defuse the situation. Unlike in Hitchcock’s metaphor, it’ll be people with long-term, debilitating conditions like dementia who feel the damage.
Read the near weekly bad news stories about the NHS and you’d be forgiven for thinking that the crisis we face is just typified by surges in people visiting A&E, cancelled operations and a struggle to get a GP appointment.
Yet that’s not even close to the whole picture. A quiet crisis is emerging in council budget meetings up and down the country where adult social care budgets are being stripped to the bone by funding cuts from central government. People living with dementia, or caring for someone who is, are better placed than most of us to understand what’s going wrong.
Dementia is, at its heart, a medical condition – a disease of the brain – without an effective medical treatment. As a result, people with dementia are reliant on both the health and the social care system, requiring support with day to day tasks such as washing, dressing and eating. The impact of austerity on this vital preventative system has seen over £2billion cut from social care in this parliament, with a predicted £4.3 billion black hole by 2020.
It’s a pleasing sign of the consensus emerging that all three of the main political party manifestos contained reference to structural reform of the NHS and integration between health and social care. Yet amidst talk of an £8billion injection here and a Time to Care fund there, our political leaders are failing to address the fundamentals of the chronic underfunding of care which is in turn ratcheting up the pressure on the NHS.
Hospital beds are increasingly being occupied by people with dementia who have reached crisis point due to lack of support in the community. Many can’t be discharged because our health and social care systems are arguing over who is going to assess, organise, provide and fund an appropriate care package.
Talking about the NHS without addressing this huge gap in funding for social care is nonsensical, but nor should it just be about the financials. A shift towards good community based care has the ability to transform quality of life for the most vulnerable in society, promoting greater independence and helping to alleviate the loneliness and social isolation many experience.
What’s encouraging is that we are seeing good practice integration models popping up at a local level. With an ageing population, over a million people will have dementia by 2021.
We need to see political bravery to correct this huge underfunding to create a health and social care system which, if fit for purpose is too lofty an ambition, fit enough to cope with dementia before the figurative bomb sitting under the table finally explodes.