Examination of Witnesses (Questions 80-99)
NATIONAL HEALTH
SERVICE
15 OCTOBER 2007
Q80 Mr Davidson: If it is not acceptable,
why is it accepted? You are saying that it is not acceptable,
so why does it happen?
David Behan: The induction
standard has probably not been applied properly by employers.
Q81 Mr Davidson: So who is responsible
for policing that?
David Behan: The Regulator
is responsible for policing that.
Q82 Mr Davidson: Why has the Regulator
not policed it, then?
David Behan: If those issues
are found by inspectors when they visit, the role of the regulator
is to raise them with the owners and managers of the establishments.
Q83 Mr Davidson: That clearly has
not worked. Otherwise, the National Audit Office would not have
written this. If the system were self-correcting in the way that
you indicate, circumstances where somebody did not have the language
would be picked up by an inspector and corrective action would
be taken. No problem—we would move on. But the way the Report
was written leads me to believe that the problem is more systemic
than that.
David Behan: The key strategic
challenge is how we can begin to recruit people to work in social
care. How can we get young people who are leaving school to come
into social care, and then allow them to develop a career? We
need to build that up.
The Minister launched a five-point plan
to raise the status of social care so that we can actually "grow
our own", as opposed to what some people in the care sector
have been doing over the past four or five years, which is recruiting
from abroad. A key issue is whether we can develop social care
as a career that people see as attractive, so that they can see
themselves coming in, perhaps straight from school, and developing
a career over the years. The strategic move that we need to make
is about creating a career in care services that people see as
attractive. Then we will be able to get out of some of the short-termism
that has created pressure for people to recruit from abroad.
Q84 Mr Bacon: Professor Banerjee,
you started your discussion of the working group by referring
to three key themes that you have already found during your first
four meetings. You said that the first was early identification,
but you did not have a chance to finish with the others. What
are the themes, apart from early identification?
Professor Banerjee: To put
them in order, the first is about public attitudes and understanding,
but it also covers professional attitudes and understanding. We
have already rehearsed some of the issues. It is terrifically
important to help in ridding the public, and some professionals
as well, of some of the misconceptions that exist about the lack
of treatability of dementia, for example. That is the first: improving
public attitudes and understanding.
The second theme is about enabling early
identification and early treatment for people with dementia. Again,
we have spoken about some of the reasons why that might be of
help. The sooner individuals get a diagnosis, the more likely
they are to be able to use it to make plans about their future
and to receive the care and support that will help them to live
the best life that they possibly can with their dementia.
The third thing is improving the quality
of care for people once they are diagnosed. The work covers diagnosis
to end-of-life care. It necessarily includes care for people in
the community, which involves case management, which we spoke
about; care for people in acute hospitals, which involves good
quality liaison services and good working in general hospitals;
care for people in care homes, which we spoke about as well, and
improving the quality of input that individuals in care homes
receive; and, finally, end-of-life care. Things that work for
people without dementia do not work for people with dementia,
especially at the end of their life, so we need to have specific
provision for those individuals to ensure that their end of life
is managed as well as possible.
Q85 Mr Bacon: That is very clear.
Your working group has one year. When did it start? The Report
was published on 4 July. Was your working group set up the following
day, so to speak, or did it take a while?
Professor Banerjee: It took
a little while, but as I said, we have met on four occasions.
At the moment, our plan is to deliver the report a year after
the announcement.
Q86 Mr Bacon: So by next July.
Professor Banerjee: A bit
earlier than that, actually. It is more likely that we will need
to get a final draft of our report sorted out by May so that we
can consult on it and then publish a report.
Q87 Mr Bacon: And then what?
Professor Banerjee: The important
thing about the strategy—the thing that we have been asked
to do—is not just to develop a national dementia strategy,
but to generate a strategy and implementation plan, which will
look at levers available and the ways in which provision is funded
in the NHS and social care. Over the next year, we will focus
on that very closely.
Q88 Mr Bacon: Are you chairing this
working group?
Professor Banerjee: I am
chairing it with Jenny Owen, who is the social service director
for Essex, and who brings a social care perspective to it.
Q89 Mr Bacon: Who is responsible
for improving dementia care in England?
David Nicholson: I am responsible
overall. I am responsible for setting the direction and vision
and for identifying levers within the system to make it happen.
Q90 Mr Bacon: If I were to ask you
who was responsible for improving cancer care in England, you
would say the national cancer director.
David Nicholson: No, I would
say me.
Q91 Mr Bacon: Oh, would you?
David Nicholson: He helps,
supports and advises, but he does not run the cancer service or
design the system and the levers that are necessary to make things
happen.
Q92 Mr Bacon: Is it still Mike Richards?
David Nicholson: Yes, it
is Mike Richards.
Mr Bacon: We had him here as a witness.
David Nicholson: He has made
a fantastic impact on cancer services generally.
Q93 Mr Bacon: Yes, but do you have,
or are you going to have a national dementia care services director,
in the same we that he is national cancer director?
David Nicholson: That is
one of the matters that the strategy will consider.
Q94 Mr Bacon: So, do you think that
Professor Banerjee will end up recommending himself for the job?
Or is that what you would like him to do?
David Nicholson: I think
that you should make your own judgment. We have found that having
a national clinical director is an enormously powerful way in
which to focus.
Q95 Mr Bacon: But you do not have
one at the moment?
David Nicholson: Not at the
moment, no.
Q96 Mr Bacon: But it is a thought?
David Nicholson: It is a
possibility.
Q97 Mr Bacon: And if you do, how
far off is it likely to be?
David Nicholson: We will
think about the emerging findings at the end of November and the
beginning of December, as part of the operating framework. So
theoretically, we could consider it then.
Q98 Mr Bacon: And you do not necessarily
have to wait for the publication of the green and white versions
of his report before going ahead?
David Nicholson: No, and
if we are not careful we will lose a whole year if we do not get
something moving forward.
Q99 Mr Bacon: That is what I was
concerned about. Okay, that is interesting.
I would like to ask about the care for
people—this was the last thing that you said, Professor
Banerjee—who have got dementia. On page 30 of the Report,
there are some shocking quotes about the service from focus groups
that the National Audit Office held, such as: "Yes, you've
got dementia. Take these tablets. There is the door" and:
"When your husband is diagnosed ... you suddenly realise
that you've lost your future, you need support to come to terms
with this." Those are just illustrative examples. It sounds
as though there is a huge gap between what ought to happen when
people are diagnosed with dementia—not only for those diagnosed,
but for those around them—and what actually happens. Is
that fair?
Professor Banerjee: Diagnosis,
and the breaking of that diagnosis to the person with dementia
and their family, is a gigantically important episode in the life
of that person and the family carer. It is not to be taken lightly.
I think that the focus-group points that you brought out, and
other experiences that people have had, suggest that in some cases
it is treated lightly. That is perhaps through a lack of understanding
on the part of individuals at that point. I know that diagnoses
can be made well and that information can be given at any time
to people in a sensitive and coherent way that is understandable
to people with dementia. That information is also available to
family carers.
That moment can be used to give information
and instil hope for the life that people with dementia have afterwards.
What we have here are examples of it being done badly, but we
also have the NICE guidelines, which are very helpful and set
out clearly what good information and support would be. You cannot
abandon the individual after making the diagnosis. There is a
need to follow it up. There are good quality services all over
the country that are doing that with people with dementia. The
problem is that not everybody is getting that. There is a lot
of good practice, but also poor practice. We need to ensure that
good practice happens invariably.
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