Dementia is one of the signs of the ageing process and a significant number of people; irrespective of their colour and gender would go through this journey in their life time. The disease carries a "stigma" which can be demeaning to suffers and their family members who assist them with their functional activities of daily living. The ill-health may present a momentous threat to the wider welfare service in the 21st Century and beyond if strategic investment in human resources are not made. This is due to increasing chronic medical conditions; longevity; the growing older peoples' population; globalisation; migration and liner family units. However, the current social policy on immigration and universal benefits have influenced the opportunities for influx of migrants who could potentially be employed in the care sector to assist older people with their holistic care needs (Held 2000).
It is quite obvious there are gaps in how services are provided within the wider older people service, which leads to a large number of re-admissions and delayed discharges as services are not joined up (DoH 203; Lymbery 2004). Good practice suggest; in older people's "mental health" services, the need for a holistic assessment of the person's physical and mental health needs are key to maintaining and supporting the person and their informal caregivers to remain in their own homes for as long as possible. This requires a commitment from all services to work together to achieve this. In practice, this is not always easy due to conflicting priorities and financial restraints both in the acute hospitals and local authority budgets. What would really help is a joint commissioning strategy across all agencies and even pool budgets.
Reflecting on dementia service, practice observations have highlighted gaps in meeting holistic needs of the service users; this is due to disparities within the health and social care sectors. Conflicting policy decisions and different organisational cultures have created some difficulties for older people and their families to access services and support systems available to them. They have to go through different health and social care services to be able to gain access while repeating themselves as they go through the process, seeing different people/specialist and formal caregivers. Nonetheless, this is despite the present and previous government's endeavours to develop strategies to address the gaps, which ensures joint strategies between health and social care.
Joint working initiatives are intended to oversee a design models for services in place that underpinned whole systems approach in the sectors. This model is crucial to facilitate a modernised health and social care that is capable enough to address the growing older people's care needs now and in the future. By all means, this is critical in this period of financial challenges that agencies work together to ensure the best outcome for vulnerable older people. Thus, collectively the organisations can achieve best value by looking at services from the perspective of whole systems while giving priorities to the following measures:
Risk minimisation
The current eligibility criteria (DoH 2010) has provided a new assessment matrix that underpinned assessment models however, most health and social care authorities have focused on "Critical and Substantial" needs while moderate and low needs are ignored. This policy decisions are in contrast with long-term measures to reducing future critical and substantial needs that are likely to cost a lot of money in the future. Preventative services have the potential to curtail spending both in the short and long-term processes. It would help to stabilise and co-ordinate community service, give the professionals the opportunity to plan and execute procedures that are designed to minimise risks and speed up responses by health and social care teams. The key critical success factors are to provide people with the tools to make decisions about what keeps them well, maintains their quality of life, empowering them to be responsible and active in their own community, reducing the dependence on health and social care.
Choices and control
Personalisation of services have provided an avenue to uphold choice and control while seeking access to services and this is a critical ingredient for supporting older people to live independently in the community for as long as they wish to do so. Equally, housing and assisted living equipment such as "Telecare systems", individual budgets or direct payments are important ways of ensuring independence whilst maintaining safety environment and support. This provided service users with the opportunity to choose their own personal assistants to support them with their functional activities of daily living. It has also intensified flexibility in the social care market, providing a range of choices and interactions between service users and providers of services. The model has the propensity to remove barriers, which hinders equity and quality of care giving; while older people and other vulnerable users are able to challenge discrimination in the service. Personalisation, linked with "Telecare" and assisted living tools surpasses the benefits of managed/direct provision, whilst service users are able to exercise their human rights. Nonetheless, it is expected that for some people living at home alone perhaps can increase the danger of vulnerability but it is important that we do what we can to understand and minimise this with regular support and monitoring.
Monitoring of services
An essential component in services delivery is the ability to stabilise checks and balances while achieving best value and quality of care. By contrast, practice observations have revealed that consistent services review is lacking and a high proportion of care packages have not been reviewed for a number of years and this has contributed to poor budgetary control. Therefore, continuous reviews and monitoring of services have the potential to reduce dependency culture, duplication of services and maximisation of resources, giving the growing older people population; liner family units and demographic change. Interestingly, personalisation of services is one of the ways to remedy some of the mishaps within the service as the service users are able to demonstrate the ability to choose their own personal assistants and manage their budgets. Monitoring is core to effective services delivery, quality, equality and equity as having a trained worker which respects individual dignity, choice and promotes empowerment is both satisfying to the professionals delivering a service and for the person receiving this good quality service. However, the quality of any service depends on the people who deliver it. Quality of service is the most important aspect of our service delivery model.
To sum up, we all have to remind ourselves that these are not just services for "older people". These are services we will all be using at some point in our life time therefore, it is important that we ask ourselves, "What type of services would we desire for when we need it..."? Our futures are all at stake. An ad-hoc financial management is not the answer for our future existence, effective and constructive planning is imperative to safeguard older people services now and in the future.
References
1. Department of Health (DoH 2003a). The Community Care. (Delayed Discharges) Act (2003): Guidance for implementing:HSC 2003/009: LAC (2003)21, London Department of Health.
2. Department of Health (2010). LAC (2010) Fair Access to Care. Guidance on Eligibility Criteria for Adult Social Care, London Department of Health.
3. Held, D. (Ed) (2000) A Globalising World; Culture, Economics, Politics: London Routledge.
4. Lymbery, M (2004). Delayed Discharges, preparing for reimbursement, journal of integrated care, 12.4 (pp28-34).