When Professor Woodford-Williams was director of the Hospital Advisory Service (later the Health Advisory Service) in the 1970s, she declared that the measure of the quality of a health service was the care being given to people with long-term illnesses and disabilities. Her mission, and ours, was to improve the lot of patients housed in the back wards of mental hospitals and hospitals for older people. She and we were following through from the revelations and campaigning of Barbara Robb and others – seeking to make good where there had been hidden neglect.
There is much pomp and value in initiatives to encourage early diagnosis of dementia in its several forms, to promote health and other approaches to reduce the incidence of the condition and to modify its progress and the quality of life lived with it. Yet in our discussions within Dementia Conversations it is the care and difficulties in receiving appropriate care for those who survive into the most altered and damaged states associated with advanced dementia, which exercise us most.
Access to long-stay hospital beds in the 1970s was at the discretion of a Consultant Psychiatrist or Geriatrician. The beds became base components of a comprehensive service which spanned care at home, including assessment and supportive visits at home or in a care home, outpatient clinics, day hospital care, respite care, as well as admission to assessment and treatment units in a general hospital.
Outdated mental hospital wards and wards for older people have been closed. Almost all long-term care placements are now within private or charitable organisations. It is not easy to see these as components of an integrated comprehensive service. Admission is not by a decision of a clinician who will remain responsible. Decisions on NHS Continuing Care are made by committee with guidance from a decision making tool – The process and the outcomes feel wrong to many of us in many circumstances: people who are cruelly damaged by a progressed dementia or other pathology being dismissed as in need only of social care – means tested and a burden on Local Authorities. Local Authorities which have been stripped of funding which is needed to provide services appropriate to needs and expectations. The misery of the illness is compounded by the misery of the dishonest avoidance of responsibility for healthcare.
I am diverted to this by finding an account in the Manchester Evening News of the closure of Monet Lodge – following attempts by the Care Quality Commission to help improve the care being provide for residents: The mental health and dementia hospital where staff 'didn't know patients' names' and 'told them to sit down whenever they tried to get up' - Manchester Evening News
Latterly run by Making Space, a mental health charity, my understanding is that Monet Lodge was created after the closure of Healey House in response to a Commission for Health Improvement report Abuse claims spelt end for Healey House - Manchester Evening News
A report I had reason to question: www.emerald.com/insight/content/doi/10.1108/14668203200400026/full/html