On 3 January the UK government announced an independent commission on adult social care. Led by Louise Casey, the new commission has the potential to truly fix the social care system once and for all. However, the commission’s work will be in two stages, with the second stage not due to conclude until 2028, leading some to ask whether it risks kicking this important issue into the long grass. Major reform of social care is something that successive governments have attempted but not achieved. The Health and Social Care Committee has now launched an inquiry into the costs of this inaction. After years of discussion, debate and dithering, this begins to feel more like a problem of political will and implementation than a problem of ideas. We must now start asking ourselves whether the concept of “reform” is in itself a barrier to change. Because social care reform is inevitable, does it stop us reaching for more tangible policy solutions that immediately improve people’s lives?
Reform is needed, but we don’t need to wait for it
Dementia training for the care workforce is one of those solutions. A new report from Alzheimer’s Society, “Because We’re Human Too”, highlights the clear need for social care training. In England, guidance from both the Care Quality Commission and NICE says care staff should have appropriate training to deliver quality care. Yet only 29 per cent undertake any kind of dementia training and less than half (44 per cent) of people living with dementia and their carers rate care staff’s understanding of dementia positively. The report also sets out the real benefits of high-quality dementia training for individuals with dementia and their carers, for the care workers who look after them, for care providers, and for the wider health and social care system. These benefits translate into cost savings to the health and care system of £2,000 per care home, per year, through reductions in the need for primary, hospital, emergency and community health care. Of course, dementia training is not a silver bullet, and the need for reform will not get any less urgent. But, as well as making an immediate difference, it would also make progress with some of the knottier problems that wider reforms need to address. For example, high-quality training can improve retention and reduce turnover. Skills for Care data in England shows social care staff who receive regular training in their role have a lower turnover rate (31.6 per cent) than those who do not (40.6 per cent), with learning and development noted as one of the top three retention factors.
You can’t fix social care without fixing dementia
Dementia training is not a niche issue for social care. Almost one million people in the UK live with dementia, and the majority of people drawing on older-age social care have dementia. Additionally, around 60 per cent of people who draw on care at home and 70 per cent of those in old-age residential care in England have dementia. It is estimated that its cost to social care in 2024 alone was £17.2bn, and £7.1bn to the healthcare system.
Growing consensus
The consensus and momentum around dementia training for social care is growing all the time. In November, Care England, the largest representative body of adult social care providers, came out to strongly support the call for funded mandatory dementia training, describing it as “a crucial step in improving care for people living with dementia”. In 2024, led by Skills for Care, the adult social care sector came together for the first time ever, both in celebrating the immense value of the care workforce and developing a strategy to support that workforce. It set out recommendations to attract and retain, train and transform it, including a recommendation that all care staff should undertake dementia training mapped to the Dementia Training Standards Framework. A Nuffield Trust report from November 2024 said that, while there are examples of good dementia care, it is not delivered consistently across England. Despite people often wanting to stay at home, services have not developed to meet these needs and the care offered is too often not personalised to individual need and preference. The report said the government must “act to equip the workforce to provide a high standard of dementia care” including exploring options for mandating dementia training in health and social care where it will improve quality.
Urgent need for reform
More needs to be done to create a care system which works for people living with dementia. This means looking at funding, quality, workforce, support for unpaid carers and a person-centred approach. Dementia is the UK’s biggest killer, and prevalence is growing. By 2040, it is estimated 1.4 million people will live with this devastating, terminal condition. Research published by the Alzheimer’s Society earlier in the year projected that by 2040, increasing dementia prevalence would result in an additional 76,000 people living in residential homes and an extra 30,000 in nursing homes. And with one in six hospital beds occupied by someone with dementia, the need to relieve pressures on the NHS is clear. But we cannot let the big question of “reform” stand in the way of short- term improvements. Alzheimer’s Society wants to see the UK government introduce a statutory duty for providers to ensure all adult social care staff undertake dementia training. We need to think about the bigger questions around social care reform and make real progress on answering them. In the meantime, interventions like training can improve people’s lives, support our valuable care workforce and help the current system to work better
We want to work with you. Contact us: change@alzheimers.co.uk
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