The Challenges of Dementia Care: A Student Project
Juan Yanguela, a student on the Evidence Based Social Intervention and Policy Evaluation (EBSIPE) MSc course, discusses his experience of the course, and what he has learnt through his project work on a particular social policy problem – in this case dementia care for people aged over 75.
As part of their programme of study, Master's students at Oxford’s Department of Social Policy and Intervention this term undertook an analysis of a number of policy problems. The goal of the exercise was to suggest durable and feasible policy responses on the basis of a precise and evidence-driven interpretation. For the exercise, we first researched the problem, breaking it down by analysing the political, social and economic dimensions. We then interrogated the available evidence on the constituents of the problem, the issues and actors involved and how it has evolved within and across countries. Thirdly, we assessed the resources needed to satisfactorily address the problem and suggested a policy response, being mindful of the factors making for likely success.
The Policy Problem
Our group focused on the improvement of the provision of dementia care for those aged 75 years and over in the UK. Throughout the Social Policy Analysis module, we learned to utilise different analytical frameworks to examine the magnitude and complexity of social problems, evaluate the viability of different policy options, map the different stakeholders involved and assess the quality of the evidence available. The use of these techniques helped us gain a better understanding of a given social problem. For example, we became aware of the fragmentation between the social and health care sectors and the common misconception that dementia care is provided by the NHS. The reality is very different: the state usually only provides means-tested social care for low income groups, which results in most people not adequately planning for the future.
This lack of individual financial planning, along with the increasing prevalence of dementia, among other factors, illustrate the necessity of both incentivising private funding and making more state funding available. However, addressing this would require coordination with other policy areas (e.g. pensions) and would probably face political barriers in a context of austerity.
Our Policy Proposal
Taking all of this into account, our policy proposal focuses on facilitating information sharing to promote integrated health and social care. The aim is to create an online hub that includes information about all the different forms and providers of care for dementia patients at the regional level, enabling better planning and choice of the best care to suit each individual.
The hub would be developed by setting up regional round tables bringing together general practitioners, care centres, social services, home workers, volunteers, and dementia associations. The use of the hub by these stakeholders would be encouraged to make sure that regardless of the point at which patients or carers seek help, patients can access information about the care that best suits them, and carers can access information about what support is available for them and their patients. The use of this approach is supported by evidence that integrated care improves patient outcomes, and by the success of similar policies in France and Australia, where trained Local Area Coordinators have helped in reducing costs and promoting information sharing.
Barriers to implementation
Being aware that the current referral practices used in primary care, such as the protocol followed by GPs, might represent a barrier to the use of the hub, we propose running a regional pilot scheme to gather further evidence for the effectiveness of better communication in facilitating integrated care and improving the quality of care. Evidence of success on a regional scale could be used to convince powerful stakeholders, such as central government, to support the rolling out of our policy on a national level.
My experience of the project
Having a background in the biological sciences, I found it challenging to approach a social problem involving many different stakeholders and political constraints. I therefore found the analytical frameworks introduced in the workshops extremely useful. Furthermore, working alongside people with different backgrounds and with diverse points of view really helped me gain a broader understanding of the topic and helped the group find a more creative solution. I think that the multidisciplinary character of this Master's course is one of the factors that make it unique.
About the Author
Juan Yanguela is an MSc candidate in Evidence-Based Social Intervention and Policy Evaluation (EBSIPE) at the University of Oxford. He holds a BSc in Biomedical Sciences from the University of Manchester. In his undergraduate studies, he focused on the evaluation of public health interventions in the area of neglected tropical diseases. At the Department for Social Policy and Intervention, he hopes to increase his understanding of the social determinants of health and learn to design and evaluate policies aiming to reduce health inequalities between different social groups.
The views expressed in this article are the author's own and do not necessarily reflect any editorial policy.