The SDO r ev iew of r espit e ser v ices and shor t - t er m br eak s for car er s for people w it h dem ent ia is t im ely in t he cont ex t of a num ber of m aj or
gov er nm ent init iat iv es. The dev elopm ent of t he Nat ional I nst it ut e for Clinical Ex cellence ( NI CE) and t he Social Car e I nst it ut e of Ex cellence ( SCI E) , as w ell as t he int r oduct ion of t he NSF for Older People ( DH, 2001) , all highlight t he gov er n m en t ' s com m it m en t t o im plem en t ev iden ce- based policy . St andard 7 of t he NSF for Older People focuses on t he pr ov ision of ev idence- based m ent al- healt h ser v ices and on pr om ot ing int egr at ed ser v ices t hat offer ear ly
diagnosis, t r eat m ent and suppor t for older people and t heir car er s.
of ser v ices differ ed fr om t hose t hat ex ist t oday ; for inst ance, t he im por t ance of ser v ice pr ocess out com es ar e m or e w idely r ecognised ( Nicholas, 2003) . Unfor t unat ely , ev aluat ion st udies t ended t o be based on ser v ice configur at ions t hat no longer ex ist ( r espit e car e in NHS hospit als and t o a lesser ex t ent day hospit al car e) .
I n spit e of t he lack of r obust ( cost - ) effect iv eness ev idence t o suppor t t he use of par t icular t y pes of r espit e car e, a num ber of is sues w er e highlight ed w hich hav e im plicat ions for policy and pr act ice. One of t he m ain im plicat ions of our findings is t hat t he planning, deliv er y and ev aluat ion of shor t - t er m- br eak ser v ices m ust be set in t he cont ex t of ot her suppor t ser v ices ( as illust r a t ed in t he effect iv e- r espit e py r am id, Figur e 5. 1) . What ev er t he qualit y of indiv idual short - t er m br eak s in a localit y , m any ot her ser v ices and sy st em s w ill hav e an im pact on t heir t ak e - up and effect iv eness – including, for ex am ple, t he m edical m anagem ent of dem ent ia, access t o healt h and social car e ser v ices, and sy st em s for assessm ent and r ev iew of bot h car er s and car e r ecipient s. Counselling, benefit s adv ice and adv ocacy also hav e an im por t ant r ole t o play in encour aging and enabling car er s t o t ak e br eak s , and as such w ill r equir e sufficient and secur e funding.
A fur t her im plicat ion is t hat ser v ices need t o be sufficient ly v ar ied and div er se t o m eet t he needs of car er s and car e r ecipient s in a r ange of sit uat ions and fr om a r ange of back gr ounds. For ex am ple, dem en t ia does n ot j u st affect older people. Resear ch indicat es t hat t her e ar e ar ound 1 7 000 people under 65 w it h dem ent ia in t he Unit ed Kingdom ( w w w . t hecliv epr oj ect . dem on. co. uk / ) . The et hnic pr ofile of Br it ain’s older populat ion has changed consider ably in t he last t en y ear s. Asian and black Car ibbean car er s hav e differ ent aw ar eness of dem ent ia t han do w hit e people but t her e is v er y lit t le ev idence on how t his w ill affect t heir use of r espit e ser v ices and shor t - t er m br eak s.
The im por t ance of flex ibilit y and t he per son- cent r ed appr oach, as enshr ined in St andar d 2 of t he NSF for Older People, im ply t he need for spar e capacit y t o be built int o r espit e ser v ices. This has par t icular im plicat ions for local
aut hor it ies w ho w ill need t o ensur e t hat t heir Car er s Special Gr ant allocat ion r em ains dedicat ed t o dev eloping shor t - t er m- br eak ser v ices now t hat it is no longer ring- fen ced by cen t r al gov er n m en t .
At t he sam e t im e, qualit y st andar ds m ay need st r engt hening t o r educe v ar iabilit y in t he qualit y of, and access t o, differ ent ser v ices. They also need t o hav e t he flex ibilit y t o accom m odat e t he w ishes of car er s and car e
r ecipient s, w hich m ay differ for differ ent gr oups r eflect ing t he div er sit y j ust m ent ioned.
Anom alies in char ging and benefit s sy st em s, w hich m ay det er car er s fr om t ak ing t he br eak s t hey need, should be addr essed.
This r ev iew also has im plicat ions for t he r ecr uit m ent and r et ent ion of high- qualit y st aff, and for t heir on- going t r aining and dev elopm ent . I t has highlight ed t he im por t ance of t r aining for bot h front - line car e st aff and for doct or s, in t he r ecognit ion, diagnosis and t r eat m ent of dem ent ia; in t echniques of car e, w hich ar e associat ed w it h t he best out com es; and in under st anding t he needs and r oles of car er s. These issues w ill be par t icular ly
relevant t o t he Nat ional Car e St andar ds Com m ission, and t o a r ange of pr ofessional t r aining bodies.
The st udy has highlight ed t he im por t ance of t he r esponsiv eness and
accessibilit y of local social ser v ices depar t m ent s ( t he gat ew ay t o m ost shor t - t er m br eak s) , an d in par t icular of r egular assessm ent and r ev iew ( for bot h car e r ecipient and car er ) . As local aut hor it ies now hav e bot h a dut y t o assess car er s ( ev en if t he car e r ecipient is not assessed) , and pow er s t o pr ov ide t hem w it h ser v ices t hat can help t hem t o car e ( Car er s and Disabled Childr en Act 2000) , it is clear t hat t he car er ’s assessm ent can be a k ey t ool in
ident ify ing car er s w ho need a br eak . The r ecent int r oduct ion of t he Single Assessm ent Pr ocess should pr ov ide new oppor t unit ies t o ensur e t hat good assessm ent and r ev iew pr act ices ar e in place. The need t o ident ify car er s w ho w ould benefit fr om a shor t - t er m br eak also r einfor ces t he case for
ident ificat ion, and in par t icular for t he ex pect at ion in t he new Gener al Medical Ser v ices ( GMS) cont r act t hat general pr act ices hav e a pr ot ocol for car er ident ificat ion and a m echanism for t he r efer r al of car er s for social ser v ices assessm en t .
Fur t her m or e, t he Car er s ( Equal Oppor t unit ies) Bill w ill, if it becom es law , giv e car er s new r ight s t o infor m at ion and gr eat er c hoices and oppor t unit ies for w or k , educat ion and lifelong lear ning – all of w hich hav e im plicat ions for t he dev elopm ent and pr om ot ion of r espit e for car er s of people w it h dem ent ia. Last but by no m eans least , pat ient choice is being pr om ot ed t o enhance pat ient access t o, and inv olv em ent in, healt h and social car e decision- m ak ing. I n t he case of dem ent ia, t hough, it can be pr oblem at ic t o elicit pat ient
pr efer ences. I n pr act ice t her e is oft en an int er- dependence of t he v alue placed on ser v ices by car er–car e - recipient dy ads. I t seem s appr opr iat e, t her efor e, t o enhance t he oppor t unit ies for car er s ( and people w it h dem ent ia) t o help shape r espit e ser v ice pr ov ision.