I spent a lot of time physically in Manchester, for one reason or another. As a ‘Northern power house’, it happens to be only two hours away from London Euston on the train.

When news of the ‘People’s Republic of Manchester’ was breaking last year, I remember the criticism that came with it from the NHS policy stream. That is, locally devolved powers might undermine the national nature of the health service. At worst, the devolved Manchester was also devolving blame for cuts to a local level.

It’s possibly no coincidence that Phillip Blond has been involved with both the DevoManc agenda and the Big Society. In terms of the ‘Big Society’, one of Blond’s fundamental arguments can be interpreted as that ‘the left’ did not actually deliver on its communitarian politics.

One of the central premises of the Big Society is that individualism is best given  empowerment of people’s relationships with one another. The effect of a monopolistic relationship with the State, or as more the case outsourced private providers, is that such relationships do not gain power.

Coincidentally, it happens that one of the biggest criticisms of ‘dementia friendly communities’ is that it is in some way or other a ‘cover for cuts’. The problem was that, temporally, the Big Society surfaced at approximately the same time as the austerity-led agenda following the global financial crash.

Whilst latterly there has been talk of care homes forming ‘community hubs’ as part of dementia friendly communities, it appears likely that a central thrust of dementia friendly communities, policy-wise, was to promote ‘independent living’. This ‘independent living’ rose to prominence from the disability movement.

With the Prime Minister Dementia Challenge, there has been muttering on the spotlight received by dementia (even given the devastating cuts in social care), compared to disability (including the demise of the Independent Living Fund).

Dementia is not a natural part of aging: that is why it has become important to separate the WHO ‘age friendly cities’ policy stream from dementia friendly communities, even though they show many commonalities (and to separate ‘independent living’ from ‘successful aging’).

But it is nonetheless clear that there is some sort of relationship between the ‘health of the nation’ and resources the State has to play with.

I am physically disabled, which is why I particularly appreciated the in-city tram service within the city of Manchester, which made it very easy for me to move around the city of Manchester.

For the wellbeing of people living with dementia, there has been a growing realisation that integrated services go substantially more than merely health and social care (important though they are); they necessarily involve, for example, housing and transport. It is symbolic than the policy streams of ‘social determinants of health’ and ‘friendly cities’ or ‘friendly communities’ have maintained their silos both at national and international level.

But, with growing realisation of international instruments such as the United Nations Convention on the Rights of People with Disabilities, rights-based advocacy is reaching another level. The use of the word ‘community’, especially given the devolved nature of politics recently, puts in sharp focus at what level ‘friendliness’ (however so defined) operates.

Glenn Rees, current Chair of Alzheimer’s Disease International, has often commented on the ‘dementia friendly societies’ policy stream of Alzheimer’s Australia and the contribution of Ita Buttrose. Manchester throws up the question of ‘why stop at community?’ It might be that it is actually necessary to devolve national functions to a local level if only to empower individuals and us collectively.

First published on Living better with dementia

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3 Comments

  1. As a note of explanation, I’d better say what on earth the point of this article was. In mitigation, I wrote it for my specialist blog on dementia policy. It was meant to be a general discussion of whether independent living is consistent with communities, and whether Manchester could help us here with the dementia friendly communities policy. Independent living can be promoted through upholding of human rights (hence the reference to right based advocacy and the UN). There’s also an argument whether individualism is in fact best promoted by strong communities – hence the reference to Phillip Blond’s work.

  2. The idea and philosophy of whole person care was what we used to call from cradle to grave care, under Bevan we had all the institutions we needed when it was needed, the problem was with the advent of the Neo-Liberals the shortcomings of the system were not remedied but used as an excuse for private sector intervention.

    Thatcher proclaimed that the private sector knew best and that they would create a new utopia in health care at all levels even to the point of putting flowers at your bedside.

    People though forget too easily what was provided during the sixties up until the eighties, forgot about the real investment during those days, and instead we find care has diminished under privatisation and turned health care in to the dystopian nightmare where people are left to die at the side of the road, as we do not have enough ambulance personnel to get them to hospital in time.

    Only a couple of weeks ago I actually witnessed first hand what I have been reporting over the last four years; I heard screaming and crying from the back of my house, thinking it was young people horse playing around I took no notice, but then the noise persisted beyond what I felt was usual, and as I was typing on my computer upstairs in my little office, my wife appeared and asked what we should do about the noise.

    I agreed that we should both investigate, as we arrived near the scene a young couple coming away from it, explained that a young girl was mentally distressed and running around naked, but was being taken care of by neighbours and relatives, the boyfriend of the young girl said he had rung for an ambulance and was waiting, ambulance targets in Gloucester state they should arrive within 8 minutes, that period was way past the time and did not arrive.

    We waited possibly for half an hour then saw an ambulance near where we were only to see it turn away at the roundabout and carry on in a different direction, meaning I think that ambulance had been diverted at the last moment to another incident, which is common practice these days.

    We waited a further 15 minutes or so and heard another siren only to find that it was the police and the space of 5 minutes two police cars arrived at the scene, in all this time the young girl clearly disoriented was still making a noise and sounded deeply distressed, although she was quite a way down the alleyway and I couldn’t see her.

    After a further 15 minutes my wife and I decided there was no point in waiting around any longer as the authorities were now in control and went back home, the noise still persisted and in all that time, no ambulance arrived to treat or care for this young girl.

    What this case in point emphasises, is that Neo-Liberal doctrinaire policies have brought these crisis upon us which would never have happened in the sixties, that there is also evidence that this not just a local south western problem but as we have previously pointed out is happening all over the country.

    The young woman that was attacked in the street and lost her baby, waited for over an hour before the police could not let the situation drag on any longer, drove the young woman to the nearest hospital themselves.

    This is not uncommon up and down the country, but when will people especially those who claim to support our NHS recognise the degree of collapse in our services. Due explicitly to the Neo-Liberal agenda of privatisation.

  3. Sorry forgot to mention, the young woman that was attacked on the street in London.

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