Services for people with dementia and their families in England are commissioned with a lack of integration and an inconsistent approach creating gaps in service provision. Therefore, families affected by dementia are not receiving the appropriate care in a timely manner and often access support at crisis point. This reactive and crisis driven approach to care is costly financially and can have a negative impact and quality of life of those affected. The ABC model offers an adaptable framework that can inform service provision and improve opportunities to create seamless peri- and post-diagnosis dementia services for families affected by dementia.

The number of people with dementia is expected to increase globally. People with dementia are not affected in isolation and any intervention should also support their families and carers. Intervention is best delivered using a relationship-centred approach and a case management model. Case management has an established and successful history in supporting people with long-term conditions and those with a diagnosis of severe mental illness. This article, the last in this dementia series, discusses the Admiral Nursing case management approach to supporting patients and families affected by dementia, and provides recommendations for establishing a gold standard model of case management.

This rapid decline in spending mirrors wider cuts to local authority budgets over the period. The National Audit Office estimated that local authority funding reduced by 25 per cent in real terms between 2010/11 and 2015/16 24 , while the Care Quality Commission have reported that 81 per cent of councils reduced their spending on adult social care over the same period 25 . Trends in income from healthAs figure 13 above shows, direct cash transfers from the NHS spent on older people's social care organised by local authorities has been rising. In 2006/07, the first year data was collected, the NHS transfer totalled just £204 million, rising to £250 million by 2009/10. However, since 2010/11 the value of the NHS transfer has shot up. In 2010/11 the transfer increased to £350 million, and has since quadrupled to £1.33 billion in 2015/16. As a result, cash transferred from the NHS has grown from two per cent of the total public spend on older people's social care in 2006/07 to 16 per cent in 2015/16. With the NHS now facing serious provider deficits and a substantial gap opening up between income and demand, there must be questions about how long this trend is sustainable.

Much of the UK’s ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs’ clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenarios and reported greater confidence in communicating with registered healthcare professionals. Some found role-play participation challenging. AWTD sensitised HCAs to the experiences of residents with dementia, and those with limited dementia experience gained a fuller understanding of the disease’s effects. Staffing constraints affected participation in group training. Training using simulation is valuable in this setting, particularly when delivered flexibly. Further work is needed to explore its potential on a larger scale.