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Why not have a global summit on living well with dementia?
Yesterday, the UK Department of Health plumbed to new low depths.
Actually, the week had started well. The Department’s 2014/5 corporate strategy which they had published included ageing and living well with dementia as a top priority.
The day before yesterday, the All Party Parliamentary Group on dementia had produced a thought provoking report which helped to map out a future landscape for English dementia policy.
This had included care coordinators, which I think would be very useful provided we get the appointment of such a rôle correct with people with the right skills, behaviours and experiences.
This included a proposal for “integrated care“. I personally feel we should attempt to introduce a large scale cultural transformation towards whole person care.
But why on earth nothing on specialist nurses as a critical rôle in the workforce?
Is it because the APPG report was hugely biased towards the Alzheimer’s Society not other large dementia charities such as Dementia UK?
Many of us are rightly concerned about the provision of specialist clinical nurses such as Admiral nurses.
But the summit yesterday #globaldementia was painfully bad in intellectual balance. The Department of Health Twitter account for the event was clearly manned by people who have little experience in the current policy of dementia in England.
Their “live blog” was as fascinating as watching a mouldy slice of Stilton get even more mouldy.
The number of tweets by members of the Department of Health far outweighed the tweets from elsewhere, relative to the sheer numbers in each of the two populations. I meanwhile continued to tweet a not inconsiderable number of tweets, including my own blogposts on language, whole person care, and social prescribing.
And this for me was the most telling slide of what has gone fundamentally wrong.
The use of toxic language to meet targets:
I have worked in research for dementia not continuously for seventeen years, including the top mark in my MBA in marketing.
I am quite sensitive to corporate marketing.
The drug companies need to come clean and to be honest.
They have had two decades of trying to produce a medication to slow progression of dementia. NICE is currently unable to recommend any anti-dementia drug that slows progression, albeit can improve symptoms for a few months.
The opportunity cost for this is incredible.
Both Cameron and Hunt produced unedifying language about dementia such as its effects on “humanity” and “horrible”, while unashamedly talking about the stigma of the wide ranging condition.
One of the key messages of “Dementia Friends“, a £2.4 million funded programme which appeared from nowhere in the current Government by the Department of Health and Social Care Fund, but “an Alzheimer’s Society initiative” (when not ambushed by the phrase “Public Health initiative”), is that “you can live well with dementia”.
Someone please tell this to Dr Dennis Gillings.
THE lowest point of yesterday was Gillings, telling Helga Rohrer, a passionate advocate and person living with dementia, about the need for ‘translationary research’ in response to a direct question about living well with dementia. Such research has been touted as finding a cure for dementia in the forthcoming decades.
He is the “World Dementia Envoy” for a panel which does not even have a direct patient or carer representative.
How completely offensive.
Martin Prince gave a fairly standard patter on an economic situation analysis of intervention after diagnosis. Well respected, he ignored completely the notion of any intervention on the wellbeing of a person with dementia.
But think this through. This would have involved an appreciation of how to measure the effect of an intervention of wellbeing in dementia. What type of dementia for example?
And do drugs affect wellbeing? The answer is actually by and large no.
There have been reported effects of memantine helping with wellbeing in dementia, presumably through affecting predominantly neuropsychiatric symptoms in certain patients (e.g. psychosis or aggression)?
But the drugs thus far have modest COGNITIVE effects. Prof Martin Rossor whom I respect wholly was right not to overinflate their importance, but right to draw attention on some value for some.
Yesterday was a well orchestrated cover, as a “legacy event” for the G8, for the current Government marketing for Pharma.
In the guise of the meme ‘private and public partnership”, please read “Pharma would like some of your State welfare benefits?”
The whole spectacle was unedifying.
It was an insult to people living with dementia.
It was an insult to a social care system which has been stripped of money during this current Government. Why don’t we have an ‘awareness’ campaign for that then?
Put quite simply, it was an obscene insult to many in the field, including academics in wellbeing.
It consolidated the notion of people with dementia being used for “tokenism” purposes.
Looking on the bright side, it was an outstanding example of “tokenism” and “non-participation”, compared to “citizen power”, as per Shelly Arnstein’s work.
I’ll continue blogging on my blog, which I increasingly see as blogging the other side of the story on dementia, while the others shill for Britain. Some unpaid.
Finally, I’ll leave the last word to @KateSwaffer, Consumer Champion for Alzheimer’s Australia, and a person living with dementia:
Time for a change in government.
Acknowledgements: It was Val Hudson who first alerted me to Arnstein’s work; this was a Twitter thread involving me, Val and John Ashton. Val has a longstanding and wide ranging background in dementia, including working for the late great Prof Sir Martin Roth, Emeritus Chair of Psychiatry at the University of Cambridge, inter alia.
Welcome to the BPP Legal Awareness Society!
The BPP Legal Awareness Society is part of a vibrant community of student societies at BPP, which any student of BPP can join.
Non-members of BPP are warmly invited to keep in touch with the Society’s activities through its lively Twitter thread, along with its blog which is kept up-to-date by a number of members of the society. Zerbakht is the Society’s officer for corporate news content on the blog.
It is a separate entity from BPP, however its members feel it reflects the lively spirit and commitment to high standards of BPP. The mission of the society statement is: “Putting law at the heart of business“. This explains that we wish to explain to students, and the public at large, why an understanding of the law is pivotal to an understanding of business and the rest of society.
It holds regular meetings at BPP Law School Holborn (Sam is in charge of our events). Future guest speakers, in the near future, including a partner in English employment law, an expert in social media and the law, and a member of a leading ABS in England. All students across the wide range of BPP-taught disciplines are invited to attend. We also hope to have a greater outreach – whilst the Twitter thread has been going for some time, we’ll soon be publishing regular podcasts. Katie-Claire is the Society’s Officer in charge of that project. Gizem (the Society’s Corporate Liaison Officer) will be promoting good relationships with City firms, where many BPP law students end up completing their training contract at least.
We have a new logo. It’s a lion, to reflect our shared values with the place where we study. However. it’s distinct. The image represents the student body, which is friendly, intelligent, energetic, young, resourceful and focused.
If you’re a past, current, or future member of BPP, you can join here. We should especially like to hear from you if you’re at an early stage in (or about to start) an undergraduate degree course, but considering a career in business, law or finance.
Will opposites attract?
I am posting this following a recent tweet this afternoon. Incidentally, my article got a very hostile reception the first time around, Sundeep and Neil!
Lawyers in training often become bewildered as to how parts of their course ultimately gel together. This possibly contributes to their uncertainty in choosing which part of the law to specialise in. For example, how on earth does constitutional law, including the rule of law and human rights, relate to the different specialisms of law, such as immigration or housing? And what have they got to do with the big powerhouse corporate law firms, if anything?
A surprising fusion of these ingredients could hold the key to solving a different problem that has been vexing English and Welsh law for several decades, at least. That is, the issue of what to do about the provision of legal aid.
A community law centre, where the lawyer might examine a sensitive landlord-tenant dispute, may seem ‘worlds-apart’ from the work of a corporate lawyer, who may be advising on a multi-billion-pound, headline-grabbing deal. However, it is possible that these circles might mix more in future, due to the current circumstances.
Access to the law: back to the basic constitutional law
One of the very first things that law students focus on in their constitutional law courses is the ‘rule of law’. Indeed, the rule of law underpins the work of both ‘divisions’ of lawyers: the barristers and the solicitors.
In 1977, the influential political theorist Joseph Raz identified several principles that may be associated with the ‘rule of law’ in some (but not all) societies. Some of Raz’s principles include the fact that the courts should be accessible, i.e. no man should be denied justice, and that the principles of natural justice should be observed, particularly those concerning the right to a fair hearing.
And what of the actual reality of today, in England and Wales?
“The Government strongly believes that access to justice is a hallmark of a civilised society. The proposals set out in this consultation paper [on the reform of legal aid] represent a radical, wide-ranging and ambitious programme of reform which aims to ensure that legal aid is targeted to those who need it most, for the most serious cases in which legal advice or representation is justified.”
‘A brief history of legal aid’
Legal aid in England and Wales was originally established by the Legal Aid and Advice Act 1949, with the aim of providing equality of access and the right to representation before the law. The scope of legal matters covered in 1949 was very tightly drawn.
However, today legal aid in England and Wales costs the taxpayer £2bn a year – a higher per capita spend than anywhere else in the world. It is argued that the current scheme is available for a too wide a range of issues, including some which should not require any legal expertise to resolve. The provision of legal aid is now governed by the Access to Justice Act 1999 and supplementary legislation.
The possible effect of the proposed legal aid reforms
Many civil cases will no longer be eligible for legal aid, and fees paid in civil and family cases will be cut by 10% across the board, according to Ministry of Justice plans set out in the consultation paper, “Proposals for the Reform of Legal Aid in England and Wales”, released in November 2010.
The UK government has estimated that, under the plans, £350m will be saved from the Ministry of Justice’s budget by 2014/15, if its proposals are implemented in full.
Ken Clarke QC MP, the Secretary for State for Justice and Lord Chancellor, has said in an interview that,
‘I believe that the taxpayer should continue to provide legal aid to those who need it most and for serious issues. But the current system can encourage lengthy, acrimonious and sometimes unnecessary court proceedings, at taxpayers’ expense, which may not always ensure the best result for those involved. The proposals I have outlined suggest clear tough choices to ensure access to public funding in those cases that really require it, the protection of the most vulnerable in society and the efficient performance of the justice system.’
Reaction from the solicitors
The cut in legal aid may offend the rule of law. For example, the Law Society Chief Executive, Desmond Hudson, has warned that:
‘If the government persists with these proposals, it would represent a sharp break from the long-standing bipartisan consensus that effective access to justice is essential to underpin the rule of law. Legal aid clients are some of the most vulnerable in society and good legal representation where required is essential if they are to obtain justice. The Society will now consider the green paper in detail.’
The effect on the high street – the community law centres
‘Law Centres’ employ solicitors and case-workers who specialise in debt, discrimination, housing, employment, welfare benefit, community care, mental health law, and immigration and asylum law. Their initiatives are truly inspirational.
In an open letter dated October 2010, Julie Bishop, Director of the Law Centres Federation, provides a very interesting description of the impact that the financial recession – a possible driver in the need to cut costs in legal aid services – has had on the high street legal services:
“We serve 120,000 clients every year. The recession is hitting our clients hard. Already, the Employment Tribunals Service has recorded an increase from 10,800 to 19,000 in the number of cases related to unfair dismissal over the past year [October 2009-10]. ACAS has recorded a 13% increase in enquiries for conciliation services. Law Centres have experienced a 30% increase in clients assisted with employment and discrimination cases.”
An example of where the Law Centres have made a substantial impact is in Brent. Brent Community Law Centre stated that the cuts to legal aid will leave two options for those in poverty on Jobseeker’s Allowance: “a move from poverty to extreme poverty, or possession or eviction if they do not pay their rent.”
They cite that a single person living in a one-bed flat paying £180 per week will have to contribute £18 to the rent out of a weekly income of £65.45, leaving £47.45 for all other expenses including fuel. A separate (but linked issue) which compounds vulnerability is the proposed capping of housing benefit. It is estimated that this will cost claimants in Brent an average of £8,817,844 per year. This loss is to be shared among 1,988 claimants. If their rents are not reduced, they will have to pay £4,436 per household out of their own income. Currently, the Brent Law Centre is able to advise on this issue.
Brent Law Centre argues there will inevitably be far more possession cases in the county court because landlords, whether council or private, will bring court action for rent arrears. In addition, they believe that the impact on costs for other departments, such as social services and child protection need to be assessed.
Brent Law Centre, only through the goodwill of an army of unpaid volunteers, is currently able to provide legal advice and assistance for residents of Brent on a range of legal issues including education, employment, housing, immigration, mental health, public law and welfare benefits.
An unlikely solution?
It has not gone unnoticed that one of the effects of losing £350m from the existing £2.1bn budget may be to put corporate law firms under greater pressure to contribute to the provision of legal aid.
High profile pro-bono interventions by the household names in corporate law can become tied to big international events – such as helping out at the Sierra Leone war crimes tribunal (Weil Gotshal & Manges), or representing wounded soldiers in compensation cases against the Ministry of Defence (Hogan Lovells).
Nonetheless, doing pro bono has become attractive to graduates in an increasingly competitive job market, where law firms are keen to attract the best graduates, and graduates are keen to demonstrate their social awareness.
However, it is true that many newly-qualified graduates do contribute much time for free to the local community, often in very deprived areas, but find the work immensely fulfilling. This is despite the fact that their Managing Associates and Partners will not tolerate any compromises in their professional ‘day job’.
Who knows where this is heading?
The ideal outcome might be for a restructuring of legal aid services, such that the public and lawyers have a clear idea where the money is going to, and which enables fair access to legal services for the public. The crunch question inevitably becomes: “where this money is coming from, if it’s not the taxpayer?”
Brent Law Centre is just a single example of where professional lawyers give their skills free-of-charge for the benefit of the community, but it would be tragic to see a situation where lawyers cannot even do this because of the ‘system’.
It might be, even, that the corporate lawyers have a crucial part to play for the benefit of society, in contributing towards the maintenance of legal aid in the high street law.
RBS' international expansion plans in emerging countries – a joint venture in China
The Royal Bank of Scotland (RBS) is the first UK bank and the seventh bank internationally to get approval to enter the investment banking business in China. RBS is poised to unveil a financial securities joint venture in China, to capitalise on thriving markets in the engine of Asia’s booming economy. A BBC report states that sources reveal the bank is in detailed talks with Chinese group Guolian Securities, and that the announcement of a deal could come very shortly.?? Such a joint venture would build on minority stakes that RBS already has with two Chinese financial companies, Galaxy Futures and Suzhou Trust. The tie-up with China’s Guolian Securities will allow RBS to manage share sales and issue debt in China’s fast-growing financial markets.
In 2010, initial public offerings in China amounted to around two thirds of the world’s total. RBS’ vision is to bring British, European and US companies to China, and allow Chinese investors to gain access to foreign companies, equities and debt. Foreign companies are not currently allowed to list shares in China but that is expected to change in the near future. Morgan Stanley, UBS, Deutsche Bank, CLSA Asia Pacific, Credit Suisse and Goldman Sachs have also received approval to set up securities ventures in China. A tie-up with a Chinese partner is a pre-requisite for a foreign bank wanting to enter the securities business.
RBS will have a 33% stake in the venture, which will be known as “Hua Ying Securities”. Hua means “Chinese”, while Ying means “British”. RBS wishes to be a top bank in China, and the joint venture will be based in Wuxi, Jiangsu Province, about two hours away from Shanghai. RBS has thus far declined to disclose how much the bank had invested in the venture.
RBS, 83% owned by the taxpayer after being bailed out by public money at the height of the financial crisis, has in fact been seeking a new Chinese securities joint venture for some time. The government has said it will ultimately sell its stake in RBS, but is unlikely to do so until the Independent Commission on Banking, due in September, reports its findings.
RBS is seeking to shore up its business in China, after it was forced to sell a stake in Bank Of China in 2009 for 1.6bn pounds. China is a core market for RBS in Asia as well as globally. RBS had intended to continue to invest significant resources in building their wholesale and investment banking businesses there.?? Therefore, in addition to their existing joint venture interests in Galaxy Futures and Suzhou Trust, they have also seeking a securities joint venture.”
RBS’s formidable move comes as many major international banks are focusing on China’s market in securities – tradeable financial assets such as equities and bonds – for growth.?? Analysts have said this drive had been sharpened in the wake of economic fragility in Europe and the United States. UBS, Credit Suisse, Goldman Sachs, Morgan Stanley and Deutsche Bank are among global banks with securities joint ventures in China. RBS has sold 311 RBS branches in England and Wales, and seven NatWest branches in Scotland, to Santander of Spain, while also disposing of assets such as Linea Directa in Spain, Sempra Metals, the oil and European energy business venture, and GMS, its payment processing business that includes the WorldPay brand. RBS has thus far quit retail branch banking in several overseas territories where it lacked major scale such as Taiwan, Hong Kong and Indonesia.
A successful joint venture will allow RBS to take part in that country’s thriving domestic capital markets, such as issuing debt and equities, underwriting bonds, etc. The rationale is clear. Recent data this month showed that Chinese industrial output exceeded forecasts, highlighting that the country’s economy had remained buoyant despite government efforts to clamp down on bank lending and property speculation.?? RBS has also signaled that it wishes to withdraw from retail banking in many overseas locations but in many cases it wishes to add to investment banking operations where profitable overseas.
