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Implementation of the strategy

Development and implementation

In developing the yearbook, we were interested in examining how governments committed to the delivery of the actions of the plan, to ensure it benefited people with dementia, their families and carers. Countries approached this in considerably different ways, with some providing detailed information regarding timescales, departmental/organisational responsibility and in a limited number of cases (notably Denmark and Finland), specific costing or sources of funding. In all strategies, the Health Ministry/Directorate had overarching responsibility for the implementation of the plan, either through an existing structure or through a delegated committee or group.

Interim progress reviews/reports

England, Ireland and Switzerland all produced interim progress reports, detailing the progress made in each area, detailing the next steps and future work. In the case of Switzerland, this resulted in the extension of the lifetime of the strategy in order to allow sufficient time to progress work towards the implementation of the commitments.

The review of England’s strategy (specifically the implementation plan) focused on key actions (18/50 committed actions) related to its implementation but was also the only interim report which contained some form of public consultation.

Action plans

A considerable number of strategies contained indicators, setting out the purpose of an intended goal or commitment, the responsible organisation or department, as well as measures for success (and how this would be demonstrated) and timescales for implementation. These were presented in a number of ways, including incorporation within the main texts of the strategy, annexes or as an accompaniment.

Strategies which included such action plans included Denmark, England, Finland, Flanders, Germany, Ireland, Luxembourg, Northern Ireland, Slovenia and Wales.

As noted previously, Portugal was distinct from this approach, giving regions one year to produce regional action plans which would outline how they will implement the national strategy.

Implementation committees and governance

A number of strategies indicated that specific committees would be established to oversee the implementation of the strategy, including Cyprus, Greece, Israel, Italy, Malta, Northern Ireland, Portugal, Scotland and Wales. There was little detail in the strategies as to how these governance groups would operate or what the composition of their membership would be.

The most detailed governance structure was outlined within the Swiss plan, setting out the three distinct bodies which would oversee the implementation of the strategy. The primary body with responsibility was the coordination committee composed of statutory governmental bodies, a consultative group which included patient organisations and other stakeholders, and a platform group which contained offices of the cantons etc. which had direct responsibility for the implementation of projects within the strategy.

Other points of interest

Many of the strategies were linked into, or are strands of, overarching policy drivers. Norway’s was the only strategy which was a direct auxiliary of another care strategy, linked in with other areas of work and funding streams across different areas. All other strategies, whilst fitting in with a wider agenda, were distinct strategies in their own right.

Some examples of these linkages included the Czech Republic and Finland proposing changes to health and social care legislation to allow for shifts in the provision of care services for people with dementia. In addition, Finland, Germany, Northern Ireland, Scotland and Wales all articulated links and parallels with existing domestic policy such as health and social care, local delivery through better coordination of services and quality improvement as well as other areas of reform.

The Finnish, Norwegian and Welsh strategies were the only strategies to explicitly reference the usage of routinely gathered data as a measurement against the commitments in the strategy (though other strategies recognised the importance of routine data gathering.)

Malta’s strategy references the need to ensure that people with dementia, their families and carers are involved in the process of implementation, whilst the strategies of Cyprus and Flanders also committed to ensuring people with dementia were involved in future dementia policy. Germany was distinct in its commitment to develop over 500 local groups to ensure that people with dementia, their families and carers were involved in policy decision-making processes, including in relation to the implementation of the national strategy. The Norwegian strategy also proposed national questionnaires as well as the development of quality indicators which would allow people with dementia and their carers to share their experiences in relation to policy and services.

Ireland was distinct in that in addition to its own governance arrangements, including an interim review, it committed to an independent evaluation of its strategy and the implementation of the actions contained therein.

Overall, we can see that there is a broad range of approaches to the implementation of the strategies, focused on a number of different areas. Again, it is perhaps disappointing that there is not more clarity on how the governance arrangements will ensure that the experiences of people with dementia, their families and carers will help play a role in the implementation of the strategies. However, it is encouraging to see such a variety of methods used to ensure the strategies are implemented, including the clear links with other policy agendas that support improvements both to policy and practice.

 

 
 

Last Updated: Monday 29 April 2019

 

 
  • Acknowledgements

    This report received funding under an operating grant from the European Union’s Health Programme (2014-2020). The content of the Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains
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