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Areas of interest within the strategies

Introduction

This sub-section will address some points of interest identified during the comparative analysis, without going into the same level of detail as those in the rest of the report. However, these points are useful to consider as they provide an insight into the context in which the national dementia strategies have been developed by governments, as well as their ability to effect change as policy drivers in their own right.

Open-ended vs. time-limited

One such discrepancy between strategies was identified between governments that opted for an open-ended national strategy and those that did not. The Czech Republic, Flanders (Belgium) and Scotland (UK) all have short-term time-limited strategies, of four years (Czech) and three years (Flanders and Scotland); by comparison, Denmark, Finland, Netherlands and Malta all have time-limited eight year strategies. However, about a third of the strategies (eight including one of the neurodegenerative strategies) were open ended, with no date in place for completion.

As part of the Portuguese strategy, the devolved regions have one year to develop regional dementia plans, detailing how they will give effect to the national dementia strategy.

For strategies which have no stated date for conclusion, unless advised otherwise by the national association, this report assumes that the strategy continues to be in effect with stakeholders working towards implementation. The Cypriot strategy is, ostensibly, concluded. However, the national society indicated that many of the actions of the strategy were not completed and that they are still advocating that the government should work towards the aims and, where necessary, update them.

Terminology

Across the different strategies, there was significant variation in the language and terminology used in relation to different aspects of services, awareness raising or support.

Whilst very few of the strategies were prescriptive as to the nature of individual services (the majority of strategies focused on more high-level descriptions of inputs/ outputs), some strategies (including Greece and Malta) provided detailed descriptions of some services that should be provided and the nature of the staff who should provide them. One such example was that of day care services in Greece, which seemed to outline a more community-based, clinician-intensive service delivered by Allied Health Professionals, nurses and social workers, by comparison to a more socially-focused model, which prioritises social connections, participation in the person’s community and meaningful activity.

This is not to suggest that the approaches are mutually exclusive or that one approach should be favoured over the other – indeed the implementation of the Greek model incorporates these different elements. Rather, by identifying this point, this report’s identification of this point demonstrates that whilst many strategies may refer to similar services (e.g. day care centres, post-diagnostic support etc.), the delivery of services and practice of professionals is likely to be significantly different, even when common terminology is used. As most countries did not offer this level of detail in terms of service delivery, it has not been possible to explore in more depth the extent to which there is variation on commitments made under the same heading.

National strategies vs action plans

A related aspect is that of the names of dementia strategies. In some case, they are referred to as national dementia strategies, national action plans or health action plans (amongst others). Whilst in the majority of the cases there was no explanation given as to why the governments had chosen a specific name, there were some instances in which a fuller explanation was given or presented itself.

The English, Irish and Swiss strategies all had separate ‘action plans’ which chartered the progress of their strategies (usually about midway through the term of their fixed terms strategy). Some of the strategies also had implementation plans or accountability measures “built-in” through appendices.

This document has included the comparison of Germany’s “Fields of Action” document as a point of reference as it contains actions and commitments, and is an official publication of the Federal Ministry of Health. However, it is important to note that it is not a strategy or action plan per se. We have therefore referred to it as a “strategic document” throughout to acknowledge this distinction.

The distinction between a strategy and action plan is illustrated in the case of the Portuguese strategy. It is noted within the strategy itself that stakeholders involved in its drafting proposed the inclusion of more defined and specific measures in order to achieve the proposed commitment. In this instance, the stakeholders were told that this was not the suitable place to include such a measure, as the strategic document was solely to address high-level overarching priorities, with “regional action plans” the most suitable level for details around implementation.

Again, this section does not seek to advocate a specific approach to creating or naming a strategy, rather it intends to draw attention to the different status of dementia strategies, as well as the ability these documents have to change policy, practice and services, to improve the lives of people with dementia, their families and carers.

Resources and funding

As a final consideration, the status of the strategies, in some cases, is linked to the funding and available resources to implement the intended outcomes. Broadly speaking, the strategies can be broken down into four categories.

We know from discussions with some members that the lack of funding or dedicated resource has limited the implementation and realisation of the aims of some of the strategies:

  • Fully funded (resources identified and secured): Denmark.
  • —Fully costed (funding sources identified but not secured): Greece.
  • —Limited funding commitments for specific work: Some strategies (e.g. England, Finland, Germany, Netherlands and Norway).
  • —No information on costing/resources: All other strategies.

From discussions with member organisations, we are aware that in a number of circumstances there are strategies with no resources dedicated to them, making the process of achieving significant change within their societies and systems more difficult.

 

 
 

Last Updated: Monday 29 April 2019

 

 
  • Acknowledgements

    This report received funding under an operating grant from the European Union’s Health Programme (2014-2020) and from the Robert Bosch Stiftung. The content of the report 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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