This month, I’ve had more communications than usual from family carers. It’s a huge privilege, of course, when a family carer takes the time and trouble to get in touch to express their delight with the Butterfly Scheme: “It’s made a big difference, giving me confidence that he’s being looked after and everyone is aware of his needs,” was a particularly welcome message the other day – and not one I could ever have sent about my own mother’s hospital care.

I did, though, have two messages this month which, whilst very supportive of the scheme itself, were reporting situations where it hadn’t been fully delivered – and every team around the UK and Ireland does ask people to please let them know if anything can be improved upon; no matter how hard you try, there will be times and situations where – whether through staff shortages, individual team members who haven’t yet been trained or for a whole host of reasons – the care isn’t what we’d hope. Within the scheme we have a very clear philosophy: please tell us if anything can be improved upon, because we want to get this right.

The theme that ties together these three examples, though, is dementia care leadership. With the very positive messages, there is always excellent dementia care leadership; excellent dementia care won’t happen without it. When I talk about leadership, I refer not only to the hospital’s overall Butterfly Scheme / Dementia Lead, but also to those leaders at ward and team level, many of whom demonstrate phenomenal dedication and passion in their dementia care delivery. Great dementia care doesn’t happen by chance; it has to be led.

So, what about those cases where something wasn’t right? Does that mean the leadership was faulty? Interesting!

In one case, the absence of a great Lead who had not been substituted during her extended, planned leave had left her with a significant amount to catch up on when she returned – an uphill struggle which would not have been needed if leadership had been maintained during her absence. Can you imagine any other hospital leadership role not being covered during someone’s absence, though? Why do we still, time and time, again, witness dementia care leadership being seen almost as an aspiration in an ideal world, rather than an absolute necessity which directly affects the safety and well-being of at least 25% of the hospital inpatient population – and, alongside them, their carers, whose anxiety and well-being will be severely impacted by sub-standard dementia care? How can it still be possible in 2018 to overlook the need for dementia care leadership at all times?

In the other case, there was exemplary dementia care leadership in place throughout, but the problems being described stemmed from issues with the general care on one specific ward. The family carer did recognise that the care delivery problems were at ward level, but couldn’t know the anguish of the dementia care leadership team who were unable to get that ward’s dementia care to where they wanted it to be until its other problems were addressed. Even excellent leadership can’t override all issues – but I know it’ll kick into place as soon as that ward is in a position to receive it.

A job advert being circulated by a member Trust this week gave me hope: “This is a brand-new opportunity. We are looking for a motivated registered healthcare professional with proven leadership at Band 6 or above and a passion for person-centred dementia care.” Yes! Expanding the dementia care leadership team! Looking for someone who we know can really lead! Must have that passion for person-centred dementia care!

But what about the cost: can we afford such posts? The salary advertised was between £31696 and £41787 per annum. Getting dementia care wrong extends hospitals stays; as I demonstrate in all my teaching, there are many, many ways in which staff members can unwittingly extend someone’s length of stay by not getting dementia care right. If a hospital bed-night costs £400, let’s just think that through. My own mother once had a planned 5-day stay extend to 22 days – and that entire extension happened only because of well-meaning but inappropriate dementia care that covered a whole range of roles and issues. I’ll do the maths for you: that’s £6800 of additional care costs for just one person – potentially over 20% of the cost of a dementia care leadership salary.

I’m not interested in nominal dementia leadership roles. I’m not interested in be-dementia-lead-alongside-the-day-job roles. What we need – and can’t afford not to have – is dedicated dementia care (dementia care!) leadership teams, across all hospitals, continuously. As I know from the many shining examples I have the pleasure of working with, they make all the difference in the world.