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It is estimated that a third of people in the United Kingdom with signs of dementia are living without a formal diagnosis. In Wales, the proportion is nearly half. Some explanations for the gap between prevalence of dementia and number of diagnoses include living with a long-term partner/spouse and systemic barriers to diagnosis. This study recruited participants from the Cognitive Function and Ageing Studies-Wales (CFAS-Wales) cohort, randomly selected from people aged over 65 living in two areas of Wales, who met study criteria for a diagnosis of dementia and did not have a record of a formal diagnosis in general practice records. We aimed to understand more about the contexts and circumstances of people who live with and cope with cognitive difficulties without having a formal diagnosis of dementia. We conducted qualitative interviews with six participants and their spouses, and additionally with four family members of three invited people who were unable to take part. Themes were generated using thematic analysis. We present the argument that there is an adaptive response to low service levels and a complex interaction between the expectations of levels of service, perceptions of the legitimacy of cognitive problems and the right to make demands on services. This paper concludes that more could be done to address barriers to diagnosis and treatment services for those living with symptoms of dementia, but that the value placed on diagnosis by some individuals might be lower than anticipated by government policy.
The limitations of public policy can often be exemplified by high-profile scandals and news stories, which contain within them multiple policy failings. In 2017, that was the Grenfell fire. In 2018, it could be argued that it was the treatment of people from the so-called Windrush Generation – people who arrived from the Caribbean in the post-war era and were facing detention or deportation due to recent changes to immigration law. This exemplified the ‘hostile environment’ that had been a deliberate aspect of recent Home Office policy, and for many people, it was also linked to the broader rise of racist incidents that have been recorded since the 2016 Brexit referendum, as well as the rise of populist and anti-immigrant politics more broadly.
It is therefore timely that Andy Jolly's chapter, which starts this section, focuses on a related issue that has received much less attention in the public and academic debate: the treatment of people from what he calls the Air Jamaica generation, who came to the UK from the Commonwealth after the Immigration Act 1971. As Jolly explains, ‘families in the post-Windrush era did not come as British passport holders, but were “subject to immigration control”, with no recourse to public funds’ and thus risked becoming undocumented if they overstayed the length of their visa. He shows that children of this generation are often invisible in social policy discussions because they lack the legal right to paid employment and are subject to the no recourse to public funds (NRPF) rule. This excludes them from accessing welfare provision, including most social security benefits, council housing and homelessness assistance. The chapter draws on a unique empirical analysis of data relating to support under section 17 of the Children Act 1989, one of the few welfare entitlements that children and families with NRPF retain, finding that support varies widely and is ‘all but invisible’ in policy debate. Ultimately, he argues that without access to mainstream social security, section 17 is an inadequate safety net to prevent poverty. This, in turn, stems from discriminatory legislation and policy, resulting in a situation that can reasonably be called ‘statutory neglect’.
This book examines critical debates in social policy, including discussions on modern slavery, welfare chauvinism and the Grenfell Tower fire, to offer an informed review of the best in social policy scholarship over the past year.
Current policy emphasises the importance of ‘living well’ with dementia, but there has been no comprehensive synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We examined the available evidence in a systematic review and meta-analysis. We searched electronic databases until 7 January 2016 for observational studies investigating factors associated with QoL, well-being and life satisfaction in people with dementia. Articles had to provide quantitative data and include ⩾75% people with dementia of any type or severity. We included 198 QoL studies taken from 272 articles in the meta-analysis. The analysis focused on 43 factors with sufficient data, relating to 37639 people with dementia. Generally, these factors were significantly associated with QoL, but effect sizes were often small (0.1–0.29) or negligible (<0.09). Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health (including depression and other neuropsychiatric symptoms) and poorer carer well-being were associated with poorer QoL. Longitudinal evidence about predictors of QoL was limited. There was a considerable between-study heterogeneity. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
The recent plays of Martin McDonagh have fascinated and repelled critics for nearly a decade. His idiosyncratic blend of rural Irish mythology and ‘in-yer-face’ aggression has both caused consternation and won high praise, but the motivations and inspirations of McDonagh's work have not been widely discussed. Here, Catherine Rees addresses some of the common critical assaults on one of his most contentious plays, The Lieutenant of Inishmore (2001), and seeks to rescue the playwright from misunderstanding and heavy-handed critical treatment. She also aims to clarify some of the issues surrounding this politically charged and controversial work, and discusses it within the wider context of British and Irish drama. An earlier version of this article was given as a paper at the ‘Contemporary Irish Literature: Diverse Voices’ conference at the University of Central Lancaster in April 2003. Rees has presented on various aspects of McDonagh's work at a joint American Conference for Irish Studies and British Association of Irish Studies conference, and is currently working on a PhD about his plays at the University of Wales, Aberystwyth.
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