“Our society overvalues youth and undervalues older adults. There is an assumption that if you are old, frail, and especially if you have dementia then you cannot possibly have good quality of life – this is simply not true. People with dementia themselves and the families that support them perform everyday miracles of creative adaptation to enable them to live well with dementia. Health and social care services have a duty to support them in making these miracles happen.”
From conducting nationwide trials on drug effectiveness, to championing dementia as a national and international health and social care priority,
Professor Sube Banerjee MBE has committed his working life to improving outcomes for older people with dementia and their families by improving the quality of care they receive.
When he started in psychiatry, he had no doubt that he would become a child psychiatrist. However, a placement on the training rotation with an inspirational multidisciplinary community mental health team for older adults changed his plans completely.
“I wasn’t looking forward to my placement in old age psychiatry. When you trained in medicine in the 1980s the care of older people was seen as very much the bottom of the pile and old age psychiatry was very much the Cinderella of Cinderella subjects. But when I met the patients, it became clear that they had all the best stories, and the work was a fascinating interplay between physical and mental health and between health and social care.”
His passion for working with older people was also fuelled by a sense of injustice that there was a lot that could be done to help them that was not being done. Working with the team and their clients, his understanding of the need for patient-centred care, and the multiple factors affecting older people’s wellbeing – biological, psychological, and social – grew. The team’s true multi-disciplinary approach was decades ahead of its time.
I was lucky enough to become part of a real multi-disciplinary team where traditional hierarchies had been abandoned. For example, the team was not led by the consultant old age psychiatrist but a senior Occupational Therapist. The other team members, nurses, social workers and others, brought so much to the table; we delivered more and better care together than we ever could have done separately.
He never did get to do child psychiatry.
The belief in the value of team working as the solution to the challenges of 21st Century health and social care drives his current work. The
Plymouth Integrative Health and Social Care Education Centre (PIHC) at the University of Plymouth enables students across the Faculty of Health to learn with and from each other, identifying and building synergies between health professional training courses, ultimately aiming to lead to better outcomes for their future patients.
While training as a psychiatrist, Sube saw the value of research to help improve clinical outcomes for older people. He began his research career working with local authority home care services in Lewisham, identifying high levels of depression and dementia and low levels of recognition and treatment. This led to a fellowship on the treatability of depression in the disabled elderly clients of home care services. The data, published in the BMJ, showed that therapeutic nihilism in this group was baseless.
On completion of his fellowship, he was appointed as a Senior Lecturer at the Institute of Psychiatry in 1996 and as Professor of Mental Health and Ageing in 2003. Clinically he worked as an honorary consultant at the Maudsley and then as Clinical Director of its Older Adults service. He generated and evaluated novel models of service delivery including memory assessment services. This innovation led to his secondment to the Department of Health (DH) as its senior professional advisor in older people’s mental health and dementia in 2004, where he made the case for dementia being a national health priority and was subsequently appointed to co-lead the development of the National Dementia Strategy for England, carrying out the largest consultation delivered by the DH, ultimately identifying three key areas for action:
- Improving public and professional attitudes to and understanding of dementia
- Enabling early diagnosis and treatment
- Improvements in care provision from diagnosis through to end of life
This work has stood the test of time and has been internationally influential, with Sube working with the World Health Organisation on international dementia policy. He led the UK ministerial enquiry into the use of antipsychotic medication in dementia which resulted in the use of these medications being more than halved, saving the lives of an estimated 1,000 people with dementia. He has continued to champion improvements in quality of care leading influential NIHR-funded trials, published in The Lancet showing that commonly used drugs to treat depression (HTA-SADD) and agitation (SYMBAD) do not work and cause significant adverse effects.
In the last decade his work has come to include the role of education in preparing the next generation of healthcare professionals for the challenges of an ageing population. He describes as ‘one of his proudest achievements’ the
Time for Dementia initiative. This sees nursing, health professional, and medical students paired with a family affected by dementia, visiting that family every three months for two years, and enables them to see the world of health care from the viewpoint of the families. To date over 5,600 students and 1,600 families have taken part. It is being rolled out across England and is already part of the curriculum for Plymouth’s medical and mental health nursing students.
“It’s invaluable because students get to see health systems from the point of view of that family, experiencing both the positive and negative. Our students are taught about how the system manages the old and frail by those who know best – the older people themselves.”
Balancing research, clinical care, and policy work with his leadership role at Plymouth, it’s clear that a patient-centred multi-disciplinary approach to his work is something that is ever present and a passion within his life.
“It’s great to have variety, and the most important thing is that each activity feeds the effectiveness of the others. I knew I wanted to help people with dementia and their families as there was so much to be done, and I keep that at the heart of the work I do with students, patients, and beyond.”