Jobbing Doctor watches as the Government attempts to repair the sad state of dementia care in this country
Dementia is going to become an increasingly important aspect of the health of our country. As a jobbing doctor, I see the effects of this difficult condition every day in my clinical practice.
Surprisingly, it does not seem to affect the people who suffer this illness very much, and they often stay physically robust. The major effect I see is on the families of the person with the illness.
I applaud the fact that there is a report from the National Audit Office (NAO) reviewing Government strategy in this area. But as is entirely typical of this current administration, they have opted for the eye-catching initiatives to address the problem, and as a result are unlikely to see much change in provision of effective services of those with dementia.
One of the most baleful experiences in virtually every GP’s life is to visit some of the private residential homes where many of these people will end up. There is a constant changeover of staff, most of whom are entirely unqualified and are paid at the minimum wage permitted (which is less for 16 and 17-year olds, so they are often employed in place of older and more experienced staff). It is unusual to be attended to by anyone qualified, and those assisting the doctor often do not know the patient, or why you have been summoned.
Often you are ushered into the common room where everyone is sitting in arm chairs, arrayed around all four walls with the blasting out of daytime television, which drowns out anything you can elicit from a history and examination. This is my only contact with Loose Women, Diagnosis Murder and (direst of the lot) Doctors. Despite the development of Dignity Champions (another very New Labour idea) there seems no dignity in this whole experience.
I think we all recognise that the care of those with dementia is patchy, and the Care Quality Commission is investigating one of our local residential homes at the moment (and it is by no means the worst).
The Government has rightly acknowledged the great problems here, as outlined by activists like Terry Pratchett, and have put together policy. One of their suggestions is that we should have a memory clinic in every town. This is so people can be referred to ‘specialists’ so that they can get an early diagnosis.
Dementia is actually one of those conditions where I feel that an early diagnosis is neither necessary nor helpful. Firstly, because in the early stages dementia can be confused with other illnesses, such as depression. Secondly, the diagnosis is (in my view) is so dire and life-changing that it should not be made unless the condition is observed over a period of time by someone who knows the patient. Thirdly, early diagnosis does not result in any different outcome. Current treatments are, frankly, marginal.
Our local PCT (which is in the process of re-badging itself on the instructions of the Government from Dullsville Primary Care Trust to NHS Dullsville) has actually circulated some of the local doctors to see what we feel about spending money on this idea. The response from my colleagues is to say that it is irrelevant, unnecessary and the money should be spent on more important priorities. This was some of the politer responses.
So we have the NAO saying things are not working that well, and NHS Dullsville wanting to set up a pretty useless memory clinic in every town (Dullsville actually consists of 3 towns, so that is 3 clinics).
Jobbing Doctors just sit back and observe ‘car-crash’ policy making.