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Will the dementia DES benefit patients? No

People with dementia, their families and carers urgently need better support. All too often, all they experience is stigma.  New case finding as proposed by the dementia DES will divert already limited resources away from those most in need. It will alarm many by also detecting cases of mild cognitive impairment, which may never progress to dementia.  It will raise false hope for medical treatment even though the benefits of current drug treatments are small. It has the potential to alert commissioners to the scale of the problem and benefit a small number of patients slightly but at the cost of harming both the most and the least sick.

This proposal is reminiscent of the Royal College of Psychiatrists’ 1992 Defeat Depression Campaign. Far from relieving the suffering of vast numbers hitherto hidden, many people with milder depression which would have been self-limiting were medicalised. Meeting the demand thus generated stretched services and diverted resources from those most in need.  Prescription of antidepressant drugs soared, even though the evidence suggests their benefit is small, particularly in mild to moderate depression and many people suffer side effects and discontinuation reactions. Pharmaceutical companies benefited, but did patients?

If adequately funded, one could imagine a DES which provided patients with more support (such as dementia nurses) in the primary care setting and encouraged closer working between GPs, nurses, social workers, mental health workers, patients, their families and carers. The funding associated with this proposed DES is not adequate to meet these needs and will harm a great many.

The number of people with dementia is set to grow and as a society, we must put in place resources to meet their needs. Deciding how to fund social care, improving provision of mental health care and nursing in the community, integrating health and social care and continuing to look for effective interventions would help. But simply finding more cases will not.

Dr John Cosgrove is a GP in Birmingham.

In favour? Click here to read the argument in favour.