When the Health Secretary stood up in the House of Commons at the end of February to declare that ‘some GPs still think that it is not worth diagnosing someone with dementia’, I am sure that he had more illustrious members of our profession than me in mind.
Given that former RCGP president Iona Heath and award-winning writer Margaret McCartney are among the dissenters raising concerns about the Government’s proposals to screen for dementia, I am in good company when I add my name to the list.
Accusing healthcare professionals of nihilism in the debate on dementia has become one of Jeremy Hunt’s favoured tactics as he seeks to defend his policies. In the same Health Questions session, he accused GPs of ‘a lack of understanding that we absolutely have to put right’ – providing the rather amusing image of the Secretary of State calling Drs Heath and McCartney to stay behind after class for extra lessons on how to care for someone with dementia. Since Mr Hunt believes that dementia drugs can ‘help stave off the condition for several years,’ and ‘private sector companies…know that the size of their potential market of people with dementia is huge,’ we must wonder where his own lessons on the subject are coming from.
If, when I am accused of believing it is not worth diagnosing someone with dementia, we mean that I believe that a diagnosis of dementia followed by a staggering lack of real, practical and emotional support may sometimes be worse than no diagnosis at all, then I am guilty as charged.
If it means believing the priority in dementia care is to improve hands-on support for those already diagnosed, rather than to drive up diagnosis rates arbitrarily, based on questionable estimates – guilty as charged.
If it means standing up to oppose a population-based screening programme that is being rolled out nationally through the proposed dementia DES, without any analysis of benefits and harms and against the current evidence base – guilty as charged.
If it means believing that informed patient consent must be central to any screening programme (or ‘case-finding’, if we must use that politically convenient term), and that ambushing our elderly with questions about their memory when they have attended for something different amounts to bad medicine, then guilty as charged.
The Government seeks to portray those who oppose their plans as ‘the usual suspects’: a group of ignorant, obstructive and backward looking GPs in need of retraining.
What they choose to ignore, however, is the broad church of those who have voiced concerns. When I joined a collaborative group in writing to The Telegraph over the plan to test all over 75-year-olds for the early signs of dementia, the list of fellow dissenters included Sally-Ann Marciano and Beth Britton, both of whom lost their fathers to dementia in 2012.
Their views cannot be so easily dismissed, since they are the very people the Government claims to be helping with their proposals, and their personal experience of caring for a close relative with dementia gives them an authority to speak on the subject which many so called health experts lack (including myself).
Beth in particular would be expected to welcome steps to screen for dementia, since her father’s diagnosis did not come until nine years into a 19-year journey. But as you can see from her excellent blog, she is all too aware that what matters to a family affected by dementia is not a label, but meaningful care.
Even this week the list of candidates for Jeremy Hunt’s remedial classes in dementia care has grown longer with the publication of a letter in the British Medical Journal by Carol Brayne, professor of public health medicine at Cambridge, calling for an evidenced-based approach. The list of co-signatories to this letter is impressive indeed, spanning psychiatry, geriatric medicine and social work as well as public health.
The Health Secretary must be wondering to himself how he can possibly re-educate us all – the scale of the task is increasing every day. He won’t be daunted by it, however, for he has a solution ready to hand that can be applied to any difficult situation – he’ll get the private sector in to do it for him.
Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.