Published by Daily Mail
The disease reduces the victim to a shell of humanity, emptied of all joy, emotion and recognition. As cognitive ability declines, so too does the memory, the capacity to feel, dexterity in language and the intelligence to reason. Tears give way to mourning; despair to grieving for the living. Loved ones become strangers; relationships are turned to shadows. It is a dreadful affliction; terrifying for the victim, and profoundly distressing for all around to witness.
There is no prevention and no cure. Dementia is an inescapable and irrecoverable destiny.
Which is why it’s a little odd that the Department of Health tried to make it a contractual obligation upon GPs to be proactive in the timely assessment of patients who may be at risk from the illness.
In expert finger-wagging mode, Health Secretary Jeremy Hunt announced: “Getting patients an earlier diagnosis of dementia and supporting those with long term conditions are my main priorities. I want GPs to take the lead in making this happen.”
And so, from 1st April 2013, the nation’s GPs were instructed (on pain of financial penalty) to embark upon a mass programme of assessment and examination of all those who are deemed ‘at risk’ of developing the condition. You may have been a perfectly healthy and remarkably active 60-year-old, without any neurological symptoms or memory problems at all. But the Health Secretary urged your local friendly surgery to inform you that, with regret, you may be prematurely doomed to senility.
As if torturing the elderly with this hysteria were not enough, GPs have spent three months writing to all those who have a family history of dementia; those with Down’s Syndrome; those who smoke or drink large amounts of alcohol; atherosclerosis sufferers; the obese; those with learning difficulties; and the millions of us with high blood pressure, high cholesterol levels, diabetes or depression.
The number of ‘at risk’ patients is longer than any NHS waiting list: it is estimated that as many as 2.4 million people fall within these categories, and Jeremy Hunt wanted all suspects dragged down to their local GP’s surgery and assessed for the fatal signs of mental decline.
Bizarrely, the proposal was to link fund-holders’ payment to the number of assessments a practice carried out, with the obvious inherent enticement for them to discover herds of ‘at risk’ individuals in every flu outbreak. The BMA had to make the (rather obvious) point to the Secretary of State: ‘Practices should never come under pressure to assess patients for dementia who may not ultimately warrant or benefit from assessment.’
Fortunately, the Department of Health has finally seen sense on this, after three months of combative GP harassment. Now, instead of screening en masse for random ‘case finding’, doctors are encouraged to make ‘opportunistic offers’ of dementia assessment where they consider it appropriate to make such an offer.
This is an undoubted improvement, but the ethical argument and clinical benefits are still not clear. What is the point of increasing dementia diagnosis without improving the requisite support services available locally? What is the point of alarming a patient if they then have to wait months to get into a memory clinic?
Those who undergo the health check and pass with flying colours will be told that they remain ‘at risk’, and so must be reassessed at regular intervals. It is a life-long oppression from which there can be no mental convalescence.
And for those who manifest the early symptoms, there is absolutely no cure, and (pace ‘Big Pharma’) no substantially effective treatment. The moment memory loss is detected, the sickness is well-advanced and you’re down to your last spare set of brain cells. The decline thereafter is inexorable, unyielding and cruel.
In such circumstances, the compassionate GP would usually have waited for the patient to mention the symptoms, and then, with gentle reassurance, they would have been told that it’s nothing to worry about; it’s just a natural part of growing old. Now, attending practitioners must follow up their ‘opportunistic offers’ with testing and re-testing which will inevitably induce agitation and anxiety in their patients, who will then be prescribed pills that don’t work.
This isn’t local healing or devolved trust: it is state-induced anguish.