More than a decade ago the Royal College of Physicians warned too many care home residents with dementia were spending their final months and years in a state of suspended consciousness occupying a half-world, waiting for death to come. It highlighted the use of the "liquid cosh" – the practice of keeping challenging residents of old people's homes quiet and easy to manage by prescribing high doses of anti-psychotic drugs.
Twelve years on from the original report, ministers belatedly announced an action plan to tackle the problem after an independent review estimated 180,000 people with dementia were receiving powerful cocktails of drugs, three quarters of them inappropriately. This is the background to yesterday's report by the National Audit Office which found dementia services in England are not being given the priority they deserve. Nothing better illustrates the truth of that conclusion than the persistent drugging of our most vulnerable elderly people.
The NAO warns that the Government's dementia strategy, published last year, praiseworthy though it is, will not be worth the paper it is written on unless it is backed by genuine commitment. That commitment is lacking as shown by the Government's failure to make dementia a national priority, alongside other priority areas such as cancer and heart disease.
Ministers insist it is still early days – the strategy was only launched last February – and that change will happen. But it is not clear how the £150m allocated to NHS trusts to support the strategy over two years is being spent, or even if it is going into dementia services, according to the NAO. Up to two thirds of dementia sufferers still never receive a formal diagnosis of their condition because of stigma, the negative attitudes of GPs and a lack of urgency attached to diagnosis. They are unnecessarily admitted to hospital, stay longer and are prematurely referred to residential care because of a lack of specialist community support.
The scale of the challenge is immense – an estimated 600,000 people in England have dementia and the number is expected to double in 30 years. But if we cannot get their care right now we will reap the whirlwind in the decades to come.