Call for improved dementia care

Care for people with dementia in England and Wales must be more co-ordinated, with better access to specialist services, a watchdog says. The National Institute for Health and Clinical Excellence also called for carers to be given access to counselling as part of its guidance.

But campaigners said the advice was being overshadowed by the decision to restrict use of four drugs. NICE said dementia care was not just about giving drugs to people. The recommendations, produced in conjunction with the Social Care Institute for Excellence for services in England and Wales, cover the whole spectrum of services from day centres to access to consultants.

It said there should be a co-ordinated and integrated approach to allow referral across the health and social care divide. NICE also said there should be better access to scans and memory assessment services - specialist clinics led by consultants - to help improve diagnosis and treatment.

And the watchdog warned people with dementia should not be excluded from other non-dementia health services just because of their condition. Carers were also recognised in the guidance. There are thought to be 1m carers helping to look after the 750,000 people with dementia - over half of whom have Alzheimer's disease.

NICE said carers should get their needs assessed by health and social care professionals and be given access to a variety of support including psycho-therapies.

But campaigners criticised the "confusing mess" after guidance also restricted the use of drug treatments at the same time - a move widely known of in advance. The watchdog is facing a legal challenge over its decision to deny people with early or late-stage Alzheimer's disease access to donepezil (Aricept), galantamine (Reminyl) and rivastigmine.

A fourth drug, memantine (Ebixa), is to be used only in clinical studies of people with moderately severe to severe Alzheimer's disease. Two companies - Eisai and Pfizer - have notified NICE that they intend to seek a judicial review of how the decision was reached. NICE has until 28 November to respond to the companies before they decide whether to push ahead and take the case to court.

Alzheimer's Society chief executive Neil Hunt said: "On the one hand the health body is moving to improve care and services for people with all types of dementia, and with the other snatching away the only drugs that can provide them and their carers with a hugely improved quality of life. It's not about care or treatment, people with dementia have the right to both."

But NICE chief executive Andrew Dillon said dementia care was not "just about giving people drugs" and the guidelines gave the "best attainable care for people with dementia".

Ray Tallis, emeritus professor of geriatric medicine at the University of Manchester, said: "I welcome the fact that they have looked beyond a very narrow focus on drug treatments whose benefits are marginal to the broader issues that will really make a difference to the quality of care."