NICE emphasises social care for people with dementia

BMJ 2006; 333 doi: (Published 23 November 2006) Cite this as: BMJ 2006;333:1085
  1. Michael Day
  1. 1London

    Joint health and social care guidelines have been published aimed at integrating the care of the 700 000 people in England and Wales with dementia and their carers.

    The report by the National Institute for Health and Clinical Excellence (NICE) and its social services equivalent, the Social Care Institute for Excellence (SCIE), aims to boost services that are currently dogged by lack of coordination between hospitals and community care.

    Andrew Dillon, the chief executive of NICE, said the guidelines, which were the first his organisation had produced with the social care group, “demonstrated the real importance of health and social care professionals working closely together.”

    The guidance, which covers the full range of medical, psychological, and social treatment, recommends that memory assessment services should be the single point of reference for all people with a possible diagnosis of dementia. It also says that people with dementia must not be excluded from any recommended services because of age or learning disability. In addition, £20m (€30m; $40m) should be set aside for the psychological support of carers.

    Tim Kendall, a consultant psychiatrist and the joint director of the National Collaborating Centre for Mental Health, said: “I think this guideline is a real asset to NICE and SCIE and will lead to huge improvements in dementia care throughout England and Wales.”

    However, the guidelines also include NICE's highly controversial ruling that excludes more than 50 000 patients with Alzheimer's disease from NHS treatment with cholinesterase inhibitors.

    Patients' groups and professional associations reacted with fury last month when NICE announced that it would not relax its ruling on the drugs for people with mild or advanced disease (BMJ 2006;333:774).

    As a result, from this week patients with a new diagnosis of Alzheimer's disease will be able to get the drugs through the NHS only if they have moderate disease.

    Mr Dillon denied that the timing of the new joint guidelines for patients with all types of dementia was designed to deflect attention away from the ban.

    Neil Hunt, chief executive of the Alzheimer's Society, said, “By releasing these guidelines today, NICE is trying to cynically cloak its flawed evaluation of Alzheimer's drug treatments.

    “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 [it is] 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.”

    He added: “It would be a tragedy if many of the positive recommendations made in today's guidelines are overshadowed by NICE's devastating decision on Alzheimer's drug treatments.”

    Ray Tallis, emeritus professor of geriatric medicine at the University of Manchester, said: “I welcome these guidelines and in particular 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—and hence the quality of life—of people with Alzheimer's.”


    • Dementia: Supporting People with Dementia and their Carers in Health and Social Care is at