Carers of people with dementia have a hard time; not only do they have to contend with the illness but they also receive limited support and poor services. A recent UK parliamentary committee report criticised the whole range of dementia care.1 It highlighted poor diagnosis (only a third of people with dementia receive a formal diagnosis), fragmented home support, untrained staff in care homes, and a failure to recognise or manage dementia in general hospitals. This leaves difficult decisions for those redesigning services. Who will offer long term support? What will be the role of the voluntary sector? In the accompanying paper, Charlesworth and colleagues tackle these questions in a randomised controlled trial of a scheme for befriending carers of people with dementia.2

Carers have high rates of anxiety, stress, and burnout. Their life expectancy is reduced, and up to a third of carers of people …