Tag Archives: care home

End of the chemical cosh long overdue

Finally. Here is a government announcement that is years overdue: the use of anti-psychotic drugs for people with dementia must be cut by two-thirds by November 2011.

After many years of campaigning by carers, patient groups and some in the medical profession, the government has finally taken action – something the previous administration should have done years ago.

Prescribing anti-psychotic drugs to people with dementia who have behavioural problems – also known as the ‘chemical cosh’ – has long been a scandal with health and social care. Newspapers have regularly carried stories on loved parents who have been turned into “zombies” by these drugs, usually administered against the family’s wishes.

What is more surprising to me is that evidence of the harmful effects that these drugs can have on people with dementia – including shortening their lifespan – has been available for some years, yet the practice continued unabated. The simple fact that they are not licensed for long-term use by people with dementia should give a clue here – if they had benefits for the majority of people, then surely there would be recommendations to prescribe them. Seems blindingly obvious, you would think.

While anti-psychotics do benefit a minority of dementia patients – hence why there is not a complete ban – they are often prescribed for their sedative effects on people with dementia with challenging behaviour.

This is where the biggest change needs to come; in the culture of dementia care. There is still an over-reliance on drugs – from GPs and care staff – and this has to be challenged, and this directive will give much-needed focus to it.

But it is no good just cutting out anti-psychotic drug use. What also needs to happen is an increase in training for carers, care home staff etc in dementia and its effects, and in non-drug related treatments and therapies, such as reminiscence therapy, that can help people with dementia.

I know of several dementia care homes that pride themselves on being ‘drug-free’ (within reason) and there is no reason why this shouldn’t be an industry standard. As usual, best practice is out there and it needs to be disseminated better. Good practice needs to be shouted from the rooftops and demonstrated at seminars, conferences and in magazine articles and journals.

Finally, a bit of credit where credit is due: Paul Burstow has made good on the commitment he made while in opposition to tackle the anti-psychotics issue.

Indeed, while the government has come in for heavy criticism for its social care policies and proposals in recent weeks, this is one policy they should be congratulated on. Now it is up to GPs, care home staff and carers to make good on this.

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Filed under adult social care, dementia, Mental health, social care

When free social care isn’t really free

Continuing my recent theme of social care funding (or lack of it), this story from the Financial Times website on Sunday – and oddly, not really picked up by anyone else – caught my eye.

In it, Lord Lipsey and Lord Joffe – 2 former members of the Royal Commission on Long Term Care – attack Gordon Brown’s plan for free personal care for all. They claim it would create ‘perverse incentives’ for people to stay in their own home, where they would have care for free, rather than going into a care home, where they would have to pay.

While these 2 have form here – their 1999 minority report rejected the Royal Commission’s proposal for free personal care, for instance – they do have a valid point.

In Scotland, where there is already free personal care (it isn’t totally free, as some think, but that is another blog for another day) the costs of it have far outstripped the initial estimates and there are fears over the sustainability of the policy.

The government reckons this policy would cost £670 million, but given the Scottish experience it could be far higher and, given the state of public finances currently, I’m struggling to work out where the money would come from without affecting other services.

Cynics might say that the policy is just an attempt to win votes at the next election – it is said that it was dropped into Gordon Brown’s conference speech at the last minute – but if it works, it could have adverse consequences for other social care services, something they can literally ill afford.

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Filed under Social care funding