In the “war against dementia”, where are our “boots on the ground”?


In my quest for knowledge about what is working and what isn’t working in dementia service provision, I often ask Agnes Houston MBE for advice.

“Scottish allied health professionals are brilliant!”, she once said.

Agnes, herself living with dementia, is in a good position to evaluate how good service provision has been in Scotland. This brings up to date the old adage from Sir William Osler, “Always listen to your patient“.

Of course, things have moved once since Osler’s day. Patients using the NHS when they’re ill also aspire to live in healthier times as a person in the community.

In September 2012 the organisation of International Chief Health Professions Officers (ICHPO) provided an agreed definition of an Allied Health Professionals:

“Allied Health Professions are a distinct group of health professionals who apply their expertise to prevent disease transmission, diagnose, treat and rehabilitate people of all ages and all specialities. Together with a range of technical and support staff they may deliver direct patient care, rehabilitation, treatment, diagnostics and health improvement interventions to restore and maintain optimal physical, sensory, psychological, cognitive and social functions.”

After my own coma due to meningitis in the summer of 2007, I could not walk or talk. I could not make a cup of tea, let alone plan a shopping trip in a local supermarket. With the help of a superb physiotherapist and occupational therapist in the neurorehabilitation ward of the National Hospital for Neurology and Neurosurgery, I was able to relearn from scratch these skills. I had in fact been a junior doctor there.

I think it’s easy to get wound up in processes in policy to do with allied health professionals, and only to view them within the never-ending prism of ‘vanguards’ or ‘new models of care’, but anyone with reasonable clinical experience will know of their pivotal importance in healthcare.

That is not to say we should overlook the opportunity of how they can operate in the community, including primary care settings, hospitals, hospices, and care homes, best to promote continuity of care and wellbeing. The driving force for this might indeed be reducing the ‘financial gap’, but my perspective is very much on reducing the ‘wellbeing gap’.

Today brought very conflicting news internationally. On the one hand, the UK Government were able to secure from parliament a mandate for bombing ‘ISIS’/Daesh in Syria with military air strikes. On the other hand, it was the International Day for Disabilities in celebration of enabling people. I have written about the latter issue here already.

At first, it might seem the military analogy of dementia might have a lot going for it. For example, a Doctor from a distance might authorise a prescription of a cholinesterase inhibitor, at a comparable distance in the air for a military strike. It is not clear what the borders of dementia are, in the same way geographical boundaries in Iraq/Syria have been argued to be poorly described. There is a need to form a geographical coalition to defeat Daesh, in the same way that countries around the world, including the G7, are “defeating dementia”.

But are the foot soldiers, indeed, “allied health professionals”? If the enemy is dementia, these foot soldiers in the absence of an outright cure thus far or effective sustainable long term treatment are potentially encouraging people to co-habit with the enemy.

So there are clearly limitations with the military analogy.

But the foot soldiers can give people with dementia the ‘tools’ to function well, such as access to exercise or assistive technologies, broadly in keeping with a reablement or rehabilitative approach for any long term condition; or they may come in the form of Admiral nurses to empower carers with coping strategies.

So what’s the problem?

We don’t have enough of these ‘boots on the ground’ for dementia.

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