Richard Smith: what use are memory clinics?

Richard SmithThe government’s dementia strategy, which promises a memory clinic on every corner rather than a chicken in every pot, is not working. That’s not surprising as it’s the easiest thing in the world to come up with grand sounding strategies but one of the hardest to get them implemented. As the economist Alan Maynard says, the NHS does 8/10 for bright ideas but 4/10 for implementation—and without the implementation you have nothing but empty promises, which are worse than no promises.

But is a memory clinic on every corner a good idea? I’m doubtful.

My lovely and amusing mother has had no short term memory for about three years now, and sceptical as I am of many medical benefits I thought that we ought to “get into the system.” So we started with the GP. Despite the fact that the man in the corner shop could tell you in about two minutes that she has no short term memory, the GP had to administer a standard questionnaire. Unfortunately, he didn’t have time for the full questionnaire—so asked us to come back after some blood tests.

Every time my mother and I engage with the NHS I have to drive from London to her town—let’s call it Elysium–some 40 miles away. Usually when I visit I go by train, but I need the car to transport her to the various clinics, some of which are 10 miles from Elysium. So the climate suffers.

We have to go the branch clinic of the surgery if we want a blood test in under three weeks. So I drive down, drive her to an obscure corner of Elysium, and she has the blood test. 

Two weeks later I drive back to Elysium and we go to the GP. Surprise, surprise nothing is abnormal in the blood tests. Unfortunately he doesn’t have time to do the full questionnaire, but it’s obvious she’ll need to go to the memory clinic—so he refers her.

But first she needs a CT scan. “Is all this worth it,” asks my mother who’d prefer never to see another doctor or nurse as long as she lives. “Well it might help keep you living on your own for as long as possible,” I answer without much conviction.

More than half a century ago she lugged me screaming to the fracture clinic at King’s College Hospital. Now I’m lugging her. Neither of us liked either visits, but we enjoy the symmetry of the relationship and “we ‘ave a laugh.” There’s lots to laugh at.

So a month later it’s back for the CT scan, which is in another hospital 10 miles from Elysium.
Six months later we have our first visit to the memory clinic in yet another town. We see a charming occupational therapist who takes a very full history and declares this to be a prelude to seeing the psychogeriatrician.

Another six months pass, and we see the psychogeriatrician, who is kind and helpful. He tells us that the CT scan is mostly normal with “a little scarring.” He’d now like some psychological tests. My mother hates the whole experience.

We the have an interlude while my mother has her hip replaced. A striking feature of these encounters is the staff giving my mother elaborate instructions without grasping that she has no short term memory—despite me saying “My mother doesn’t have very good memory.” Maybe I should have been blunter.

After another year we are back on the memory clinic treadmill, and we go back for my mother to have a whole swathe of psychological tests. They take about two hours, and she hates them.

We wait a month or so (to be honest I’m forgetting the sequence, but it’s about three years overall), and then we go back to see the psychogeriatrician. The psychological tests show my mother has very poor short term memory and is not well oriented, but her language skills are good. I knew that. Crucially, she’s just under the NICE cut off for drug treatment, but the psychogeriatrician is willing to prescribe the drugs anyway. My mother and I have had many conversations about whether she should take drugs.

“What’s the point of all these visits? What can they do?” she asks.
“They could prescribe you some drugs that might help.”
“But they won’t improve my memory.”
“No, but they might stop it getting worse.”

She’s not keen on the drugs, and I’m very doubtful that they’ll make much difference, but I’m falling victim to the disease of “needing to do something.”

So we take the drugs—which in itself involves another trip because Elysium Boots doesn’t have enough in stock. We stick notices up on the wall about when to take the drugs. It’s obviously a philosophical problem getting somebody to remember to take drugs for poor memory.

Predictably after about a month it becomes apparent that she’s not taking them—and I see that she never wanted to take them. I’d pushed her into umpteen tests and visits to clinics at considerable cost to the NHS for no benefit at all.

I ring the memory clinic to say thank you but we’re signing off. They are happy to have us a back if and when we need more help—but what will they do?

I can’t help thinking that maybe the government would do better to spend the money it appears not to have for memory clinics on opera or something with tangible benefit. The one overall benefit of all these visits is that my brother is developing a stand up routine around memory clinics, which are intrinsically comic. “You get there, and it’s empty. Everybody has forgotten to come.”