FORMER headmaster Ivan Garnham was looking forward to his retirement. He and his wife, Hilary, had been keen fell walkers throughout their long marriage and with her own retirement coming up, both of them planned to get out on to the hills and dales of North-East England as much as possible.

But a few years after Hilary retired from her position as a lecturer at New College in Durham, something odd happened.

"She suddenly lost confidence in driving. She had her own car but didn't want to drive it anymore," recalls Ivan, who was head teacher at Tanfield Lea Primary School for more than 22 years.

"There were other odd things about her behaviour which I suppose I put down to absentmindedness."

As time went on, Hilary's behaviour became more and more erratic and out of character.

"She developed an obsession with needles... then the hallucinations started," he says.

Hilary, a mother of four grown-up children, told Ivan she could see imaginary children around the house.

Then she started asking Ivan who he was.

"The hallucinations were just frightening and then she started asking me who I was... and I had an awful job trying to persuade her that I was her husband," says Ivan.

Hilary also became confused, angry and - at times - aggressive.

As his wife's behaviour continued to deteriorate, the couple - who live near Stanley - were referred to a specialist at Shotley Bridge Hospital. Tests showed that Hilary had the early stages of vascular dementia, a form of degenerative brain disease similar to Alzheimer's disease. To try to calm Mrs Garnham down, a consultant prescribed a drug called Aricept.

Within weeks the situation had changed beyond recognition.

"Things improved enormously. Hilary became much calmer," says Ivan. "The drug seems to take away the anxiety and fear which dementia patients have."

Since his wife was diagnosed with dementia, Ivan has become a strong supporter of the Alzheimer's Society charity.

Hilary regularly attends a local day centre run by the society, giving Ivan a much-needed break from 24-hour care at their home.

Life is tough for the 79-year-old - who admits that the strain of looking after his wife is "hammering" him - but what really gets him going is the recent guidance from the National Institute for Health and Clinical Excellence (Nice) which will mean that tried and tested anti-dementia drugs will be denied to NHS patients.

Despite protests from charities, doctors, nurses and more than 9,000 individuals - the biggest ever response to a consultation - Nice has ruled that three dementia drugs (Aricept, Exelon and Reminyl) should only be funded by the NHS for people in the moderate stages of the illness.

Ivan is incandescent with anger that the drug which had such a calming effect on his 70-year-old wife in the early stages of her illness is to be denied to others.

Just as bad is Nice's recommendation that the NHS should not fund the drug Ebixa in the late stages of dementia, despite the Alzheimer Society's concern that it is the only effective drug available to patients in this category.

"Doctors are now going to have to tell people that they will have to suffer even more before they can be given these drugs - you can come back to me when things are really bad. It is totally wrong," Ivan says with feeling. He is also astonished at the Nice guidance on Ebixa,which is relevant as his wife moves towards the late stages of dementia.

"Anyone who knows anything about dementia knows that the later stages of this illness are awful," says Ivan. "My wife is moving into that area now. To think there is going to be nothing for her is just frightening."

Ivan agrees with the Alzheimer's Society chief executive Neil Hunt who has appealed to the Government to take a broader view of the cost of dementia care.

Last week, speaking to Alzheimers Society supporters in Northallerton, Mr Hunt said: "We need to see these drugs not as a panacea, but as part of a proper care plan for people with dementia."

Like Mr Hunt, Ivan Garnham believes that restrictions on drugs at the earlier and later stages of dementia will cost the NHS and social services dear.

"As carers in our homes, we are saving the NHS a tremendous amount of money. This new guidance will lead to more people being cared for by the state. Instead of keeping them at home they will have to go into care of some sort," says Ivan.

Unlike Scotland, where social care is free, Ivan fears that people like him - who have worked hard all their lives - will end up spending their savings on private care which should be provided by the state.

Ivan doesn't claim to be an expert on dementia, but his strong views on the Nice guidance are shared by one of the country's top consultants in this field.

Dr David Anderson, who chairs the specialist Faculty of Old Age Psychiatry with the Royal College of Psychiatry, is blunt: "We think it is a terrible decision. It is wrong for moral reasons but it is also wrong because all the dementia experts in the country believe it is based on a flawed process which is fundamentally wrong."

Dr Anderson, who represents around 600 specialist old age psychiatrists around the UK, said he did not know of a single dementia expert in the country who agreed with the Nice guidance.

"Nice says you don't get a return from treating early stage patients, you only get a financial return when you treat the more distressed, disabled middle stage of the disease and you hold them longer at that stage," says Dr Anderson.

But to the Liverpool-based hospital consultant, this is like saying you won't treat someone in pain until it gets unbearable - because you then get better value for your money.

"There are lots of scientific data - and Nice accepts this - that the benefit in terms of mental functioning is just the same in the early stage as it is in the middle stage," he adds.

"It is complete anathema for doctors not to treat illnesses at the earliest opportunity."

The consultant, who works at the Mossley Hill Hospital on Merseyside, says the three early stage drugs which Nice wishes to restrict until the mid-stage of dementia, all reduce the level of disability in patients, usually allowing them to live at home with their families for a longer period.

"If you begin treating someone with Alzheimer's early on, they are not very disabled. They are managing their own lives, taking part in family life and having a good quality of life," says Dr Anderson.

Giving a patient Aricept, Exelon and Reminyl will demonstrably improve their mental function but it may seem there are few other measurable benefits.

So from the 'value for money' point of view it may be argued that the NHS does not get much return on its investment.

That view is rejected by psychiatrists because they see the benefits of the drug in helping patients to live more normal lives at home for longer.

Turning to Ebixa, Dr Anderson, is particularly scathing about the effect of excluding that drug from NHS funding for late stage dementia sufferers.

"Ebixa is particularly beneficial for a sub-group of patients who are aggressive, disturbed, distressed and may have psychotic symptoms like hallucinations. Not being allowed to prescribe this drug has great implications, not just for the patient but for their families," he says.

Ivan Garnham agrees: "What people like Nice forget is that there are at least two people involved in every one of these cases. The patient and the carer.

"I am a fit bloke. I don't drink, I don't smoke but I don't know how much longer I can keep going."

For Ivan, the prospect of some of the most needy people in the country - and their families - being denied access to the treatment they need does not bear thinking about.

"The care my wife has received from the NHS has been excellent but we - and other people like us - have been badly let down by Nice."

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