In the unlikely setting of St Peter's parish centre in Farnborough, Hampshire, history was made last week when more than 200 people turned out to witness the launch of Britain's first "Alzheimer's cafe". On the same day, a damning report from the commission for health improvement outlined a catalogue of cruelty and degrading treatment of dementia patients at the former Garlands hospital in Cumbria. Patients had been tied to commodes, shouted at, sworn at and deprived of food.
The coincidence of these dramatically contrasting events shows that dementia care remains shockingly inconsistent. A disease of the brain that attacks memory, speech and perception, dementia is a painful reality for 700,000 people in Britain, but is still poorly diagnosed and dealt with.
At first glance, the concept of the Alzheimer's cafe seems remarkably simple. Once a month, people with dementia, their carers, relatives and social care professionals will meet in a cafe environment to socialise, unwind and, possibly, carry out an initial assessment leading to a much-needed service.
Bere Miesen, the Dutch psychiatrist who pioneered the idea, says: "The Alzheimer's cafe is an informal way to make contact with each other, to receive a consultation and feel at home. In the Netherlands, patients feel they have a place to just be. This way the patient and their family don't have to deny or avoid the illness."
When Miesen launched the first cafe in Holland, in 1997, it was housed in a lecture room at Leiden University. The next month, it moved to a hotel. Finally, it arrived at its current resting place - a room in a nursing home in Warmond.
Each month, the trailblazing cafe is attended by between 100 and 150 people, including psychotherapists, nurses, priests and social workers. With assistance from up to 10 volunteers, guests pay two guilders (about 66p) each for refreshments, listen to music and take part in discussions on the disease.
Miesen says the cafe system is more developed in the Netherlands because of a history of robust multi-disciplinary working and more than 30 years of visible work on dementia, which affects an estimated 250,000 people in the country. There are now 10 Alzheimer's cafes in Holland and one in Belgium.
Kandy Redwood, carers' support worker for social services in the Alton and Aldershot area, is determined to alter Miesen's perception of Britain's backwardness. As the driving force behind the new initiative, she first heard about the Dutch scheme from a neuropsychologist last June. "I thought it would be great to pursue," she says. "I asked social services to agree to the idea and they were on board from the very start, sanctioning my visit to Holland to attend a course and meet Miesen."
On her return she made a number of presentations - to the local Alzheimer's Society, health and social services - and received an enthusiastic response. Professionals agreed to devote two hours of their time to the cafe every month.
And no one complained about footing the annual cost of £7,000, split between Rushmoor and Hart primary care group and Hampshire social services department. Most of the money goes towards the cost of hiring the centre, administration and paying care assistants to provide extra support.
The scheme could not have come soon enough for the 200 carers who are supported by Redwood. More than two-thirds of them care for a relative with Alzheimer's disease. The majority are elderly themselves and feel stigmatised by the condition. In some cases, Redwood is the only person they will have seen in two months. "It is very difficult for carers to get time for themselves, recharge their batteries or receive respite support," argues Redwood. "The isolation they experience is sometimes unbearable. People in stage one dementia can drive their carer crazy as they follow them around constantly for reassurance."
Joan James, 67, understands this. She tirelessly cares for her 70-year-old husband, Albert, who has Alzheimer's, and is preparing herself for the day when he no longer remembers her.
Married for 47 years, Joan noticed that something was wrong with her husband nine years ago when they were living in Bethnal Green, east London. "I used to give him his dinner, which he would take upstairs to eat in front of the television," she says. "This time, when I gave him his dinner he turned it over without realising it."
Soon after, Albert found it difficult to put on his tie or button his shirt. A visit to the GP gave the condition a name. But apart from a short trip to a day centre, Joan has largely cared for Albert single-handedly.
When it started to get too much, the couple moved to Farnborough to be near their two sons, who help alleviate some of the burden. Now Joan's health is also under threat. She sleeps only two hours at night and describes herself as "a bag of nerves". Albert, who utters fully formed sentences amid indecipherable ones, says he "doesn't like having dementia".
Joan and Albert have already experienced the benefits of attending the Alzheimer's cafe, during two test runs held earlier this year. Albert reports: "I like it." His wife says: "When I come here, I feel more relaxed. I don't have to worry about him for two hours."
The cafe can already boast successful cases from the earlier trials. In one instance, the behaviour of an elderly man who attended a day centre run by social services was proving difficult for the staff. It was clear he needed to be assessed. He was brought to the first cafe trial by his family. Also there were the health consultant, manager of the mental health day service and Ed Thompson, service manager responsible for commissioning services for older people.
Thompson explains: "I was able to network and, within 24 hours, we got him into a health service for an assessment. That would normally have taken us a week to do."
In another case, a distressed woman caring for her husband was at the end of her tether, despite having day care support once a week. On the basis of one visit to the cafe, the consultant psychiatrist and service manager worked out an extra day's support for her within 20 minutes.
With an enthusiastic endorsement from Harry Cayton, chief executive of the Alzheimer's Society, the Hampshire-based cafe is already being promoted as a beacon of good practice. With the government expected within the next month to announce a national service framework for older people, the initiative could find itself a focus of attention.
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