Dementia Care
To ask the Scottish Government what steps it is taking to address the matters raised in the Mental Welfare Commission for Scotland’s report, “Dignity and respect: dementia continuing care visits”. (S4T-00723)
I welcome the Mental Welfare Commission’s report on dementia continuing care that shows that the level and quality of care and support are, in many cases, not meeting the standard that we expect. Although we are making significant progress in many areas of dementia care, such as diagnostic rates, post-diagnostic support, and acute hospital care, it is essential that people who have dementia receive safe, effective, and high-quality care at all stages of their illness and in all care settings, whether that be at home, in hospital, or in residential care. The standards of care for dementia in Scotland, which were published in 2011, make clear that everyone has a human right to such care. We continue our national approach to workforce development and education, to support services in meeting the standards.
At national level, action is under way in a range of areas to address many of the issues that are highlighted in the report, particularly through national commitments to improve care in specialist national health service care facilities and to reduce the inappropriate prescribing of psychotropic medication for people with dementia.
We will work with the Mental Welfare Commission, Alzheimer Scotland and others to consider, carefully but rapidly, other matters that are highlighted in the report, and to develop an action plan. The report reminds us all that dementia is now and will be in future one of our foremost public health and societal challenges.
The integration of health and social care will enable more people with advanced dementia and more complex care needs to live well and for longer in their own homes, reducing reliance on long-term care in specialised and continuing care units. We work with services throughout Scotland to support that aim.
In “Scotland’s National Dementia Strategy: 2013-16”, commitment 11 is,
“We will set out plans for extending the work on quality of care in general hospitals to other hospitals and NHS settings”,
and commitment 13 is,
“We will finalise and implement a national commitment on the prescribing of psychoactive medications”.
The MWC report expressed major concern about the prescription of psychotropic drugs without regular review. What steps will be taken to ensure that commitments 11 and 13 are met?
On commitment 11, work is being taken forward that is focusing on how the dementia standards are applied in the acute hospital setting, particularly in NHS wards and units that have a key function in providing assessment, care and treatment to people with dementia. The intention has been that, on completion of that work, the approach will be rolled out to non-acute settings such as continuing care units, which are often in community hospitals. We are considering how to speed up the process of rolling out the approach in the continuing care setting, which the Mental Welfare Commission highlighted in its report. We will consider how to take work forward as part of the action plan that responds to the report.
On commitment 13, the strategy sets out clearly that there is a need to reduce the unnecessary use of medication in all care settings and that medication should be regularly reviewed and updated. At its most recent meeting, the dementia strategy implementation and monitoring group considered commitment 13 and agreed on the approach that should be taken in implementing that aspect of the strategy.
We will liaise with the Mental Welfare Commission, Alzheimer Scotland and others on how we can ensure that commitment 13 is implemented as quickly as possible, so that we can be assured that individuals receive medication appropriately and that their medication is regularly reviewed and properly recorded.
Alongside that, as part of the action plan I will consider what further action we can take to ensure that sufficient work is being done to introduce activities that can reduce the need for medication for individuals in such settings.
I hope that I have reassured the member that work on the commitments has started and that we intend to consider how to speed up the process of implementation.
The Mental Welfare Commission referred to a disparity in the provision of continuing care beds across Scotland’s NHS boards. How does the Government propose to attack that disparity?
NHS boards will differ in the number of continuing care beds that they have, for a variety of reasons. For example, a health board that has a greater focus on supporting and providing care in the home and community setting might not have as many continuing care beds as a board that has a greater focus on in-patient or residential beds. There can be a variety of reasons for the disparity.
The member will be aware that the Cabinet Secretary for Health and Wellbeing made a statement to the Parliament recently in which he set out plans for care provision in Scotland, which include consideration of the number of continuing care beds in Scotland and policy on the provision of such beds. Work is on-going to develop the guidance in this area and to look at the specific number of continuing care beds that we have in Scotland. Once that process is complete, we will be able to set out the national approach to the provision of continuing care beds in NHS boards across the country.
I welcome the detail that the minister has given on a number of aspects of the very worrying report from the Mental Welfare Commission, which is almost as bad in some areas as the Bridgend report in Wales, which led to significant action by the Welsh Government.
The minister has given details on a couple of issues but there are so many others in the report. I therefore press the minister to accept that the Government should provide time for a full debate so that we can look at the things that are not going right. I acknowledge that Scotland is ahead in terms of dementia standards, early diagnosis and early support but, clearly, we have severe problems in relation to the most severe cases—as illustrated by the report—and we need to have a full debate on the matter.
My reading of the report is that, frankly, if the Care Inspectorate had done the report, it would have closed some units and said that there should be no further admissions in some others until the situation was improved. We do not yet have an adequate on-going inspection system—four years between reviews by the Mental Welfare Commission is not good enough.
I recognise the member’s acknowledgement that Scotland is broadly ahead in the way in which it delivers dementia care, but the report highlights a significant area that needs improvement and further action. As I mentioned in my response to Roderick Campbell, I have asked officials to develop an action plan that is specific to the report recommendations. Of the 20 report recommendations, three are specific to the Scottish Government and we accept all of those.
I want to have not only an action plan but a monitoring and implementation approach to ensure that the work is driven forward at a local level, where delivery bodies have a responsibility to do that. I hope to have that action plan by the end of the month. That may be an appropriate opportunity to hold a full debate on the matter. I am more than happy to take away the member’s suggestion on that.
With regard to the inspection regime issue, the report highlights that many—in fact, the vast majority—of the carers who were interviewed were satisfied with the care that was being provided to their relatives. However, that sends a signal that there are issues with people’s expectations for such care. I will consider how we can best address that issue, because it is clear that a number of units have not been providing care of an adequate standard. The carers should have been aware of that and should have been able to alert the appropriate agencies to look into the situation. We have to look at the issues in the round, and consider how we can ensure that carers are better informed about what they should expect of the care that is provided to their relatives.
When the Scottish Government published “Scotland’s National Dementia Strategy” in 2010, it promised to adopt the principles of the charter of rights that was produced by the cross-party group on dementia. Does the minister agree that the report demonstrates a failure to adhere to the charter and in particular to the principles of accountability and empowerment? The fact that most dementia sufferers are going for longer than a month without getting fresh air is a disgrace. There are simply not enough staff receiving dementia-specific training.
The report highlights a number of areas in which the level of care for individuals with dementia and the way in which it is delivered have been unacceptable. Some basic standards of care have not been met, and that is not to be tolerated.
The 2010 strategy set out the broad areas in which we required improvement, which included the need to sign up to a rights-based approach. As I mentioned in my opening response, I believe that there are human rights issues for the individuals concerned, particularly where they are being prescribed medication that may be inappropriate, and those issues must be addressed. The updated strategy that we published last year seeks to drive that agenda further forward. We recognise that there has been a broad improvement in the way in which services for individuals with dementia are delivered in Scotland.
As Richard Simpson said, Scotland is seen as a world leader in a range of areas in delivering dementia care. We need to ensure that we take appropriate action in the areas in which deficiencies have been identified to deal with the issues robustly and as swiftly as possible. The action plan that I have requested from officials is intended to drive that work forward and to monitor how action is implemented effectively throughout the country.
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