World Alzheimer's Day
The final item of business today is a members' business debate on motion S1M-2187, in the name of Cathie Craigie, on world Alzheimer's day.
Motion debated,
That the Parliament expresses its support for World Alzheimer's Day, held on 21 September every year; recognises its aim of raising global awareness of dementia and its impact on families; notes that around 58,000 people suffer from dementia in Scotland, and further recognises the importance of the work of organisations such as Alzheimer Scotland - Action on Dementia in supporting sufferers and their families.
I thank MSPs for attending this evening's debate and all my colleagues who have supported the motion. I also thank Alzheimer Scotland—Action on Dementia, which has been helpful to me over the past week in preparing for today's debate, and the Scottish Parliament information centre, for the useful briefing paper it issued to members.
My motion, which was lodged at the beginning of September, highlights world Alzheimer's day on 21 September. Obviously, today is not 21 September, but the motion's sentiments apply whatever the date and I welcome this evening's opportunity to debate the issue.
There are 58,000 people with dementia in Scotland—more than the adult populations of the towns of Cumbernauld and Kilsyth put together. Fifty-five per cent of dementia sufferers have Alzheimer's disease; 97 per cent of people with dementia are more than 65 years old; and 25 per cent of people over 85 will have dementia. A little-known fact is that dementia is the fourth biggest killer after heart disease, stroke and cancer. Alzheimer's is a progressive illness that affects memory, understanding and behaviour. As many people know, the day-to-day activities that we take for granted, such as going to the shops and speaking to friends, gradually become more difficult. Difficulties increase and eventually basic tasks such as dressing, cooking and eating become impossible without the help of a carer.
There is growing awareness of the needs of dementia sufferers and their families. Most people have a relative who suffers from dementia or know someone who suffers from it and the research supplied by SPICe indicates that one in five of us will probably develop the illness. It is time that we sat up and took notice of the condition.
I welcome the action that the Scottish Parliament has already taken to help people with Alzheimer's and their families. The Adults with Incapacity (Scotland) Act 2000—one of the first pieces of legislation passed by the Parliament—gives welcome rights and legal protection to sufferers and their families and carers. The Regulation of Care (Scotland) Act 2001 will improve the quality of social services and give carers more input into the inspection of care services. A major step forward since Malcolm Chisholm's debate on dementia awareness week last September—which was also held after the fact—is the Executive's commitment to introduce free personal and nursing care. That corrects the great injustice of dementia sufferers paying for the care that they need due to their illness.
However, there is still more to be done. What we need to do does not necessarily cost magnificent sums of money. The first point of contact is usually the general practitioner through the local health centre. That is not always a good point of contact. Sometimes, people are sent away thinking that they have dementia, that it is just a normal part of growing old and that there is little that the doctor can do. That is wrong. People should not go away from their first point of contact with such a negative outlook. They should be pointed in the right direction to find help, assistance and advice, not only for themselves but for family members who will be involved in their care.
Care packages must be provided where professionals and all those involved in caring for the person can communicate on equal terms for the good of the individual and their family. The services are usually available, but resources are wasted when professionals and managers do not speak to each other or share information. Sometimes, they do not pick up on the valuable information that is available through home carers and home helps. I hope that the minister and his department will continue to take action to change that, because it can make a difference.
Early diagnosis is essential. Without it, Alzheimer's sufferers and their carers and families cannot fully access the help and treatment they need. Early diagnosis provides an opportunity to plan for the future and participate in important decisions before further deterioration occurs. It is also important because the drugs that are available work best on patients with mild to moderate Alzheimer's. Often, the earlier the treatment, the more effective it can be.
Will Cathie Craigie join me in questioning the attitude of Grampian Health Board? It has instructed GPs in Grampian not to prescribe the new drugs that are available, which would delay the onset of Alzheimer's.
Thanks for that intervention. I hope to address that issue later in my speech.
It is estimated that approximately 23,000 patients in Scotland have mild to moderate Alzheimer's. Of those, 11,500 may be eligible for treatment and approximately 40 per cent are expected to respond positively to treatment.
It is essential that people with Alzheimer's disease are able to access the available treatments. Three drugs are licensed in the UK. They do not work wonders for all, but they can make a huge difference in the lives of many people with Alzheimer's, ranging from offsetting the symptoms of the disease to enabling people to do everyday things for longer.
The potential for help makes early diagnosis even more essential. I understand that a delay of even a few months in treatment means that skills, which may never be regained, can be lost. It is important to note that the drugs that are licensed in the UK do not work for all people with dementia, but they offer hope of a better quality of life for many.
As Richard Lochhead said, Alzheimer Scotland—Action on Dementia released a report today. It shows that people in some areas of Scotland are 12 times more likely to be able to access treatment than those in other areas. It follows the Health Technology Board for Scotland's comments on the National Institute for Clinical Excellence's guidance. The HTBS's comments aimed to
"maximise the access of eligible patients in Scotland to these drugs that have been shown to be clinically and cost effective for the treatment of Alzheimer's disease. "
That statement was widely welcomed by a lot of people who suffer from Alzheimer's, their families and those involved in their treatment and care. The HTBS's comment recognises the need for GPs in Scotland to be able, in discussion with a specialist, to administer the treatment.
Alzheimer Scotland's report shows that, in the main, there are no long waiting lists for assessment or treatment but, despite the HTBS's welcome guidance, according to the information given by health boards throughout the country, a postcode lottery still exists. In Ayrshire and Arran Health Board, 47 per cent of people likely to be suitable for treatment are being treated. The figure falls to as little as 3.8 per cent in Orkney. I am sure that colleagues agree that that is not acceptable. A person's address should make no difference to their ability to access medication or medical treatment. I hope that the minister will address that point.
The era of no available treatment is ending. We must ensure that people who could benefit from treatment—those with mild to moderate Alzheimer's—are able to access it.
My motion pays tribute to the work of Alzheimer Scotland, other charities and voluntary organisations in highlighting and supporting the needs of people with Alzheimer's, their families and carers. I reiterate that sentiment. Carers are a very important part of this. I am sorry that I have not had time to go into that point in detail; some colleagues might like to raise that point.
Dementia has been recognised as a separate medical condition for only about 40 years. Opportunities to highlight it, such as this debate, are important and I hope that we will be able to make progress as a result. Some changes have been made in the past year. I hope that, next year, we will be able to stand up in the chamber and say that there have been some changes for the good.
A large number of members want to speak. I ask members to limit their speeches to three minutes in order to accommodate all those who want to speak.
I congratulate Cathie Craigie—I am sure on behalf of the chamber—on bringing this issue forward as a members' business debate. Although the debate is headed "World Alzheimer's Day", the date does not really matter. For people with Alzheimer's and their families, relatives and friends, every day is world Alzheimer's day, because their world has been destroyed.
Many soft and sincere words have been spoken on this issue. However, as Cathie Craigie rightly pointed out, people too often say that the disease is part and parcel of the aging process. I urge that, at local level, there is close liaison between general practitioners and all the available support systems in our communities to ensure that people do not simply say about a sufferer, "Oh, she's just forgotten what she went out to buy in the high street." I agree with Cathie Craigie about carers. They are very important people without whom many of those who suffer from the disease would be in more difficult circumstances.
I want to highlight the issue of postcode prescribing, which Richard Lochhead raised. I read the Alzheimer Scotland—Action on Dementia report "Postcode prescribing persists" with deep concern. Although many constituents have raised this issue with me, I did not realise that the statistics would be quite so disastrous. Orkney Health Board has the worst provision, followed by Grampian Health Board, Tayside Health Board, Highland Health Board and Dumfries and Galloway Health Board. The information that, in my area, only 4 per cent of people with Alzheimer's are likely to have the drugs that are available is quite appalling.
The report says:
"Grampian has only very recently allocated any money at all to these treatments, and even now has only budgeted £25,000 for the remainder of this year, which is seriously inadequate."
Furthermore, the health board is not prepared to guarantee that the amount will not be revised downwards as part of a prioritisation exercise.
The two most restricted health boards are Grampian and Greater Glasgow. In Grampian, for example, only donepezil is available on prescription. This problem has to be seriously addressed. How is one health board able to allocate £123,000 for the treatment of Alzheimer's while another can allocate only £25,000?
I hope that the minister will respond to those questions. We are not asking for a levelling-down of resources. For the sake of those who suffer from Alzheimer's, we are looking for a levelling-up.
I am grateful to Cathie Craigie for the opportunity to discuss this subject. In the first two and a half years of the Parliament, much of the Health and Community Care Committee's deliberations have centred on the needs of the elderly. It has been a particular privilege to be part of that exciting process.
I note that, according to an Alzheimer Scotland—Action on Dementia press release issued on 20 September, Susan Deacon said that the health service is giving more help and support to this area and that a range of measures, from extra money to extra care and short breaks, is already in place. We constantly hear about the levels of funding that have been allocated to social work and the national health service and the expansion of services, but access to them diminishes almost daily.
The Scottish community care statistics for 2000 show that the number of elderly people seen by a health visitor in the 12 months from 1999 to 2000 fell by 34,400. In the same year, the number of elderly clients seen by a nurse fell by 13,300. In the three years from 1997 to 2000, the net expenditure on all community care fell by £45 million and from 1998 to 2000, the decrease in home care clients was more than 9,000.
I would like to think that the extra money mentioned in the press release—I do not doubt the commitment—is being spent wisely. We can measure that only by the number of people who benefit.
Almost 35,000 people who have Alzheimer's live at home—the statistics are quite fearsome—as they need more community-based services. In the Highlands—the region that has benefited most from Arbuthnott funding—the respite care that is offered to people with dementia at Migdale hospital in Bonar Bridge is being reduced from six to four weeks a year. That is the example that I know of. The situation may be the same in all community hospitals. I do not know what is happening in the rest of Scotland. The reason that Alzheimer Scotland was given for that reduction is bedblocking. After two and a half years of the Scottish Parliament, 169 beds in the Inverness area are still blocked. Unless we sort that out, the elderly will suffer and we will not be able to offer them the resources they need.
The Woodlands Centre in Inverness is a day centre for people with Alzheimer's. I have visited it several times. It is much valued by sufferers, their carers and their families. The real cost per hour for that non-profit-making centre, which allows almost one-to-one care, is £8.51, yet the social work department will pay no more than £7.41. Moreover, we are told that, like other social work payments, it is under review. That review is still continuing after 12 months.
Two weeks ago, two sisters whose mother had Alzheimer's phoned me. She was taken into a Church of Scotland home. They were told that the social work department had no money and that their mother would be delivered to their doorstep in a taxi on Friday. They said, "We will be out. We are not looking after her any more." They did not feel good about that, but it was the only way in which they could force the social work department to address funding.
I accept the points that have been made about postcode prescribing, and I hope that something will be done through the HTBS. I would further welcome the vaccine that is being developed to help prevent the onset of Alzheimer's. Although it is in only the early stages of assessment, it is an exciting prospect.
I thank Cathie Craigie for giving us the opportunity to address this issue again. As she said, Alzheimer's is the fourth biggest killer in Scotland and affects 60,000 Scots. It actually affects far more than that, because it affects the families of sufferers and those who care for them.
Alzheimer's is a progressive and incurable illness of the brain. We have heard in passing that drugs are available that are effective for some sufferers, especially if the illness is diagnosed early. We must therefore do a better job of circulating information not only to the general public, but to our general practitioners and other health and social care professionals, so that Alzheimer's can be diagnosed as early as possible and the drugs that might be available can be most effective. If people are referred early to day care facilities such as those that Mary Scanlon and I visited in Inverness during our community care inquiry last year, those facilities can play a major role at least in delaying the onset of Alzheimer's.
The points that members have made about postcode prescribing, picking up on today's report from Alzheimer Scotland that shows that people in some parts of the country are 12 times more likely to be given access to drugs that might help with the condition, are well made and important. This morning, the Health and Community Care Committee questioned the minister—he can respond again this evening—on the wider issue of postcode prescribing.
Scotland has a population the size of Birmingham. It is common sense that we would not expect people in one part of Birmingham to have access to drugs to combat Alzheimer's if people in a different part of Birmingham did not. We cannot accept the fact that in the national health service throughout Scotland, people are subjected to a lottery of care in terms of Alzheimer's drugs, and may be 12 times more likely to get help in one part of the country than they would be in another.
We should not neglect to say that the Scottish Parliament has taken on board many of the points that have been made by sufferers of dementia and their carers. We have done good work in a relatively short period of time. As Cathie Craigie said, in our first year we passed the Adults with Incapacity (Scotland) Act 2000, which had been called for by the families of the sufferers of dementia for three or four decades. The Regulation of Care (Scotland) Act 2001 will have an impact on the provision of services.
The Community Care and Health (Scotland) Bill that is going through stage 1 in the Health and Community Care Committee will also have a major impact. The last time we debated Alzheimer's and related issues, many members talked about the need to introduce free personal and nursing care. We now know that that is on its way, but that is only one of the small parts of the legislation that will have an effect. It will make joint working and the pooling of budgets more possible, for example.
I raise this point at this moment as it is an area on which I hope the bill will have an effect. I hope that Margaret Smith agrees that if a confused 90-year-old man arrives at the accident and emergency department, it is unacceptable to keep him on a trolley for five hours without any attention. That is no way to treat somebody who suffers from Alzheimer's.
I have no hesitation in agreeing with Robin Harper on that point.
The bill stresses the need for greater services for carers, and particularly stresses the need for independent assessments to be given to carers to enable them to access services and information on what help might be available.
We have made great strides, but in terms of the provision of day care services, early diagnosis and the national provision of drugs that might assist people with dementia and Alzheimer's, there is still much to be done.
I congratulate Cathie Craigie on securing this debate.
I am wearing two hats: I am the convener of the cross-party group on older people, age and aging and I have an elderly mother who suffers from Alzheimer's. The minister, who is a previous convener of the group, will be aware that we have discussed Alzheimer's and dementia at length. We decided that inadequate information is available to carers, who are often therefore unable to recognise the symptoms of early dementia or even later Alzheimer's. I hope that the minister will respond to that point.
Education is important. Robin Harper mentioned the elderly man who was left on a trolley for five hours. Perhaps some of the nurses and porters who were there did not realise that that elderly gentleman was suffering from dementia.
It is important to remember that carers have a difficult job. The arrangements for respite care are inadequate. It is distressing for the carer to be able to spend only a couple of hours away from the sufferer. It is also distressing for the sufferer to be confined within four walls and unable to get out. Home support would be helpful, as would extra day care and respite care. I hope that the minister will respond positively to that point and to the others that I have raised.
I congratulate Cathie Craigie on securing this important debate and add my support to the views that she expressed.
As Cathie Craigie said, one in five people over 80 years old will develop dementia—that is one in every 100 people in the country. It is crucial that full support is given to sufferers and that everyone is well aware of the issues surrounding dementia.
The issues surrounding postcode prescribing have been highlighted by a number of members. According to Alzheimer Scotland's report, Greater Glasgow Health Board, which covers my constituency, lags well behind what is needed in terms of provision of treatment for sufferers of dementia.
The report also highlights concerns about the restrictive nature of Greater Glasgow Health Board's drug provision. Although the treatment of dementia is an important area—and I hope that the minister will comment on it—the debate needs to be about more than that.
A recent study by the Centre for the Economics of Mental Health calculated that the United Kingdom has to spend £14 billion treating and caring for dementia patients. It estimated that the average Alzheimer's condition requires 45 hours of home care a week. Mary Scanlon mentioned some of those figures. A home help often costs in excess of £9 per hour—that also causes concern.
As we all know, a great deal of the care for dementia sufferers is done by unpaid carers who are family or friends of the sufferer. One of Alzheimer Scotland's greatest strengths is the support and training it provides for such carers, who are often in a distressing situation. I hope that the Scottish Executive will continue to acknowledge and value the work of carers and provide support.
I have only recently become aware of the 24-hour dementia helpline that Alzheimer Scotland provides. I am sure that that is a lifeline for many people in times of crisis or when they do not understand what is happening to them as sufferers, to a loved one or to someone for whom they care.
Raising awareness of the different manifestations of dementia is also vital. We must consider research. We need to look to provide greater funding for research into the cause of dementia. Since the identification of the tau gene by American researchers in 1998, there has been much talk of developing a vaccine, but the cause and development of the disease are not yet fully understood.
Although the money that is spent on treating dementia in Britain outweighs the money that is spent on treating heart disease and stroke, the amount that is spent on researching dementia pales in comparison—it is less than 10 per cent of the money that is spent on researching heart disease. Given that there appears to be light at the end of the tunnel with the advances that have been made in research, it seems that improving research into the causes of dementia should be given priority.
The fact that we are having this debate today is testament to the excellent work that is being done daily by Alzheimer Scotland and by carers all over the country who look after those who suffer from dementia. I am delighted to add my support to the motion.
I, too, congratulate Cathie Craigie. I also congratulate organisations such as Alzheimer Scotland and the many thousands of carers throughout Scotland, without whom many services for sufferers of Alzheimer's disease would not exist. Many important points have been made in the debate and I am acutely aware that I am fortunate in that many speakers—not least Sandra White—have a more personal and direct experience of Alzheimer's disease than I.
I want to take a bit of time to reiterate two points, because they are extremely important and I trust that the minister will take time in his speech to address them. I will talk later about drugs and the problem of postcode treatment, but before I do, it is important to point out that for many sufferers of Alzheimer's disease, treatment is primarily about management of their condition and the care that they receive. That is why it is vital that, notwithstanding the debate about the availability of drugs, we ensure that the right support services are in place for sufferers where they need them. We must also ensure that adequate respite care services are available for the benefit of the many thousands of people who care voluntarily for friends or relatives who suffer from the disease.
Mary Scanlon mentioned Migdale hospital in Bonar Bridge, which I have visited in recent months. That hospital is a vital community resource, but for much of the past few years it has had a question mark about its existence hanging over it. As Mary Scanlon said, it must limit the amount of respite care that it offers to sufferers of Alzheimer's disease in that area. I do not think that that is unique to Migdale hospital; I am pretty sure that it is replicated in other parts of Scotland. Although we have come a long way on many aspects of the care and treatment of people who suffer from Alzheimer's disease, we have a considerable distance left to travel to ensure that the right support services are in place for those who suffer from the illness and for the people who care for them.
It has already been said that drugs are available to slow down Alzheimer's disease in those who show mild or moderate symptoms. The point has been made—correctly—that that underlines the need for early diagnosis of the disease. The Health Technology Board for Scotland recently recommended prescription of those drugs, where that is clinically appropriate. However, the reality is—as has been reflected in many comments that have been made in the debate—that the drugs are not universally available and that the postcode lottery remains because, notwithstanding the advice that the Health Technology Board issues, local drugs and therapeutic committees take their own decisions, which are often limited by financial constraints.
Richard Lochhead mentioned Grampian Health Board, which has instructed GPs not to prescribe the drugs, and other members mentioned other health board areas in that context. The minister—not just tonight, but in future—must address that issue, because it goes beyond the provision of drugs for Alzheimer's disease and relates to drugs for the treatment of many conditions.
When Susan Deacon established the Health Technology Board for Scotland, she said that it would eradicate postcode treatment; in reality, it has not done so. The board or any organisation that succeeds it will not eradicate postcode-based treatment until it gains the power to do so.
I will close with what I believe to be the germane question that the minister must answer this evening. How do we ensure that, in a country of 5 million people, access to drugs will in all cases depend on clinical assessments, not on where people live?
I support this excellent debate. I will approach it from the care-in-the-community angle; I am much less equipped than other members to discuss the medical angle. The care of Alzheimer's sufferers is typical of and central to our whole care-in-the-community effort, and it reveals many of the past failures in care in the community. Malcolm Chisholm and other people, including people in some councils, are making efforts to address the problem. However, the system is still defective, particularly with regard to the amount of help that is given to people who suffer from Alzheimer's so that they can remain at home in a safe condition, and with regard to the adequacy of the support that is given to their families so that they can look after sufferers.
We have recently debated the situation of carers and, although we are beginning to do something about their situation, far too little attention is paid to them and too little money is put at their disposal. My former Westminster constituency—now Margaret Smith's Scottish parliamentary constituency—Edinburgh West, has a very good voluntary organisation that helps in giving relief to carers who look after people who suffer from Alzheimer's. That organisation is continually struggling to survive however, and we could perhaps give more money and effort to the voluntary sector to help carers and increase the relief that they get.
Our medical system is naturally more interested in the more dramatic, exciting and politically attractive—if I can call them that—forms of mental problem, and in high-pressure surgery and that sort of thing, which we might watch on television on the odd evening that we spend at home. We are not so good at looking after conditions such as Alzheimer's, which are a hard daily grind for the people who are involved. Such conditions are not romantic, but cause terrible trouble to sufferers and their families.
I urge the minister to keep up his good work. The more help, encouragement and cash that he can give to councils to run support services for Alzheimer's sufferers, their families and carers, the better.
I add my congratulations to Cathie Craigie on securing this evening's debate. Last week, I had the privilege of attending and speaking to a conference that was organised by the specialist section on the psychiatry of old age of the Royal College of Psychiatrists. I came away from the event with a number of serious concerns.
It is the professionals' view that not nearly enough is being done either in policy development or in application of resources, despite all the work that the Executive and others have done on various strategies. There might now be a clear strategic identity for the elderly mentally ill, but little progress has been made in changing attitudes—both within and outwith the national health service—to dementia and other mental disorders among the elderly. That is despite the fact that a demographic time bomb is ticking away quietly, with the year-on-year increase in the proportion of over-65s and over-75s in the population.
The health service in the 21st century must persuade older people and the professionals who deal with them that mental disability is not an inevitable consequence of aging. Older people seldom query changes in their mental health. They must learn the importance of recognising symptoms of mental health problems such as memory loss, a decline in their abilities in daily living or loss of pleasure in daily activities. Although dementia is irreversible, a great deal can be done for people who suffer from dementia and for their carers. I echo the points that Donald Gorrie made about care in the community and the distance that we must still travel in that direction.
At the moment, unless people who suffer from dementia are diagnosed, they are unlikely to receive support and services until they reach the later stages of the illness, when there is a crisis. However, primary care screening is too much of a hit-and-miss affair and is very dependent on the approach that is taken by individual GPs. The treatment of Alzheimer's is a case in point. Four years after the launch of the first drug treatment for the disease, we are experiencing a postcode lottery. As I understand the situation, the disparity in uptake is not due solely to budget limitations in health boards. Differences in local practice play a major part in causing problems. In many areas, GPs are not referring patients to hospital specialists or to memory clinics, where they exist. It is significant that the area of highest uptake is Ayrshire and Arran, where memory clinics are very much in existence.
I have no doubt that one of the main barriers to progress is the prevalence of agism in the national health service and in wider society. The attitude still prevails when priorities are being set that our elderly are worth less than other age groups. The Parliament must lead the fight against such attitudes and I hope that the minister will champion that cause.
Two more members have indicated that they wish to speak. I would appreciate it if both members would keep their remarks as brief as possible.
I begin by declaring that I am the joint holder of a research grant from the UK Alzheimer's Society and that I am the director of a care home that looks after some people who suffer from dementia.
I want to make one or two brief points. The programme planning group on mental illness in the late 1970s and early 1980s resulted in the Timbury report, which proposed domestic-style accommodation for people who suffer from dementia. However, only one unit was ever built. We had 15 wasted years of failing to develop a proper dementia policy. This Parliament has reversed that process quite rapidly through the Adults with Incapacity (Scotland) Act 2000, the Regulation of Care (Scotland) Act 2001 and the Community Care and Health (Scotland) Bill that is now before the Health and Community Care Committee. Other members have referred to those measures, which will provide important support to individuals who suffer from Alzheimer's.
The point about early diagnosis has been well made. We need integrated clinical networks between secondary and primary care. We also need to enhance the capacity of local health care co-operatives to ensure that the conditions that we are discussing are picked up and managed. As other members said, management of Alzheimer's is as important as its medical treatment. Inappropriate use of drugs to manage the condition is one of the most reprehensible aspects of the current situation. We must develop adequate skills to manage the behavioural or psychological aspects of Alzheimer's through the LHCCs and community psychiatric nurses.
As other members said, we need more research. We must use the health check for the over-75s much more rigorously in order to make early diagnoses. As part of the performance assessment process, we need to ensure that not just seven, but all health board areas have memory clinics.
Finally, we must eradicate postcode prescribing, which is a disgrace. Nearly 100 patients are waiting for treatment in my constituency, which covers the Forth valley area. However, waiting for treatment is not an option, because the condition deteriorates and drugs do not reverse Alzheimer's, as is the case with other conditions; they merely arrest deterioration. People who must wait six months for treatment are six months down the line toward quite a cruel death, during which their families will have a dreadful time.
I found it absolutely intolerable that a constituent who consulted me the other day—a war pensioner whose main carer has developed Alzheimer's—must wait for the appropriate drug and must pay £100 toward treatment.
The condition must be carefully monitored. I say to Richard Lochhead that specialists, not GPs, should do that. The follow-up for those for whom the drug does not work is that they must be taken off the drug, otherwise the treatment is cost-ineffective. That work is done best by properly trained people and I regret to say that not all GPs are adequately trained in dealing with the condition.
Perhaps it is relevant that I should speak in the debate because I am the oldest member of the Parliament. I try to keep the deterioration of my grey cells at bay by the mental stimulation that I get from our debates, which I attend regularly. If that is not good enough, I fall back on crosswords. John Young, who is three months younger than me, and I will both qualify for a free flu injection. I was glad to learn that, in a year or two, we will qualify for something even better: a screening.
I remember having a 99-year-old granny who had absolutely nothing wrong with her—she had her wits and her speech. When I was a child, it never dawned on me that that was not normal, as all my aunts and uncles were well over 80. When he was 82, my father went to the fish market in Glasgow at 7 o'clock every morning. He died because of his addiction to smoking.
Several members have mentioned research. Janis Hughes made a significant point about research being a priority, with which I agree. At the back of my mind is the feeling that Alzheimer's is an unnecessary condition. That is simplistic of me, but that is what I feel. If only we could put our finger on what to do to stop the condition. When we consider research, we should also examine whether mental stimulation is a preventative, as I am certain that it is. I have visited literally hundreds of residential homes across the Highlands—I have visited some of them many times and I do not think that one exists that I have not visited—some of which have people with Alzheimer's. I have been struck by those homes that provide their residents with great mental stimulation. The nurses in those homes believe that such activities will stave off the condition. Are they right? Do we know the answer to that vital question?
We all have pet medical theories, which must annoy doctors enormously, and I have tried out my theory on visits to psychiatric hospitals in my area. I ask why the bright grannies whom I knew did not get Alzheimer's? They had nothing wrong with them. I am not talking only about my granny but about all those grannies who lived in fairly poor conditions in tenements in Glasgow and who were as bright as buttons. Their diet was different from a modern diet. I have tried out that theory on psychiatrists who dismiss it as nonsense. Yet my 99-year-old granny never had food out of a tin or a packet. She probably always ate all the things that we are told, quite rightly, to eat, as did all my long-living aunts and other relatives.
Research should consider the prevention of Alzheimer's. I am perfectly certain that care in the community, which is a good policy, has prevented many people from sinking into that condition. We do not know the answers to those questions, but I hope that research will bring them to light. I shall not say anything about the drug aspect, because the arguments have been well rehearsed. Let me say only that, for the people close to the person who gets this illness, it is the saddest thing in human life.
I congratulate Cathie Craigie on securing the debate. I have no hesitation in agreeing with the motion and with many of the important points that have been made in the debate.
As the motion indicates, there can be no doubt about the need to raise awareness of dementia or about the importance of Alzheimer Scotland's work in supporting sufferers and their families. Since its establishment in 1994, Alzheimer Scotland has become the leading national organisation providing specialist services for people with dementia. Its local day care and befriending services, respite breaks, carer support and education groups, campaigning activity and information and national 24-hour helpline services—to which Janis Hughes referred—all make a significant contribution towards the improved understanding of, and provision of service to, people with dementia and their carers. I have no hesitation in recording our admiration and respect for Alzheimer Scotland's work.
I am also pleased to pay tribute to the University of Stirling's dementia services development centre, which is at the forefront of world thinking on what can be done to help sufferers of dementia. I was pleased that the Executive was able to provide a grant of £0.5 million to assist the centre with the construction of its new Iris Murdoch building and I was delighted to lay its foundation stone last month.
The needs of dementia sufferers are broad and diverse and demand a broad and diverse response. Many speakers referred to elements of the Executive response, such as the framework for mental health services, the carers strategy, the Adults with Incapacity (Scotland) Act 2000, the Regulation of Care (Scotland) Act 2001, the recommendations of the care development group's report and our whole joint-working agenda. I will deal with some of those issues and with postcode prescribing, which has featured prominently in the debate.
The framework for mental health services sets out a template for dementia services. Last year, we stepped up the implementation of that framework through the creation of the mental health and well-being support group. During its visits, it has been paying attention to those who use services and their carers. I recall its report on its visit to Ayrshire and Arran Health Board, which referred to the good practice and strong local basis of innovative dementia projects. I also remember the example of home care and weekend services, which were being developed in Orkney with the help and involvement of Alzheimer Scotland.
However, the positive examples of service innovations are balanced by reports of less developed local services in other parts of the country. With that in mind, I was delighted to approve the round two focus for the support group. That focus includes the development of co-ordinated inter-agency approaches to dementia services and support.
Services are improving, but there is no doubt that they need to improve further. Once again, Alzheimer Scotland's recently produced document, "Planning Signposts for Dementia Care Services", offers the statutory agencies real pointers on how to improve such services. I concentrated on that document in the members' business debate that I secured last year, to which Cathie Craigie referred. I remember that one of the features of that document was the importance of early-stage therapeutic services, including drugs, and early-stage support services, including information. Early diagnosis is also important, as Cathie Craigie said, and we are determined that there will be a better understanding of the disease among professionals and service providers so that that can happen.
Alzheimer Scotland's document is a useful and comprehensive document against which the planning agencies can measure their services and I commend Alzheimer Scotland for its production. Reference will be made to it in the forthcoming report from the chief medical officer's group on health care and older people. He will also address the charge of agism to which Adam Ingram referred.
Several people mentioned the carers strategy. I remind members of the extra money that is going into that strategy and of the 22,000 extra weeks of short breaks that will, I am sure, be welcomed by the carers of people with dementia.
Drug treatment and postcode prescribing featured prominently in the debate. I understand and share the concerns of members and of Alzheimer Scotland. People rightly find it unfair that access to a particular drug or treatment should be determined by where they live. As I said at the Health and Community Care Committee this morning, the Executive is committed to tackling postcode prescribing. We have an extensive work agenda to ensure that all patients have access to consistent, high-quality NHS services no matter where they live.
Will the minister explain how he intends to ensure such access to services in the Grampian Health Board area? As has been said, only 4 per cent of suitable patients there get new treatments. Even when the specialists to whom Richard Simpson referred have recommended that the drugs be prescribed, the GPs cannot do so because of the £25,000 limit on their budget.
As I was about to say, we should welcome the guidance from the Health Technology Board for Scotland. That body has been somewhat criticised in the past few days, but it has put a Scottish angle on its work and has developed the NICE guidance in relation to the possibility of GP prescribing in rural areas that do not have access to specialists. As Richard Simpson reminded us, the thrust of the guidance was that it should be specialists who do the prescribing. That is beginning to happen in Grampian but I accept—as today's report indicates—that there is wide variation in the amount of money that is being provided for new drugs. I think that all health boards are now providing some money, so nowhere are the drugs not used at all. However, there is clearly room for improvement. Richard Simpson also referred to the Forth Valley Health Board area. I note that a short-life working group there has produced proposals. I hope that that will lead to improvements in the amount of prescribing in that area.
Will the minister give way?
I am in my last minute, so I had better not. I have many topics to cover and I will be able only to summarise them. The number of topics indicates the breadth of the agenda in terms of what sufferers and their carers need. It also indicates the breadth of the response required. Alzheimer Scotland has always campaigned for free personal care and I pay tribute to the work of Jim Jackson in the care development group.
Mary Scanlon talked about home care services. I accept that there have been problems over a long period. However, the trend has been reversed. I remind members of the £100 million that was announced by Susan Deacon last October and of the £100 million that was announced by Angus MacKay in June. Both those announcements will lead to big improvements in the development of home care services.
The wider joint-working agenda includes single shared assessments and the joint management and resourcing that will come for older people's services next April. Much is being done, but much remains to be done. I shall certainly pay close attention to the various points that have been made today.
I assure the Parliament that we acknowledge the importance of world Alzheimer's day in raising awareness of dementia. We also acknowledge the work of Alzheimer Scotland, which I know will continue to work with us in helping the thousands of people who suffer from dementia and their carers.
Meeting closed at 17:59.