Chamber
Plenary, 11 Feb 2009
11 Feb 2009 · S3 · Plenary
Item of business
Accident and Emergency Services (Dementia)
I am grateful to all those across the political parties who signed the motion. I am particularly grateful to the members of the cross-party group on Alzheimer's who worked diligently to prepare the report "People with Dementia in NHS Accident and Emergency—Recognising Their Needs", especially Professor June Andrews, who is in the public gallery; Dr Gillian McLean, from the Royal College of Psychiatrists; and Jan Killeen, from Alzheimer Scotland. As well as those three stars, we have a great group of people on the cross-party group, including people from the Mental Welfare Commission for Scotland and the Scottish Commission for the Regulation of Care, who worked and commented on various drafts, as did my fellow MSPs Mary Scanlon, Richard Simpson, Marilyn Livingstone and James Kelly. I am grateful to the Minister for Public Health and Sport, Shona Robison, for the letter that I have received from her fully endorsing the report and announcing the issuing of draft guidance to health boards. I am sure that she will give more detail on that in her summing up. I will ask for clarification on a few points in a moment.
Part of the cross-party group's remit is to raise awareness of the issue of Alzheimer's, so I want to use the opportunity that the debate provides to demonstrate the challenges that face people with dementia in a hospital environment. I therefore ask members in the chamber to imagine for a moment what it must be like to have Alzheimer's or dementia. If members saw the television programme about Terry Pratchett last week, they will know that dementia can create such a fog of confusion that it can be difficult some days to perform even simple tasks such as tying a tie or making a cup of tea. Dementia is often associated with memory loss, but it can also affect someone's judgment, co-ordination, balance, speech, understanding and moods and their ability to communicate even with those closest to them. Not only can someone present with that complex range of symptoms, their capacity to undertake and understand simple actions can change from day to day.
Can members therefore imagine what it must be like for someone with this multifaceted illness to present at accident and emergency? Even for those who fully understand what is happening, A and E can be a difficult place to be at the best of times. As our report demonstrated, people with dementia can wait for up to seven hours for assessment in A and E. Anyone who has waited for half that time will know how challenging that can be for people with mental incapacity.
The cross-party group's recommendations include using an electronic tag that could flag up to any general practitioner or out-of-hours medical professional that home assessment followed by an appointment, if necessary, would be preferable to a patient being dispatched to sit in A and E, where clinically appropriate. It might be that an X-ray would be required to eliminate the possibility that there has been, say, a wrist fracture. Urgent access to that kind of diagnostic testing by community teams would prevent attendance at A and E, unless treatment was required. However, achieving that will require much better joined-up working in the community. For example, we spoke at the cross-party group about linking to local memory clinics and old age psychiatrists. The minister has addressed that at point 4 of her guidance. I note the associated comment that
"multiple programmes should already be in place to support this."
I would welcome her assurance that she will look closely at implementation to ensure that there is joined-up working across the system, from GPs and NHS 24 to social services and community health teams, where appropriate. Better training, including expanding the range of available options, will result in better outcomes. I welcome the minister's recognition of the importance of that.
With some simple measures, we can save beds and staff time spent trying to handle what can be difficult and challenging situations. Those measures can also save lives because we know that increased mortality rates, higher readmission rates and functional decline are all associated with this vulnerable patient group, who are particularly subject to adverse incidents in hospitals.
For some people, hospital admission will be necessary. The report asks that national health service boards support the Alzheimer Scotland initiative to have a dementia nurse attached to every hospital. At present, Alzheimer Scotland funds three nurses in three board areas. Rather than wait for that initiative to be rolled out, we said in our recommendations that we believe that it is a priority for the initiative to be undertaken across the NHS in Scotland. The minister's guidance notes that dementia-trained nurses are already in the system. I would welcome clarification of whether she supports the principle that each health board should attach a dementia specialist nurse to a hospital to take forward protocols and to support families and carers.
On television a week ago, Terry Pratchett described his feelings on being diagnosed at an early stage with Alzheimer's disease. He said that he felt as though he was standing on a beach—the tide had gone out and there was no one else there. Let us send out a message to people with dementia and their families that no mum or dad, gran or grandpa, neighbour or friend will stand on that beach alone. We in the Scottish Parliament will walk with them on that journey and we will do what we can to make it an easier one. We will change things. Today, in the Scottish Parliament—their Parliament—the tide is turning for them.
Part of the cross-party group's remit is to raise awareness of the issue of Alzheimer's, so I want to use the opportunity that the debate provides to demonstrate the challenges that face people with dementia in a hospital environment. I therefore ask members in the chamber to imagine for a moment what it must be like to have Alzheimer's or dementia. If members saw the television programme about Terry Pratchett last week, they will know that dementia can create such a fog of confusion that it can be difficult some days to perform even simple tasks such as tying a tie or making a cup of tea. Dementia is often associated with memory loss, but it can also affect someone's judgment, co-ordination, balance, speech, understanding and moods and their ability to communicate even with those closest to them. Not only can someone present with that complex range of symptoms, their capacity to undertake and understand simple actions can change from day to day.
Can members therefore imagine what it must be like for someone with this multifaceted illness to present at accident and emergency? Even for those who fully understand what is happening, A and E can be a difficult place to be at the best of times. As our report demonstrated, people with dementia can wait for up to seven hours for assessment in A and E. Anyone who has waited for half that time will know how challenging that can be for people with mental incapacity.
The cross-party group's recommendations include using an electronic tag that could flag up to any general practitioner or out-of-hours medical professional that home assessment followed by an appointment, if necessary, would be preferable to a patient being dispatched to sit in A and E, where clinically appropriate. It might be that an X-ray would be required to eliminate the possibility that there has been, say, a wrist fracture. Urgent access to that kind of diagnostic testing by community teams would prevent attendance at A and E, unless treatment was required. However, achieving that will require much better joined-up working in the community. For example, we spoke at the cross-party group about linking to local memory clinics and old age psychiatrists. The minister has addressed that at point 4 of her guidance. I note the associated comment that
"multiple programmes should already be in place to support this."
I would welcome her assurance that she will look closely at implementation to ensure that there is joined-up working across the system, from GPs and NHS 24 to social services and community health teams, where appropriate. Better training, including expanding the range of available options, will result in better outcomes. I welcome the minister's recognition of the importance of that.
With some simple measures, we can save beds and staff time spent trying to handle what can be difficult and challenging situations. Those measures can also save lives because we know that increased mortality rates, higher readmission rates and functional decline are all associated with this vulnerable patient group, who are particularly subject to adverse incidents in hospitals.
For some people, hospital admission will be necessary. The report asks that national health service boards support the Alzheimer Scotland initiative to have a dementia nurse attached to every hospital. At present, Alzheimer Scotland funds three nurses in three board areas. Rather than wait for that initiative to be rolled out, we said in our recommendations that we believe that it is a priority for the initiative to be undertaken across the NHS in Scotland. The minister's guidance notes that dementia-trained nurses are already in the system. I would welcome clarification of whether she supports the principle that each health board should attach a dementia specialist nurse to a hospital to take forward protocols and to support families and carers.
On television a week ago, Terry Pratchett described his feelings on being diagnosed at an early stage with Alzheimer's disease. He said that he felt as though he was standing on a beach—the tide had gone out and there was no one else there. Let us send out a message to people with dementia and their families that no mum or dad, gran or grandpa, neighbour or friend will stand on that beach alone. We in the Scottish Parliament will walk with them on that journey and we will do what we can to make it an easier one. We will change things. Today, in the Scottish Parliament—their Parliament—the tide is turning for them.
In the same item of business
The Deputy Presiding Officer (Alasdair Morgan):
SNP
The final item of business is a members' business debate on motion S3M-3215, in the name of Irene Oldfather, on recognising the needs of people with dementia...
Motion debated,
That the Parliament notes the launch of the report, People with Dementia in NHS Accident and Emergency - Recognising Their Needs, by the Cross Party Group on...
Irene Oldfather (Cunninghame South) (Lab):
Lab
I am grateful to all those across the political parties who signed the motion. I am particularly grateful to the members of the cross-party group on Alzheime...
Ian McKee (Lothians) (SNP):
SNP
I congratulate Irene Oldfather on obtaining this most important debate. I also commend the cross-party group for the sensible suggestions in its Alzheimer's ...
The Deputy Presiding Officer:
SNP
I call Mary Scanlon, to be followed by Dr Richard Simpson.
Mary Scanlon (Highlands and Islands) (Con):
Con
It is never easy to be wedged between two doctors in a medical debate.I thank Irene Oldfather for bringing this debate to Parliament. As one of the conveners...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
I add my congratulations to Irene Oldfather for today's result. It is a testament to the hard work that she has put in, and to the hard work of others such a...
Margaret Smith (Edinburgh West) (LD):
LD
I begin by thanking Irene Oldfather not only for securing this evening's debate but, more important, for her tireless and tenacious work in trying to help ma...
The Minister for Public Health (Shona Robison):
SNP
I thank Irene Oldfather for bringing this important debate to the Parliament. We have led the way in making dementia a national priority. I welcome the suppo...
Mary Scanlon:
Con
In my reading and preparing for the debate, an issue that MSPs have raised over the years was once again brought to my attention. I refer to the problems of ...
Shona Robison:
SNP
Quite a lot of work has been done on the issue, particularly considering the new role of the senior charge nurse. We want to ensure that those in that leader...
Meeting closed at 17:39.