Hansard

I add my thanks to Richard Lyle for lodging the motion for debate, and I thank all the members who have made valuable contributions.

I welcome Alzheimer Scotland’s “Delivering Fair Dementia Care For People With Advanced Dementia” report, and I agree with the motion that the report is “an important contribution” to the public debate on how we improve dementia care and services and in particular to our “understanding of advanced dementia”.

I also agree with the proposition in the report and the motion that it is crucial that people at all stages of the illness, including advanced dementia, have the right to equal access to the high-quality expert care and health services that they need, “on an equal basis” with other progressive conditions. That right is regardless of whether they are at home, in residential care, specialist NHS care or in acute settings, and, of course, I agree with the report and the motion that the healthcare interventions should at all times be

“free at the point of use.”

The Government has welcomed the “Fair Dementia Care” report. We are giving careful consideration to its recommendations and are engaging with Alzheimer Scotland, the Convention of Scottish Local Authorities and others on those. Many of the recommendations in the report are being considered as part of our work to change and improve adult social care support in Scotland.

As a mental health nurse with over 30 years of experience, I have seen many changes in how we deliver services. My first job as a staff nurse was in a long-term care of the elderly ward. Most of those patients suffered from some form of dementia, but most of them would now be cared for in their own homes with social care support and others in residential or nursing home settings—more homely settings that are closer to their own communities, family and friends.

Things have moved on greatly in that time and we know that the demand for social care support is growing due, in part, to our ageing population. Therefore, it is important that we have a social care system that fits today’s needs, that is well placed for developments and demands to come and, crucially, that focuses on the people who use the support, rather than the processes that deliver it. That is why we are working with people who use social care support—carers, COSLA and a wide range of partners from across the sector—to develop a national programme to support local reform of adult social care support.

Emerging priorities from the evidence include a shared agreement on the purpose of social care support; equity of experiences across Scotland; transparency of systems, processes and decisions; raising awareness of social care support and its value for individuals and for Scotland; and valuing and supporting the workforce.

The “Fair Dementia Care” report makes a series of recommendations on social care support charging, including consistency of charging. As part of the reform programme, we will also explore the cost of care and how it is paid for. We will develop a process for working collectively to consider alternative models for funding social care that will support Scotland’s people into the future. Our models must enable investment at both ends of the scale—in intensive care and support needs and in lower needs care and preventative support.

The programme is identifying some of the key areas for reform so that we can make smart and sustainable changes to ensure that our social care support is fit for the future. Delivering high-quality health and social care for people living with dementia at all stages of the illness and in all settings is a high priority for this Government and the foundation of our three national dementia strategies since 2010. Over this time, we have received international praise for our approach to dementia policy in Scotland, including our world-leading national approach to post-diagnostic support.

The fair dementia care report is concerned in particular with access to healthcare for people with dementia who are in care homes. I agree that it is important that an individual’s access to high-quality dementia care should not depend on where they reside. I highlight the major Care Inspectorate report of 2017, which focused on 145 care homes. It found good progress in particular in the provision and quality of person-centred care and personalised care plans.

Our 2017 to 2020 national dementia strategy continues to focus on key areas such as post-diagnostic support and integrated home care, with an additional focus on the advanced stages of the illness, including palliative and end-of-life care.

We are continuing to help to educate and train the workforce on the complexities of dementia care, including in its advanced stages. We also continue to take national action in support of people with dementia in acute care. We are working with Alzheimer Scotland and NHS boards to support the Alzheimer Scotland dementia nurse consultants programme. Those nurse consultants have been hugely important in driving strategic local change in acute dementia care. A report on the programme has just been published. It sets out the achievements of the nurse consultants over 2015 to 2018 in key areas such as helping to embed and lead expertise in dementia care and developing staff expertise. The range of actions led by the nurse consultants includes improved person-centred care, improved responses to stress and distress in acute care and improved linkages to other care settings and the community.