Hansard

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 as Dr Gillian McLean, Professor June Andrews and Jan Killeen of Alzheimer Scotland. I declare an interest as a psychiatrist who has connections as an honorary chair at the University of Stirling, having previously carried out some research on dementia at that university.

Other members have referred to the fact that there are some 60,000 sufferers of dementia, of whom two thirds are in the community. In 1980, I was part of a mental health planning group that produced the Timbury report, which was largely ignored. We estimated at that time that there were only about 20,000 people with the condition, which demonstrates how much it has increased. As the "Mirage of Health", as it has been described, changes—as heart disease begins to decline, as it has done for 15 years, and as we begin to tackle cancer more effectively—the next element of ill health that will be prominent is dementia, so it is right that we are debating the issue.

It is a challenging task, as Mary Scanlon said, to diagnose dementia in A and E, but if poorer levels of cognition and poor memory at least are not recognised in that setting, the people who work in that setting are doomed to achieve a great deal less than they otherwise might. Mary Scanlon said that 70 per cent of patients with dementia who present at A and E are not already diagnosed, which is true, but it is also estimated that about 25 per cent of A and E patients suffer from dementia. It is, therefore, important that the proper tools are put in place.

To begin with, we need formal guidelines, but I note that no such guidelines are mentioned in the report. We need to ensure that the triage tools that are used are more sensitive to dementia, and that cognitive function is assessed, rather than simply using the Glasgow coma scale for people with depressed consciousness. There is a need for the use of appropriate tools to achieve much fuller psychological assessments, such as the mini mental state examination, a memory impairment scale or other validated brief intervention tools that would allow diagnosis.

It is important that people in A and E are properly trained—the specialist nurses to which the report refers can play a part in that, along with places such as the Dementia Services Development Trust in Stirling. If people are aware and adequately trained, they will be much more able to deal with those issues.

Staff need to consider issues other than those that are usually straightforward. They need to consider things such as hydration and nutrition, because dementia patients are often not aware that they have not had a drink or a meal. Issues such as drug toxicity, to which Dr McKee referred, are also important, because they can occur more in people who are confused and are not taking their medication appropriately.

We have talked repeatedly in the chamber about violence towards staff, which is very unwelcome in any setting, but staff need to recognise and remember that aggression, for example, in some patients may be a presentation of pain. Other members have referred to the emergency care record, which needs to be flagged up as part of the quality and outcomes framework contract in general practice so that NHS 24 can try to ensure that patients are managed at home and not brought to hospital. If patients do go to hospital, NHS 24 can warn A and E that the person suffers from dementia. Also, hospital pharmacists—not only in A and E, but in the general hospital—need to have access to the emergency care record. I have asked parliamentary questions on that matter.

We can make progress, but it is important that this group of people, who are often neglected, achieve and receive the support that they need. Such people must never be boarded out—that is, they must not be transferred to another ward for the purpose of releasing a bed. Even moving a patient with dementia from one bed to another within a ward is not appropriate. Protocols and measures must be put in place.

I welcome the Government's response to the cross-party group's report, and I again congratulate those who were involved in its early production. I was glad to be present towards the end of its production; I hope that my comments were helpful.