Hansard

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 support and attention that the Scottish Parliament and, in particular, the cross-party group on Alzheimer's have given to dementia, and I look forward to continuing to work with the Parliament in future. Last year, when I met the Scottish Dementia Working Group—the only patient-led dementia group that we know of in the world—it showed its support for our commitment and focus, but it was clear that there is more work to do before we can be satisfied with dementia services in Scotland. I agree.

In the past year, we have taken several steps to establish dementia as a national priority in practice. We now have a national NHS target that requires all health boards to deliver by 2011 agreed improvements in the early diagnosis and management of patients with dementia. From the review visits at the end of last year, it is clear that boards are already getting to grips with that important agenda. The mental health collaborative, which supports local delivery of national NHS targets, published a toolkit at the end of last year that is designed to enable boards to analyse their dementia services from the perspective of those who use the service. The information from the analysis will be used to make progress with local service redesign to improve interventions, outcomes and the patient experience of the service.

Health boards are working with general practitioners to improve their knowledge and understanding of dementia with the aim of increasing the rate of early detection and referral to specialist services. Diagnosis means more than going on a register; it triggers regular physical health checks for those with dementia, as well as formal assessment of the needs of those who care for them. To build on the work to improve diagnosis, we have commissioned Alzheimer Scotland and the dementia services development centre at the University of Stirling to carry out work in Lothian, East Renfrewshire and Renfrewshire, and Shetland to develop better structured intervention, support and information services following first diagnosis. The work is intended to develop our understanding of how we can best offer those services so that they meet patients' and carers' needs in an understanding and sensitive manner.

The project has developed from what we have already learned from the work of the dementia services development centre in Forth Valley NHS Board. That work provided a focus for service development, together with information, education, and tools and techniques to implement change, with the aim of improving the overall experience and outcomes of care for people with dementia. We published the outcomes of that work last year, and boards are now using that information in the redesign and development of services.

NHS Health Scotland is offering post-diagnostic support through the publication "Coping with Dementia—A practical handbook for carers", which is widely available in Scotland, and through the publications "Worried about your memory?" and "Facing Dementia: how to live well with your diagnosis", which were recently updated by NHS Health Scotland working with Alzheimer Scotland and the Scottish Dementia Working Group.

In 2008 we undertook research into public attitudes to and understanding of dementia, and we will shortly launch a pilot public awareness campaign in Tayside to increase the number of people with dementia coming forward for diagnosis. We will evaluate the outcome of the campaign and use the learning from that to inform possible future national campaign work.

Irene Oldfather mentioned memory clinics. They are one way in which dementia can be identified and responded to, and recent research has identified that they are a common component of old-age psychiatry services in Scotland.

We are taking forward work on awareness raising, early diagnosis and information for people with dementia and their carers. The development work on the integrated care pathways, which will be accredited from later this year, also brings a focus to end-of-life care, social support and quality of care. I am glad that those developing the English strategy have been able to learn from the Scottish experience.

We, too, are happy to learn, and I welcome the report from the cross-party group on Alzheimer's. It has highlighted the needs of people in A and E who have dementia and identified areas in which clear improvement is possible, and I am pleased to be here to respond to the debate on it, particularly given that my response can be positive.

It is important that we can identify properly those who come into A and E who may have dementia and that we can track them through their time in the unit. In that way, we can ensure that they receive the sensitive care that they need. Staff in A and E need to know how to care for people with dementia, and it is important that cultures and behaviours are appropriate for this patient group. I agree that the more that we can do to prevent those with dementia ending up in A and E the better, but if people end up in A and E the way in which they are treated is crucial. It is for that reason that I have written to all NHS board chairs and chief executives to indicate my support for the report and provide guidance on how boards can implement its recommendations. The guidance that was provided was drawn up with the support of the dementia services development centre.

I turn to the two points that Irene Oldfather raised. On the first point, I assure her that we will look at how to ensure joined-up working across health and social care as implementation takes place. Although the report's recommendations focus on A and E, they are relevant to other care settings, so it is important for us to do that.