Alzheimer Scotland responds to Dignity and respect: dementia continuing care visits report from the Mental Welfare Commission
Alzheimer Scotland is deeply disappointed by the extent of the problems highlighted in the Mental Welfare Commission’s Dignity and respect report; particularly with regards to on-going issues with medication, access to specifically-skilled staff and the suitability of care environments.
We understand that doctors must be able to prescribe the drugs they think are appropriate (given individual circumstances) and we appreciate that, for some people in these environments, that this will include prescribing psychoactive medication. However, what we do not understand and seriously object to is that the proper lawful procedures are not being followed, as highlighted in this report. Our view is that these procedures must be followed; it is widely known that such drugs can cause falls, strokes and increased mortality among people with dementia. Failing to follow the proper procedures is unlawful as well as a potential breach of human rights and must cease now.
In addition, we believe that the staff in these environments are being let down by a lack of investment in the resources required to deliver the highest quality of care and treatment. We are extremely concerned that there may be a shortfall in the level of staffing in these environments, as they provide care to people with some of the most complex and difficult support needs. This requires an exceptionally high level of skilled staff; something the Dignity and respect report clearly indicates is not being prioritised. Appropriate access to Psychological Services, Allied Health Professionals (such as Occupational Therapists), Pharmacists and a full range of meaningful activities (including Activity Co-ordinators) are essential components to delivering good quality care which must be better co-ordinated. These human interventions are as important, sometimes more important, than any medication for people with dementia. Therefore these interventions must be regarded in the same way as other forms of treatment and provided equally and consistently throughout Scotland.
There is a clear need for this level of specialised NHS continuing care and, as the report highlights, this is valued by carers and family members. However, there are also significant problems with many of these environments, particularly being able to enjoy the outdoors. We believe that if current premises are not fit for purpose then we must take immediate action to rectify them; ensuring that NHS Boards provide homely, caring and safe environments for people with dementia, according to their fundamental human rights. This would not be difficult to achieve and we call upon each NHS Board to make immediate investment plans in this area.
We believe that NHS Boards can respond quickly to the findings of this report. Dementia continuing care highlights that there are approximately 800 people with dementia in 52 NHS continuing care units across Scotland. These are some of the most vulnerable people within the NHS system; given the size and scale of the NHS, this is very small number of people who can easily be prioritised and action quickly taken to bring about real and rapid improvement.
Alzheimer Scotland has been working with NHS Boards and Scottish Government to support improvements in acute general hospital care for people with dementia. This includes:
- implementing Promoting Excellence, a training framework which sets out the knowledge, skills and behaviours expected of all staff;
- Standards of care for dementia in Scotland; and,
- a 10 point action plan for all NHS Boards to drive improvements in the care treatment and support of people with dementia.
This work is supported by Alzheimer Scotland Dementia Nurse Consultants and around 500 Dementia Champions in hospitals across Scotland. Scotland’s current National Dementia Strategy includes commitments to extend this work to NHS units which provide longer term care for people with dementia and to reduce the inappropriate prescribing and management of psychoactive medication for people with dementia. We fully support the recommendation of this report that work on these commitments is accelerated and we will do all that we can to support those involved to progress an immediate and effective response to this report.
Alzheimer Scotland believes that the Mental Welfare Commission should be commended for its thoroughness in producing the Dignity and respect report. This is a highly significant document evidencing a broad range of problems in the care of people with dementia who receive NHS continuing care.