DEMENTIA STRATEGY

Speech delivered on Wed 9th Sep 2009

I have been impressed by the speeches of those members of all parties who have preceded me in the debate. It has been an excellent debate and many knowledgeable speeches have been made.

It has frequently and famously been said that a society is to be judged by how it treats its old people. I think that we all agree that Scotland has a long way to go in its treatment of dementia sufferers.

Dementia affects more and more people. In part, it is a product of improved medical services and better lifestyles that lead to a longer lifespan, which is good in many ways. We heard about the estimated 69,500 sufferers. That figure is set to rise to 127,000 by 2031, which is not all that far away, and 6 per cent of people over 65 are affected. On that measure, eight of our number in the Parliament can expect to be affected by dementia in future.

That is an illustration of the national numbers, but the figures are also stark at local level. In Glasgow, there are an estimated 6,676 sufferers-I do not know how such precise estimates are made, but those are the figures-and, in South Lanarkshire, 3,390. A percentage of those people are also under 65, which has not been much stressed. The numbers pose great challenges, not only for health and social care services but, more particularly and more immediately, for families and carers. Tom McCabe was right to dwell on the importance of support for carers, who hold not only the whole system but the health of individuals together.

In June, we received the report called "Remember, I'm still me"-produced jointly by the care commission and the Mental Welfare Commission for Scotland-on the provision of care in residential homes. It seemed to me at the time, and still does today, that it was one of the few, stark, totemic reports that are immediately and obviously definitive. I lodged a motion and asked some parliamentary questions on the matter, which is little enough. I am pleased that the Scottish Government has accepted the report in its entirety and is to produce a dementia strategy, although it is disappointing that it has been deferred until the spring. There is a great deal for the strategy to do. Like most things, it will not be cost free, but a good deal of the challenge is to do things differently and better. There are a number of big must-dos.

We must change culture and attitude. Irene Oldfather talked about changing the way that we think and do. That is absolutely right. As the report demonstrates, sufferers remain people. They must, as far as possible, continue to make decisions and be responsible for their own lives although, as the condition develops, they cannot always continue to be entirely independent. The responsible carer is affected profoundly, which can be difficult, demanding and frustrating for family, medical and social care staff alike.

The disease alters people's perspective and their attitude to the world and can be accompanied by frustration and aggression. Sufferers can get lost and disoriented in place and time. They can be vulnerable to people who come to the door or who ring up on the phone selling windows or kitchens or, even worse, with more fraudulent intent in mind.

There can be a bizarre side. Somebody told me not so long ago that there are no smoking problems in care homes because some people forget that they ever smoked. There are, however, big problems with people forgetting to turn off the cooker, put on the gas fire properly or keep themselves warm. Accidental fires are an issue.

None of that is easy to handle, but we need more understanding, expertise and respect. I heard of a case recently involving an elderly man suffering from dementia. He was a private person and was quiet and content in his own home, but he did not like the intrusion of carers into his personal space, so he became agitated and aggressive when they came to look after him, which led to the withdrawal of the care and the suggestion that it was time for him to go into a home. I do not want to make a judgment on that-I am no expert on such matters-but it seems to me that training and understanding were required, rather than the man moving into a care home, with all the issues that that involves.

Attitude underlies other issues. No less than one third of those surveyed for the report were taking antipsychotic medication. That is helpful in some cases, but it is known to increase the risk of stroke. The official advice is that it should not be prescribed for mild or moderate psychotic symptoms. Many people were not having their medication reviewed and-Mary Scanlon touched on this-medication was being prescribed without the person being seen by a doctor. Few people had a planned annual GP check. Linked to that is the covert use of medication, from which all sorts of other issues arise, such as the lack of adequate recording of ways in which medication is used to manage challenging behaviour. The plain fact is that many care home staff, even managers, often have a poor understanding of the legal safeguards and powers, or the role of welfare guardians, which is basic stuff for anyone working in the field.

There is also the issue of planned activity-or the lack of it, I should say-outside the care home. When doors are locked, it is rare for personal plans to refer to that or to why that was the case. To put it another way, lots of elderly people are locked up in their rooms without justification. The key message is that activities that are tailored to their needs must be an integral part of a person's life in residential care.

There are many other issues in that regard, such as transport facilities, support for voluntary groups and the need for psychiatric and mental health support for people over 65, which is an issue across the country. There is much to be done in that regard. Let it truly and increasingly be said of our society that old people, particularly those with dementia, are comfortable, stimulated and cared for in the Scotland of the 21st century. That is the challenge for the strategy.

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DEMENTIA STRATEGY.