NHS Scotland draft healthcare quality strategy response

Introduction

Alzheimer Scotland is Scotland’s leading dementia voluntary organisation. We work to improve the lives of everyone affected by dementia through our campaigning work nationally and locally and through facilitating the involvement of people with dementia and carers in getting their views and experiences heard. We provide specialist services such as day care, home support and carer support (through training programmes and support groups) in over 60 locations and offer information and support through our 24 hour freephone Dementia Helpline, our website and our wide range of publications.

We welcome the opportunity to comment on the draft Healthcare quality strategy for Scotland; people with dementia will be users of many NHS Scotland services. Because age is the major risk factor for dementia, the likelihood of the person having multiple health problems is high and this presents a particular challenge to the NHS. There are approximately 69,500 people with dementia in Scotland; this is number is set to double in the next 25 years.

Comments on the draft strategy

The draft strategy is complex and difficult to follow, there is a need for a user friendly Plain English version of the strategy in order to reach the wider audience you wish to engage and ensure it is owned by everyone in Scotland.
Capturing patient experience and the proposed framework of potential areas for measurement outlined in the draft strategy would seem to provide an appropriate framework for measuring quality.

Alzheimer Scotland agrees with the principles and aims of the strategy; putting the individual at the centre of care is essential to ensuring their particular needs are understood and met. For people with dementia and their carers this requires those delivering health care services to have an understanding of the illness, staff need training in understanding the illness and positive approaches to communication and care.

Barriers

There is a lack of awareness of the care needs of people with dementia in the NHS:

• A recent research report by the Alzheimer Society in England found people with dementia, who occupy a quarter of all hospital beds, are staying far longer in hospital than people without dementia who go in for the same treatment. It also found variations in the quality of care for people with dementia, with the majority of people with dementia leaving hospital worse than when they arrive and a third entering a care home unable to return home.
• The Scottish Parliament Cross Party Group on Alzheimer Disease report on people with dementia in NHS accident and emergency highlighted there was no standard system for the care of people with dementia attending accident and emergency. This was compounded by a lack of knowledge about the illness which is hampering appropriate treatment being given for the illness or accident that brought them to accident and emergency.
• In hospital people with dementia may risk malnutrition because staff do not realise they need help to eat or drink and or do not have the necessary time to assist. The Mental Welfare Commission inspection of continuing care wards found many of the wards reported difficulty in ensuring patients are getting the help they need with eating and drinking .

Alzheimer Scotland advocates mandatory dementia care training for all health and social care staff working with people with dementia at a level appropriate to their remit, with an emphasis on knowledge and skills to assist communication with people with dementia.

November 2009