Dementia — Debate

Part of the debate – in the House of Lords at 12:11 pm on 25th June 2009.

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Photo of Baroness Thomas of Walliswood Baroness Thomas of Walliswood Spokesperson for Women and Equality 12:11 pm, 25th June 2009

My Lords, I feel quite shamed by that speech. I do not think that I shall be able to do quite as well but I am glad to take part in this debate.

Like many people, I have some experience of dementia in that I was the person most closely involved in the care of my mother as she gradually disappeared into the mists of the disease. I recall that one of her most frequent questions was, "Who is paying for all this?". She was always reassured when I managed to say, "Well you are, darling". That was one of the last questions that she asked me before she died. So the patient may be "demented" but that does not mean that they have lost all their good sense, their marbles or their customary behaviour. One of the other things that she used to say when I arrived to see her was, "Would you like a glass of sherry, darling?". There was not a glass of sherry in the room but it was her habitual wish to offer refreshment to a guest that prompted her to ask that question.

Last year, I took part in the work of the All-Party Parliamentary Group on Dementia, which concentrated on the prescription of anti-psychotic drugs to people with dementia who are living in care homes and on the need for better trained and better paid staff, both of which have already been referred to. The all-party group's recommendations reflected our serious concerns about the use and misuse of these psychotic drugs. It emerged that patients with mild behavioural symptoms were being given anti-psychotic drugs, often for long periods. Although the Mental Capacity Act requires care personnel to consult patients and their carers, the group found that this was not done, with the result that neither patients nor their carers understood the reasons for prescribing these drugs or what their effect might be on patients. At the same time, doctors prescribing anti-psychotic drugs often did not visit patients sufficiently to appreciate their effect on those with dementia. We concluded that better monitoring of patients by physicians might well lead to a reduction of doses or even to the discontinuation of the use of the medication for a patient.

More profoundly, we concluded that the rapid resort to anti-psychotic drugs for patients who might, for example, be distressed by the move to a different and unknown place was, in itself, a sign of underlying problems with respect to the training, recruitment, development and pay levels of those working within the care sector. The more recent report from the All-Party Parliamentary Group on Dementia—I did not take part in that—recommends that all care staff working with elderly people should receive dementia care training.

The Alzheimer's Society supports these recommendations and is calling on the Department of Health to develop dementia-care-related skills in the workforce. In my opinion, it is of great importance that all care workers share a common training and a common understanding of the needs of Alzheimer patients. Equally, leadership of care home staff by the senior staff member can assist the staff to understand, and therefore serve, their patients more thoughtfully and sensitively. Good examples of that were brought to us during the work of the all-party group.

I make these points because they indicate the very precise targeting of proposed solutions to the practical problems encountered in care homes. Obviously a government strategy will be more comprehensive than what I am talking about, but we have to keep remembering that it is the high proportion of patients in private homes, and the high proportion of patients who are still not receiving proper care, who need to be encompassed in such a strategy, with the right protocols and training for staff and the right protocols for medical practitioners to ensure that, in things like the giving of drugs, the process is properly and correctly aligned to the needs of the patient and is not simply an automatic way of dealing with a difficult patient.

One of the problems about being in an old people's home is that, by definition, you are vulnerable there. You are on your own; there may not be anyone in your family who can visit you on a daily or even a weekly basis. It depends where you are living in relation to the rest of your family. Cases where the nearest family members, who may still be at work or be looking after their own children, live far from their elderly relatives in their care home present particular difficulties.

The first advice that I would give any responsible family member is to ensure that any residential home chosen for the patient should not be far from the home of the person most likely to visit the patient. I made what turned out to be the stupid mistake of thinking that my mother would be better off in her own home town. That was not true; she would have been better off down the road from where I lived. That would have been much better for her and, obviously, much easier for me. Again, if I were advising a family on learning to cope with an Alzheimer patient, I would suggest creating a rota of visits in such a way that the entire burden is not left to one person and that the patient is helped to remember their grandchildren—and, in the case of my mother, their great-grandchildren—in other words, their true life outside the residential home.

The all-party group's reports have made several important recommendations about the use of anti-psychotic drugs, the major subject of the report. They have dealt with the question of harm and the question of their not being kept under supervision by doctors. A recommendation was made that a new system for regular specialist assessment of vulnerable patients in care homes should be established, which would also involve the GPs responsible for day-to-day medical care. I am not sure whether any progress has been made in response to the recommendations of the previous report from the all-party group, rather than the most recent one. How much have the Government been able to do in response?

The group's second report on this matter, the most recent, is concerned with the training for the care of people with dementia. It recommended that dementia training, including communication skills, should be mandatory for all care home staff; that dementia training should play a larger role in the training of GPs; that staff turnover needed to be reduced; and that local authorities should use their commissioning powers to drive up standards. Again, I am not sure whether the Government have responded to these suggestions. I am also not certain that any serious steps have been taken to create a recognised training programme for care home staff. The need for such a training programme has been mentioned by everyone who has spoken so far.

I apologise if this speech has appeared somewhat scrappy. Neither the document with which we have been supplied nor the subject lend themselves to this sort of debate; in other words, one needs more time to expand one's thoughts. I have not been able to make any response to any of the excellent speeches made, for example, by those who spoke before me. I look forward to the Minister's response and hope, for all our sakes, whether as suffers or carers, that the new approach really will make the difference.