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Health: Dementia

Volume 715: debated on Monday 14 December 2009


Asked By

To ask Her Majesty’s Government what plans they have to ensure that patients with dementia do not stay in hospital longer than is warranted by the condition that led to their admission.

My Lords, we all agree that hospital stays should be for as short a time as possible, but that must be balanced against the complex health needs of a patient with dementia. The National Dementia Strategy addresses the issue, including the appointment of a senior member of staff to improve the quality of care for people with dementia, proper training for all staff and specialist older people’s mental health teams working in hospitals.

I thank the Minister for that Answer. At present, up to a quarter of hospital beds are currently used by older people suffering from dementia, with unacceptable variations—as I am sure she will accept—in the quality of care they receive. Recently, both the National Audit Office and the Alzheimer’s Society highlighted opportunities for significant NHS cost savings in hospital care which could be more effectively reinvested in workforce development and community services if care for dementia patients was moved into appropriate services in the community. Will the Government be taking this recommendation forward and, if so, how?

The noble Baroness points to an important problem. As I said in my Answer, the problem here is the complexity of dealing with someone with dementia in hospital. For example, if someone is admitted with a broken leg and then diagnosed with dementia, a whole new health team and social care kick in. It is not straightforward. However, that is not an excuse for adding to the length of the stay in hospital or for there not to be adequate care. We are committed to the National Dementia Strategy, which has been the focus of debate in your Lordships’ House on more than one occasion, and we are working closely with the Alzheimer’s Society on its implementation. An important part of that implementation is dealing with people who have dementia and who are in hospital. No doubt money could be saved. However, this is not an appropriate target to set because, ultimately, clinical decisions will have to be taken by the doctors concerned.

My Lords, the Minister will be aware that it is estimated that over the next 15 years there will be more than 1 million people with dementia in this country, which will cost the nation as a whole £25 billion. What planning is taking place in the Department of Health to account for these numbers and to ensure that our hospital services and our already overstretched and under-funded mental health services are not swamped by these patients?

We are two years into the 10-year National Dementia Strategy, which has had widespread support and has been backed by funding of £150 million in its first two years. Its major strands include early diagnosis, support for those who care for people with dementia, training, increasing the science base and research; it is a very comprehensive strategy. A 10-year strategy is the way to deal with this issue.

Does my noble friend agree that, because dementia affects different people in different ways, they should all be treated individually regardless of whether or not they are in hospital?

We need to make sure that we prevent people with dementia from going into hospital in the first place—my noble friend is right about that. The way to do that is to make sure that doctors can diagnose dementia early and that people receive the right level of treatment and support in their homes to enable them to stay there and avoid hospital admittance.

My Lords, under the Government’s current plans for healthcare in the community, many more nurses will have to be peripatetic. How many does the Minister expect to move out of the hospitals and into the communities?

I do not have a precise answer in front of me but the noble Lord is right that nurses will have to work in the community, as many of them already do. It is not a question of taking nurses out of hospitals but of increasing the number of people who are trained to deal with those with dementia and of adding to the community teams which support their families.

My Lords, while undoubtedly excellent work is going on under the National Dementia Strategy, does my noble friend agree that the pockets of good practice are at best patchy? What is the Department of Health doing to ensure shared learning about co-operation between health, social care and third sector organisations, which provide so much care?

There is a ministerial group, led by my honourable friend Phil Hope, whose membership covers all the different groups that my noble friend mentioned. It meets regularly to make sure that the strategy is both carried forward and implemented.

Does the Minister agree that, since one-third of older people admitted to hospital in an emergency are suffering from either a confusional state or dementia, the assessment and diagnosis of dementia in hospital and the solving of the problem which the noble Baroness, Lady Greengross, raised, must start at a very early point of diagnosis? At the moment, there is no such assessment in diagnosis in 50 to 60 per cent of hospitals. How can this be addressed?

One way in which it is being addressed is by every hospital having a senior member of staff charged with providing leadership for improving the quality of care for people with dementia, for hospital staff having the proper training and for the development of the kind of pathway for people with dementia to which the noble Baroness referred. That cannot be delivered in a year; it is why we have a 10-year strategy.