Health: Dementia

Baroness Gardner of Parkes Excerpts

Wednesday 22nd January 2014 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what action they are taking to inform the public of the particular problems associated with dementia and the support available for individuals suffering from that condition.

[Baroness Gardner of Parkes (Con)]

My Lords, dementia is such an important issue that I am pleased to have the opportunity to focus attention on it tonight, at a time when it has been very much in the news. My belief is that people need to be informed. Without doubt, a degree of stigma attaches to the diagnosis of dementia. For this reason, many people prefer to use the word “Alzheimer’s” rather than the wider term “dementia”. I have found this to be the case for years and we need to ensure that that attitude changes. No stigma should attach to any medical diagnosis of a condition that the person did not bring upon themselves, be it dementia, epilepsy or cancer.

I am old enough to remember clearly when, in the 1950s and earlier, people would say when they heard of someone they knew being diagnosed with cancer, “I wonder what they did to get that”. The attitude was that cancer was a punishment for the wicked only. Over the years, people have had a much greater understanding of diseases and the internet has made it easy for them to learn about cancer and its causes. Because cancer is so widespread there has been marvellous research in the subject. Information has created an awareness of the great importance of early diagnosis as the best hope of a cure. Now people know that hereditary genes may cause additional vulnerability in some people.

Just last week, I read an interesting article on a change of diet being the way to avoid dementia. It recommended a high-fat diet, which has always been deplored in the past. It stated that all white bread, pasta and sugar—in fact almost all carbohydrates—should be eliminated from one’s diet, that gluten-free products should be used and that, in following the “five a day” health advice about fruit and vegetables, only certain fruits of the low-sugar type should be consumed. This new diet seems as extreme as the low-fat diet was, but in reverse. At present, these are the views of Dr David Perlmutter, a neurologist. The article in the Times on 18 January sets out much more detail about them.

Reading constantly conflicting dietary reports is not good for anyone; what we need is solid evidence-based research. At present, it is not possible to know who will develop dementia. It is no respecter of persons and can strike the most brilliant people. Research is essential to determine what measures can be taken to prevent dementia from developing and to control the progress of the condition.

In the early stages of dementia, often a person is aware of their mental deterioration but, as the condition progresses, they can lose all awareness. Usually, short-term memory goes first. There are therapies that can be applied to bring back happy memories from long ago that give pleasure to patients.

In the Daily Telegraph of 28 December last, there was a report to the effect that dementia patients were bedblocking to the extent that urgent cases could not be admitted to major hospitals. There were other very distressing press reports, for those who have relatives or loved ones needing special care, of horrible and degrading attacks on such patients, who could not defend themselves.

Solutions are needed. I think that it is time for us to rethink some of the treatments and facilities that we have thrown out of the NHS. More daycare provision would allow patients to enjoy those hours in a safe and caring environment while providing necessary relief for carers. Respite, on a daily or longer-term break basis, is essential for relatives and carers to enable them to fulfil that very important role.

Cottage hospitals were ideal for dementia patients needing in-hospital care but who did not have urgent or immediate need for acute services. Both day centres and cottage hospitals require full-time nursing and genuinely caring staff. Those staff filled a need and were a valuable part of the NHS. Dementia cases need genuinely caring support.

I support the view—and the changed stroke care in London has proven this—that we need highly specialised centres where essential, urgent care can be provided for some life-threatening conditions. Such centres, which are being developed, should be used for cases in need of immediate and urgent high-intensity care, and the patient should remain in until ready to return home or to go to an appropriate intermediate-care facility.

Nursing is an essential part of any patient’s treatment at all levels. I think it is splendid that nurses now can obtain the highest qualifications, and I am a strong supporter of nurse practitioners. Specialist nurses in whatever field are invaluable to patients, consultants and the NHS. However, I remain convinced that it was a mistake to insist that all nurses must have A-levels and obtain full academic qualifications. The loss of the SEN qualification has done great damage. Some of the best nurses I have known—and I have been involved in most levels of the National Health Service—could never have gained sufficient A-levels for university entrance.

When I have taken part in health discussions at the Commonwealth Parliamentary Association international conferences, I have asked what other countries have done in nurse training. There is fairly wide agreement that nurses should be able to train at various levels to meet patients’ needs. Nurses with high clinical skills and qualifications are needed, but so, too, are less qualified but capable, compassionate, caring nurses who are willing to carry out the most mundane tasks where there is a need and to treat people as valuable human beings, not just cases.

In most Commonwealth countries, they have nurses train to the top level, but when they brought in academic degrees for nurses, they retained that intermediate level of nursing which we call the state enrolled nurse. I am convinced that the Government should be liaising with the nursing profession to look into the issue of our need at that intermediate level. It is no good saying that people can become “care assistants”. Even the talk of registering care assistants has not moved people in a way that would make them proud to bear that title. People consider it an honour to be called “nurse”, and so it is, but there can be nurses and nurses, and titles could be appropriately chosen to make clear those who had a degree and others.

Dementia can cause isolation as the patient becomes cut off from reality. It is only at the early stages of the condition that the patient is able to realise that they are losing contact with reality. Some treatments can delay progress, but, at present, nothing can turn back the clock. It is very hard for loved ones to see progressive dementia in a friend or relative, and it can be a great test of their patience, as often the sufferer becomes increasingly repetitious or even difficult.

The number of people likely to suffer from dementia is projected to double over the next 30 years, so there will be further pressure on services. The Local Government Association states that there will be a funding gap by 2020. It cites the Greenwich advanced dementia service as a new model of care for people with advanced dementia which, to date, has supported more than 100 people to stay in their own homes and is saving up to £265,000 a year on reduced care home costs and hospital admissions.

Dementia patients are more likely to die or suffer an injury than other patients. A study of more than 17 million hospital visits found that patients with the condition had far higher mortality rates, longer lengths of hospital stay and a higher likelihood of readmission than other patients. They are also three times more likely to suffer a fall while on a ward than other patients. There were 380,000 such incidents in a year.

As with so many health conditions, accurate, up-to-date and well presented information for patients, their families and friends is vital. Specialist charities can help with providing just such information and reassurance to support the information received from the health professionals. Today in my GP’s waiting room, I checked the large number of information leaflets for patients. These covered almost everything but there was nothing on dementia.

However, my doctor told me that the practice has put people in touch with the Contented Dementia Trust, which has proven to be of great help to carers. Often, dementia can be associated with changes in temperament, with some sufferers having spells of violence and others lengthy times of apathy. Carers find it valuable to know that these situations can arise and how to deal with or prevent them. It is an important point that these specialist charities, of which the Contented Dementia Trust is one and the Alzheimer’s Society is another, can help with providing such information and reassurance.

Marvellous progress has been made in healthcare and people are living so much longer that dementia, usually associated with ageing, is becoming a major issue. Florence Nightingale stressed the importance of the need for a patient’s cleanliness and comfort; to those, I would add caring. These essentials remain the same today. We must do more to see that genuinely caring help is provided while working towards having greater understanding, better information on the condition and a promising future due to continuing and developing research.

I thank all the speakers tonight, who can make a real contribution to the debate on this important issue. Research is the only real answer. Until we can fully establish the cause of dementia, we cannot develop methods of prevention or means of curing the condition. The Government can encourage research and increase awareness and understanding of the crucial need for genuine caring for dementia cases, and they should do so.