Dr Peter J. Gordon
NHS Consultant in Psychiatry for older adults,
Clackmannanshire Community Healthcare centre,
Mr Geoff Huggins
Head of Mental Health
The Scottish Government
Mental Health Division
St Andrew’s House
Thursday, 12 September 2013
Re: Scottish Government policy on dementia
Thank you very much for arranging to meet with myself and Dr Margaret McCartney next week.
I thought it might be helpful to offer a few areas for us to discuss. To keep brief I will just bullet-point a few suggestions:
- Issues around ‘consent’ e.g. for memory testing and how well informed this may be
- Issues around “awareness” – e.g. the military-style simplification of dementia as the only form of memory loss
- Issues around evermore frontline re-organisation between many “pillars”
- Issues around confidentiality (this is emerging as an issue with the current Post Diagnostic Support HEAT Target)
- Re-distribution of responsibility across a wide range of professionals carries potential consequences
- The incresing focus on reductionist tests (in A & E triage for example AMT4) instead of as an adjunct to time-honoured holistic nursing and medical assessment
- The potential for the unforeseen stigmatisation of our elderly i.e. being rated for cognition alone rather than as a whole person
- The risk of mis-diagnosis, over-diagnosis are legitimate concerns just as under-diagnosis has been. Over medicalisation is a concern. It risks diverting resources from those most in need and causing anxiety in those who perhaps need not. I will attach a BMJ article on this very subject from 10 Sept 2013.
- The potential for policy to diverge from evidence, ethics and philosophy. All must be important part of said. Here, my personal wish would be to see greater involvement of (1) the views of our elders, (2) public health and (3) the medical humanities (GlasgowUniversity have a great department and could help)
I will close there.
I struggled to find correspondence between us (through Dr Rhona Morrison) on the issue of early diagnosis. Perhaps your filing is better than mine and you can find a reply from Scottish Government. I know you did reply, but not at all sure it was in writing.
Dr Peter J. Gordon