Dementia patient's hospital treatment 'degrading'

The watchdog recommended better training and monitoring of care

A Scottish hospital has been severely criticised over the care of an 80-year-old woman with dementia.

BBC Scotland has learned that the hospital involved was Ninewells in Dundee.

Before her death, the woman was given dozens of sedative doses over 16 days in ways the Mental Welfare Commission deemed distressing and unnecessary.

NHS Tayside said the treatment was "woefully inadequate" and said it had begun a programme of improvements.

The woman, known as Mrs V, has not been named to protect her family's identity.

Mrs V was admitted to a ward for the elderly at Ninewells in December 2008 after she developed a chest infection, which meant she had difficulty swallowing. She also had dementia.

Over 11 days she was given no food and became increasingly agitated because she could not understand why people around her were eating.

She was given sedatives rectally 57 times and by injection 29 times, an amount described in a report as "astonishing".

Eventually, when she was allowed to eat small amounts, she became calmer and did not need as much sedation. The woman later died in hospital.

The Mental Welfare Commission for Scotland, which examined the case, said her treatment was degrading, unnecessary, and may have breached her human rights.

The commission's report, Starved of Care, said Mrs V was given repeated, uncomfortable and undignified administrations of sedative medication.

'Not typical'

Dr Donald Lyons, chief executive of the commission, said: "We found this to be a wholly inappropriate way to treat a person with severe dementia and life-threatening physical illness.

"Our investigation revealed that nursing attitudes, medical decision-making and monitoring of medication were poor, and that there was a complete lack of a shared view on the best way to manage people with dementia who become physically ill."

Several recommendations for improvement and better training have been made and subsequent visits to the hospital found care had been improved.

The recommendations to the NHS board involved included training on the management of delirium and use and misuse of medication, along with risk assessment guidance and triggers for advice from mental health specialists.

The commission added that visits to a range of general hospitals suggested the case was not typical of the care which people with dementia receive.

Dr Margaret McGuire, NHS Tayside director of nursing, said: "The standards of care received by this patient were woefully inadequate, wholly inappropriate and utterly unacceptable.

"Since this event we have initiated a number of service improvement programmes for dementia patients.

"As part of these improvements, we have appointed a nurse consultant in dementia care who is leading improvements in care for our dementia patients and ensuring all members of staff who care for dementia patients have appropriate training and education."

Ms McGuire added that the Mental Welfare Commission had revisited the hospital twice since the case and had acknowledged the improvements.

A Scottish government spokesman also branded the care given as "unacceptable".

He said: "Many of the issues the report identifies are already being addressed through the national dementia strategy published last summer. Work is well under way at national and local level to make these improvements and we expect that to continue over the coming months.

"For example, the strategy - Scotland's first ever for dementia - was clear that general care in acute hospitals needs to get better at identifying and supporting people who have dementia."

Standards of care for people with dementia are due to be published next week.

A spokeswoman from the Scottish Human Rights Commission said: "The possible infringements of core human rights principles as highlighted in the report - the right to dignity and to be free from degrading treatment - need to be taken seriously and lessons learned by all."