How is the nature of the healthcare system in Scotland

(private and state-funded) impacting measures towards improving

dementia care?

Global Politics Engagement Activity

Word count: 2000

 According to the World Health Organization, almost 10% of the world’s population
over the age of 60 suffer from dementia, globally costing US $818 billion, or 1.1% of the
world’s total gross domestic product (“Dementia”). In Scotland, approximately 90,000 people
have dementia, with 96% specifically affecting the over-65 age demographic (“Alzheimer
Scotland”), an alarming statistic demonstrating the socio-economic impact of dementia on
Scottish society. Dementia has a personal connection, as my Grandmother recently
passed away from the illness, at her private care home. While knowing she was
receiving high-quality private care made me feel happy, it did make me question
whether this was the same for others who were not in the same socio-economic
situation as my family. Deliberating whether there may be ana lack of equality linked to
dementia care in Scotland, I questioned whether everyone with dementia in Scotland
has access to high quality care.

Human rights are inextricably linked with healthcare. Human rights are “the
indivisible rights which all humans are entitled to by virtue of their humanity, without
discrimination” (Murphy) and Articles 3 and 25 of the UDHR, the bedrock principle of
human rights. Due to the non legallynon-legally binding nature of UDHR, the UK
government has ratified the Convention on the Rights of Persons with Disabilities. This
UN binding treaty requiring states to ensure people with disabilities enjoy full equality
under the law, highlighting the state’s involvement to promote human rights for people
with dementia. Non-government organisation (NGO) Alzheimer Scotland works to
“ensure that all legislation, policy and strategies affecting people living with dementia
are underpinned by human rights” (“Alzheimer Scotland”). A target for actors involved
in dementia is to remove the stigma associated with the disease and reduce the social
and economic marginalisation people with mental disabilities face.

There is a substantial problem manifesting within the healthcare in Scotland

surrounding the sustainability of current dementia care. Sustainable is the idea that
“development should meet the needs of the present without compromising the ability of
future generations to meet their needs” (“Sustainable Development”). Within the ‘Three
Pillars of Sustainability’, this can be considered social sustainability, but the

1
impact on the government’s allocation of resources has implications on economic
sustainability. While dementia numbers continue to increase, National Health Service
(NHS) Scotland estimate that by 2036, the number of will increase by 82% to 164,000
(“NHS”), making me question whether the current system, put in place by the
Scottish government, is sustainable with an aging population in the Western world?
Thus, I aim to question “how is the nature of the healthcare system in Scotland
(private and state-funded) impacting measures towards improving dementia
care?”

From researching online, I could see that Alzheimer Scotland, the most active
non-state actor advocating for equality for people with dementia (“Organisations -
Dementia MKN”), had a centre in Aberdeen. I attended one of their volunteer-led
‘Musical Memoirs’ sessions where I partook in singing activities with patients and
their carerscareers. By hosting activities involving the patient, carer and other family
members, I saw it helped family members see that there is still a part of the person’s old
self still within them, thus helping in domestically reducing the stigma associated with
dementia. Additionally, to understand the role of the NHS in the dementia field , I spoke
to Lyn Irvine, a dementia nurse consultant for the NHS, who emphasised the growing
interconnectedness between private and state-funded care homes in order to promote
a sustainable dementia care system in Scotland.

Additionally, I conducted an interview with Maureen Watt, Member of Scottish

Parliament and former Minister of Mental Health, the leading Scottish government
representative for the dementia field. During our conversation, we discussed a wide
spectrum of issues in Scotland linked to dementia, including the sustainability of the
current system, and whether an inequality in the quality of care exists between
private and state-funded care homes. Ms Watt highlighted the importance of the
Scottish government’s role in creating a sustainable platform whereby dementia care is
accessible, universal, and enact the necessary legislation to ensure the human rights for
people with mental disabilities are practised across society.

2
 Importantly, I visited the private care home where my Grandma resided, Inchmarlo,
and a state-run care home, Allachburn, in order to observe whether there was an obvious
difference in quality between the two types of care. At Inchmarlo, I spoke with one of the
nurses, Amy Holton, about why families like mine feel the need to put their loved ones into
private care, and what the advantages of private care are. At Allachburn, I was given a tour of
the home by manager Michelle Riddock and discussed with her whether there are any
inequalities state-funded care homes face when dealing with the growing number of people
with dementia, and from a community level of analysis, what needs to be done to ensure
dementia is understood and not stigmatised.

The nature of the healthcare system in Scotland for dementia means that it is
inevitable that a lack of equality exists. State funded care homes are a council-run sector paid
through taxation and ‘free at the point of delivery’ (Perkins). Managed by the NHS, in 2016
the Scottish government spent £12 billion on healthcare, approximately 40% of their
allocated budget (“Healthcare in Scotland”). In contrast, private care prides itself on being of
higher quality than state-run care, and is accessible to those who can afford the fees. When
visiting the private Inchmarlo Care Home, nurse Amy Holton talked about how private
dementia care tends to be “more person-centered” than public healthcare. Similarly, at
Allachburn, manager Michelle Riddock said that because private homes have access to more
funds, they can generally create a “better environment” with more “freedoms” (eg. visits,
outings) When comparing Allachburn and Inchmarlo, the biggest difference I noticed was
that at Inchmarlo, every room had an en suite, compared to communal facilities at
Allachburn, highlighting the economic disparities between the private and public sectors in
Scotland. While private care evidently provides superior personal care, Ms Watt MP believed
that many private care homes prioritise profits rather than improved care, but acknowledged
that state-run homes lack the facilities private homes have, with a third of the UK’s state-run
care homes needing refurbishment and 7% being considered inadequate (Ruddick). While the
lack of equality surrounding the quality of care may be reducing, people with dementia
remain a marginalised group in Scottish society.

3
 Within the population of people living with dementia in Scotland, more inequalities
exist further disenfranchising this marginalised group. Both Maureen Watt MP and Michelle
Riddock raised the issue of further inequalities for the 4% of dementia patients under the age
of 65 (“Alzheimer Scotland”). Ms Riddock, who stated there were a couple of people in
Allachburn under-65, said a “potential inequality” exists because they must pay for personal
care, unlike those over-65 years. Similarly, Ms Watt MP admitted that this 4% “struggles
to become a priority” for the Scottish government. Human development refers to the process
of enlarging people’s freedoms and opportunities, and improving their well beingwellbeing
(“About Human Development”). Crucially, health is one of the three main measurement tools
used by the Human Development Index to access human development levels (“Definition”).
Therefore, one of the ways to promote human development is through binding legislation that
helps vulnerable people in society have the same equality as everyone else. A value of
interviewing Ms Watt MP was that she gave me an exclusive insight into what measures the
government aim to take to improve the situation for the 4% under-65. The soon to be
implemented ‘Frank’s Law’ in 2019 will provide free personal care for under-65 year
oldsunder-65-year-olds (Millar), underlining the steps Scottish government are taking to
remove this inequality, and highlighting the strengths of ‘people power’ who advocated for
this change. Development and inequality are inextricably linked, so for Scottish society
to become a fairer and more equal place, these measures must be taken.

Legislation from the Scottish government is taking important strides towards reducing
inequality and ensuring the human rights for people with dementia are addressed. NHS
dementia consultant Lyn Irvine explained how the ‘Care Inspectorate’ reduces inequality. As
a government-run organisation, it has the power to close any care home that doesn’t meet a
nationwide standard (“BBC”). The Care Inspectorate transcends the public-private divide and
has an important role in reducing differences in care quality between state-run and private
care homes. The government’s implementation of the Care Inspectorate can be considered
‘hard law’, which is binding legislation and is imperative to reduce inequalities. This has
proved

4
to be one of the most effective ways to reduce inequalities in society and promote human
development in Scotland. Evidently, political factors have a crucial role in both reducing
the inequalities and ensuring the sustainability of the current Scottish dementia system.

External political factors could significantly impact the sustainability of the dementia
healthcare system in Scotland. Maureen Watt MP highlighted that one of the key issues is a
lack of nurses, as dementia nursing isn’t attractive to the younger generation. This may prove
to be increasingly problematic with ‘Brexit’, the UK’s democratic decision to leave the
European Union, as many of the current dementia nurses are foreign (Stephenson). The
potential restrictions to foreign skilled economic immigration could have an extremely
detrimental impact on dementia care in Scotland. While attitudes towards state sovereignty
are becoming increasingly realist in contemporary global politics (Rachman), as
demonstrated by Brexit, the consequences this could have for certain marginalised
populations is worrying.

One of the biggest issues Scottish dementia suffers face is ‘stigma’. The lack of public
awareness in the past has meant that dementia and other mental illnesses have been given
negative labels. Alzheimer Scotland is an NGO taking measures towards improving dementia
care, highlighting the value NGOs can have for raising awareness and giving voices to
marginalised groups in society. By singing with the patients at the Alzheimer Scotland-led
‘Musical Memoirs’, I saw how these activities provide an opportunity for the carers and
patients to have a break from the everyday struggles of dementia, as indicated by the
laughter and joy witnessed, and help break down the stereotypes associated with dementia.
Alzheimer Scotland wanting to promote the freedoms and opportunities for dementia
sufferers models Amartya Sen’s Capability theory (Heywood). For Scottish society to
develop, marginalised groups need to have the same capabilities as everyone else, a hallmark
feature of universal human rights.

Human rights are a crucial part of the process to improve dementia care in Scotland.
Ms Watt MP maintains that human rights “underpin everything” the

5
government does to improve dementia care, and explained how they work with NGO
Alzheimer Scotland to ensure the “Charter of Rights for people with dementia” is a crucial
element of improving dementia care. The charter outlines the standard set out by the United
Nations, emphasising the “socio-economic burden” created by unsustainable dementia care,
and strategies that can promote the human rights of people with dementia (“Dementia”
Mental Health). This includes the ability “to participate in and contribute to society” and
prevent “discrimination” at all levels (“Alzheimer Scotland”). The ‘second generation’ right
to healthcare without discrimination highlights the nexus between promoting human
rights and achieving equality in Scottish society. If human rights continue to be
implemented as a backbone to all dementia strategies and legislation, inequalities in the
healthcare system will reduce.

Healthcare is an economic and social right entitled to every citizen of a country, but
inequalities across Scottish society mean different qualities of care can be accessed
depending on one’s socio-economic situation. While visiting both private and public
dementia care homes provided a visual indication of the inequalities that exist between the
contrasting sectors, engaging with a MP to understand the importance of creating a
sustainable and robust dementia system in which human rights are equal across society made
me grasp what makes healthcare a distinctly political challenge. With an alarming projection
of future dementia patients and a stigma still inhibiting human rights from being achieved,
while my engagements informed me that steps are being taken, a lot still needs to be
done. In order to promote social sustainability in Scotland, the universality,
accessibility, and affordability of the healthcare system must meet the needs of all
suffering with dementia.

6
Works Cited:

“About Human Development.” Measure of America - A Project of the Social Science

Research Council, Measure of America,
<www.measureofamerica.org/human-development/.>

Alzheimer Scotland. “Number of people with dementia in Scotland 2017.” Alzheimer

Scotland,
<https://www.alzscot.org/campaigning/statistics.>

Alzheimer Scotland. “A Human Rights-Based Approach to Dementia.” Alzheimer

Scotland,
<www.alzscot.org/campaigning/rights_based_approach.>

“Definition of 'Human Development Index'.” The Economic Times, Economic Times,

<economictimes.indiatimes.com/definition/human-development-index.>

“Dementia.” Mental Health | Scottish Human Rights Commission,

<www.scottishhumanrights.com/health-social-care/dementia/.>

“Dementia.” World Health Organization, World Health Organization, 12 Dec. 2017,

<www.who.int/news-room/fact-sheets/detail/dementia.>

“Healthcare in Scotland | Scotland Is Now.” Scotland,

<www.scotland.org/live-in-scotland/healthcare.>

Heywood, Andrew. Global Politics. Palgrave Macmillan, 2015.

Holton, Amy. “Private dementia homes in Scotland.” 18 July 2018.

7
“Inspectors may force closure of Aberdeenshire care home.” BBC News, BBC, 3
August 2018,
<https://www.bbc.com/news/uk-scotland-north-east-orkney-shetland-4504906

2.>

Irvine, Lyn. “NHS role in dementia care.” 23 July 2018

Jackson-Preece, J. “Security in International Relations.” University of London, 2011.

Johnston, Diane. “Alzheimer Scotland’s role in dementia care.” 13 July 2018

Millar, Jim. “Frank's Law Will Roll out in 2019 Says New Health Minister.” The
Courier, 29 July 2018,
<www.thecourier.co.uk/fp/news/local/angus-mearns/696726/franks-law-will-rol l-
out-in-2019-says-new-health-minister/.>

Murphy, Robert, and Charles Gleek. Global Politics: Supporting Every Learner
across the IB Continuum. Pearson Education Limited, 2016.

NHS. “Dementia.” NHS Health Scotland,

<www.healthscotland.scot/health-topics/dementia.>

“Organisations - Dementia MKN.” NHS Choices, NHS - Scottish Social Services

Council, www.knowledge.scot.nhs.uk/dementia/organisations.aspx.

Perkins, Anne. “What We Need Is a National Social Care Service | Anne Perkins.”
The Guardian, Guardian News and Media, 11 Apr. 2017,
<www.theguardian.com/society/2017/apr/11/national-social-care-service-centr alised-
nhs.>

8
Rachman, Gideon. “Donald Trump Leads a Global Revival of Nationalism.” Financial
Times, Financial Times, 25 June 2018,
<www.ft.com/content/59a37a38-7857-11e8-8e67-1e1a0846c475.>

Riddock, Michelle. “State-run dementia homes in Scotland.” 17 July 2018.

Ruddick, Graham. “Is Private Equity Really Fit to Run Care Homes? | Graham
Ruddick.” The Guardian, Guardian News and Media, 4 May 2016,
<www.theguardian.com/society/2016/may/04/private-equity-care-homes-cash- crisis-
council-tax.>

Stephenson, Jo. “Scotland Ramps up Efforts to Recruit Nurses from Overseas.”

Nursing Times, 20 June 2018,
<www.nursingtimes.net/news/workforce/scotland-ramps-up-efforts-to-recruit-n
urses-from-overseas/7024955.article.>

“Sustainable Development.” IISD, International Institute for Sustainable

Development, 12 July 2018,
<www.iisd.org/topic/sustainable-development.>

Watt, Maureen. “Scottish government’s role in dementia care.” 19 July 2018