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Dementia Sufferers

Volume 465: debated on Wednesday 24 October 2007

I begin by welcoming you to the Chair, Mr. Marshall, in what I hope and believe will be an important debate. From sitting in that Chair, Mr. Marshall, you will know that debates in this Chamber are often described as important or significant, but I believe that the care of those with dementia justifies those terms.

We have not been good at recognising the significance of the matter in the recent past. To give a parochial and internal parliamentary example of that, there are 531 all-party groups, which range in significance, on subjects from nuclear power to table tennis but, as of June this year, there was no all-party group on dementia. Even within the House and despite the interest shown by individual Members such as those here today, we have not sustained pressure on the issue as we might.

It is not widely recognised outside the House that there is a medical condition that affects 700,000 people, is likely to be contracted daily by 500 new people, is terminal, has no cure, will grow in incidence by 40 per cent. in the next 15 years, and for whose development there is no treatment. If it were, we would expect the pressure on the Government to devote time and resources to it to be considerable and for it to come from many quarters. Those are the facts about dementia in Britain, but there is no sustained pressure on the Government to take action on dementia in the way that there is for other medical conditions.

Before dealing with the question of remedies, we must ask ourselves why that is the case. In February, the “Dementia UK” report was published. It was part-commissioned by the Alzheimer’s Society and was intended to provide, in its words, coherent evidence of the scale of dementia in the UK, and to combat inadequate attention from policy makers. The National Audit Office report entitled, “Improving services and support for people with dementia” was published in July. As I am sure the Minister will remind us, the Government will complete a strategy on dementia by the end of next summer. I welcome that, although it has been a long time in coming. I have no doubt that, in part, it was prompted by the two reports to which I referred.

It is clear from those reports that dementia incurs a huge cost. The NAO estimates the annual economic burden of the condition to be £14.3 billion, which is a colossal figure. It is more than the costs incurred by strokes, heart disease and cancer combined. Perhaps the scale of the difficulty has deterred us from dealing with the condition in the past, but population ageing will increase the problem.

There are emotional as well as economic reasons for our unwillingness to face up to the problem. General practitioners are sometimes unable or unwilling to make a dementia diagnosis in the absence of a cure or effective treatments. They perhaps feel that such a diagnosis would be without hope. More generally, we all find it difficult to face the prospect that the condition will affect us or someone we love. We might be able to see ourselves becoming afflicted with other conditions that get a great deal of financial and emotional support from the public, or with a physical disability, but mental health conditions are often overlooked, as the Minister knows, and we do not wish to face the prospect that it may happen to us. Again, that might explain why widespread, consistent and sustained pressure for action on dementia has not been brought. What needs to be done and what should we hope for in the Government strategy next year? I should like to address some issues on which I hope that the Minister will offer reassurance.

I have no doubt that the Government strategy will cover the issue of diagnosis. It is important that dementia is diagnosed not because that will set someone with the condition on a path to a cure—there is no cure—but because it enables sufferers and their families to make the necessary plans and to cope better with what is going to happen. Diagnosis brings about huge emotional stress but, at the time of the diagnosis, people have a great deal to think about and plan for. As the Minister knows, it is important—people often ask for this—that there be a single point of contact to enable people to get the necessary information and advice on the help and services that they can take advantage of. Too often, that is not available.

Officials from the Department of Health, including the chief executive of the NHS, David Nicholson, appeared before the Public Accounts Committee on 15 October to discuss the NAO report. I am pleased that the hon. Member for Southport (Dr. Pugh), who is a member of that Committee, is here today. The officials were asked about a number of things, including the issue of a single point of contact. The officials reacted positively to the idea of providing a single point of contact where none currently exists but, less encouragingly, they spoke only of how such provisions might be made within the NHS. To some extent, that is understandable—they were NHS officials, after all. However, I hope that the people who will create the Government strategy will think about the issue more widely.

I hope that the strategy group looks at examples of good practice such as the Newbury Memory clinic. Everyone who goes there is referred to an Alzheimer’s Society adviser. We could look at that model with a view to national coverage, partly because there is a great deal of experience and knowledge vested in the society and similar campaigning organisations, and because the advice and support of voluntary bodies is more welcome and trusted by those who suffer from Alzheimer’s and other forms of dementia than information from Government agencies and sources. I hope that the Minister will assure us that consideration will be given to how to provide resources to the voluntary sector to carry out that important role.

We must also look more generally at the issue of mental health services, and ask whether they are up to the challenge and are capable of dealing with the mental health problems of older people, or of going in that direction. Concerns have been expressed about those issues, not least by the Royal College of Psychiatrists. Dr. David Anderson, chair of its faculty of old age psychiatry, has levelled a fairly robust criticism of the situation that will give us cause for concern. He said:

“Some PCTs and Trusts are proposing the dissolution of specialist older people’s services with patients transferred to the care of general psychiatry services with no training in older people’s mental health, including putting older people on general wards claiming this creates an ageless service. This is a dishonest way of cutting costs to the detriment of older people and is not motivated by, nor will it achieve, meeting the needs of older people. It will provide older people with an inferior, second-rate service. The government’s priority status for mental health is read as mental health for adults aged 16-64. PCTs have no interest in anything other than target-driven working-age mental health services”.

I hope very much that the Minister will take account of those criticisms and ensure that the upcoming strategy addresses those concerns.

I fear that the issue of medical research will not be dealt with adequately in the Government’s strategy. The striking predicted growth in the incidence of dementia to more than 1 million sufferers by 2025 and to 1.7 million sufferers by 2051 is predicated on the absence of a cure and effective treatments. It seems to me, and many others, that successful research is the only way in which we can slow that growth. What is concerning is that little of the necessary research is currently funded or undertaken.

Only 1.4 per cent. of research papers since 2002 have been on this subject. Between 2000-01 and 2004-05, in respect of the national research programmes, at least, funding for research dropped in cash terms from £12.9 million to £6.8 million and, as a percentage of the health budget, from 0.03 to 0.01 per cent. I accept that the Government increased funding last year, but still the UK spends 24p per citizen on research into dementia compared with, for example, the 66p per citizen that is spent in the United States. It is illogical that we should spend so much less on research into dementia than we do on research into other conditions that cost us, as a state, proportionately much less.

One third of dementia sufferers live in a residential care home. The NAO report says that half of people in residential care homes and two thirds of people in nursing homes have some form of dementia. It follows from that, inevitably, that training for staff in residential homes is essential. Sadly, that type of quality training is not widespread, and there are consequences, one of which, as the Minister well knows, is the serious concern about inappropriate administration of sedatives in care homes. There are no two ways about it: care home staff need to be properly equipped to deal with dementia.

There are also too few specialist places. Again, on the NAO’s estimate, there are 124,000 registered places for 201,000 dementia sufferers. However, we have to be careful on this, because a good many care homes—in my constituency and, I am sure, in the constituencies of other hon. Members present—care admirably for those with the milder forms of dementia, with the support of the families concerned, despite not being technically registered places for dementia sufferers. We ought to be careful not to jeopardise the good care that is being delivered by being over-dogmatic on descriptions.

We must go on to consider the two thirds of dementia sufferers who live in their own homes, looked after in the main by 476,000 unpaid carers. Those carers are, of course, a lifeline. They are the only thing that stands between the dementia sufferer and much more expensive, not to mention undesirable, admission to residential care, which is not looked for by anyone. A substantial part of the huge cost to the nation that dementia brings with it is the time of carers, which is worth billions of pounds—money that the state would otherwise have to provide for that care. That, if there were no other reason, is a good reason to support those carers.

Of course, carers of all types suffer a huge range of difficulties. This debate does not allow us the scope to go into all of those, but let me make the argument that those who care for dementia sufferers perhaps have it hardest of all, because caring for someone with dementia does not only place physical demands on the carer. That condition also erodes the emotional and conversational bond between the carer and the person cared for. In very many cases, we are talking about spouses or children where the rest of the family might be far away. That can be an extremely lonely experience. In essence, dementia sufferers need the carer more and more as the carer loses more and more of them. That is an extremely difficult situation for carers to find themselves in. The Minister will recognise that any dementia strategy worthy of the name must offer practical help and assistance to those who care for people with dementia.

It is also important to co-ordinate well what we do on dementia. Last week, at the Public Accounts Committee, the NHS chief executive was asked about the possibility of a national dementia care services director. His answers on that were positive. He said, in connection with experience on cancer:

“We have found that having a national clinical director is an enormously powerful way in which to focus.”

That must be right. He was also asked when the appointment of such a national director might be considered and he confirmed that we might not have to wait until the Government’s dementia strategy is published. He said that

“if we are not careful we will lose a whole year if we do not get something moving forward.”

The point that the NHS chief executive was making is indicative of a wider point. The NHS operating framework for next year will be instituted in November or December of this year, substantially in advance of the publication date for the dementia strategy, so the question arises: how much of the preliminary research that will go into making up the dementia strategy will be made available to the NHS to use in determining that operating framework, so that the NHS can be influential in doing what is necessary and urgent to help dementia sufferers and their carers? We know, from what David Nicholson has already said to the Public Accounts Committee, that a national director’s position is under consideration. What else might be fed through to that operating framework in order for those changes to be made earlier, rather than later? Specifically, will there be a national dementia care services director, and will that decision be made before next summer, when the strategy is revealed?

Among the final subjects that I want to touch on, necessarily briefly, are the emerging technologies that we all hope will make life better for dementia sufferers. I am talking about telecare and extra care housing. These developments are happening throughout the country, in different localities, and are very positive and welcome. In what ways will the strategy encourage those types of solution, appropriate to the local context?

The last point, which is vital, concerns respite care. It is essential that respite care is available for dementia sufferers but, more than that, that the quality of that care is extremely high. This point is not unique to those who care for people with dementia. We know from all our experiences with carers that if the quality of respite care is not high, it is no respite at all. Many carers have said to us that the worst weeks of their lives have been when they took a week’s holiday, went away and spent the entire time worrying about what was happening to the person for whom they care. Yes, we should have respite care—and more of it, by all means—but may we please ensure that the quality of that care is high?

All the things that I have mentioned need to feature in the Government’s dementia strategy, which needs to make clear how they will be delivered. Simply setting goals and leaving it to health and social services authorities to decide how those goals may be met within existing budgets will not be sufficient. Worse still would be to conceive a strategy, announce it, declare victory and move on to the next problem, because a resolution of the problems that dementia poses will require sustained engagement from all of us, but particularly from the Minister and the Government.

The Minister knows that all those with dementia, all those who care for them and all those who advocate on their behalf have waited for the strategy and genuinely look forward to its publication. I hope very much that the Minister will do all that he can to ensure that when the strategy is revealed to them, they will not be disappointed.

I congratulate the hon. Member for Rugby and Kenilworth (Jeremy Wright) on securing the debate, which deals with a topic of great importance in my constituency and that of every hon. Member present. During carers week, I met a group of carers from Warwickshire whom the hon. Gentleman had invited to the House. I know that care and carers’ issues are of concern to him.

As parliamentary champion for carers week, I have met some constituents who care for people suffering from dementia. There were quite a number this year—that was not by design, it was just how it happened. Listening to them talk about their experiences has driven me to want to improve the support that they receive.

I have previously raised my concern about the impact of caring on carers’ health. We know too little about the subject and more research should be done, but it is clear that caring for a dementia sufferer has an impact on health. Evidence from carers themselves suggests that such caring is physically and emotionally exhausting. A study reported in the British Medical Journal noted that caring for people with dementia was stressful and that 30 to 50 per cent. of such carers experienced depression. A study in the United States has discovered that caring has an impact on the immune systems of carers for dementia sufferers and stroke victims in particular.

Dementia affects about 700,000 people in the UK, and the number of sufferers is expected to grow to 840,000 by 2010. I met a carer in my constituency who had been caring for her husband, who suffered from vascular dementia, for a number of years. He was also fed with a PEG tube—percutaneous endoscopic gastrostomy tube—and had a variety of other needs. His wife was a remarkable person who gave him a truly amazing level of care. She told me, “I am his nurse,” and described how she fought to establish a routine of care and to train paid care workers to her own exacting standards.

The biggest issue that the carer faced related to respite care. She managed to get a break each week, with support from Crossroads Caring for Carers, but only for short periods to play bingo twice a week and to shop for two hours at the local supermarket. Every attempt to use respite care for longer periods, especially one recent attempt, had proved traumatic. In fact, as a result of poor standards in one local care home, she had to visit the home repeatedly during the week to point out to the paid staff what they were not doing correctly. Her husband came home with an infection that she thought could have been avoided. She was so stressed at the end of what was meant to have been a respite week that she developed rashes and had to visit her GP.

My constituent had further worries about the support that she should have been receiving. She found that certain essential supplies were not made available to her. Although she received a free supply of incontinence pads, the pads that she needed when changing her husband’s pads were not supplied and had to be bought. Such problems and her concern about the low quality of respite care available locally made me feel that the situation was just not good enough. I wrote to the Commission for Social Care Inspection and others on her behalf.

After carers week, I visited an excellent drop-in and buddy service in my constituency that is run by Age Concern in Salford for the carers of people with dementia. I talked to carers while the people for whom they cared were supported by Age Concern staff and volunteers. The service was designed for people suffering from early onset dementia. Some of the people there were in their 50s, but many of the carers had been supported by Age Concern’s project for so many years that they carried on coming. I commend that service and hope that it will continue to be funded through the carers grant for many years to come.

I discovered that those carers talked about similar issues to those raised by the carer whom I had visited in her home the week before. One described to me how he felt that he had to fight the system to get his benefit entitlement and the supplies that he needed, on top of fulfilling the most exacting and difficult caring responsibilities. He found the process draining. I had a long discussion with carers about the inadequacies of local respite care. They were experts. They knew where the best standards were to be found, and they knew which homes were of low quality.

My hon. Friend the Minister has described Alzheimer’s and other forms of dementia as asking new questions of our health and social care system, just as we are doing in this debate. He has announced the development of a national dementia strategy, which is to be published next year. Such a strategy must help to tackle some of the inadequacies in current services and to cope with the expected substantial increase in demand due to an increasing number of dementia sufferers.

The Minister has said that we must bring dementia “out of the shadows” and that people with dementia and their families should

“feel able to seek support at the earliest possible stage”.

I agree wholeheartedly.

Does the hon. Lady share my disappointment with the local government settlement in the comprehensive spending review, which represents just a 1 per cent. increase a year in the budget in real terms and less than half the overall increase in Government expenditure? Does she feel that as the needs of dementia sufferers grow, the hope of training and other support in social care is unlikely to be delivered?

I shall leave the Minister to deal with that political point.

While speaking of care for dementia sufferers, I have discussed unpaid family carers. That is appropriate because two thirds of older people with dementia receive care in the community, mostly from unpaid carers. Up to half the people with dementia also have depression and, as I mentioned, a third of those caring for an older person have depression themselves.

As the hon. Member for Rugby and Kenilworth said, dementia costs the health and social care economy more than cancer, stroke and heart disease combined. Two wards in my constituency have high levels of deprivation and health inequality. I know that one ward has high levels of heart disease and the other has very high levels of stroke. The risk factors for diseases such as vascular dementia are similar to those for heart disease and stroke. It is likely that there are many dementia sufferers in my constituency—many of the carers whom I met during and around carers week were caring for dementia sufferers—but I do not have the information about dementia that I have about other serious diseases.

Given the national picture, it is fair to assume that there are probably some 1,000 dementia sufferers in each parliamentary constituency, and possibly more. Owing to my constituency’s high levels of health inequality and stroke, it is likely that we have more. I want to do what I can to advocate for those dementia sufferers and their carers and to improve the services that they receive. Many of them are managing without services and, indeed, in some cases, without a diagnosis.

Clearly, better awareness is needed, and sufferers must be referred earlier. That should lead to earlier diagnosis, which could help to ensure that the needs of sufferers and carers are assessed. In other debates, I have referred to carers’ rights to have their own needs assessed. Carers are providing remarkable levels of care to people with dementia and they should be supported. A further step is to improve treatment and support so that people with dementia are treated with dignity and respect.

It is key, as the hon. Member for Rugby and Kenilworth mentioned, that we ensure that health care staff and those in respite care homes receive training to equip them to identify and meet the needs of this group of people. One of the carers whom I met reported to me that after her husband had spent a week in respite care, the person in charge of the care home complained about his behaviour, which he said other patients had found disturbing. All the behaviours being complained about were classic to dementia sufferers and were what she dealt with every day as an unpaid family carer.

I pay tribute to all the carers whom I have mentioned today and to the organisations that support them, such as Age Concern, Crossroads and the Princess Royal Trust for Carers. I asked one of the carers what extra support or help she needed and told her that I would pass on what she said to Ministers. She asked for two things: support for an occasional longer spell of shopping so that she could wander round the shops rather than racing around in two hours every week; and respite care that would enable her to leave home for a week, or occasionally two. She has not been away for two weeks since her husband’s illness started.

We must ensure that standards in respite care homes are raised substantially, so that the carers whom I have described can have a decent break from caring without spending the whole time worrying about the standard of care. Such carers are the care for dementia sufferers and they deserve our support.

I congratulate the hon. Member for Rugby and Kenilworth (Jeremy Wright) on raising this issue and putting his case so well. He made a number of highly specific requests. I hope that the Minister has written them down because they are entirely deliverable.

I think that everyone has a personal tale to tell about dementia, often involving their own families. My personal memories go back to a gap year and working on a geriatric ward with some people with fairly extreme cases of dementia. Three tragic cameos stick in my mind from that time. I remember trying to stop an individual quite unknowingly eating a bar of soap by trying physically to take it out of his hand. I remember struggling to change the soaked trousers of a pre-senile dementia case—someone younger than I am now—and the look of affronted bewilderment and anger on his face as he came to terms with what was being done to him.

I remember another man who had entirely exhausted the efforts of his caring family because he was inordinately restless. He was admitted to hospital and acted with similar manic restlessness in the ward, fiddling with other people’s belongings and moving from place to place. One day, the staff and patients could take no more and he was put in a chair with a bar across it. Five days later—and after hours of struggling—he died, exhausted, of a heart attack. We never saw him again.

That is the rough end of dementia, and we all accept that it is a huge problem. Some say that it affects half a million people, some say more. As we have heard, there is no identifiable cure and the situation is likely to get worse. Wanless has told us that there will be millions of suffers and that the cost will be billions of pounds.

As is the case for most illnesses of age, dementia is a disease of degrees, ranging from forgetfulness to complete personality disintegration and regression, with a loss of control over bodily functions and the loss of all sense of time and place. It therefore makes differing, yet always distressing, demands on carers and the caring services. The size, scope and nature of the problem are relatively well understood. However, the life of individual patients who have the problem is not as well tracked.

Most dementia patients visit a number of different organisations under the health service because of their complaints, not all of which are to do with their dementia. They interact with a multiplicity of agents and local government, NHS and voluntary bodies. They see their GPs, and they might see people from a mental health trust and those from the acute trusts who deal with physical problems. Also, of course, they see social services for one reason or another. A flaw in their general care is that no single organisation has overall responsibility for managing their condition, or even ensuring that the information held by one organisation is shared with others.

There are genuine difficulties. The hon. Member for Rugby and Kenilworth referred to the National Audit Office report, which the Public Accounts Committee, of which I am member, discussed on Monday. The report showed some disturbing facts. It established that GPs were less confident in diagnosing dementia than before. That is partly because they are under pressure to diagnose at an earlier stage than hitherto, and they are possibly reluctant to give people prematurely what may be a fatal diagnosis. Diagnosis in care homes is weak, with 62 per cent. of people there suffering from some form of dementia, although that is not necessarily on the records. Equally disturbing is the fact that although many sufferers are admitted to a general hospital for physical conditions, a correlative mental health assessment is not made at the same time. That would be an easy place to pick up the problem and to deal with its symptoms.

One could be quite brazen and say, “Does that really matter? After all, the outcome is inevitable and it is not good.” When pressed on that question the other day by the Public Accounts Committee, David Nicholson and his officers were emphatic on that point and said that it did matter how early a diagnosis was made or attempted. Research shows that early diagnosis has an appreciable affect on the standard of care, even if it does not do much by way of a cure. It slows progress, so people can be put in touch with memory clinics and the like. All that is good and, given the will, it is something that the Government could advance.

The hon. Gentleman also made the point—I think that he has stolen some of my thunder—about the need for one person to be solely responsible for the condition of specific patients. The Public Accounts Committee gave that idea a warm welcome. We need better community management of the condition, which is certainly prevalent. A single reference point for carers would be more than helpful. I suspect that the reference point would be not the GP, but a specialist attached to a practice who was trained in geriatric medicine. That is not the only way in which the aim can be achieved, but there is certainly a need for a single reference point.

Under the quality and outcomes framework, GPs are financially incentivised to treat dementia. QOF points are gained through the way in which GPs manage the condition and report on it. I am less than convinced that the outcomes of the framework are rigorously evaluated and that people are properly rewarded for doing the right thing, with poor practice identified and monitored and good practice properly rewarded, and good practice not only encouraged, but spread.

Dementia patients often have a multiplicity of problems. Dementia is an illness of age, and with age comes other ailments. Dementia patients have particular difficulty in getting across to the doctor that they have a possibly serious physical condition that has nothing to do with their dementia. We know that dementia patients can suffer mental health problems that are not directly related to dementia. For instance, it is understandable that one could be depressed when demented. It is inappropriate to treat only for dementia, not for depression.

We also need to improve the care in care homes, which was another point raised by the hon. Gentleman. Figures show that 28 per cent. of care homes have specialist places. However, some 62 per cent. of those in care homes have dementia, which probably means that the bulk of the staff looking after them are not specifically trained. Indeed, as the NAO makes clear, those staff are not all good English speakers. The Minister will understand that the big move in care homes to keep wages down often involves a high use of immigrant labour. Some such staff are well qualified and very good at the job, but from time to time there will obviously be communication difficulties.

Some 40 per cent. of dementia sufferers in care homes are treated with neuroleptic drugs. In some cases that is wholly appropriate, but some situations that are chemically managed could be treated in other ways. There is good and bad practice in nursing homes and care homes. Good practice should be spread and bad practice eliminated, when possible.

That brings me to the topic of elder abuse, which relates not simply to dementia. One shocking figure suggests that 500,000 people are the victims of abuse in the later stages of life. It has to be said that they are usually abused by people in positions of trust, and often in the home. Abuse has an extraordinarily broad definition. Not only are those being cared for being abused, but sometimes those who have dementia or Alzheimer’s are capable of making life very uncomfortable for carers themselves. Indeed, 33 per cent. of care givers claim to have been abused at some time. It is certainly an area in which training, understanding and support is sorely needed and required for all involved in the process.

Ultimately, we all accept that there are no magic solutions. There are a number of helpful steps that the Government could take immediately. However, good things do happen. We need research breakthroughs and better drugs. There has been a lively debate about what drugs are available in certain places for dementia sufferers. I accept that for reasons that we do not properly understand, some drugs work for certain people but not for others. Considerations of value for money are also involved in the use of certain drugs across the piece. None the less, we need to investigate further why some drugs obviously work for some people but not for others, as is suggested in carers’ reports.

I cannot pass over the fact that we have had only a paltry 1 per cent. increase in the supporting people budget. That will create a monumental headache for local authorities such as mine. The large number of elderly people living in the area is not reflected in the funds available for treatment.

We all support increased respite. We all want to see quality care, not the cosh of the drug, as it were. As the hon. Member for Rugby and Kenilworth said, we also want better integration with voluntary bodies, which play a valiant and necessary supplementary role in developing care across the piece. Finally, we need more research investment.

Beyond that, however, there is a bigger public health agenda. We must all face the fact that mental decline is a side effect of ageing, and we all suffer it to a degree— some more, some less. The effects are not the same across the board, however, and they can be accelerated or retarded by lifestyle. That is where the public health agenda interacts with therapeutic endeavour. An awful lot of work still needs to be done on that, and the Government recognise that to some extent and are setting about doing something.

If the concept of good old age is not an oxymoron, it is certainly an ideal and one that we should hold. In our ageist society, sadly, it is one that has yet to be recognised.

I start by paying tribute to my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), who, along with the Alzheimer’s Society, got the all-party group on dementia off the ground. I also pay tribute to the Alzheimer’s Society for its lobbying. As Members of Parliament, we are constantly lobbied by organisations, but the society has been significantly more effective than many others.

The all-party group will become a crucial tool not only in raising awareness, but perhaps in bringing about a change in policy and bringing all political parties together to find some of the solutions to what is, at times, a difficult problem. I share my hon. Friend’s surprise that such a group did not exist before, given that, as he has said, we have all-party groups on a number of subjects, including table tennis. The fact that we did not have a group on dementia is remarkable, given that 700,000 people suffer from some sort of dementia.

One reason for that is that this is a difficult issue.

I am pleased to see the Minister nodding in approval, because this is not a terribly party political issue. It is, however, a difficult issue, because it is not very sexy. Some illnesses and problems attract great media attention, and we find them somehow easier to deal with, but dementia is one of the hardest to tackle. Geriatric care, as it used to be known, often came at the bottom of the pile in terms of funding, and psychogeriatric care came even lower. Although people with dementia are by no means all over 65, a significant number are. As parliamentarians, we have a duty to change things and to address this extremely difficult issue.

My hon. Friend has mentioned several issues, including research, and more research clearly needs to be done. We must do what we can to slow the progression of dementia, because that will have a significant impact not only on those who care for people with dementia, but on the Government’s budget.

My hon. Friend has discussed training, which is a terribly important issue that also arises for people with learning difficulties and for parent carers of children with profound disabilities. We need training for hospital staff, dentists and other care staff—people whom we take for granted, if we are well—because they may not recognise the needs of people with dementia and may, indeed, not recognise dementia when they see it.

My hon. Friend briefly mentioned the over-prescribing of neuroleptic drugs. He was at pains not to be critical of their use, but we should accept the fact that using them significantly increases the risk of someone having a stroke, which would obviously have a profound impact on somebody who is already suffering from dementia. To some extent, the use of neuroleptics is a signal of our feelings of impotence when it comes to dealing adequately with people with dementia.

For the purposes of clarity, I certainly do not criticise all uses of neuroleptic drugs. My point concerns the nature of the care that is delivered in a particular care home and whether that care home is registered as suitable for dementia patients. I certainly know of people with mild dementia being well looked after in settings that have not been formally ascribed the status of being suitable for dementia patients, so we must be careful not to be overly dogmatic on that point.

Yes, I thank my hon. Friend for clarifying that. As he has rightly said, some excellent care is undoubtedly delivered.

My hon. Friend went on to mention the idea of a director of clinical care for dementia, and there is no doubt that the leadership and vision that such a post would bring to this field would have a significant impact not only on producing better outcomes for people with dementia, but on getting rid of some of the stigma associated with dementia.

The hon. Member for Walsingham talked about the impact of caring on carers and about stress and depression—

My apologies—the hon. Member for Worsley (Barbara Keeley). Wherever the hon. Lady hails from, her points were well made. She mentioned stress, depression and social isolation among carers. She talked about the inadequacies of care support and about the fact that the care provided in some residential settings does not replicate the care that people receive in their own homes. She noted that carers’ confidence in respite care is crucial to determining whether they use it, which they need to do if they are to continue with their burdens. She also mentioned organisations such as Age Concern and Crossroads, and she gave a moving account of individuals’ experiences.

The hon. Member for Southport (Dr. Pugh) described the rough end of dementia care in graphic terms, and I could share similar stories with him, having been a district nurse some years ago and having also seen people in care home settings. He referred to what happens on the ground, which is so important. He also mentioned key workers and training. Finally, he discussed elder abuse—a subject that we do not often feel comfortable addressing.

The hon. Member for Barnsley, Central (Mr. Illsley) is not with us today, but at Prime Minister’s Question Time he raised the issue of Aricept and the fact that the National Institute for Health and Clinical Excellence has not issued the data model that it used. NICE can play a significant part in the care of people with dementia, but its role has been overlooked. NICE does not currently take into account the social costs of care, but they are extremely important in evaluating the cost-effectiveness of any drugs that come on to the market to treat conditions such as dementia. I agree with the hon. Gentleman that it is important for us all to have sight of the data model that NICE used.

Will my hon. Friend join me in congratulating the Minister on two fronts: first on recognising the failures of the current system for dealing with people with dementia, and secondly on announcing the development of a new strategy to deal with dementia? Does she share my concern that the missing link, as Help the Aged has called it, is research—my hon. Friend the Member for Rugby and Kenilworth mentioned that point? Will she join me in hoping that the Minister will deal with that aspect of the matter today?

I thank my hon. Friend for that intervention. His points were well made. Of course, I should not do otherwise than join him in his two points of congratulation, and in making the point that more research money is crucial.

The other issue that has been touched on today is the 1 per cent. increase in the supporting people budget. An important aspect of it is cost shifting between the NHS and social services, and the feeling among local authorities in some parts of the country that their budgets and the money that they get from central Government are for ever shrinking—it is becoming extremely difficult for them to give effective care in people’s homes and to support carers of people with dementia. It is crucial that, given such resource constraints, we ensure that every penny is well spent.

My hon. Friend has mentioned pressure on council budgets. The current number of dementia sufferers in the East Riding of Yorkshire is 4,700. It is expected to be more than 7,700 by 2021—a very few years from now. I hope that the Minister will take on board the need for additional funding, to take account of what is probably the biggest issue facing British society—dealing with an ageing population.

My hon. Friend has made the point extremely well, and I expect that the Minister and hon. Members all agree that one of the main issues, and one on which we at times have our heads in the sand, is how to cope with our ageing population; how, as the hon. Member for Southport has suggested, to create a society that is not ageist in its approach; and how to look after those who will have to carry the burden of caring for those who cannot care for themselves.

In conclusion, I should like the Minister to deal with the points raised by my hon. Friend the Member for Rugby and Kenilworth, whom I again congratulate on obtaining the debate. However, I also want to ask him a question: who will care for carers if we do not? There will be no one to save the Government £6 billion a year as those carers now do—it has been estimated that £1 of Government money spent in the voluntary sector provides between £11 and £15 in services—and there will not be enough care home beds in which people with dementia can be looked after, or enough residential home places. I hope that the dementia care strategy will address the problems not only of people with dementia, but of the people who care for them.

I am sure that the Minister agrees that this is not a party political issue. He looked slightly nervously at me, as if I were going to attack the Government, but I do not want to do that. All that I want to do is make the lot of people with dementia, and those who care for them, better, and this debate is an important step towards securing that goal for the future.

I am well briefed. I congratulate the hon. Member for Rugby and Kenilworth (Jeremy Wright) on securing this debate on a crucial issue. It seems that the issue will touch an increasing number of families—indeed, we know that that is happening. Many people seem incredibly uncomfortable talking about it, but it will become a growing challenge for our society. I have said that we need to bring dementia out of the shadows. It asks questions of the health and social care system—and of families and society—and we have not been able to address that issue thus far. Together we need to find a solution. We need to match our ambition to find a solution to the scale of the challenge.

I thought that the hon. Gentleman’s speech was thoughtful. I am delighted that he is to be the chairman of the all-party parliamentary group, and I look forward to working with the group to make a difference. In response to an important point that he made, I shall talk about the national strategy, but developing and announcing that strategy will be only the beginning of the journey. The key will be the delivery and implementation of change in every community, so that people who use services, and their families, have a very different experience from the one that many have so far had. The parliamentary group and, indeed, Parliament, have an important role in making sure that that happens.

I pay tribute to the hon. Member for Guildford (Anne Milton). I was not looking anxiously at her, but at the hon. Member for Beverley and Holderness (Mr. Stuart), because he and I know each other rather well. I congratulate the hon. Lady on making this one of the rare occasions when an Opposition spokesman has not made a partisan point of any kind. That inspires tremendous respect for her, because this debate needs to be conducted on an all-party basis.

I also pay tribute to the hon. Member for Southport (Dr. Pugh) for a thoughtful speech in which he raised issues that have not been raised elsewhere in the context of dementia. He raised the matter of elder abuse, which is sadly another growing problem in our society. I suspect that our public discourse on elder abuse is now at the same stage as our public discourse on child abuse was 20 or 30 years ago. Sadly, as I said this week, society is not as outraged by the abuse of an older person as it is by the abuse of a child—something that we should all want to address.

The hon. Member for Southport also referred to therapeutic interventions. Older people need to be supported in maintaining their health for as long as possible, so early intervention and prevention are crucial. My view is that not enough work is going on in communities to deal with loneliness and isolation among older people. Politicians of any colour never said, in passing the 1990s community care legislation or in developing policies since 1997, that it was not the responsibility of local communities, local authorities or anyone else to treat older people’s loneliness and isolation as a shared responsibility, and programmes were introduced to address those issues. In our thinking about social care, addressing loneliness and isolation should be an integral part of the system.

Will the Minister join me in paying tribute to groups such as one in Cranleigh in my constituency, which started walking for health programmes for older people, with the unexpected benefit that, having been set up to give older people in particular more exercise, the programme has also provided an important social outlet for people who might not otherwise get out and who feel isolated?

I am delighted to pay tribute to that group in the hon. Lady’s constituency. It is important to remember that, although the notion of an ageing society is presented as being all about burdens and negativity, many of the present generation of older people are healthier than any previous generation, which is a trend that will continue as a result of medical advances and improved affluence. We should also remember that many of the current older generation are more affluent than the previous generation. We should not present the situation as just negative. There is a challenge that requires us to think differently about our communities and public services, but it is by no means a negative. Politicians all have a responsibility to think about what that means for policy.

I want to mention in response to the remarks of the hon. Member for Southport that we are reviewing the entire regulatory system on protecting older people from abuse. “No secrets” was guidance issued to local authorities some years ago, and we are undertaking a fundamental review of it. We are examining the case for legislation. I am not a believer in introducing vast amounts of regulation and legislation, unless it can be proved that it adds value and will make a difference. However, if the absence of that regulation or legislation is failing adequately to protect older people, we have a responsibility to consider toughening the system.

The hon. Member for Beverley and Holderness is right that we must include research in our process. Although that is not one of the primary objectives of the national review, I have made it clear, as the lead Minister on these issues, that we must look at research if the process is to have credibility and integrity. We will be looking at investment in research.

I am grateful to the Minister for giving way and for the words that he has just uttered. When can we expect to hear the result of the examination of potential improvements in research spending, which, as my hon. Friend the Member for Guildford pointed out, halved from 2001 to last year?

We intend the national dementia strategy, when it is published, to reference our view on going forward on research, so it will be clear as part of the process. At the moment, that is not identified as one of the priorities for the development of the strategy, but I am willing to include it and to look seriously at research.

I say gently to the hon. Gentleman that the Conservative party has made no commitments, as far as I am aware, significantly to increase investment in local government. If it has, there will be tax implications about which we would be delighted to hear a little bit more. Hon. Members in Opposition parties are constantly stacking up all sorts of spending commitments, which is worthy indeed, but, of course, Governments must fund such commitments.

The Minister has been party to creating joint working between health and social care in order to try to create a seamless system. In that context, the decision of his Government to make such a discrepant allocation of funds between local government and health looks peculiar. I am not responsible for my Front Bench’s position. Personally, I would prefer to see a clearer and more balanced allocation between health and social care, so they can move forward together. If anything, social care’s need for cash seems even greater than that of health at the moment.

There was an era not that long ago when nothing plus nothing came to nothing, and those of us in the House who remember it know the dreadful state in which public services were left as a consequence. Frankly, it is a little disingenuous of the hon. Gentleman to make that point, when there have been record levels of investment in all public services year on year in the past 10 years, but I will address the serious issue.

If we are going to transform services for older people and disabled people in our society, we need a far more integrated approach between the NHS locally and local government, and between the voluntary and private sectors. We certainly need to look at the balance of resources between the NHS and services that are commissioned—not necessarily provided—by local government. I do not think that there is any difference between us in terms of direction of travel. The White Paper, “Our health, our care, our say”, committed us to considering, where appropriate, a redirection of resources from the NHS to local government in terms of the provision of certain services. I shall tease the hon. Gentleman by saying, “Watch this space.”

The Minister is right; this is the wrong subject for political knockabout. The key point is that the Government, by setting out their objectives in a strategy, will properly raise expectations in the dementia community as to what can be done. If those objectives are not supported with the necessary funding, we will find a good deal of disappointment among the dementia community, which is why concerns are being expressed about where the money will come from, in addition to the worthwhile policy objectives.

Yes, I agree entirely with that. But the hon. Gentleman must accept that his party is not saying to the people of England, “We are going to spend a lot more money on dementia.” There has been no such policy commitment.

Let me make it clear that there will be a 1 per cent. real-terms increase going into local government, and the NHS will receive roughly a 4 per cent. real-terms increase. The combination of those increases is significant. The Department of Health has an amount of money specifically for social care, the detail of which has yet to be announced.

In the spring next year, the Prime Minister will announce a new deal for carers. He has set up a consultation process, meetings are taking place throughout the country and in the spring there will be an announcement about additional enhanced support for carers, the funding of which has not yet been committed or announced as part of the comprehensive spending review. In addition, some of the commissioning decisions at a local level should be different from the current ones, in terms of the use of existing resources and, certainly, with regard to joint and integrated commissioning between the health service and local authorities. It is easy for an Opposition Member to suggest that this is just about more and more money, and then not make any commitments to spend any.

This is also about using existing resources more effectively and getting the decision makers on the ground to take dementia more seriously. The chief executive of the national health service appeared before the Committee and had to acknowledge that the system is letting too many people down, and to make commitments in that area, which is important. However, that has to be reflected in decisions made locally by those who run NHS and local authority organisations and those who make commissioning decisions. Part of the strategy will be to ensure that dementia is given a much greater focus and a much greater priority, which is consistent with the scale of the challenge that dementia now presents to communities and families.

I want to talk a little bit about how we are approaching the strategy. I deliberately appointed somebody with an NHS background, Professor Sube Banerjee—head of mental health and ageing at the Institute of Psychiatry and a clinical director for the mental health of older adults at the South London and Maudsley NHS Foundation Trust—and Jenny Owen, who is executive director of adults, health and community well-being in Essex, jointly to develop this national strategy. Health and social care are working together, arguably for the first time, to ensure that the strategy is truly joined up, and the strategy delivery should reflect that.

I have also appointed Neil Hunt, the chief executive of the Alzheimer’s Society, to play a central role in the strategy’s development and to make sure that we are engaging with and consulting all those out there who have specialist knowledge and concern and passion about the needs of people with dementia. Our external reference group, for example, will include Barbara Pointon, the lady who incredibly courageously allowed a documentary about the deterioration in her husband’s condition to be filmed. After that documentary, all that was debated in the media was whether her husband died on camera or not. What an outrage! Why did the media not generate a debate about Alzheimer’s and dementia, rather than having an insider techie debate about whether the actual death was filmed? That really makes people angry. Meeting a person like Barbara Pointon, who has been through that hell and is prepared to go on platforms everywhere and argue the case for better, improved services for dementia, makes one realise that such people are the true people of courage in our country.

I would like to associate myself with the Minister’s comments. The courage of people who have been through such an experience is extraordinarily humbling. I agree with him that without people such as Barbara Pointon, our ability to debate and find solutions to some of these problems would be much less apparent.

I agree with the hon. Lady’s sentiments. Neil Hunt and the Alzheimer’s Society have done a tremendous job in raising awareness of these issues and pressuring the system to take them far more seriously than it has done hitherto.

I pay tribute to my hon. Friend the Member for Worsley (Barbara Keeley). She has used her experience and her passion for both social care and the needs of carers ever since she became a parliamentarian. She has made a tremendous impact in raising the profile of these issues in Parliament and more widely. Although, as she said, this is not a very sexy issue, it is important that individual parliamentarians champion issues that are less sexy than others. Out there, for the families and people in our communities and our constituencies, these are the issues that arguably matter far more than some of the others on which we spend a lot of parliamentary time. I pay tribute to her for the work that she continues to do in this area.

My hon. Friend has made a number of important points. The effect of caring on the health of the carer is something that we need to consider as part of our work on the new deal for carers and on the national dementia strategy. She is absolutely right on that point. She also referred to the fact that carers are usually the experts on the people for whom they care, which professionals forget too often. The relative—the husband, wife, son or daughter—knows far more about that person and what they need and want than a professional will ever be able to. In some of our public services, we have to change the culture of how carers are treated. Arguably, we need to do so more in the NHS than in the social care system.

Will the Minister pick up the point made by my hon. Friend the Member for Rugby and Kenilworth about expanding the voluntary sector and the role that it has to play?

The hon. Gentleman is even reading my mind now. I was just going to come on to that point.

On the question of expert carers—hon. Members should listen, because I do not think that this is widely known—we are developing an expert carers programme that we will launch in the summer of next year. Up and down the country, local training courses will be available for carers to help them with practical issues such as lifting and handling and with some emotional issues, so that they feel confident in taking on and working with the professionals and the public services not confrontationally, but to represent the best interests of the person whom they love. Empowering people is an important part of improving services. Yes, we can improve the leadership, structures and funding, but we also need to give those who use the services and family members far more control, power and confidence to fight for their needs and rights.

As well as the new deal for carers, I should mention that the Prime Minister has established a standing commission on carers under the leadership of Philippa Russell, a well-known activist for disabled people. She is a carer herself, with an adult son with learning disabilities. The idea behind the standing commission is to consider the long-term challenges that we face with caring responsibilities in our country. Inevitably, at the heart of that will be the ageing society and dementia. That standing commission will be an important step forward.

My hon. Friend the Member for Worsley also raised the question of respite. We have just announced a significant investment, as a result of a lot of all-party support, for disabled children and their families, with a particular focus on respite. One of the things that the new deal for carers must consider is respite care for adults. We have recently put some money into the system, and into local authorities specifically, for emergency respite care. Carers have told us that that is often a problem. When they have an emergency, it is very difficult to access respite care, and we need to build on that.

I am proud of the fact that the Government have given an annual grant to local authorities since 1999 specifically to support carers. It is a ring-fenced grant, and it is transparent. In recent years, it has not been ring fenced in the sense that we cannot force local authorities to spend it in the way in which we want them to, but a transparent and clear amount of money has gone to every local authority since 1999.

On raising the quality of respite care, does my hon. Friend agree that it is not strictly a cost issue, but a regulation issue? The discussion I had with local carers about quality standards raised a question about regulating to minimum standards. When the homes that were being complained about in my constituency were checked, they were at minimum standards and then they slipped below them between times. The problem is regulation, rather than cost.

I agree with my hon. Friend, although to some extent I think that there is a combination of factors. We have a regulatory system that secures minimum standards for the first time, and such standards did not exist before we introduced them. However, we need to do far more than secure minimum standards. People are entitled to expect quality personalised care. The next challenge for our health service and our society is to regard public services as offering people not only minimum standards, but highly personalised services. That is the next part of the mission when it comes to strengthening the public services at the heart of a decent society.

If the Minister is about to move on to this subject, I apologise. Before he leaves the subject of the voluntary sector—

I was about to echo the comments made by the hon. Gentleman, other hon. Members, the Princess Royal Trust for Carers, Crossroads, Age Concern and Carers UK—we could go on and on. The voluntary sector is at the heart of our capacity to provide quality services and to enable people to feel comfortable about accessing services. We know that for some people, the voluntary sector is closer to communities than the statutory sector can ever be, and we also know that because there is a different history to the growth and development of the voluntary sector, it is in a position to advocate for people, often in an incredibly powerful way.

When, as the Minister responsible, I talk about integration of services in local communities, I do not just talk about the local NHS and local government—I always talk about the voluntary sector and the private sector. If we harness all the resources effectively that are being spent on care through those different sectors, we will end up with much higher quality, better services for people by simply using existing resources, without debates about the ongoing need for additional resources.

On the single point of contact, the Minister has talked about the desirability of involving the voluntary sector, and I am sure that we all agree about that. However, does he think that it would be a good idea for the single point of contact to be provided by the voluntary sector rather than by the state?

That is a difficult point. I personally believe that in every community there should be a single point of contact, which I would describe not as a one-stop shop, because that is unrealistic, but as a first-stop shop. If someone logs on to a website, visits a place or makes a call, somebody should ensure that they end up in the right place for the support that they need. We should aim to achieve that in every community.

Who would end up providing that service is open to debate. In some communities, the voluntary sector is undoubtedly best placed to do so. In other communities, the voluntary sector is underdeveloped, and the service would have to be provided by a statutory agency. Securing the notion of first-stop shops in every community, particularly in terms of older people, carers and the ageing society, should be an objective and ambition that we promote.

Turning to the strategy, first, we want to raise awareness about dementia, so that people begin to spot the signs at the earliest conceivable stage. Awareness-raising has to be not only about professionals, but about friends, family members and workmates. We know, as the hon. Member for Southport has said, that early intervention makes a difference. Recognising and spotting the signs, and not dismissing the symptoms as something entirely different, is incredibly important. Raising awareness and trying to remove some of the stigma is also crucial, and we will consider the best ways in which to do that.

Secondly, we want early diagnosis and intervention. All hon. Members know that GPs cannot be expected to be experts on every single condition. We have to ensure that primary care professionals have the maximum possible knowledge about dementia and a professional commitment that, if there is doubt or uncertainty, they will ensure that the person is referred appropriately to someone with specialist knowledge and expertise, rather than dismissing them or telling them that it is nothing to worry about. A major part of the strategy will be to consider how people access professional support and to ensure that we get those professionals to work with us to ensure early diagnosis and intervention.

Does the Minister agree that we need to recognise people’s concerns about, and fear of, a diagnosis of dementia, and to look at what is being done in Croydon, I believe, where what used to be called a dementia clinic has been renamed a memory clinic, and where referrals are now taken up more fully?

I agree with the hon. Gentleman that it is important to recognise models of best practice. There is a lot of very good provision out there from which we can learn. We need the standards of all to be brought up to the standards of the best. Part of our strategy needs to involve highlighting places such as the Croydon memory centre and other services that already are providing the kind of support that we want to provide to everyone.

Given that dementia is the subject of today’s debate, will the Minister comment on dementia in young people, which is an extremely serious condition and, as has been said, a fatal diagnosis?

One of the benefits of the reshuffle is not only that I retain my job, but that, for the first time, I am responsible for all mental health provision in the Department. That means that I am responsible for the mental health of children, adolescents and adults and for dementia as whole, which is one of the issues that I need to address in assuming those integrated responsibilities. I agree entirely with the hon. Gentleman, and his question is a new question being asked of our society. Quite frankly, the system cannot cope with younger people who develop dementia. The hon. Member for Southport has also referred to that point.

The third focus of the national strategy is on improving the quality of care, whether it is provided in people’s homes, hospitals or care homes. I have a really important point to make here: there can be no excuse for the neglect of older people, whether it is on a hospital ward, in a nursing home or through a home care service. We must continue to campaign to put respect for dignity at the heart of all care services. I do not accept the idea that we should always blame a lack of resources. There are certain non-negotiables and practices in the way that older people are treated that bring nursing and the NHS into disrepute.

I also believe, however, that managers, as well as front-line staff have a responsibility in this matter. Wards where more than 50 per cent. of the patients have dementia require different staffing arrangements from those where that is not the case. We pay NHS managers to make those decisions and to get that right. In the same way that there has been a debate about pupil-teacher ratios in the education system, we ought to have a debate, not about Ministers prescribing a certain number of nurses per patient on every ward in the country—that is not our job—but about managers, whose job it is to ensure appropriate staffing arrangements, especially if staff are having to cope with a ward on which dementia sufferers predominate, and if we want to give dementia sufferers high quality, personalised care.

I agree with the hon. Member for Southport and others about offering an integrated service to the patient and family members. Service users—patients and family members—are not interested in whether the service is provided by someone who describes themselves as a health professional or a social care professional; they are interested in a joined-up, integrated service that is sensitive and that meets their needs. They do not want to be passed from pillar to post between different administrative structures, so we need clear lines of accountability and responsibility at a local level.

I appreciate that the Minister is running out of time, but I do not want him to run out of it before touching on co-ordination, and specifically on a possible national dementia services director. Some very heavy hints have been dropped by the chief executive of the NHS about the desirability of that. Will the Minister tell us if, or when, that will happen?

Professor Banerjee, who is leading on that, is the Department’s clinical advisor on dementia. He is not a national director for dementia, and I need to give further consideration to that proposal. The difficulty is that, understandably, every area in the health service wants a national director. I have just appointed somebody in the Department to lead on autism. Previously, no official was leading on that issue, which is presenting a growing challenge for our society where children and young people are concerned. Indeed, the problem of adults with Asperger’s is now raising many issues. I cannot give a cast iron commitment today, but I shall reflect on the hon. Gentleman’s point. Certainly, that issue must be addressed as part of the national strategy. As David Nicholson has said, however, there is a strong case for having such a director. We have an excellent national clinical director for older people, Professor Ian Philp, who is highly regarded but who is not a dementia specialist. We will consider that possibility as part of the national strategy.

Clearly, training front-line staff is crucial, and we need a combination of universal basic knowledge and highly specialist skills. However, we still have a long way to go. For example, let us consider domiciliary care workers. As more and more people choose to remain in their own homes, rather than to go into hospital or institutionalised care, more of the service will have to be provided by home care workers. We need, therefore, to have a particular look at their expertise, knowledge and sensitivity to the needs of people with dementia; that applies to all professionals. On one hand, we need some minimum knowledge among the universal professionals and system, and on the other, we need a cadre in every community of people with specialist knowledge and expertise in dementia.

Finally, of course, we need to look at the relationship between national policy and leadership, and what happens on the ground with local priorities. I say gently to the hon. Member for Rugby and Kenilworth that all political parties are united around the notion of localism and devolution and of not doing things from offices in Westminster and Whitehall. As we develop the national strategy, therefore, we must consider the pressures, incentives, levers and accountability mechanisms that we can put into the system, but which will not compromise the right of people on the front line to make key decisions. We must ensure, however, that they do not neglect people with dementia, and that those with dementia and their families are given greater priority and a greater status in decisions than has been the case thus far.

One of the reasons why we are debating this issue today is the lack of a national policy in the past, and another is the fact that people in local communities continually tell us that they are not getting the expert, personalised services that they need and want. Carers frequently tell us that they are not being treated with respect when decisions are being taken about dementia sufferers.

We have a long way to go. The challenge is to create the right balance and dynamic between providing clear national policy, leadership, standards and objectives, and understanding that in the end we are heavily dependent on the managers and professionals on the ground to make a difference. Furthermore, putting more powers in the hands of users and their families, through individual budgets, direct payments and simply giving them a greater ability to complain and to articulate their views, will have a major impact on raising standards and the quality of care in this area, as in many others.

I end by paying tribute to hon. Members for the all-party way in which they have approached this incredibly important issue. We are all committed to bringing dementia out of the shadows, and we have a solemn responsibility to those with dementia and their families and to ensure that we improve the quality of their lives.