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Age Discrimination (Health Care)

Volume 502: debated on Wednesday 16 December 2009

I am grateful for the opportunity to address this important issue on the day on which we rise for the Christmas recess. One curious thing about the lottery process for Adjournment debates is that one can apply assiduously for a topic for many a week, then find that one has the pleasure of securing it on the last day before we adjourn for Christmas. I am sure that we can therefore look forward to a quality debate but not a quantitatively long one.

Many aspects of health care give rise to concerns about how age is used as a proxy to determine—or, in some cases, deny—access to health care, even when the evidence does not support such practices. There is plenty of evidence that age discrimination takes place in cancer and stroke care, cardiology, foot care and continence and palliative care. Rather than going through the evidence for discrimination relating to each of those conditions, I will focus on one area that demands urgent attention—mental health.

After reviewing the literature and evidence, it is hard not to reach the conclusion that the national health service is institutionally ageist. That is certainly the view of doctors specialising in the care of older people, so I welcomed the Secretary of State’s admission in October that age discrimination is still commonplace in health care a decade after the national service framework for older people was meant to have banned age bars and age discrimination across the NHS. It is clear that relative to mental health services for people of working age, the mental health services available to older people have got worse. I stress the word “relative” because there have been clear improvements in some aspects of mental health care for working-age people.

I recently hosted a reception in the House on behalf of the Royal College of Psychiatrists to highlight its call to action at a local level and on the part of individual clinicians. I am grateful to the Royal College for providing me with a briefing for this debate. If we took what we know from the published research and applied it to a typical group of 10,000 people over 64, this is what we would find: 2,500 would have a diagnosable mental illness. Of those, 1,350 would have depression, 500 would have dementia and 650 would have other mental illnesses. Most of those people would go undiagnosed and untreated. According to the King’s Fund, older people are the only part of the population in which the number of people with mental illness will increase by 2026. If nothing else, we are required to address that demographic demand. A concerted response from Government and the NHS at all levels is necessary.

Inevitably, debates such as this—I am sure that the Minister has experienced this on many occasions—turn on what is wrong and needs to be put right rather than dwelling on what is good and wonderful. I make no apology for that, as I hope that he understands that this debate is about raising concerns. I accept that the present Government have not been idle. National service frameworks, “New Horizons”, psychological therapies and the national dementia strategy are just a few of the initiatives that they have taken. However, I am concerned that insufficient attention has been paid to the mental health needs of older people. That lack of attention is not just harmful to the individuals concerned; it wastes taxpayers’ money on late and inappropriate interventions and treatment.

To illustrate, in a typical 500-bed district hospital, an average of 330 beds are occupied by older people, 220 of whom have a mental illness. A shortage of trained staff and age-appropriate services mean that those patients remain in hospital for longer and are more likely to be readmitted as emergencies later. The Government have focused on dementia, with good reason; I have no objection whatever to that. The national strategy is welcome, as was the recent announcement on anti-psychotic drugs. I thank the Minister for getting in touch with me on the day of that announcement. However, a much broader approach to the development of age-appropriate mental health services is required in order to drive change.

The World Health Organisation forecasts that depression will be the second biggest contributor to health costs by 2020, just 10 years from now. The rate of depression is set to rise by 30 per cent. among over-75s, and by 80 per cent. among over-85s by 2026, just 16 years from now. Depression is three times more common than dementia and it increases with age, with the poorest most at risk. It is linked to a greater reduction in health than any other long-term condition, and it leads to a sharper decline in overall health when combined with any other long-term condition.

Nevertheless, just one in six older people with depression receives any treatment, compared with one in two younger people with depression. It is a major risk factor for suicide and the cause of 80 per cent. of suicides. Although it is good news that the suicide rate has fallen in the past decade, it has not changed among older people. As a result, the suicide rate in people over 65 is double that of people under 25. Research evidence also shows that older people with mental illness stay in hospital longer and are more likely to die in hospital or to lose their independence and be discharged to a care home.

I have been listening to the hon. Gentleman’s remarks, and I accept that he might be about to develop this point. However, does he agree that one concern, which I suspect we share, is that the amount of research effort, particularly into dementia, Alzheimer’s and the mental health of the elderly, needs to match the demographic curve? We need to put the research effort behind where things are going. At the moment, there is some question in most people’s minds about that. Is he equally concerned?

The hon. Gentleman is absolutely right to raise that concern, which I hope is shared by all parties. He is two pages ahead of me, but I will return to that point, if I may.

One study found that a person suffering from undiagnosed dementia is three times more likely to die in hospital than other older people. The same research also found that a large number of admissions were inappropriate and could have been prevented by prompt medical care in the community. Lack of specialist assessment is a recurring theme linked to poor-quality care, poor outcomes and waste of taxpayers’ money.

Why are things like this, and what needs to change? The introduction of a national service framework on mental health in 1999 kick-started change and investment in new services, but the drafting of the frameworks reflects an age bias. One need only look at the fact that 149 pages in the NSF for mental health are devoted to the mental health of people of working age, compared with just 17 pages on mental health in the older people’s national service framework. What does that tell us about relative priorities a decade ago? The national directors of both mental health and older people’s services accepted in 2004 that not as much progress had been made in developing new mental health services for older people, and I am told by the Royal College of Psychiatrists that little has changed since then.

As I said earlier, the progress made for working-age people means that older people with mental health issues are worse off now in relative terms than they were 10 years ago. A serious lack of equity remains in access to mental health services. My point is not to claim a lack of good intent on the Government’s part; policy initiatives and national guidelines exist. However, the evidence is compelling that none of that has gained any traction on resource allocation and practice. The National Audit Office has documented how older people have been denied access to assertive outreach, crisis resolution, home treatment and early intervention services available to adults of working age. Other research has revealed a similar pattern of exclusion from hospital liaison, rehabilitation and psychotherapy.

What needs to be done? As I said, the national dementia strategy is welcome. It is an essential although insufficient response to the mental health needs of older people. The Minister and the hon. Member for Eddisbury (Mr. O'Brien) will know that I have a keen interest in dementia research. Only yesterday, I had the pleasure of receiving an answer to a written question to the Minister about the new ministerial taskforce on dementia research. I was fascinated by the answer:

“The remit of the group will be to maintain the momentum begun at the summit by developing a new vision for the future of dementia research and advising on practicable ways to achieve that vision.”

Visions are all well and good. They are useful because people can be pointed towards them. However, a taskforce on research must assemble the building blocks of the additional cash that needs to be invested in the area.

The answer goes on to say that the first part of the body’s remit is

“to devise ways to use available resources more effectively to help increase the volume and impact of high quality dementia research”.—[Official Report, 14 December 2009; Vol. 502, c. 739W.]

That implies that existing cash is to be used, rather than that more will be allocated, and we know that there is a huge gulf between the amounts committed to dementia research and to conditions such as stroke, heart disease and cancer. Finally, the answer states that membership of the body has yet to be finalised. It was announced in July. Five months on, it has not met and its membership is not yet set. Will the Minister say when it will begin its task?

Investment in improving psychological therapies is welcome. However, time will tell whether we will see an equitable roll-out. One in five older people’s mental health services report having no access to clinical psychology and one in three community teams do not include clinical psychologists. The British Association for Counselling and Psychotherapy commissioned an independent review on counselling older people, which concluded that counselling is effective with older people, particularly in the treatment of depression.

It is disappointing that mental health services are not included in the Government’s new entitlements regime that replaces the existing framework. For example, if a person is waiting for cognitive behavioural therapy and the 18-week milestone is passed, there is no redress. There is no funding to allow them to get the provision elsewhere. Why were mental health services left out of the entitlements approach? I am sure that will be of interest to many people outside the House.

An evidence-based approach to developing age-appropriate mental health services would save money and deliver better outcomes for older people. Older people’s hospital liaison services save money. They reduce the length of hospital stays, cut readmissions and result in better outcomes. For example, a Liverpool hospital that had a high readmission rate for older people set up a specialist liaison mental health team for older people in 1999. An analysis of 324 high-risk people who were referred to the team’s social worker because they had complex needs found that they had a 7 per cent. lower six-month readmission rate than the hospital’s older patients in general. It also found that 96 per cent. of referrals were assessed on the day of referral and, of the readmissions, only 13.5 per cent. were considered inappropriate.

Care home liaison can save time and money. It can also help to reduce anti-psychotic drug prescribing—something on which I have campaigned for many years, so I welcome the recent announcements. It is estimated if we made the changes needed in that area we would save £55 million a year. A specialist older people’s mental health care team in Doncaster runs a home liaison team to provide services to care homes. That has helped to reduce admissions to hospital, improve the quality of care and provide training to care home staff. In its first year, the team received 460 referrals and admissions to hospital reduced by 75 per cent.

Crisis home treatment teams can cut hospital admission rates by a third, reduce the length of hospital stays and reduce admissions to long-term care. In west Suffolk, a crisis resolution home treatment team for working-age adults was extended to include over-65s. Older people had previously had no alternative to being admitted to hospital. Most people with whom the team dealt were suffering from depression. The number of older people admitted fell by 31 per cent. as a result of the extension of the scheme, without any loss in patient or carer satisfaction. There is huge potential to unlock resources and reallocate them to services that deliver better outcomes for patients.

Delivering age-appropriate mental health services requires a more informed work force in primary care, general hospitals, care homes and social care, as they must be able to tailor services to fit individual and age-specific needs. The last remaining barriers within and between health and social care need to be torn down. Integration of services is essential to delivering equity and efficiency. Mechanisms such as local area agreements should play a part in ensuring that we have seamless services with integration and multi-agency working on the ground.

Older people’s mental health should be a national priority in the NHS operating framework. I was disappointed to read today in a written answer from the Secretary of State that the new operating framework for 2010-11 is silent on that and that mental health services do not register as a national priority. Not even the dementia strategy registers as a national priority. That is a missed opportunity and a great shame. If guidance, policies and strategies are to get traction, they need to be backed up.

I did not spot the written answer, as I was engaged on something else this morning. However, if the framework suggests that mental health, let alone dementia, is not a national priority, does the hon. Gentleman think that that is an admitted change from what was promulgated under previous Secretaries of State, which was that cancer, cardiac and mental health services were the three priorities that the Government were seeking to address?

That was my reading of the Secretary of State’s written answer. If there is a misunderstanding, I would rather the Minister cleared it up today. Certainly, my reading of the written answer that was published today is that mental health services, including dementia services, do not feature at the top level of the operating framework. They have to be placed at the top level to get the traction that I assume the Government and the Department want the national strategy to have. I know that there is a debate over whether such decisions should be devolved locally. However, the Government clearly intend to drive change in dementia services. The only way to signal that intention is by making it clear in the framework. I want to get that on the record, and I hope that the Minister will clarify this matter in his response.

In conclusion, the biggest challenge to our health and social care system is the ageing population, as it has been for a decade or more. In particular, the challenge is the mental health of our ageing population. Currently, need is not being meet and evidence is not being translated into practice. There must be a shift in Government policy to the health needs of older people and a comprehensive approach must be developed. That must be a clear and unambiguous national priority. It is unsustainable to do nothing. There are huge opportunities in unlocking resources to make improvements. The case for concerted action is unanswerable. I look forward to the contributions of other hon. Members and to the Minister’s response.

It is a pleasure to serve under your chairmanship, Mr. Cook, and to speak in this important debate on the last day before the House rises. I congratulate my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) on securing the debate and on his consistent and vigorous leadership on older people’s issues. Long may he continue to be such a champion for older people.

According to leading older people’s organisations, age discrimination remains the most common form of discrimination in this country. We must take it much more seriously. Perhaps this point is for a different debate, but that is largely due to the failure to put age discrimination on the same footing as other forms of discrimination. Although there are attempts to address that, concerns exist that there will not be the same clarity regarding age discrimination that there rightly is for other forms of discrimination. In a less obvious way, prejudice plays a part in the health and social care systems. Unfortunately, we still hear examples of older people facing neglect, receiving second-class services, being socially segregated and having restricted opportunities. Far more needs to be done to address that.

The figure to which my hon. Friend referred is shocking: almost half of all geriatricians think that the NHS’s failure to provide older people with the level of care to which they are entitled amounts to institutional ageism. That is according to the leading geriatricians in the country, and we should all be deeply concerned about such comments. More than half of those same geriatricians—55 per cent.—said they were personally worried about their own prospects for receiving adequate care from the NHS when they are over 65. Alex Mair, chief executive of the British Geriatrics Society, was quoted in The Guardian as saying

“the NHS is currently failing older people”.

The figures show that people over 65 already account for more than 60 per cent. of hospital bed days, and therefore are responsible for the greatest proportion of expenditure on health and social care. In 2007, 8.2 million people were aged over 65 in England and Wales. That figure is projected to increase to 11.6 million by 2026, which is an extraordinary increase of 46 per cent. Similar rises are projected for the prevalence of disability and dependency. The burden on the health and social care system will therefore increase.

A number of reports are worth mentioning: first, the report on the barriers facing older people, which was undertaken by Sir Ian Carruthers, the chief executive of NHS South West, and the Bristol council chief executive, Jan Ormondroyd. It found that older stroke patients received less adequate care than young sufferers, and that almost half of doctors who cared for older people believed that the NHS was institutionally ageist. I was concerned to see that the report goes on to show in some detail the treatment that my hon. Friend has outlined, particularly regarding mental health. The report “Equality in Later Life” also demonstrates that older people are discriminated against regarding access to out-of-hours and crisis services, psychological treatment and alcohol services.

I am afraid that there still appears to be institutional ageism within some of the main NHS services. On cancer, women aged over 70 are not automatically called for breast cancer screening, despite firm medical evidence of a clinical need for that service. Older women with breast cancer receive a lower level of care than younger women, and are less likely to be diagnosed via needle biopsy and triple assessment. They are also less likely to undergo surgery or receive radiotherapy than younger women. When compared with a 65 to 69 year-old woman, a woman aged 80 or older is five and a half times less likely to receive triple assessment for operable breast cancer, and 40 times less likely to undergo surgery. Even women as young as 70 or 74 are more than seven times less likely to receive radiotherapy following breast conservation surgery.

Department of Health figures suggest that compared with other comparable countries, the UK experiences 15,000 extra deaths from cancer a year in the over-75 age group. In relation to that figure, the gap between the UK and other countries appears to be widening, as does the gap between older and younger age groups in UK.

On stroke treatment, older people are less likely to receive cholesterol-lowering treatments recommended for the secondary prevention of stroke, despite the treatment being equally medically effective across all age groups. Although rates of secondary drug prevention are generally low—26.4 per cent. of patients aged 50 to 59 received treatment compared with 15.6 per cent. of patients aged 80 to 89, with a figure of just 4.2 per cent. for those aged 90 or over—there are lower rates of treatment to prevent stroke in older people, and substantial under-investigation in routine clinical practices for patients aged 80 or over.

On cardiology, according to Age Concern and Help the Aged, 46 per cent. of GPs and care of the elderly specialists and 48 per cent. of cardiologists treated patients aged over 65 differently from other patients. People aged over 65 were less likely to be referred to a cardiologist, given an angiogram or given a heart stress test. Cardiologists were less likely to recommend operations to open up blocked coronary arteries for older patients, and older patients were less likely than younger people to be prescribed cholesterol-lowering statins.

I make those points before coming to the main topic covered by my hon. Friend: mental health. According to Age Concern and Help the Aged, mental health is the clearest example of age discrimination in health and social care policy. A report published in 2009 by the Royal College of Psychiatrists states that tens of thousands of people over the age of 65 are being denied access to specialist mental health services because of arbitrary age limits. That is primarily because the national service framework for mental health extends only to working adults up to the age of 65. There is simply not enough cross-over between such frameworks for mental health and older people. What steps will the Minister take to try to ensure that the frameworks work together more coherently, to ensure that older people cease to get a rough deal by apparently falling outside those frameworks and falling between two stools?

In a survey carried out by the Royal College of Psychiatrists, members of the old-age faculty reported having been

“told of evidence that specialist services for older people with mental health problems, including dementia, are being cut purely to meet the financial pressures created elsewhere in the NHS, and to meet the demands of the Secretary of State that financial balance must be achieved”.

Will the Minister say whether that survey finding is correct, because clearly that is of real concern? We are having a debate about already inadequate mental health services for older people, yet the Royal College of Psychiatrists survey shows that concern exists that services will be cut further.

The Government have of course invested extra money to fund working-age adult mental health services up to the age of 65 during the past three years. Clearly, that is welcome, and I think that people would say that services are improving. However, why should that stop at 65? If the framework is going to stop at 65, why is there not more of a mental health strategy for older people from the age of 65 onwards?

I share my hon. Friend’s passion for pushing the dementia issue up the agenda, both in our hospitals and care homes and on the research side. That point was made by the hon. Member for Eddisbury (Mr. O'Brien), who speaks for the Conservatives. Unless we can start to ameliorate the effects of the many distressing conditions that come under the umbrella of dementia—and hopefully prevent those conditions and perhaps even find the cure—the real concern remains not only that we will fail to tackle the problem of inadequate health care for older people, but that we simply will not deal with the financial time bomb that will affect the NHS and the care system.

The amount of funding for dementia care—I have raised this issue directly with the Prime Minister—remains inadequate. We are all aware that the recession and the reduced funds available to the Government and to us all is an issue; nevertheless, we must look at the impact of not investing more in dementia research. Dementia still receives only 3 per cent. of the medical research budget. I suspect we would all agree that that simply does not add up to a sensible proportion, considering the number of people currently suffering from forms of dementia, the effect on their families and on their ability to work, and the huge demographic increase in the number of older people projected to take place in the coming years.

The report, “New Horizons: A shared vision for mental health”, states that funding for mental health research will triple. Will part of that be research on dementia, or is that a separate budget? Where will that money come from: is it from the existing research budget or a different pot of money? Can he say where the money will be targeted specifically? Will it deal with some of the mental health issues facing older people that we have raised today?

This is an important debate and I am pleased to have been able to contribute; it is a shame that more hon. Members have been unable to do so, perhaps because of the timing, as I am sure it is a matter of concern to many of us. Until older people receive the same care and service from our national health service as everyone else, there will still be a feeling that the institutional ageism that has been commented on by our leading physicians does exist.

I am well aware that St. Nicholas will be rushing down chimneys across the country in the coming week. He was born in 270 A.D. and is still going strong, so he should be a model for us all as we head into mature age. I have also discovered that the etymology of Nicholas is “victory of the people”—it may sound amazing, but it is—so it seems fitting to invoke him here in the mother of Parliaments. Whether he is a redistributive socialist or a right-wing philanthropist is a debate for another time, I suspect, however much hon. Members might encourage me to stray from our subject. All that allows me to wish you, Mr. Cook, the Minister and the hon. Members for Sutton and Cheam (Mr. Burstow) and for Leeds, North-West (Greg Mulholland) a very merry Christmas.

The issue we are discussing is serious and one on which it is our job to hold the Government to account. I hope that the Government’s response will be redolent of the spirit of good will to all men, and all women, and not disproportionately to some who are not old. It is also right during our debate, in thinking about discrimination, age, health care and general well-being, that we remember that many people cannot look forward to Christmases as we do, because of poverty or loneliness in this country or due to war abroad.

However much we disagree in this place, we are all here with equal mandates to make a difference and, through our aspirations, in their diverse ways, to make this country, and indeed this world, a better place for all people of all ages. I congratulate the hon. Member for Sutton and Cheam on securing the debate and giving the matter the airing it indubitably merits, and the hon. Member for Leeds, North-West on the reinforcement he provided.

With the Equality Bill having received its Second Reading in the other place only yesterday, it seems apt to begin with the Government’s pronouncements in that Bill on age discrimination. The Opposition have made it clear that we welcome the Government’s inclusion of age discrimination in the debate surrounding the Bill. The Minister for Women and Equality asserted on Second Reading of the Bill in this place:

“No one should suffer the indignity of discrimination—to be told, ‘You’re old, so you’re past it’”.—[Official Report, 11 May 2009; Vol. 492, c. 553.]

Although she no doubt intended her words to apply primarily to the workplace, they highlight a chasm in the Government’s thinking on age discrimination—the NHS and social services.

Our social care system is still predicated on age banding, at 18 and—topically—at 65. Indeed, the Government are clutching somewhat desperately to the 65 cliff edge in their rapidly collapsing attempts to reform social care. Disability living allowance has been safeguarded for those under 65, but not for those over 65, under the recent pronouncements and the very words of the Secretary of State for Health. I say “rapidly collapsing” because last week the Secretary of State said, as we all heard, that there would be “no cash losers” among those currently receiving attendance allowance and disability living allowance. Given that the reforms in the Green Paper are based on the roll-up of such benefits into the funding package, presumably the Government are not planning to reform social care for those in receipt of those benefits.

Furthermore, the Government have given no pledge that people in the future who have needs similar to those who currently receive attendance allowance and disability living allowance will receive an equivalent cash benefit. That is why we continue to hold them to account over that issue. To pick up on the Prime Minister’s pre-election report, we will soon be fighting an election to protect not only today’s pensioners, but those of the future.

The great irony is that if the Government had not played politics with the Green Paper; if they had been open and honest and published the full modelling that we and all the charities in the Care and Support Alliance called for in advance of the deadline for responses to the Green Paper consultation, but which was not forthcoming—I stress that point in case they reply that they have published something; and if the Prime Minister had not decided to run an election manifesto through the reform with his attempted but failed dividing lines, they might never have caused that confusion over the issue in the policy world, in charities and, above all, in the minds of older, and often vulnerable, people.

The reforms of social care being debated by the Government have also failed to address carers and their benefits. Nothing has been done about the cliff edge that exists for carers who earn; I am focusing on the reference to age discrimination in the title of the debate. There is no ability set out in the reforms to smooth benefits to reward work. More pertinent to the debate is the Government’s failure to instigate a discussion of the fact that carer’s allowance stops at 65. Where will the equality legislation leave that issue? I hope the Minister clarifies that.

Would it not also be helpful if the Minister said whether he is minded to bring forward the timetable for doing something about benefit reform? The carers strategy refers to 2018, which is a rather long time to wait.

That is a fair request, so perhaps the Minister will take the opportunity to address it. It is particularly fair in the light of how the social care reform Green Paper has been transmuting and transforming itself over recent days, rather than over a planned period of years, or even weeks or months. It has undergone the most radical transformation of policy in the past few days, some would say on the hoof.

The hon. Gentleman’s point is fair, because the Government seem to be inconsonant with the timetable, which seems to be advancing rapidly on one side, but with the benefits not being addressed effectively and being postponed until 2018. The Minister will have the opportunity to respond to that.

Only last month a report commissioned by the former Secretary of State for Health, the right hon. Member for Kingston upon Hull, West and Hessle (Alan Johnson), found that elderly people frequently receive worse health care than their younger counterparts—a point that has already been referred to. It laid the serious charge that, in an institutional sense, the NHS discriminates against those people. That was covered fairly extensively in media reports at the end of October. Doctors identified patients over the age of 65 and suffering from mental illness as particularly prone to discrimination, as has been emphasised.

I turn now to mental health. A Royal College of Psychiatrists report found that tens of thousands of people over 65 are being denied access to specialist mental health services because of the “arbitrary” age limits, which is precisely the point that has already been referred to. Mental health services have traditionally been configured by age, which means that someone aged 65 can receive a wide range of support through adult mental health services, but a person who is only one year older, regardless of their need, might be placed in an older people’s service where the same support is simply not available.

The over-65s are also denied access to a range of services available to younger adults, including psychological therapies, early intervention, and rehabilitation and addiction services. The hon. Member for Sutton and Cheam placed particular emphasis on that point. I should therefore emphasise equally the fact that I hope that the Minister will clarify the situation, particularly given that several interventions were made, which have been answered.

The written answer that the hon. Gentleman received restates the Government’s priorities, but omits mental health, which we thought was one of the three issues to have been promulgated as being of great importance over the past decade.

The other question that has arisen relates to the priority that will be given to different areas. Will there be a reallocation of resources? Will there be any extra resources? The issue cropped up during our most recent proceedings on the Personal Care at Home Bill in our debate about the potential for an increase or a reduction in the cash available to dementia research, commensurate with the demographics. We would expect the research effort to match the curve of rising demand.

I hope that the Minister explains what impact the Equality Bill will have. I hope, too, that he tells us what work his Department is doing to change cultures in our NHS. He will readily agree that the blunt weapon of legislation is simply not enough to bring about systemic change.

Earlier this year, as a result of a large exercise involving written parliamentary questions and freedom of information requests, the shocking number of older people who suffer malnutrition in our NHS hospitals became clear to me, and I decided to expose it. The figures show that 70 per cent. of all malnutrition deaths occur among the elderly. The Minister will know that every year—certainly over the past 12 years—an average of 204 people have died of malnutrition. In 2006-07, the number of patients discharged from hospital with a diagnosis of malnutrition, nutritional anaemia or other nutritional deficiencies was 139,127—an 84 per cent. increase over 1997-98 levels. There was a 12 per cent. increase in the number of patients discharged from hospital in such a state in the last year alone.

Such things matter because the number of patients leaving hospital with a diagnosis of malnutrition was 8,533 more than the number of people entering hospital in a malnourished state. That includes those who, unfortunately, went into hospital and, whatever their condition, died there, so the number is all the more worrying. The figures suggest that the nutritional status of at least that number of patients worsened while they were in hospital in 2007.

Malnutrition is not a condition that we associate with Britain, and least of all with our NHS, but the Government have presided over that increase. My colleagues and I have exposed the figures, and we wait to see what the Government response will be to these malnutrition cases, particularly those among the elderly. Surely, such things can be avoided.

The rise of malnutrition among the elderly points to underlying problems in the most basic forms of care that our elderly receive. If our elderly cannot even guarantee that they will be fed well in hospital, no wonder an increasing number of older people and their relatives are expressing concerns about the standard of care that the elderly receive through the NHS.

That is not to run down the NHS. There are solutions and there are some absolutely marvellous examples of best practice, such as the red tray system, which provides an alert without the need to face down the older person over their need for help with feeding. Above all, however, we need enough capacity so that nurses can sit at an older person’s bedside and help them feed, rather than sitting behind a screen filling out target forms.

It is important to explain how we create a stronger voice for patients, particularly the elderly and the vulnerable. Legislation may make the NHS accountable to the Government, but the patients should be given the real power to hold the NHS to account. The local involvement networks initiative, or LINks, betrays the Government’s failure to create an effective and prominent platform to allow patients to voice their views about the NHS. The Government have not been prepared to make the initiative independent of the NHS. It has been a mark of this Government that they have consistently sought to undermine the patient voice.

In that respect, I am particularly critical of the Government. At Prime Minister’s questions, I exposed the former Prime Minister, Tony Blair, who said that he had consulted before axing community health councils. He then had to write me a grovelling three-page apology to say that the Government had done no such thing and that they just did not like CHCs because they criticised the NHS. All but four of the 107 CHCs were excellent, but Labour abolished them without consultation. They did not like the criticism from CHCs, which were able to amalgamate much of the evidence. In that respect, things such as Bedwatch were very important.

The CHC system was not particularly comfortable for the Government or, let us face it, the previous Conservative Government, because CHCs were independent. However, patients trusted them because they felt that they could have their hands held without being put offside with the NHS, whose services they still needed because they were vulnerable. Patients needed the respect that they could get from organisations that they could trust, and that was possible because CHCs were independent.

Having replaced CHCs with patient and public involvement forums, the Government found that those, too, were too outspoken—particularly the Commission for Patient and Public Involvement in Health, which was the national voice. The Government therefore abolished those forums and replaced them with LINks. The contempt in which the Government held the patient voice was shown by their tagging of the issue on to another portmanteau Bill—this time, a local government Bill.

Now, Ministers are starving LINks of the resources that they need to become established and effective. I dare say that many hon. Members are receiving representations from LINks that are trying to make it clear that they do not have the resources that they need to do the job that they are required to do.

How does the hon. Gentleman see the arrangement with LINks going forward? One reason why CHCs were successful and trusted was that they had been around for a long time—a feature that we have not seen for the past decade because of the constant changes. Do we not now need some stability and an opportunity for LINks to bed down? That is certainly true in my patch, where they have been delivering some quite interesting reports, including on age discrimination.

I am grateful to the hon. Gentleman for raising that important point. Some of the better-performing LINks have often been those that bravely stuck with it through the changes. They have provided continuity and a sense of expertise, and they have benefited from a familiarity with the labyrinthine processes of the NHS, social care and other areas.

Rather than completely abandoning LINks, the solution is to ensure that they develop healthily and fit into the context of the Health Watch policy, which the hon. Gentleman will know well, because the Conservative party has had it in the public domain for the past four years, and I will describe it in a second. That will help to cover the point.

One lesson to be learned from what recently took place in Stafford relates in part to the Government’s poor support for LINks and to the lack of a strong local patient voice that can hold trust executives, NHS executives and, ultimately, Ministers to account. That is an ongoing problem. The Conservative party has therefore suggested a national and local independent voice to allow patients to highlight their concerns, as well as increased choice over services, which will enable patients to vote with their feet.

As we begin to move towards a system of payment under which local NHS services are funded according to the outcomes that they achieve for patients, rather than top-down bureaucratic targets, the patient’s perspective on their treatment will become increasingly important.

As I made clear to the Older People’s Advocacy Alliance earlier this year, we must ensure that older people, particularly those who lack the capacity to express concerns about their care, are given equal access to forums through relatives and appointed advocates. Again, we return to the important distinction between central legislation and grass-roots activity. Legislation can go only so far before older people require local advocates and trained, sympathetic staff—sometimes NHS staff—to ensure that the care they receive off the national radar is of a high quality.

As a corollary to that, I am pleased that the Government are finally conceding that quality is a far better indicator of improved health care than activity-based targets. However, cases such as that of Staffordshire general hospital and, most recently, that of Basildon and Thurrock University Hospitals NHS Foundation Trust demonstrate the distance that there is to travel before the rhetoric penetrates to the grass roots of patient care.

Conservatives strongly advocate a shift towards clinical outcomes as a measure of performance in the NHS. With that shift comes a great deal of responsibility towards vulnerable older people, in whose cases it may not be possible to achieve a better outcome or a full recovery. That is an important qualification.

We must ensure that measures such as dignity, nutrition and comfort are rewarded as highly as clinical outcomes in caring for the elderly. There must be no disincentive to delivering quality care to a person whose health is unlikely to improve. On the contrary, we must incentivise NHS staff to ensure that older people receive the care that is appropriate to their needs, regardless of their health.

Our pledge, of which the Minister is well aware, to introduce a payment by results tariff for palliative care will help to ensure that there are services on offer for older people who are terminally ill and who want a dignified and comfortable death. It was with great regret that I witnessed the Government voting against the Palliative Care Bill presented by my hon. Friend the Member for Meriden (Mrs. Spelman) earlier this year. The Bill was intended to give people the right to choose where they die, whether at home, in a hospice or in hospital. Too many older people do not have that choice and are forced to die in hospital because palliative care cannot be made available elsewhere.

I have already mentioned the case of Stafford and the more recent revelations about the standards of care at Basildon and Thurrock University Hospitals NHS Foundation Trust and elsewhere. Those cases have emphasised the fact that a hospital’s foundation trust status does not offer patients a guarantee of quality health care. It is more important than ever that we should have an effective and rigorous system of regulation at an appropriate level to ensure that hospitals that are failing vulnerable patients such as the elderly do not slip through the net. What is more, regulation must penetrate deeper into standards of care than tick-box targets. The news headlines of recent months only accentuate further the disparity that can exist between a hospital’s record on paper and the reality of the care it delivers. So often it is the elderly who are caught in the vortex.

It is vital that inspections should be carried out in person by professionals equipped with the expertise needed to identify poor care. Serious questions have been raised about the effectiveness of the Care Quality Commission, and the Government must prove to patients that they can establish a robust and trusted regulator who can act on their complaints and root out poor practice in the NHS—a regulator who is not at anyone’s beck and call, least of all of politicians, but who acts independently on the basis of evidence. Effective regulation is more important than ever in the case of many elderly people who are not in a position to stand up for their own rights or treatment.

I want to touch on the subject of cancer care. It goes without saying that older people’s health needs are typically more complex than those of other NHS patients, yet it is older people who face the brunt of discrimination in the NHS. Cancer predominantly affects older people, and the risk of developing many cancers increases with age. Nearly two thirds of cancer diagnoses occur in those over the age of 60, yet despite the high proportion of elderly people who face a cancer diagnosis, access to treatment is far from fair.

Women aged over 70 are not automatically called for breast cancer screening, despite evidence that eight out of 10 breast cancer cases occur in post-menopausal women. What is more, a Roche report reveals that only 30 per cent. of oncologists would prescribe the cancer-fighting drug Herceptin for breast cancer in a 73-year-old patient, compared to 90 per cent. who would prescribe the drug to a 55-year-old.

Inequalities are also prevalent in the treatment of lung cancer. The findings of the national lung cancer audit indicate that the proportion of lung cancer patients in England and Wales who receive active anti-cancer treatment falls with age from more than 60 per cent. for those under 54 to 50 per cent. at 70 to 74 and less than 30 per cent. at 80 to 84. Older people also struggle to get access to stroke treatment and cardiology services—a point that has already been made in the debate—and find that they are frequently pushed to the back of the queue for referral to a specialist and for preventive treatments.

In conclusion, in the next 20 years the number of people over the age of 65 will double, and the number over the age of 100 will quadruple. As pressure on the NHS increases, it is more important than ever to iron out discrimination and ensure that health care is delivered on the basis of need, not age. I hope that the Minister will today give a firm pledge to tackle discrimination head on and ensure that our elderly people, many of whom come to the NHS in a vulnerable and fragile state, are treated with the dignity and respect that they deserve, and above all equally.

I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this debate.

The Government believe—we always have believed and will always believe—that we must do everything we can to end discrimination against all age groups, including older people. Today’s debate focuses primarily on discrimination against older people, which is a defining issue of our times. It gives me an excellent opportunity, unlike some other Westminster Hall debates, to lay out the breadth of the Government’s response to the issue of discrimination in health care for older people and what we are doing to address it, as well as to deal with some of the issues that hon. Members raised during the debate.

It has been interesting for me to hear the views of the Front-Bench spokesmen—the hon. Member for Leeds, North-West (Greg Mulholland) for the Liberal Democrats and the hon. Member for Eddisbury (Mr. O'Brien) for the Conservatives—on what their priorities are, or are not, and the commitments that they are making at this stage in the electoral cycle. Older people will be paying attention to that. I did not hear a single commitment from either party, but it is for those listening to and observing the debate to draw their own conclusions.

As demography reshapes society, Governments, employers and public services have to find new ways to improve the support that is available to older people, not just in sickness but in health. We need to create a society of all ages, and that is the explicit goal of our new ageing strategy, which none of the hon. Members who have spoken in the debate have mentioned. I agree that high-quality, patient-centred health services are a key to that.

Hon. Members will know that when the Equality Bill, which is now being considered in the other place, is enacted—and I hope that it will be—it will make age discrimination illegal across all sectors, including health and social care, and will extend the public sector equality duty to cover age. We plan to bring the new public sector equality duty into force from April 2011 and the discrimination ban from 2012. Hon. Members have failed during the debate to mention the NHS constitution, which makes the commitment to a

“comprehensive health service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief.”

Those are powerful statements of intent from the Government and will certainly sharpen minds in the years ahead. However, they must be backed up by real action on the ground.

Before I come to the specifics, I want to highlight the broader sweep of the action that we are taking. The recent age equality review by Sir Ian Carruthers and Jan Ormondroyd will help us to make further inroads. It contains many of the sentiments expressed in the Age Concern and Help the Aged report published yesterday. It has also been commended by the Equality and Human Rights Commission, which produced a briefing for today’s debate, and which has welcomed the fact that its recommendation of a 2012 deadline for implementation of the ban has been taken up by the Government. It is good to know that the commission is powerfully on the side of the Government in this case. I hope that it is not among the organisations that the Opposition threaten to close if they ever return to power.

The age equality review recognises that the national health service has made progress on reducing age discrimination and provides sensible ideas on how to move things forward. We are consulting on the best way to put those recommendations into practice. One of the important messages coming out of the review was that reducing discrimination first and foremost means improving the quality of the existing services. If we can create the preventive, person-centred NHS described in Lord Darzi’s report, “High quality care for all”, and more recently in another report that hon. Members have failed to refer to in the debate, “From good to great”, which is the new five year plan for the NHS, we shall automatically remove many of the problems that hon. Members have spoken about today.

Specific aspects of treatment and care for older people have been a problem in the past, but we have taken measures to address them. The main engine of change is the 2001 national service framework for older people, a 10-year programme to improve access to screening, treatments and other services. I am delighted to say, as others have not, that the framework has led to significant increases in the number of hip replacements and cataract operations, and a more than doubling in breast screenings for the over-65s, for instance. The next steps for the framework will be to address shortcomings in audiology and to improve the commissioning of services in connection with falls, fractures and osteoporosis.

Alongside the framework, many other Government programmes are directly or indirectly improving the quality of care for older people. No mention has been made this afternoon, for example, of the dignity champions campaign. We have 11,000 dignity champions in every part of our health and social care system, from front-line care workers to chief executives of primary care trusts and local authorities, making sure that older people are treated with respect and dignity. There is a drive to abolish mixed-sex accommodation, which is a particular concern for older patients. All hospitals must abolish mixed-sex wards next year unless they are clinically necessary, or face a financial penalty. That is another important milestone for the Government.

As hon. Members said—this is something that has been mentioned—we introduced the national dementia strategy, which I was proud to launch earlier this year. It will deliver real change in the quality and scope of services for people—mainly older people, as we know—who are affected by dementia. “Living well with dementia” is the title of the strategy, and it includes new measures for diagnosis so that we can get earlier intervention and treatment for older people and support them at the outset. New ideas such as memory clinics are being developed around best practice, better services and care.

The issue that Members have particularly highlighted is dementia research, which is one of 17 key objectives in the national dementia strategy. I opened and launched a national summit on dementia research in July. It was not then but in November that I announced the creation of a ministerial group on dementia research. I am putting the hon. Member for Sutton and Cheam right on the date on which I made the announcement in Harrogate. It is my intention that the first meeting of the group will be held on 24 February. I hope that that specifically answers his question. He has a habit in debates like this of getting information out of me on specifics, and I am always delighted, if I can, to take the opportunity to give him such information.

Spending on dementia research is the key issue that the group will look at. The hon. Gentleman read out the group’s terms of reference—what it is all about. We know that by next year there will be a £1 billion ring-fenced budget for research on health services in this country. The question is how much of it will be allocated to dementia. This is not about Ministers saying, “This amount of money will be put in.” It is about independent clinicians looking at the bids coming in from the various sectors that seek research funds. Part of the problem that we have had is that the dementia researchers have not been putting in quality bids to win cash from the large pot of money, which has been growing year on year, that we spend on research in this country.

My concern is that the Dementias and Neurodegenerative Diseases Research Network, or DeNDRoN, is fully equipped and supported to improve the quality of its bids and to win more of the resource for dementia research, whether on analysis of the causes of dementia—we are a long way from finding a cure—on the care of people with dementia, on how people are treated using dementia drugs and so on. There is a great deal of work to be done. Dementia is where cancer was 20 years ago in terms of there being a talented group of individuals in research who are coming up with good ideas. The work that the third sector does in raising money and resources in its own way, international collaboration and co-ordination are all things that need to be driven forward, which is why I created a ministerial group to do just that, and to ensure that we raise our game on dementia research.

One thing that was not clear from the written answer I received was whether there will be direct involvement at a ministerial level by the Department for Business, Innovation and Skills.

I am happy to take suggestions of any kind about how we make the group work well. I want to ensure that it covers the broadest aspects around dementia research and involves all the key players such as researchers in the public sector and the private sector, if that be the case, and advice from the business community—frankly, wherever and whenever we can do the work that we need to do. We need to make the group manageable, so we must think about its membership. I have come up with a list of people. In practice, I am sure that we can engage many of the people out there, not just in this country but abroad as well.

Perhaps I sat down prematurely. The point I am making is that that Department has an overall brief in respect of science and technology. Therefore, having ministerial input from it is rather important.

The hon. Gentleman makes a good point, and I shall certainly liaise with ministerial colleagues. However, it will be my group. I will run it and ensure that it works well.

Another key aspect and plank of Government policy that hon. Members failed to mention is the end-of-life care strategy. It is worth mentioning in the tour d’horizon—the line of work that we are carrying out—as something that the Government are taking forward. The strategy is improving how older people are treated at the end of their lives, and deals with how and where they die. In addition, we are undertaking vital work in social care as well as health care.

The putting people first programme provides £500 million of extra resources to local councils. It is ring-fenced and helps them to build more personalised care services, not least for older people. In the partnerships for older people project, health and social services have joined charities and community groups to take action to reduce the incidence of people falling in their own homes, and to increase older people’s independence.

Of course, as mentioned by the hon. Member for Eddisbury, we have introduced radical proposals for social care which involve creating a national care service for the future. Despite all the arguments made in the House on Monday on Second Reading of the Personal Care at Home Bill, both Opposition parties decided not to oppose it and, I am delighted to say, it has gone to Committee. Clearly, this Government have touched on something, and we are leading the way and ensuring that those people with the greatest needs—mainly older people living in their own homes—are supported so that they can continue to live in their own homes independently, with choice and control over their life.

Another strategy that the Opposition parties failed to give the credit it deserved is the carers strategy. We will not be bringing it forward because it is a 10-year strategy—it is defined by that length of time. We have a three to five year delivery programme in place to make it a reality. It includes extra cash—not least for respite care—for local authorities, primary care trusts and groups in the community.

The hon. Member for Eddisbury raised a particular issue concerning carer’s allowance. I was intrigued by his query, because, as we know, carer’s allowance is an income replacement benefit. Someone cannot be paid two benefits at the same time, which is why carer’s allowance comes to an end when somebody receives a pension. The pension is paid, and there are premiums on top of that—the carers premium—for pensioners in particular circumstances.

I will be intrigued if the hon. Gentleman is about to tell me that his party will do something different with the carer’s allowance from what is occurring at present. I am all ears.

As the Minister seeks to challenge me, I was drawing an analogy to show where a great deal of age discrimination is institutionalised within the process. I did not make any of the allusions that he spoke about. It is well known that carer’s allowance is an income replacement benefit, although it is often perceived very differently by those who are in receipt of it. That is one of the challenges and issues that he and, indeed, all of us face.

On the subject of respite care, the Princess Royal Trust for Carers has come up with the shocking finding that, of the £50 million out of the £150 million allocated under the Government’s strategy to cover respite care—we would hope planned care as much as emergency respite care—£40 million has gone missing, yet the only response so far from Ministers is that it is up to all MPs to harry their local trust. That is obviously an inadequate answer, and I hope that the Minister can tell us where the £40 million has gone.

So no change on carer’s allowance. When parliamentary representatives from the Opposition ask me questions, it implies that they are going to do something, but clearly not in this case.

On respite care spend, the hon. Gentleman is right to highlight the question raised by many carers organisations: is the money that we have allocated to the non-ring-fenced devolved budget being spent? The Liberal Democrats have fought very hard for that in their localist agenda, yet they press me hard in the national setting on why it is not being spent locally. However, to point out that contradiction, I would need to repeat something that I have already said in many debates in the past. There is an obvious contradiction in the Liberal Democrat position.

In fact, I have met the Princess Royal Trust for Carers and others from the carer’s allowance unit to discuss this particular concern, to see whether we can do more to monitor the work that is being done on the spend of the resource, to find out where there may not be sufficient allocation, as they would see it, and to see what more strategic health authorities, for example, might do with the PCTs in their area to ensure that the respite care that is needed is properly commissioned through the new guidance that we are issuing to PCTs on how to commission services for carers, and to see that that happens in practice.

That is all very well. In previous debates on this issue I have mentioned the need for transparency to the Minister. If we are to have local accountability for decisions made by local primary care trusts about the spending of this money, we need transparency locally. However, that is missing, which is why we have not been able to hold PCTs to account locally. Surely the Minister can help with transparency.

Of course, transparency is an essential part of how a good national health service will work locally—being accountable to local people. Many things have been put in place to ensure that commissioners are given guidance on how to carry out good commissioning for services for carers, including respite care. Those local groups can take that guidance to their PCTs and discuss it with them and ensure that the local PCT is commissioning to the best quality practice that we can make available. A number of steps are in place. I can give the hon. Gentleman the assurances he requires, so that the Liberal Democrat policy is as consistent as we all would like it to be.

The hon. Member for Eddisbury mentioned malnutrition. He is right. We established a working group that produced a report earlier this year. We are preparing our response to that—he will just have to wait a little longer until we can make clear how we wish to take matters forward. I agree that practical steps can happen now to deal with issues relating to malnutrition. The hon. Gentleman mentioned a couple of good examples—red trays, and so on. I have visited hospitals where picture menus are used. Asking people to look at a picture of food rather than a description of it on a menu is a practical way of getting them to choose the food they really want. When the food arrives, it matches the picture. The cooks have to ensure that it actually matches the picture that is chosen, which raises the quality of the food provided.

There are many other aspects of the dignity campaign, including dignity champions.

I give way to the hon. Gentleman. I am giving way a lot, given the time available to me, and I have more to say on the issues he has raised.

I am grateful for the Minister’s time and, in the spirit of Christmas, for his generosity.

What will the future be of the board that was set up to write the report on malnutrition to which he is considering a response? Writing a report is one thing, but there is a need to see its recommendations implemented. Will that board be in place afterwards?

The hon. Gentleman will have to wait just a little longer. I am generous in giving him answers in these debates, but on this occasion he will have to wait for my analysis of the recommendations regarding what needs to happen and how that might be pursued, so that action happens on the ground. It is not a question of our not knowing what to do; what matters is making things happen on the ground, and that is what I am bending my mind to as I take my considerations forward.

The hon. Members for Leeds, North-West and for Eddisbury mentioned cancer treatment. There is more to do here. I am pleased to say that cancer death rates across all age groups have declined over the last decade, although the decline among older people has been much less significant than for other ages, as hon. Members have mentioned in detail. That is why we have established a national cancer equality initiative to tackle all inequalities in cancer care, including improving the treatment and services offered to older people. Early next year, there will be a new practical guide on reducing inequality, including detailed analysis from the national cancer intelligence network of data by cancer type, age and geography, so we can show where our efforts need to be focused in future. We are also looking at pilots to improve the way that older people are assessed for cancer treatment, to ensure that that is always done on the basis of clinical safety and effectiveness and never on the basis of age alone.

Other questions were raised about cancer screening. Our screening programmes are well respected internationally, with high-quality services and high levels of coverage. It is vital that we base all our screening programmes on the best international evidence. We must weigh up the effectiveness of screening certain age groups against the harm that may be caused—the possibility of false positives and false negatives—and the stress and anxiety that screening can lead to. It is not for Ministers to make any decision on the age range for screening; it is, rightly, a decision for the clinical experts. As the age equality review recommended, we will commission a programme of research into the upper age limits on breast screening.

I want to put hon. Members right on something that has been mentioned today. We are now extending our routine screening programmes for breast cancer to include women aged up to 73, and extending the programme for bowel cancer for men and women to those aged up to 75. It is important to get those facts on the record. I remind hon. Members that people beyond those age ranges can still self-refer to these screening programmes, and I strongly encourage them to do so if they have a history of cancer in the family.

The hon. Member for Sutton and Cheam began with mental health, and that is where I should like to conclude. I am grateful to hon. Members for mentioning that we have launched “New Horizons”, our new national strategy for mental health. However, before I get into that, I should like to say something about the national operating framework, which the hon. Gentleman mentioned.

I am at a loss to know what the hon. Gentleman is referring to that suggests there has been some kind of change. Perhaps he and I can correspond on this issue afterwards. Mental health is explicitly mentioned a number of times in the national operating framework, and is specifically mentioned in “New Horizons”. In the framework we highlight the importance of intervening earlier in mental health problems so that we get better outcomes and better value for money. There are five explicit references to mental health in “New Horizons”, although I will not read them out, and two explicit references to dementia. The whole of the “New Horizons” strategy is a lifespan approach. I do not think there has been a change of the kind the hon. Gentleman mentioned. Perhaps afterwards, through correspondence, we can confirm what I know to be true: that we have not changed the priorities in the way he suggested.

I was trying to clarify whether mental health has become a “must do” in the operating framework. I understand that it has tiers, and that there are some things that are nice to do but which are not mandatory for local NHS organisations to deliver on. Has mental health been elevated to a “must do”?

That is a different question from the one the hon. Gentleman raised in the debate. I thought he asked whether it had been downgraded in some way—[Interruption.] I understand now. With that in mind mental health services and the operating framework are not where they were before, with vital signs listed and five references made. We have moved on from the 10-year mental health service framework, which is now over—this is its last year—to “New Horizons”, which went out to consultation and has now been published. That supersedes the old national service framework for mental health and will tackle the historic differences, which hon. Members were right to highlight, in the way some older people are treated compared with working-age adults.

The new strategy will build on firm foundations. Spending is up by £2 billion over the past decade. We have two thirds more psychiatrists, a fifth more psychiatric nurses and more than 700 new community mental health teams, giving us a firm foundation and meaning that we can help people of all ages to access the services they are going to need.

For the avoidance of doubt, I have brought a copy of “New Horizons” with me. I shall mention annexe A particularly for the benefit of the hon. Member for Leeds, North-West, whom I do not think has read the detail. Annexe A is entitled,

“Characteristics or Descriptors of Non-discriminatory Services for Older People”,

and that is mentioned in the main body of the text, which also covers primary care, mental health services, physical health problems, issues to do with research, and so on. It specifically refers to

“community mental health teams”,

which I think the hon. Gentleman mentioned,

“Crisis Resolution and Home Treatment services, assertive outreach services, Improving Access to Psychological Therapies (IAPT) and psychological services”,

and so on. All older people should have the same access to these services that we have been building up over the past few years. I hope that that gives the hon. Gentleman the assurances that he and the hon. Member for Sutton and Cheam want about older people, who feature large in the strategy and are an important part of the future of mental health services. It is not only about mental health services; it is also about preventing mental ill health in the first place, through a cross-government strategy.

Let me provide some specifics. I will be doing a lot of work over the next few years, chairing a new ministerial advisory group on mental health inequalities to lead this agenda. We will work with the Royal College of Psychiatrists and other professional bodies to help providers re-design these services and tackle some of the cultural issues that mean that older people sometimes lose out. Training programmes for general practitioners and practice nurses, for example, will be developed, helping them become more sensitive to signs of depression among older people. This may also mean longer consultations by GPs, so they have more time to check on an older person’s mental well-being and on the physical health reason about which they may have attended the surgery in the first place; and strengthening the availability of services for older people living in residential care homes, as was mentioned earlier, where depression issues can be strong.

For clarification, the 18-week wait to which reference was made applies to consultant-led mental health services, so there is an element of this in the present system. I believe that there are signs that mental health services are changing for the better. We have seen some great examples of GPs, therapists, social workers and care providers working together to provide the integrated personal support that we need.

I am delighted that this debate on the last day before the House rises for the Christmas recess has provided an opportunity to air the matter of support for older people and of tackling age discrimination in health care. It has given me the rare opportunity to spell out at length the Government’s high and strong track record on such matters, which is all about quality and consistency. Age discrimination, like any form of discrimination, is unacceptable. We have taken some important steps to remove it from health and social care, but there is of course more to do. I look forward in the months and years ahead to addressing the many issues that I have set out today as we move closer to what everyone supports—a full ban on age discrimination across all services.

Sitting suspended.