I beg to move,
That this House wishes to see the quality of life improve for the 700,000 people in the UK with dementia; pays tribute to their families and carers and all those who campaign and fundraise for dementia charities; is concerned about the findings published in the National Audit Office report on Improving dementia services in England, HC 82, that showed the Government had failed to implement robustly the Dementia Strategy; calls on the Government to publish the report of the Nutrition Action Plan Delivery Board, which was submitted in July 2009, and in particular to respond to the inappropriate tube feeding of those in dementia care; deplores the inappropriate use of anti-psychotic drugs in the care of those with dementia; is concerned that 50,000 elderly people are forced to sell their home every year to pay for their long-term care; is concerned that the effect of the Personal Care at Home Bill will not help those with dementia in residential care; calls on the Government to prioritise research to combat dementia; proposes that the National Institute for Health and Clinical Excellence assess the wider societal value of treatments in its appraisals; and further calls on the Government to adopt a social care insurance model for residential care costs and to recognise dementia within a wider reform of social care.
We have brought this motion before the House because we are deeply anxious about the welfare of the rising number of dementia sufferers and their families, and of every elderly person in the UK who is having to live with the effects of an unreformed social care sector. Let us be clear about the scale of this issue. Of the 8.2 million people who are over 65 and of the 6 million people who use social care, 700,000 people have been diagnosed with dementia in the United Kingdom—and that figure is set to double over the next 30 years. In other words, about one in 10 of all social care users has dementia. In the context of a rapidly increasing awareness generally, the Government have promised much but delivered little to this group of people.
I am most grateful to my hon. Friend. He is absolutely right to have spotted that I said that 700,000 was the number of people who have been diagnosed with dementia. I did so precisely because of the under-diagnosis that occurs and the cases that will doubtless shortly be diagnosed.
On that point, the Parliamentary Office of Science and Technology says that 700,000 is the current estimate but that in fact only one in three of those people has had a formal diagnosis from a doctor, so the previous intervention was not correct.
The hon. Gentleman attempts to be more precise, but he will find that 700,000 is the figure for the number of people whose diagnosis has been accepted by all the agencies that need to make calculations and predictions, not least the Government. Some of that diagnosis may not have been done through a formal medical diagnosis, but it has become accepted through the other agencies as the appropriate diagnosis.
Is not this issue of diagnosis the precise point, because one of the things we were promised in the national dementia strategy was better training for general practitioners and earlier diagnosis, and that has not happened? That is why so many people are still not being properly diagnosed.
I am grateful to my hon. Friend for making that excellent point. He is right and he anticipates one of the issues that I hope to develop a little later in my speech.
There are specific measures that could improve the outlook for people with dementia, and for their families and carers, but it is important to bear in mind the fact that these social care reform issues affect all our fellow citizens who need to access and use social care services. Sufferers of advanced dementia represent some of the most vulnerable older people in our society. As we consider the challenge of meeting their needs, we must pay careful attention to the wider social care reforms that could protect the health and well-being of all elderly people. I hope that we can keep that bigger picture in mind as we debate this matter today.
First, let us consider dementia specifically. There is no masking the truth that dementia is a frightening and debilitating disease that plays havoc with the lives of those who come into contact with it, be they the sufferers of the illness, the families or the carers. The trauma of a diagnosis and the difficulty of coming to terms with the gradual loss of memory is only intensified when patients discover that little co-ordinated support is available for sufferers.
I pay tribute to all those in the third sector—in particular the Alzheimer’s Society and the Alzheimer’s Research Trust—who have supported sufferers and championed their cause. I also pay tribute to the work of my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright) and the all-party group that he founded and chairs, which has been so influential. We should also pay tribute to hard-working elected members of councils across the country and their officials who are working to provide this care at a local level, as well as to all those operating in the local government departments.
I cannot give enough praise to the family members, neighbours and friends who, as informal carers, love and care for vulnerable and elderly people and for those with dementia, who face even greater challenges. We should keep them uppermost in our deliberations and not forget the real human lives that these policy debates represent.
Two weeks ago, the National Audit Office published a broadly critical report on the Government’s dementia strategy. Among its many misgivings, it noted that
“there has not yet been a robust approach to implementation”
of the strategy; that
“it has not been given the levers or urgency normally expected for such a priority”;
and that it is clear
“that value for money will remain poor unless these weaknesses are addressed urgently.”
The National Audit Office reported, of course, to the Public Accounts Committee. We had a very good hearing on this subject in October 2007. I was promised 10 times by Sir David Nicholson, the head of the NHS, that the matter would be a national priority. That commitment was given 10 times. There have been three framework directives since then and it is still not a national priority—it is only a strategy. If my hon. Friend is fortunate enough to become a Minister for Health in May, will he consider making it a national priority?
I am grateful to the Chairman of the PAC for that intervention and for the work that he has overseen, as well as to the NAO, which has done that work. In answer to his specific question, I am glad to confirm that we have already said that, should that happy occurrence take place, this matter will be a priority. Part of my argument will be to stress how much, if one is going to state—as the Government have—that this is a priority, that needs to be followed through with actions rather than words, including operating frameworks.
Let us be absolutely clear. Is the hon. Gentleman saying that he would make it a national target or that he would leave it to local discretion? He cannot stand there, make suggestions and posture on this issue without being absolutely clear on that point.
I hope that the Secretary of State will reflect on the fact that he did not use the word “priority”, which was the word that I used. For some reason, he felt compelled to use the word “target”, which is always a potential distortion. That was a distortion. My answer is that the issue, as I am about to make clear, concerns how the actions flow from the word “priority”, once we have called it that.
I must say to the hon. Gentleman that, as vice-president of the Alzheimer’s Society, patron of my city’s Alzheimer’s group and someone who is contributing to the Alzheimer’s Research Trust, I am surprised that he is making this a party political issue. Let me ask him a simple question. The thrust of the Audit Commission’s review was that the strategy was good and that the new appointment of the director in charge of this matter will help, but that the £150 million allocated had not reached the parts for which it was intended because of the nature of decentralisation and the lack of ring-fencing. Given the Conservative party’s commitment to the new NHS board and to even more decentralisation to professionals from the Secretary of State or politicians in this House, how could the hon. Gentleman possibly determine what a priority would be locally when he could not even determine it nationally?
I am grateful to the right hon. Gentleman—no doubt he will seek to catch Mr. Speaker’s eye later, as that was a speech. Let me return to the intervention that he made at the beginning of it. He clearly needs to recognise that if anybody was making a party political point it was the Secretary of State, who intervened in the most tribal manner, as is fairly typical. The answers to the right hon. Gentleman’s questions will, happily, become clear from what I am about to say.
The NAO’s report came on the back of a disappointingly vague Green Paper on social care and a personal care pledge by the Prime Minister that the Labour party’s own Lord Lipsey has described as a “gimmick”.
Let me correct the claim in the Government’s amendment that
“the Personal Care at Home Bill will help some 400,000 people”.
It is offering free care to only 270,000 people, of whom 160,000 already receive it free. It will take only 2,384 people out of care homes—the stated aim of the policy on the human rights grounds that are critical for its intra vires—from a population of more than 500,000. It will help less than 3 per cent. of social care users. In other words, the Government have not grasped the nettle: we have an ageing population on our hands, cases of dementia are on the rise and time is running out.
By contrast, the Opposition have led the way in recognising that if a Government are to be serious about addressing the needs of dementia sufferers and older people across the country, reforming older people’s care services across health and social care in a way that is both socially and fiscally responsible must be a priority. That was precisely the answer that I gave. To cover one of the points mentioned in the intervention by the right hon. Member for Sheffield, Brightside (Mr. Blunkett), which was rapidly developing into a speech, our policies on Alzheimer’s research and pooled personal budgets, our proposals to reform the National Institute for Health and Clinical Excellence’s drug assessments, our home protection scheme for affordable guaranteed residential care and our commitment to a reinvigorated public health agenda have forced the Government to pick up the pace of reform.
The hon. Gentleman mentioned fiscal responsibility and other matters. Has he had a chance to consider the approach taken by Conservative Nottinghamshire county council? Is he learning from it? The council is privatising dementia care homes, which will mean automatically that the day care service provided for dementia sufferers, which it is also cutting, will be removed in its entirety. What would he say to that county council, which has a budget meeting coming up in a few weeks’ time?
The hon. Gentleman will no doubt have to answer to his right hon. Friend the Member for Sheffield, Brightside for introducing a party political element in his intervention. Clearly, what matters is that we should recognise that local services reflect the national priorities that have been set. If a national priority is for a dementia strategy delivered through actions on the ground rather than words, no doubt that would be more persuasive to a local council as it reached its decisions.
The National Audit Office raised four main criticisms of the dementia strategy. First, will the Secretary of State make clear just how much of the £60 million of dementia strategy funding for 2010-11 will be spent on additional dementia services? Does he have any plans to undertake a baseline assessment to see from what starting point those services are being run? We need only look at the recent carers strategy to see how urgently this assessment is needed. It emerged before Christmas that the £50 million disbursed for emergency respite care this year never reached the front line; instead it got soaked up in local primary care trust bureaucracy. Not only does that leave dementia sufferers with little hope of benefiting from resources, but it seems particularly disingenuous for the Government to take the plaudits for pledging taxpayers’ money without the funds ever reaching the front line.
On the second criticism, will the Secretary of State tell the House what the source of funding is for meeting the £1.9 billion cost of implementing the strategy over its 10-year lifespan? To date, the Government’s impact assessment has identified only £533 million of efficiency savings over 10 years, which leaves nearly three quarters—
I shall make progress, I think, as I have already answered the hon. Gentleman.
To date, the Government’s impact assessment has identified only £533 million of efficiency savings over 10 years, which leaves nearly three quarters of the budget unaccounted for. Does the Secretary of State agree that those diagnosed with dementia today need to know that there is a safety net of funding for their care and treatment as they face the years ahead?
Thirdly, the Government have yet to tackle the gaping hole in the skill set of all professionals who encounter dementia patients as part of their job. The £1.9 billion dementia strategy budget covers diagnosis and early intervention in people’s homes, but the NAO report points out that no estimate has been given for the cost of the pledges that the strategy makes for the training of NHS and social care staff.
Fourthly, can the Minister explain why dementia was not included in the Department of Health’s fixed national and local spending priorities—Vital Signs—in 2007? That serious omission—
Perhaps I can make sure that the Secretary of State knows the point that he has to answer: why was dementia not included in the Department’s fixed national and local spending priorities, Vital Signs, in 2007? The vital point is that that serious omission took place only a month after the Department had asserted in a statement to the PAC that dementia was a national priority. Is dementia really a priority?
The answer to that is, of course, no. That is because Vital Signs is the Secretary of State’s target system, and it has been discredited for distorting health provision. The precise point of this debate is that the Government are not delivering the results on the ground, even when they come out with something called a dementia strategy.
I am most grateful, Mr. Speaker. Does my hon. Friend agree that it is important that PCTs see dementia as a priority? In the NAO report on the NHS operating framework for 2010-2011, the office’s director of health value for money, Karen Taylor, said that trusts would concentrate on other issues if they were not made to focus on dementia. Is not that a fundamental flaw of the present Government’s strategy?
That is precisely the problem that arises when something is called a priority but is not then backed by action. It is why we have the motion before us today. Most importantly, we already have the evidence of what happened with the national carers’ strategy, given that the Princess Royal Trust has said that it could not find out where the £50 million for this year had gone.
The collective amnesia of Health Ministers is remarkable. My hon. Friend will remember that about a year ago my distinguished constituent Sir Terry Pratchett led a delegation to No. 10 on behalf of the Alzheimer’s Research Trust. We met the Prime Minister and the Minister of State, the hon. Member for Corby (Phil Hope), who is in his place. The Prime Minister, the Minister of State and the good and the great of the dementia strategy who were present said that the Government recognised that this was a finite, predictable problem that they would address. They have not done so. They have failed to get the money to where it is needed, whether that is training people in hospitals to cope with dementia patients in there for other reasons, or helping the voluntary sector to provide vital services.
I am grateful to my hon. Friend, who has always taken a keen interest in this important area. He is right to remind us about the visit of Sir Terry Pratchett, not least because that followed his address to the Conservative party conference’s main hall debate about dementia and how we must care for our elderly population. We were very pleased to see that that had been followed through with an invitation to 10 Downing street. Indeed, we wish to see the earnest of what was discussed there translated into action.
The Secretary of State asked my hon. Friend whether dementia should be part of the NHS tier 1 priorities. Does he agree that that was an odd question, given that dementia does not feature specifically in any of the Government’s tier 1, 2 or 3 priorities?
My hon. Friend is an expert in this subject and fully understands the difficulty that that entails. Most importantly, he recognises the priorities going forward. If we were to be given the chance to do so, we would look very carefully at the preventive agenda under the public health budgets. We would also ensure that the priorities are given to the NHS board, thus avoiding the target-based strategy that the Government have manifestly failed to deliver.
With respect, the right hon. Gentleman, who intervened earlier, should wait until I have made more progress. I will give way to him later.
The most important thing is to recognise that, in addition to the four criticisms that I outlined earlier, the Government have also made an announcement about memory clinics. I hope that the Secretary of State will tell us what is going on with the memory clinics that were promised in every town. How many towns does he think that there are in England, and how many currently have such clinics?
Despite reams of questions from me and other Opposition Members—
It is interesting that the hon. Gentleman seems to have a question about every single point that I am making. I shall come back to him, if I may, after I have made sure that the Secretary of State is aware of what I am saying. Despite questions from Opposition Members on the budget for memory clinics and the number of staff expected to be employed to deliver them, the Government could only answer:
“Decisions about the nature, number and funding of the memory clinics will be made locally by primary care trusts, depending on local circumstances.”—[Official Report, 23 February 2009; Vol. 488, c. 202W.]
What sort of a promise is that? The question for the Secretary of State today remains this: what is the precise number of planned and existing memory clinics and how many specially trained staff are there in the country?
I thank the hon. Gentleman for giving way. I discussed memory clinics, among other issues, with my PCT last week. Nottinghamshire’s Tory county council has privatised care homes in my constituency and elsewhere, with the result that day care services will go, among them day care memory clinics. Does he agree with that approach? Is it what we will see should he ever be in power, or would he adopt a different approach? We want to know.
I note that the hon. Gentleman did not answer his own question about whether there were any memory clinics in his constituency’s towns. It is vital that he applies that scrutiny to his Government’s policies. This debate is taking place because the Government have to be held to account.
I am a member of the PAC, and we took evidence on this issue on Monday. However, another issue arose that cannot wait—the appointment of dementia champions. We asked the civil servants before us how many of them there were, and where. They could not answer, although I believe that they will respond in writing to my hon. Friend the Member for Gainsborough (Mr. Leigh). The practical implementation of many aspects of the strategy does not need to wait and the Government can get on with that. Having dementia champions in PCTs and hospitals saves money and introduces the efficiency savings needed to implement the strategy.
I am grateful to my hon. Friend for that excellent point. It is an example of how we need to make sure that people at the front line get actions rather than words.
It seems that the Government have got into a habit of making unfunded pledges of late. Not only was their dementia strategy riddled with spending loopholes, but the Minister’s announcement last week of safeguarding vulnerable adults boards for every local area was equally vague about where the resources to implement the boards would come from. He made no mention of how the boards would co-ordinate with the dementia strategy, despite dementia sufferers being some of the most vulnerable people in our communities.
I hope that the Secretary of State will take this opportunity to explain why he claimed in a statement last week to be implementing a system of registration for home care workers with the General Social Care Council, when the GSCC has informed some of its stakeholders that plans for the system are actually on hold. Clearly, the Secretary of State is too busy trying to bolster his party’s manifesto to worry about making sure that these ambiguous claims are given the necessary detail, and the action points that have been highlighted.
Last week, we uncovered figures on malnourishment in our hospitals. The problem has not been dealt with, despite repeated pledges from Ministers. Evidence shows that it is the elderly who are most at risk from malnourishment in hospital, as they are often unable to express their needs to nurses. Over the last three years, I have been hammering away at this outrageous and scandalous issue. We need only look at the new year press coverage of the widespread unnecessary tube-feeding of the elderly in care homes—particularly those with Alzheimer’s—to see the harm that can be done to patients if the caring professions are under-equipped to meet the demands of dementia, both in terms of training and resources.
No, I will not give way to the hon. Gentleman any more. He is clearly rather excited.
The Royal College of Physicians undertook a review of tube feeding and deplored the practice as “completely unethical”. That the Government is content to let the elderly and Alzheimer’s sufferers be subjected to such appalling treatment as a result of overworked and under-trained care home staff is simply unacceptable. The Government have been sitting on the report of the nutrition action plan delivery board since July last year. I am glad that the amendment states that it will be published “shortly”. Given that it is six months overdue, I hope that the Minister will undertake to publish it tomorrow.
If the unnecessary tube-feeding of the elderly was not enough of a wake-up call for the Secretary of State, in November, the Government published a report overdue by 10 months on the inappropriate use of anti-psychotic drugs to treat dementia patients. Such drugs have a number of serious side effects that pose a particular risk to the elderly. They make patients unsteady and increase the risk of falls, they cause individuals to become socially withdrawn and they can accelerate cognitive decline, exacerbating the effects of dementia. Can the Secretary of State tell us what, if any, action has been taken as a result of the report? After three months, and after an initial delay of a year, all that the Government have done is appoint a national clinical director this week, although that is a welcome move.
It is a sobering thought that the suffering of millions could be prevented if we found a cure for dementia. That might or might not be possible in future, but today anything that can be done to slow the onset of the disease is to be encouraged and welcomed. The Opposition believe that the Government should not resign themselves to the status quo but press ahead in support of research into new treatments for Alzheimer’s, which is why we pledged in 2007 to increase the proportion of research budgets for work on dementia. Our policy has put Ministers under pressure to focus the Government’s attention on dementia, and I was pleased see that in November, a new ministerial group was launched to support dementia research and to help increase the proportion of the Government’s £1 billion research budget that is assigned to dementia research.
Hon. Members will be aware of the concerns recently expressed by third sector groups that the Personal Care at Home Bill will hit those research budgets very hard. I have secured a categorical commitment from Ministers that that will not be the case, but until the details of where the money is coming from for the Bill are completely disclosed, inevitably the third sector will continue to raise those concerns. Will the Secretary of State undertake to place in the Library detailed accounts to show where the money is coming from?
On where the money is coming from, the hon. Gentleman will be aware that the health budget has risen from £32 billion to more than £100 billion over the past 13 years. Dementia services are an important issue, so can he guarantee the funding that will be available if he is fortunate enough to become a Health Minister in May or June this year?
It would be very nice if the Government would match our promise and say that there will be real-terms increases to the NHS budget going forward. It is an interesting point to be made by someone from Wales, which is a devolved region. My constituency borders Wales, and my constituents are aware of the differences between health services in Wales and services in England.
Investing in high-quality research is a vital step towards discovering new and better dementia treatments. However, making drugs available to the wider population, to people who have just received a diagnosis of dementia, and to people with advanced dementia already in need of full-time care, is an altogether different challenge. Uniquely, we have pledged to change the remit of the National Institute for Health and Clinical Excellence to include a calculation of the wider societal costs of a given treatment when undertaking NICE appraisals. It is clear that dementia, as with other diseases, has an impact on local authority budgets and on public spending as a whole. Along with our commitments to value-based pricing, and to streamlining the NICE process, that will pave the way for dementia sufferers to access better drugs.
We need to offer those who are faced with a diagnosis today, and those for whom a cure may not be found for a number of years, the chance to guarantee their care needs so that they can be reassured that whatever the impact of dementia on their lives and their loved ones, they will be able to access residential care should they ever require it. I have explained to the House before the merits of our home protection scheme, and the careful calculations behind what we have promised. It was designed precisely to meet those concerns and allay the fears first raised by Tony Blair 13 years ago about a need that has remained unmet over a period of Labour government. People can now look forward to a Conservative Government delivering a well-designed scheme that deals with people’s fear of going into residential care. We need to look at the context of social reform—
The Secretary of State knows that that intervention was completely unnecessary, because it has never been claimed that it would help people to stay in their home. The idea is to meet the fears of people who have to go into residential care, by making it affordable and so that we do not discriminate against those who cannot afford it. It would not have the perverse incentive that he suggested, because of the national assessment criteria on care needs. The Prime Minister’s knee-jerk reaction in the Personal Care at Home Bill did nothing to address that issue, and deliberately discriminates against people who need residential care. Doubtless that will be debated in the other place on 1 February.
What my hon. Friend says about the proposal is interesting, because in my constituency of East Devon, we are dealing with the case of Mr. Mejor, a former Spitfire pilot, which has attracted national attention. His care is being reassessed at the moment. His daughter is his carer and he has an elderly wife, but they may have to forfeit their home. Such isolated cases are becoming increasingly prevalent around the country, but they could be avoided if we adopted Tory policies. [Interruption.]
Order. I am grateful to the hon. Gentleman. I was not disputing the word of the hon. Member for Tiverton and Honiton (Angela Browning)—I was simply making the point that I did not hear it. What I would say—and I am grateful to her for her point of order—is that it would be a good thing if the House settled down. I know that this is a highly charged matter on which strongly held views are being expressed, but that must be done in a seemly way that will command the respect of the country.
It is indeed a serious subject, Mr. Speaker. I am grateful to my hon. Friend the Member for East Devon for raising a case that has become widely known. Our reforms would enable his constituent to be better served and to receive the care appropriate for his needs.
To summarise, the issue of how we provide sustainable and affordable options for residential care is part of a wider debate on social care reform. The Government have played fast and loose with the challenge of reforming social services. Despite promises made in 1997, they ignored their own royal commission and, indeed, the whole problem, until 2008. We have had a vague Green Paper following an even vaguer consultation which has, in Lord Lipsey’s words, been blown out of the water by the Prime Minister’s announcement of free personal care late last year.
Having rushed the Personal Care at Home Bill through the House, the Government have still not given any assurances on the costings of the Bill, or its robustness in the face of a potential legal challenge under the Human Rights Act 1998. Nor will the Bill help any of the significant number of dementia sufferers already in care homes. With the Secretary of State keen to make the Bill a top-three issue in Labour’s election campaign, the House would do well to acknowledge the fact that dementia sufferers and, indeed, all older people with care needs, deserve more than political posturing on something that has not yet been properly costed.
I hope that the Government will treat today’s debate as an opportunity to discuss how we can work together to ensure that the public reap the benefits of the dementia strategy through action on the ground, and to reflect on how we build on the strategy to meet the demands that dementia will inevitably make on our health service in the coming years. We need such action, rather than words, and the Government must act quickly. It is time for Government to step up to the challenge posed not only by this devastating disease but by an unreformed social care sector, not with words or another vacant pledge, but with action at the grass roots of the NHS and social services and a concerted leadership effort at the helm of Government. A national care service does not simply come about or, indeed, become a national service simply by our using those words. It is important that the Government answer serious questions about provision, portability and, not least, who will pay. We are not just talking about the prioritisation and allocation of funding within the health budget. We are talking about supporting the work that funding enables: offering tailor-made training to staff at the front line; researching a cure; ensuring that the public have easy access to the best drugs on the market; and enabling all older people, no matter what their care needs, to guarantee their residential care in old age. All that will greatly enhance the quality of life for those diagnosed with dementia and for all elderly people seeking dignity and security in old age.
The Government announced the establishment of memory clinics, rather than memory centres, in every town. That has been amended, on occasion, to memory services. Clearly, what matters is not the building, but the training and the skills of the people offering all the NHS and care services, who need upskilling so that those services are better known by all who come into contact with patients. That will enable them to deal with many who remain undiagnosed, which was one of the earliest points made in the debate.
The issue of dementia and the challenge posed by our ageing population cry out for leadership. It is one of the greatest and completely known and predictable challenges for our political generation. I urge all Members across the House to come together on the issue and to make the difference for some of the most deserving and vulnerable people by supporting the motion.
On a point of order, Mr. Speaker. When the House adopted the Nolan principles and rules, which it did by resolution, there were two specific requirements on hon. Members, were they to receive finances or other assistance from outside bodies. The first was that the interest should be registered, which is signified by the letter R by convention and has been done in a fairly widespread way. The second is more important.
The second Nolan rule adopted by the House, as I recall, is that for 12 months after receiving such money, the Member is not able to initiate any legislation whatsoever that impacts directly or indirectly on the donor of that money. It is my understanding that a company called Care UK donated £21,000 to one of the signatories to the motion. If that were the case, can you confirm that it would not be in order for the motion to go forward?
I am grateful to the hon. Gentleman for his point of order. I will respond as follows, and I hope this is helpful to the House.
First, of course, responsibility for the registration of interests rests with individual Members. Secondly—I listened very carefully to what the hon. Gentleman said—if any Member has anxieties or is discontented about the conduct of another Member, the Member who is dissatisfied should complain to the Parliamentary Commissioner for Standards. At this very tense and competitive time, I should hope that Members would not air these matters on the Floor of the House when they are matters not for the Chair, but for the Registrar of Members’ Interests and the Parliamentary Commissioner for Standards.
If Mr. O’Brien wishes to respond to the point of order, he is welcome to do so, but he is not under any obligation to do so.
I am happy, Mr. Speaker, to take the opportunity to say that that is an extraordinary thing to be raised as a point of order, as you somewhat indicated. I can assure you, and through you the House, that any money that has been received by the office of any right hon. or hon. Member, particularly in opposition, to support their parliamentary work and particularly in relation to research, has been fully, openly and transparently declared at all times with the Electoral Commission and with the Registrar of Members’ Interests, on time and in proper conformity with all the rules, and that no possible conflict of interest could arise.
I am very grateful to the hon. Gentleman. The point of order has been raised. The response has been made. I hope that if it is pursued, it will be pursued elsewhere.
Before we proceed, I should like to say that the hon. Member for Eddisbury (Mr. O'Brien) gave way generously in the course of his contribution. I am sure that was appreciated by the House. This is an Opposition day. There is another debate to follow. Several Back-Bench Members wish to speak in this debate, and I hope that further Front-Bench contributions will be tailored accordingly.
I beg to move an amendment, to leave out from “charities” to the end of the Question and add:
“welcomes the Dementia Strategy launched in 2009 which contains a programme of work to transform services for those with dementia over five years and is backed by funding of £150 million over two years; notes that the Government will shortly publish the report of the Nutrition Action Plan Delivery Board; rejects the use of tube feeding on any grounds other than clinical need; welcomes the independent clinical review of anti-psychotic drugs which contains recommendations for the reduction in the use of these drugs for people with dementia; further welcomes the appointment of a National Clinical Director for dementia to promote better care and provide leadership for the implementation of the strategy; welcomes the creation of a ministerial group to develop dementia research; recognises that the enactment of the Personal Care at Home Bill will help some 400,000 people with the highest need; supports the Government’s proposals to create the National Care Service, the first national, universal, entitlement-based system for care and support in England; and acknowledges that the Government’s Dignity in Care campaign is working to engage local people in a social movement and to put dignity of those in care at the heart of services.”
It is hugely encouraging that today the House is again debating the care and support that we provide to older people, particularly those with dementia. Let me start on an uncharacteristically non-partisan note by congratulating the Opposition on calling today’s debate. This is the third occasion since the publication of our Green Paper that we have debated these issues. Since then, we have also passed the Personal Care at Home Bill.
In its long history, the House has never given such focused attention to this subject, which in time will touch the lives of all our constituents and arouses such raw feelings among those families most affected. When I introduced the Green Paper to the House, I said that we wanted to build an unstoppable momentum for reform of social care in England. It is beginning to feel that we are now getting close to achieving that momentum, but we need to do more. As the hon. Member for Eddisbury (Mr. O'Brien) said, we must build confidence among patients and carers groups, which have done such wonderful work in raising awareness of these issues while the political spotlight was elsewhere, that this time we are serious about change.
In these debates, I have often used general national figures to illustrate the challenge and the nature of the ageing population. Today, I want to share with the House some stark figures presented to a meeting that I attended in Wigan last week. This local presentation of figures puts things in a sharper focus. In the Wigan borough today, 49,700 people are aged 65 and over, and 5,200 people are aged 85 and over. In just 15 years, those figures will have increased to 63,900 and 9,300 respectively. Twenty years from now, there will be 75,500 over-65s and 11,900 over-85s.
If we leave the current unfair system to cope with demographic change in my constituency in the Wigan borough, it would have three social consequences. First, more older people in Leigh would be living in a more vulnerable condition with their personal care needs not being adequately met, placing a strain on other public services, particularly the local NHS. Secondly, a generation of older people in Leigh who, as in many former mining areas, are the very first in their families ever to own their properties outright, would be asked to draw on those assets to pay for care in old age, with the most unfortunate standing to lose all they have worked for. Thirdly, more people in Leigh would have to act as informal carers under even more strain as public support is spread more thinly, and would face an ever bigger battle to get help from the support system.
I understand my right hon. Friend’s commitment to his constituency, Leigh, and his use of statistics from there. Will he drop over the border and visit the important constituency of Chorley in Lancashire to see the need for a memory clinic there and the benefit that it would bring Chorley and its constituents? Will he come early and support that?
Chorley is just over the border and I would be happy to do that. Across the north-west we have seen real demographic change and a break with the past. In many communities in the north-west, people of the older generation were living in social or council housing. Today we have a generation of pensioners who have worked for and own their homes outright. It is my argument that if we leave the system unreformed, the unfairness felt by that generation will be far greater than anything we have seen so far. That is a key part of my argument for change. I would be happy to talk to my hon. Friend’s constituents about how they see the issue and how it would affect them if we failed to act this time.
May I raise a pragmatic point with the Secretary of State? Does he agree that people who need adaptations such as showers or stair lifts in order to continue to live in their own homes with dignity and independence should be able to get those without having to wait for months and sometimes even years? Can we address that point? By spending just a little money, we would save much greater sums in the longer term and give those people dignity.
The hon. Gentleman raises an important point. We have all probably seen in our constituencies how the disabled facilities grant has been stretched and has had to go round an ever-increasing number of people. In a constituency like mine, where there are lots of traditional old terraced properties, those properties need adaptations if they are to be made fit for purpose to enable people to get around. He is helping me to make my point. I am prepared to say that more money should come from my budget to invest in those homes to give people the support that they need. If we do not make that investment, the end result will be the national health service seeing those people in the accident and emergency department because they are not being adequately helped at home. That is the argument that I am advancing with some passion.
All public bodies should come together. Will my right hon. Friend comment on Tory-run Nottinghamshire county council, which, in its budget next month, proposes to cut 20 occupational therapy posts? They are precisely the people who need to make the disabled facilities grant assessment, which is a statutory requirement of councils, and, should the council’s cut succeed, it will automatically lead to more delays in my constituency.
Given that my hon. Friend has been determined to raise that issue three times, somebody ought to comment on the situation in Nottinghamshire. The Opposition studiously avoided it. Conservatives councils, by their actions, do something very different from the fine words that we heard delivered at the Opposition Dispatch Box not only in my hon. Friend’s constituency; they do something very different locally, and we should inform people of what is going on there.
Most of us in the Chamber are signed up to the idea of independent living, whereby people should be allowed to stay in their own home if they want to, for as long as possible, but does the Secretary of State not agree that there is an inherent danger in that? Care packages become critical for those people, and they should receive a holistic care package so that they do not become isolated in their own homes, which can and does happen.
I agree with the hon. Gentleman, who makes a very important point. It would not be right for people to live in their homes without the necessary support, or when they were too vulnerable to do so, but he seems to be making the argument that I made to the hon. Member for Eddisbury (Mr. O'Brien) a moment ago. I said that we should introduce public support to help people live independently, because that is what they want, whereas the hon. Gentleman said that the right policy response was to cover costs for people going into residential care. I fear that that policy, which he and his colleagues have advanced, would create an incentive to push older people too early into care establishments and not give them the support to cope at home. Once care is free in a home but not in the community, it must create an incentive for people to enter care prematurely.
None of us wants people entering care prematurely, but the Secretary of State needs to distinguish between those who are elderly and those who have some form of dementia, because if they do not have carers who can care for them at home, by definition they will be driven into residential care at some point.
Does my right hon. Friend agree that there is a huge risk in labelling people with dementia as unable to cope at home? In our desperate desire to protect older people, it is possible to say that because someone has dementia and diminished capacities, they lack the right to make sound decisions for themselves. It is our responsibility, as far as we are able, however, to tailor our care packages to enable people to remain at home. We should not take the decision to remove a person’s right to make that decision for themselves. [Interruption.]
My hon. Friend makes a point of fundamental importance, and Opposition Members would do well not to mutter and chunter about it, but to think about it for a moment. As we face demographic change, we need to rethink our ideas about ageing and the quality of life that we give to people, and our preconceived prejudices about what it means for somebody to develop dementia in later life. That is why the Government’s policy focuses on supporting people at an early stage and giving them that support so that they can maintain independence. Alongside that, we want to ensure that we work to change public attitudes to dementia and the lives that people can lead. I shall return to that point.
I was describing the situation in Leigh and the social consequences that I predict from a failure to act to reform our social care system. There is a depressing prospect if we fail to face up to the scale of demographic change. Reform of our care and support system is long overdue. One good thing that could come out of the debate would be a commitment from all parties to introduce a reform Bill in the next Parliament. That would instil confidence in those voluntary groups in our communities which have long called for reform. I hope that the other parties will be able to make that commitment today.
People with dementia would be some of the biggest beneficiaries of a fundamental overhaul of the system, but in advance of any reform we have been working hard to improve our understanding of dementia so that we can start immediately on improving services for people suffering with the disease and for their carers. Almost one year ago we published the first ever national dementia strategy, and since then we have been working to give it life—to bring dementia out of the shadows, raise awareness and set in train a system-wide process of change and reform.
We now have an implementation plan, setting priority areas for health and social care in order to take urgent action and guide the process nationally and regionally. Regional baseline reviews were completed in the autumn, paving the way for detailed joint local dementia action plans to be delivered by March, and we have a strong governance structure, pushing forward changes throughout the system. Building on unprecedented levels of grant increases since 1997, we have allocated to primary care trusts £150 million—in excess of the impact assessment figures—to support that work and make the strategy happen; and, as changes to services must be locally driven, we have given PCTs the freedom to determine their spending based on local needs. We believe that that is the right approach.
The right hon. Gentleman has dealt with the point about why he decided not to ring-fence that money, but will he deal with why he did not ask PCTs to report back on how they had spent that money, so that we could at least have ascertained whether they had spent it on what the Government had expected them to spend it on? The Government have not asked PCTs to report back on the strategy under discussion, and that is unlike what was done for the national end-of-life strategy.
I was very pleased to be in Leigh on Saturday, but I was not able to examine the services there, because I was at my right hon. Friend’s 40th birthday party. Will he join me in thanking the Alzheimer’s Society’s chief executive, Neil Hunt, who is stepping down, for his work on raising the profile of Alzheimer’s and for his contribution to the strategy? Will my right hon. Friend also confirm that the Opposition’s criticisms of the actions of PCTs would be greatly exacerbated if the Secretary of State had no powers in that area, and if the Department of Health gave away its powers to a national health service board, remaining in charge only of public health?
I am grateful to my right hon. Friend for that comment, and it was wonderful to have him in Leigh on Saturday—even if he has now raised with the whole House the question of my own social care needs and mortality. He makes a very important point, and we will all want to pay tribute to Neil Hunt for his work on raising awareness of the truly devastating effects of Alzheimer’s not just on the individual who develops it, but on the extended family who watch that terrible process unfold.
My right hon. Friend, who is quite right to praise Mr. Hunt, makes a very important point that is starting to run through the debate. We regularly hear from the shadow Health Secretary and Opposition Members a critique of ministerial diktat. They say that everything that we have done over the past decade is flawed; that we are micro-managers; that we do not let people get on with the job; and that we set too many targets. The whole thrust of the hon. Gentleman’s deputy’s remarks was to query why we are not doing more of that. When I asked the hon. Member for Eddisbury whether he would do more of it by setting national requirements, he said no. I rather lost the thread of his speech at that moment. It was easy for him to posture to his hon. Friend the Member for Gainsborough (Mr. Leigh), the Chair of the Public Accounts Committee, but when it came to the crunch he did not have any answers at all.
Does my right hon. Friend agree that one of the greatest steps that this Government have taken to improve the quality of care for those with dementia is the setting of national care standards under the Care Standards Act 2000, and that the requirement to focus constantly on the training and quality of staff and the quality of care has been a huge step forward that was totally missing from 1995 to 1997, when I was involved in domiciliary care provision for people with dementia?
My hon. Friend is absolutely right. The 2000 Act was groundbreaking. It was bitterly opposed by some, if not all, Conservative Members, but it was much needed. It changed what had been a fairly unregulated system into a system where clear standards were required. We have built on that change year on year. As she will know, we will soon require all providers of health and social care to be registered with the Care Quality Commission. This continuous drive for the improvement of quality and safety in the provision of all health and social care continues, and I am grateful for her support.
On the national dementia strategy and the steps that we have taken to ensure that we see progress on the ground, improving services for people with dementia is highly complex, but as we reach the end of the first year of this five-year strategy, progress in planning is beginning to show improvements in practice. Let us take Croydon memory service, where people have doubled the number of dementia assessments and helped to overcome the stigma attached to the disease. Assessments at the service are carried out with the patient and the carer in their home to help to maintain their independence and quality of life. Or let us look at Wakefield, where staff are working to reach as many people as possible, as early as possible when they become ill, again trying to support them in their own homes. They are bringing together social workers, district nurses and community mental health staff to create the kind of strong, close teams that make all the difference to patients and their families who need that professional support. We want to see more of those services across the country. That is the answer to the point that the hon. Member for Eddisbury made about memory services. Forty demonstrator sites have been set up around the country to look at how dementia advisers and peer support networks can help families to get the support they need.
We are also working hard to raise awareness of dementia—this addresses the point made by my hon. Friend the Member for Bridgend (Mrs. Moon)—and we will launch a public awareness campaign in March. That will be focused not only on reducing the stigma that comes with dementia and improving understanding of dementia but on encouraging people to seek help and information if they see the early signs of the disease.
Last week, we had an important interim report on our national dementia strategy from the National Audit Office; I am grateful for the attention that it continues to give to this important matter. The report describes our strategy as “ambitious and comprehensive”. It acknowledges the progress that we have made while rightly challenging Ministers to intensify our efforts. I welcome the report and take its recommendations very seriously.
We must recognise that we are in the first few months of this five-year strategy and that change will not happen overnight, but there are actions that we are taking to improve things now. For example, we know that we need to do more to improve commissioning. New joint commissioning guidance was published in June last year, and that is now helping PCTs and councils to make the right decisions in their area. We know that we need to improve training, so we have commissioned Skills for Health and Skills for Care to look at training needs across health and social care and, where gaps exist, to address them in the work force development action plan. We also know of the need to find the local leaders to drive through this programme of change. The hon. Member for Rugby and Kenilworth (Jeremy Wright) was correct to lay emphasis on that important point. The recent Alzheimer’s Society report on acute hospital care and dementia was very helpful in prompting the acute sector to give priority to dementia. I welcome that pressure and those voices calling for such change within our national health service—long may it continue.
As regards voices calling for change, will my right hon. Friend resist any calls for privatisation in the NHS, as embraced by the Conservatives, who are playing footsie with Nurses for Reform, a privatising organisation led by Dr. Helen Evans; reportedly playing footsie with Care UK, a privatising agency; and have a leading MEP, Daniel Hannan, calling the NHS a “mistake”? Will my right hon. Friend condemn that and assure me that there will be no such privatisation?
I can certainly say to my hon. Friend that we are proud of our NHS. We also, though, value the contribution made by voluntary sector and private sector providers. We have read reports about donations given to the Conservative party; I do not know the rights and wrongs of that. However, I do know that it raises a question about the independence of policy making by its shadow Front-Bench team. Well over a week ago, I wrote to the right hon. Member for Witney (Mr. Cameron) to ask him to give me assurances that that independence is not compromised—[Interruption.] Well, we need to know. I asked what safeguards have been put in place to remove any perception of a lack of independence. If I had had a reply to that letter, perhaps I would have been reassured by now, but I have not—am I not owed one so that I do not need to raise this matter? My hon. Friend makes an important point. It is interesting to see the company that the Conservatives are keeping, particularly people who repeat the claims about the NHS being a Stalinist creation.
I entirely support the NAO’s recommendation for acute hospitals to identify their clinical lead for dementia by the end of March. We are making real progress, but there is a long way to go. I can tell the House that the Minister of State, my hon. Friend the Member for Corby (Phil Hope), who is responsible for care services, and I are putting a determined and relentless focus on these services to achieve the transformation that we want to see. To help us, we have Martin Green as our dementia champion for the independent sector, and only last week we appointed the first ever national dementia clinical director, Professor Alistair Burns. Alistair will take forward our response to the anti-psychotics review to implement all its conclusions and recommendations, leading to reduced use of these drugs in the management of dementia. He will lead on the national audit of services and the action plans that follow. I pay tribute to my hon. Friend the Minister, who has driven forward work in this area and, indeed, commissioned that review by Sube Banerjee.
As we approach the first anniversary of the strategy’s launch, I am confident that we are on track to deliver our goals. I have described the NHS and social care services that I want to see in the coming years—services that are high quality and efficient, preventive and people-centred. Providing effective early support for people with dementia is a vital part of that vision. We now have the evidence to show just how crucial early invention can be. The partnerships for older people projects helped more than 250,000 older people, enhancing their quality of life, improving local working relationships and providing efficiency savings for the entire health and social care system. The evaluation of the projects was published earlier this month. It showed that through early intervention, they cut overnight stays in hospital almost by half, cut accident and emergency attendances by just under a third, and cut clinic or out-patient appointments by more than 10 per cent. For every £1 invested in prevention, there was an average saving of about £1.20 in emergency bed days. In fact, it was found that there was a £1.40 saving for secondary and tertiary prevention and a 70p saving for primary prevention services. This shows that even well-being services can deliver efficiency gains. Taken together, that makes a compelling case for changing the way in which we spend health and social care resources, as the hon. Member for Castle Point (Bob Spink) rightly said.
As we reform services, we must strive to give people more choice, convenience and control over their care, to put quality at the heart of our services, and to take more early, preventive action to keep them healthy and in their own homes, which is where the vast majority of people want to be. That is what our Personal Care at Home Bill is all about. Through this Bill, we want to provide support to more than 400,000 of the most vulnerable people in our constituencies, including people with dementia, to help those with the greatest needs, who require intimate personal care in all aspects of their daily lives. In many cases, they will already have paid significant sums out of their own pocket towards the costs of their care as their condition has deteriorated. Their family and carers will have faced considerable pressure in recent times as they have battled to get the help that they need or sought to balance the demands of their own lives with looking after a loved one. The Bill will provide powers for people to receive intensive support to prevent them from developing more serious needs. It will help them remain healthy and independent in their own homes and extend their quality years of life.
The Bill has two clear aims. The first is to end the lottery in home care for the most vulnerable people in our communities, and the second is to pave the way for a bigger reform of social care in the next Parliament and the creation of a national care service. There has been a long process of reform since 1997. We have committed unprecedented levels of grant increase to fund investment in local council services, achieved real success in improving service quality and introduced radical reform to personalise services, including individual budgets that give people control over their own lives.
However, we know that a more radical approach is needed. The people with the highest needs still face the greatest costs, and we now have a chance to build a better future for them. People need and expect health and social care services to work more closely together. They want seamless services, and they do not want to be passed from pillar to post before they receive them.
Can my right hon. Friend confirm that one major reform that we have introduced, which has been little heralded, is that when one of a married couple has dementia, for example, and sadly needs to move into a residential care home, there is no longer a requirement for that couple to sell their home at that point? This Government changed the National Insurance Act 1948, effective from April 2009. The myth is still going around that if a man goes into a residential care home, his wife has to sell the house and move out, but that is wrong. That is no longer the case, which was a major and positive reform from last April.
My hon. Friend is right that a myth is put about that we have done nothing and that there has been inertia for 10 years. There has not. We have reformed our social care system to make it fairer and taken steps towards the fundamental reform that I am saying is necessary. He is right that the house is disregarded when two people are involved, and he will know that we have gone further and introduced the deferred payments scheme, so that if the other person goes into a care home too, the house does not have to be sold immediately during their lifetime; that can be considered later.
Those are two important reforms that are glossed over by some. However, we want to go further, and that is the case that I am making today. On their own, those reforms are not enough. If we do not do more, we will face a generation of older people who experience greater unfairness as they approach care. As good as those changes were, I am prepared to accept that they will not do the job completely.
The Government’s vision is of a national care service that is fairer, simpler and more affordable, that is underpinned by national rights and entitlements, that ends the postcode lottery in care and that is personalised to individual needs. The vision is a system with quality at its heart, in which people get the care and support that they need wherever they are in the country. The national care service is about helping people live their lives in the way that they want to, putting their needs and wishes first, helping them keep up relationships with family and friends and live in their own homes as long as they can, and where possible helping them continue to work and contribute to their community.
Reform of the care and support system and the shift towards prevention is the only fiscally responsible strategy for the long term, but it is also the only morally responsible strategy. I intend to publish a White Paper in the very near future setting out the future of care and support in England. We are working to improve the services that are available now and transform them in the years to come. As we take our first steps in this new decade, we are beginning to create the momentum that is necessary to deliver once-in-a-generation reform.
I echo the words of the Secretary of State by warmly welcoming the chance to debate this important issue. I congratulate the hon. Member for Eddisbury (Mr. O'Brien) and his team on bringing the matter forward. This is a particularly important time to talk about this range of conditions—we need to remember that that is what dementia is—that have such an impact not only on the individuals who are unlucky enough to suffer from them, but on their families, carers and friends and on the communities that they live in.
Here we are, nearly a year after the announcement and commencement of the national dementia strategy, which we all welcomed as a big step forward in how we, as a country, deal with dementia. It is right and proper that we now consider the matter and where we are up to, just before we get into the campaign proper, because whoever is in government after the next election must be firmly committed to seeing the strategy through its whole 10-year period. We are certainly happy to make that commitment, as I am sure Members of all parties are.
The comments of Professor Sube Banerjee to the Public Accounts Committee were an extremely powerful way of describing the effects of dementia. He said that it was
“one of those rare diseases that people actually consider worse than death.”
We all know that dementia is becoming more and more prevalent in our society. Already about a third of people in care homes suffer from it, and the latest estimate is that there are approximately 600,000 people with dementia in England. However, as the hon. Member for Rugby and Kenilworth (Jeremy Wright), who leads the all-party group on dementia, has made clear, we simply do not know the actual number. That is partly because of the challenge of early diagnosis and partly because of the challenge of getting people to present to doctors when they fear they may be in the early stages of the condition.
The hon. Gentleman is making a very good point. May I say to him that there is a stigma among relatives, who want to protect someone in their family and do not want to admit that there may be a problem? Does he agree that we need to provide more help and support and welcome the job that carers do?
I do, and that is a very important point. I hope that our regular debates on the matter and the strategy itself will do something to deal with that stigma. We can only imagine the trauma and devastation of someone facing the possibility that they or a loved one may be facing the condition, and the effect that it will have on their life in the coming years.
Does the hon. Gentleman accept that part of the difficulty that we have, and part of what we must accept in the debate, is that dementia is not an entity but a spectrum? Someone may function quite well on one day but not on another. Depending on their medical condition, their situation may fluctuate. It is dangerous to write off somebody who has been diagnosed with aspects of dementia as “demented”. We have devised the capacity assessment, but that should be utilised only in conjunction with supportive carers who know the individual and their fluctuation.
I alluded to that in my introductory comments by pointing out that dementia is not one condition and that a number of conditions come under that umbrella, but the hon. Lady is absolutely right that dementia affects people in different ways. Many people in the early stages can lead full lives and can work. I have been pleased to work with the author Terry Pratchett, particularly on research into dementia, which, as Ministers will know, I have campaigned on. Terry Pratchett is still writing, going to our party conferences and getting the message across, and it is very important that we do that. Nevertheless, the fear and stigma will still exist, for Terry and for everybody else. They simply do not know what is around the corner, how it will affect them and how long they may live. The hon. Lady is right that that presents us all with a challenge in considering how to deal with the matter in the health and social care system.
I echo the comments of the hon. Member for Eddisbury in paying tribute to everyone currently involved in dementia care, which is a particular challenge. Of course, the wonderful people who work in our health service and in our care homes always face challenges, but those who deal with the problems of people with dementia, particularly in the latter stages, deserve our tributes for all they do for those most vulnerable people in our society. I also echo the tributes to the all-party group, of which I am a member, and especially to the leadership of the hon. Member for Rugby and Kenilworth.
The national dementia strategy for England was launched, rightly with a fanfare, last February. It made clear recommendations for improving dementia care under the key themes of raising awareness and understanding, of early diagnosis and support and of how to help people living with dementia. The National Audit Office report—HC 82—has now been published. Although it acknowledges that progress has been made in some areas, it expresses the concern that dementia services are not given the priority that they were promised a year ago—and, crucially, the priority that they need for the excellent strategy to take hold in the early stages. All hon. Members want that to happen.
My hon. Friend has alluded to a concern that many of us share: although we welcome the funds that have been delivered through the national dementia strategy, the £1.5 million provided to the primary care trust in Cumbria does not appear to have resulted in any additional services for people suffering from dementia or for their carers. Organisations such as the Alzheimer’s Society want clear, tangible, additional services to be provided for those people rather than the money being used simply to plug existing budget gaps.
My hon. Friend rightly makes the point that making a difference on the ground, in those PCT areas, is important. Without getting into the ring- fencing debate, as we often do, can the Secretary of State give us better assurances and tell us that the money is being spent, simply by asking PCTs to report back and tell us what they are doing? Every PCT that has been given the money has a responsibility to ensure that it delivers. That is a challenge for PCTs, because of their budgets, but it must happen for the strategy to work. When there is evidence on the ground that the money does not appear to make a difference to local dementia services, sanctions must be put in place so that the Secretary of State can take action. If PCTs are failing to deliver the strategy, the Secretary of State—whoever he is—should be able to say that that is unacceptable and that it will not provide appropriate care in the area.
Early diagnosis is one of the biggest challenges in the strategy. According to research from the House of Commons Library, people wait for three years, on average, before reporting symptoms to their doctor. That problem cannot easily be solved, but it is clear evidence that education must be a key part of the strategy, particularly through health professionals and GPs, to communicate to people that they should go to see their doctor and get a diagnosis. To revert to the point that the hon. Member for Bridgend (Mrs. Moon) made, early diagnosis and care from that stage can make a great difference to the condition’s progression.
The Secretary of State mentioned the concerns about local leadership. The point has been strongly made that local leadership is simply not there. Without that, the strategy will not succeed. It is not only about money, but about leadership. I urge him and the Minister to stick to the deadline of March—I welcome the fact that he has set it—for having it in place.
We need further and appropriate meshing of our health and social care systems. It is a policy challenge to which there are no easy solutions, but interesting pilots are going on around the country. The artificial divide that often exists between health and social care cannot be more meaningless than in the case of dementia. It would be good if we could use the national dementia strategy to make progress on better meshing health and social care, so that the system becomes seamless for people, whether they need something that is currently defined as “care” or something that is defined as “health care”.
One of the key ways in which that joint working can be effective is when an elderly person with dementia, who has a care package at home from a care agency, needs to be admitted to hospital and the ward staff are willing to accept the help, support, advice and guidance of those carers from the agency, who know all about the management and needs of that individual. Sometimes there can be a breakdown of communication between professional care staff in hospitals and those at home. A greater willingness to listen to advice about the care to which people respond at home could result in treatment in hospital being eased.
The hon. Lady makes an important point, which clearly shows that we need to learn from experience on the ground how we can improve matters. I shall speak shortly about the particular challenges of dementia care in hospitals.
Training is another key part of the strategy. According to the dementia care services market briefing last year, a third of care homes that specialise in dementia—I am not referring to those that do not—do not provide their staff with dementia care training. When the Minister responds, will he give us an update on progress on training? If our care professionals—people who deal with those with dementia—do not have the proper training and education on dementia, many of the good aims in the strategy simply cannot be brought to fruition.
Does the hon. Gentleman agree that there are two kinds of care training: one for people who are engaged in intensive care support for those suffering from the illness and the other for general hospital staff, who may encounter patients who have another illness but who also have elements of dementia? The latter also need training in how to respond appropriately.
Does the hon. Gentleman agree that it is important to consider expanding the role of Admiral nurses, of whom there are 65 or 70 currently in England? The nearest one to Devon is unfortunately based in Woking, but they do a remarkable job, and the body should be expanded.
That sounds like an interesting scheme, albeit one of which I am not particularly aware. Again, it is the sort of thing that should be fed into the strategy and the debate, so that we can learn from best practice throughout the country.
The Alzheimer’s Society expressed its disappointment, which I share, that the recently published operating framework for 2010-11 does not explicitly refer to dementia.
The information came from the Alzheimer’s Society. My point is that primary care trusts must view the services as important. The Government have set out their stall with the strategy, the Opposition have had a chance to set out theirs today, and I am doing it for the Liberal Democrats. However, if strategies do not filter down to PCTs, we will not have the services that we need on the ground.
May I return briefly to the operating framework? The Secretary of State is technically right that dementia is mentioned, but it is mentioned extremely fleetingly, and the importance that the Government have given to it is not in any way reflected in the priorities of the strategy.
I thank the hon. Gentleman for that helpful intervention. I do not want to get sucked into the rather bad-tempered debate about tiers 2 and 3. The national dementia strategy is clear in its prioritisation, but is that filtered through to all levels of the NHS, which it must be if it is to be delivered?
It was promised that every town in the UK would have access to a memory clinic—that was how the promise was phrased—but it is clear from the NAO report that that will not happen. The hon. Member for Chorley (Mr. Hoyle) used a different word, and spoke of memory centres, but the hon. Member for Eddisbury spoke of memory services—[Interruption.] He pointed out that the rhetoric was now memory “services” rather than “centres” or “clinics”. We need to be clear where that promise is going. Let us face it: what we are talking about is everybody in every town having appropriate access to specialist services to deal with memory dementia.
I am sure it is. I am sure that Chorley is the ideal location for many things—[Laughter.] To make a serious point, I was not trying to catch the hon. Member for Eddisbury out on the words that he uses; I am simply asking the Minister whether people in every town and city, including Chorley and Leeds, will have access to those services in the way that was promised.
Funding is a challenge for us all. We recently had a good debate on the Personal Care at Home Bill, but care for people with dementia in itself presents a huge challenge within the overall discussions on funding for social care. Dementia already costs England alone £15.9 billion a year, which will rise sharply year on year. The King’s Fund has predicted a total cost of £34.8 billion by 2026, which is an increase of 135 per cent. Dementia currently costs the country £539 a second. An amount of funding was clearly set out in the strategy—a figure of £2 billion over the years of implementation—but where precisely are we going to identify efficiency savings to secure that important funding? Without that, the strategy will fall by the wayside, so we must face that funding challenge.
I say that within the wider context of the debate on the funding of long-term care, which I have been happy to be involved in. I have spoken many times in the House on that and have held many meetings with many of the organisations involved. Dementia funding is particularly complex, partly because it so clearly breaches the artificial divide between health and social care—there are huge costs for both the NHS and local councils. We also know that as life expectancy rises and care costs increase in total, families face uncertainty about what their costs will be and how best to plan for them. That is a challenge that we have yet to face.
I welcome the Secretary of State saying that the White Paper will be published soon. I do not know whether he can commit to giving any more of a clue as to what “soon” means, but we are running out of time before we get into the campaign—there was a little too much campaigning in some of the earlier contributions—and in this Parliament.
That is very helpful. You heard it here first, Mr. Deputy Speaker. If there is nothing by 3 June, we will be asking the Secretary of State to resign.
To echo an earlier point, the Liberal Democrats are firmly committed to sitting down with both the Conservatives and the Government to find a process and a solution to the problem of funding for social care. We all need to commit to doing that in the next Parliament. The publication of the White Paper will be the time to start that process, but it will happen mainly in the new Parliament.
On funding for dementia, the Alzheimer’s Society has pointed out that dementia services provide excellent value for money, which is an indication that too often we do not consider the value of preventive care. In its 2007 report on dementia, the NAO highlighted that significant money was wasted because of an inadequate response to dementia, which we must take seriously.
I am not going to discuss the debates on the Personal Care at Home Bill that took place two weeks ago, because the matter has been dealt with, but people with dementia, and certainly people who have dementia in its latter stages, are in the category of people who will receive care at home. However, many people with dementia are cared for by spouses, partners, friends or neighbours. I made this point in the debate on the Bill, although not specifically with regard to people with dementia, but many people may not be in the Government’s figures and may not yet have come forward to say that their loved one qualifies for, and would like to receive, personal care at home. That is a note of caution, because the cost to local authorities may have been underestimated. We need a more robust assessment to include those who might wish to receive personal care at home who are not yet accounted for in the figures.
When I first read the motion in the name of the hon. Member for Eddisbury and the Secretary of State’s amendment, I was pleased to see that both contain a clear commitment to dealing with anti-psychotic drugs, which are sometimes known as the chemical cosh. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow), who has led on that issue over a number of years, has highlighted that totally unacceptable and too-prevalent practice. According to the Alzheimer’s Society report, 77 per cent. of nurse managers and nursing staff said that anti-psychotic drugs were used always or sometimes to treat people with dementia, which is huge figure. I hope it is decreasing, and it would be good to hear about progress.
We want a clear commitment not only to review the use of anti-psychotic drugs, which is included in the amendment, but to stamp it out when it is not appropriate. Those drugs have been shown to shorten life, and slow response times, mobility and cognition—of course, they do nothing to treat dementia itself. People are up to three times more likely to have a stroke while under the influence of the drugs. It is frustrating that we are still talking about the matter in that way. I would like a little more from the Minister. Never mind a review; let us have action to stamp it out. Let us educate people and ensure that our most vulnerable people are not being inappropriately treated.
Earlier in the debate, someone mentioned inappropriate treatment by the use of a feeding tube. We had the report earlier in the month from the Royal College of Physicians, which said that the procedure should be used only as a last resort, but was all too often being used inappropriately in care homes. The report suggested that the practice could be due to staffing constraints and budgets. Dr. John Saunders, the co-chairman of the working party, said:
“In the demented patient it does not prolong life, the treatment is inappropriate and futile. It is actively unethical and dubious.”
I am sure that we all agree with that, but it is thought that up to a fifth of patients with feeding tubes have them inappropriately, because either the tubes are futile or the patient could eat normally if given proper care and assistance. It is an absolute scandal that that is still going on in care homes. I ask the Minister to respond on this point and tell us whether any progress is being made. I hope that he will be able to tell us that greater progress will be made.
I was amazed to learn that it is estimated that a quarter of long-term patients in hospital have some form of dementia. The medical evidence shows that the longer people with dementia are in hospital, the worse the effect on their symptoms of dementia and on their general physical health. Of course, discharge to a care home or their own homes then becomes more problematic, and there is the danger that anti-psychotic drugs are more likely to be used.
I join the right hon. Member for Sheffield, Brightside (Mr. Blunkett) in paying tribute to Neil Hunt for his leadership of the Alzheimer’s Society, which has produced an excellent report called “Counting the Cost”. Neil Hunt has said that the NHS is not facing up to the challenge of dementia and that there is a need to improve the care given to sufferers.
The report finds that supporting people with dementia to leave hospital one week sooner than they currently do would result in savings of at least £80 million a year. Such an approach differs from the usual approach taken in health and social care, but we all need to identify such savings if we are to continue with the commitment to the national dementia strategy that we all want to see.
The issue of research is not directly mentioned in the motions today, but I agree with the comments made by several hon. Members that, alongside the issue of care, we need to look at the issue of research. The cost to the NHS of dementia is more than that of cancer, heart disease and strokes put together, but the budget for research is a fraction of that for cancer. We need to listen to Terry Pratchett and the Alzheimer’s Society and find ways to provide better care and enable people to function and work for longer through scientific breakthroughs. I ask the Minister for reassurance that we are making progress—even if it is only slow progress, given the recession—towards the £96 million research budget that the Alzheimer’s Research Trust estimates is necessary to tackle this appalling range of diseases.
I have some personal connection with this issue. My late father suffered from dementia, and my mother and I were his carers until he died aged 75. Before I discuss general policy issues, I shall make a few extrapolations from my personal experience.
I am aware that people are fearful of dementia, partly because it is not at present curable and partly because they fear many of the aspects that we have heard about today—the decline into incapacity and helplessness, and the humiliation. However, it is not always as traumatic as people fear. My father retained his optimism and good humour to the end. I like to remember his remark that the good thing about dementia was that he was able to read all his favourite books again because he could not remember how they turned out. If we can encourage that sort of attitude, among carers as well as sufferers, we might be able to make things less traumatic.
An important policy point that arises out of that experience was raised by my hon. Friend the Member for Bridgend (Mrs. Moon), who referred to the spectrum of dementia, from serious cases, with sufferers who are totally dependent, to cases in which people are able to make decisions about their own lives. My father remained aware of his condition throughout his life and he was able to discuss with us appropriate protective measures and the trade-off between too much risk and too much interference with his enjoyment of life. For instance, he never went out on his own, because he was afraid that he would not find his way home, but that did not mean that he just stayed at home all the time. When he could, he went out to enjoy the pleasures of the outside world.
The condition is not a steady state. People often imagine that once someone has dementia they experience a steady slide downwards, one day forgetting one thing and the next day forgetting two things, and so on. As my hon. Friend also pointed out, it is not like that. Sufferers have good days and bad days, just like the rest of us. It is important that carers, whether professionals or relatives, recognise the good days so that they can take a step back and be less intrusive, to give the sufferer a bit of space, a chance to explore what they can do and to use what capacity they have. On other days, the sufferer will need more support, and the carers will need to move in closer. That recognition can be difficult, and is part of the training that has been mentioned already today, especially in the sensitive speech by the hon. Member for Leeds, North-West (Greg Mulholland),
I am following the hon. Gentleman’s speech with considerable interest. Does he agree that one of the problems for carers, especially family carers, is the unpredictability of the sufferer’s response? That is why some form of proper respite care is so critical, so that carers have a chance to recover a piece of their own lives.
The hon. Gentleman is right. From talking to other families in that situation, I know that it is common for the carers to suffer much more than the sufferer, although that was not the case for my family. The person with the condition will sometimes have a diminished recognition of just how bad the situation is, but the carers can see something tragic going on, and it is important that they get support. An element of day care support is also important for the person suffering from the illness, which relates to the points made by my hon. Friend the Member for Bassetlaw (John Mann) about what is happening in Nottinghamshire.
The general problems that we face include, first, the widespread dread of Alzheimer’s and dementia, which we must anticipate will continue to increase as it seems to be a function of greater longevity. If someone dies at 40, they probably will not have Alzheimer’s—they might, but the probability is much lower. If someone lives to 90, the probability is significantly higher. The excellent report by the Parliamentary Office of Science and Technology, on which we all often depend, states that 47 per cent. of the British population know of a family member or close friend with dementia. In a great many cases, therefore, that dread is fed by personal experiences. Indeed, I would assume that some of us in the Chamber will eventually fall victim to dementia. We need to be aware of that.
On this issue, there is real public support for effective action so far as it is possible. I shall be partisan for a moment: as my hon. Friend the Member for Bassetlaw said, Nottinghamshire county council proposes to sell off all its care homes, including Bramwell, in my constituency, which specialises in Alzheimer’s care. It has conceded, in discussions with me, that the effect might be to dissipate the centre of expertise that has been built up there, because the private buyer may choose to merge it in due course with another home and so lose that focus. That seems to be undesirable.
In the local debate, a number of constituents have said that, although in other respects they are 100 per cent. behind the Conservative council and have always been Conservatives, on this issue they think that the council has got it wrong—to the point that they might not vote Conservative if it persists with its policy. We are all politicians, so this issue becomes partisan. However, even those parts of the electorate that are otherwise keen to save public money, by reducing council tax and so on, make an exception here; they feel that it is valuable to have some local centres of expertise, because any one of us or our loved ones could fall victim to Alzheimer’s or dementia and so need such a centre. If we do not, and if we spend a bit of council tax on it but find that we do not need it, we should count our blessings.
I will not, of course, engage with the hon. Gentleman on the details of what is happening in Nottinghamshire, which I do not know anything about. However, I assume from what he says that his case is not that there are not excellent examples of good quality dementia care in the private sector.
That is correct. I also would not say that every public sector home is a model in its treatment of Alzheimer’s. I am basically saying that it is important that each area has available centres of excellence, and that that should be a responsibility of local councils. We can debate how they can achieve that, although to some extent that is a secondary matter, but they should not pursue policies that result in the absence of such specialist knowledge.
The second general issue is the conflict between localism and national strategy. We tend to tiptoe around this matter; we all try to have it both ways. We are all in favour of localism and against postcode lotteries, but they are the same thing, are they not? If we have local decision making, we will get variations—one local authority will decide one thing, and another will decide something else, and for the sufferer, that will mean a postcode lottery. If they happen to live in an area where their condition—this does not apply just to Alzheimer’s—is given greater priority, they are in luck. On the other hand, if we try to govern it all from the centre, the sense of local responsibility and local decision making is lost. There is a tension there that we have to be honest about, and I shall come back to that in a moment.
The hon. Gentleman has made an important point with which we are all wrestling: how one can put portability into effect, on the ground, so that if one had to move between areas, there would not be a postcode lottery—as he put it—in the delivery of services. I hope that he has something to say—he might have been coming to this—about how a national standard assessment of care need might look. The Government have yet to answer that important question.
I agree with the hon. Gentleman; that is an important point, although, to be honest, I did not include it in my speech notes. However, I am glad that he has raised it, because it will become increasingly important. Often, somebody with difficulties will move home to be closer to relatives able to give support. The continuity of support then is extremely critical.
What should we be trying to do next? First, I would like to come back to my response to the hon. Member for Rugby and Kenilworth (Jeremy Wright). We need to develop and protect centres of expertise in each area. We can debate how large the area should be. In 2006, we had up to 131 memory centres—we probably have a few more by now—in England alone, I believe. That is a reasonable number. We can debate just how dense the network needs to be, but basically it ought to be possible for people in each area to have access to expertise. If, at some point, someone needs to go into a home, it should not be so far away that those who have cared for them until then can barely visit and so supply the support.
I believe that this is one policy area in which it is appropriate to have a national target, if I may use the dreaded word. It is appropriate that the Government place an obligation on each county council to ensure that within the county there is at least one centre of expertise for Alzheimer’s and dementia. If we do not do that, we will see what is happening in Nottinghamshire—under the pressure of costs and other considerations, councils will prioritise other matters. Centres of excellence are so important at the moment, partly because the limited support that we can give to those with dementia is an expert skill. The POST report states that the memory services that have been introduced have been shown to be “clinically and cost effective”. It is one of the rare and precious elements in our approach where we have something that actually works, and unless we can apply it locally, people locally will miss out. It is appropriate, therefore, regardless of one’s ideology in other areas, to say that the Government should require each county council to provide and maintain one such centre of excellence.
If, and when, adequate or good treatment is developed for dementia—the pharmaceutical industry is making enormous efforts, because obviously it has an interest in finding a treatment—those centres will be all the more important. What a tragedy it would be were we suddenly to find that we had a treatment but had thrown away the infrastructure to deliver it and that in some counties we no longer had that expertise. Obviously we could build it up again, but in the short term we would miss out, and that would be a genuine tragedy for the people involved.
I am grateful to the hon. Gentleman for giving way again. I wonder whether he agrees that the likelihood is that the treatment that he is talking about will not be deployed through the network that he is describing unless we spend more money on research. Would he like to comment on that?
Yes, we are part of the world community on that. It is entirely appropriate that Britain should play as full a part in research as it can. It might be that the important breakthrough will be made somewhere else and that we will develop it—that is the way things happen in medical research. Private research is intensive, because the first company to develop a treatment will do well out of it, and frankly I would not begrudge any company that success, because it would be doing a lot for humanity. I therefore accept the hon. Gentleman’s point, but we should not create illusions either. Even if we can treat such conditions, it might be that as people live longer and longer, the prospect of our mental capacity on average gradually declining will inevitably be an invisible rider beside us. It might be that although we can alleviate the problem, we will never completely remove it.
I am grateful to the hon. Gentleman for giving way to me a second time. Does he agree that, alongside the advances in medical science, which we all hope will accelerate, part of the Government’s national dementia strategy that deals with the training, the education and often the re-education of GPs in the early diagnosis of dementia in its first stages is also critical?
Yes, and I can see that the hon. Gentleman’s brain is in an excellent state, because he has anticipated what I was about to say. My next point was that we need to educate GPs, the public and non-specialist health and social care staff to recognise and respond to the signs of early onset, and to distinguish accurately between normal absent-mindedness, which is not totally unknown even in this place, and the clinical symptoms of dementia. I see that both ways in my constituency work: I see people who are convinced that their partners have Alzheimer’s when they perhaps do not and people who are shutting their eyes to it. Because we know that early recognition combined with memory services can delay the need to enter a care home, it is a cost-effective approach, which is important to the individuals affected.
As an immediate measure, we need to help people to stay at home while they can, if they want to, with support for their carers—this relates to the point that the hon. Member for East Devon (Mr. Swire) made earlier. For most sufferers, there is a trade-off between the risks of being at home in a less guarded environment than a closed mental illness institution and the benefits of being in a familiar environment that they have cherished for many years, surrounded by people they know—and hopefully love—and of drawing comfort from that environment when their facilities diminish. We should not take away that choice.
We are very risk-averse as a society. If somebody with dementia who lives at home has an accident—because they wandered on to the streets, got lost and were knocked down by a car, for instance—there are always questions asked. People ask, “How could that happen?”, “Where were social services?” and “What were the relatives doing?” However, there are risks in every part of life, including being in a closed ward. There are risks to people’s mental state and, basically, their happiness, so we should not take away people’s capability to make rational decisions just because their memory is failing. In many cases it might be possible to have a serious discussion about that. The Personal Care at Home Bill is an important contribution to that, because if free personal care is available at home in the most critical cases, in many instances it will tip the balance between early admission and admission a little later. That will not only help to reduce costs, but be beneficial for the individual concerned.
Finally, what is our long-term vision? In the long term, we hope to see effective treatment. Perhaps we will never have a complete cure for mental decline, as I have said, but we should aim for a continuous spectrum, which starts at the point at which the first symptoms are recognised and accepted as a normal part life—as one of the things that can happen when one gets older—in order to ensure that initially relatives, friends and carers are brought to accept what is happening as something natural that they can deal with; that if and when the symptoms start to get worse, there is additional care support from the local authority of the kind envisaged in the Personal Care at Home Bill; that if that person’s condition continues to deteriorate, we have day care facilities and support for carers, so that that period is less traumatic than it often is today; and, if that individual eventually needs to go into a care home, that the home still treats him or her with the respect and dignity that he or she deserves.
My father said in his final years that he had never been happier. I would like to think that in future that would be true for the majority of sufferers.
I am grateful to the Minister. The right hon. Member for Sheffield, Brightside (Mr. Blunkett) mentioned the Secretary of State’s birthday and also said—the Minister will perhaps correct me if I have got this wrong—that they were in Wigan. I remember reading a book about Wigan by George Orwell—“The Road to Wigan Pier”—my abiding memory of which was the tripe shop, whose tripe was described by the proprietor as being the most beautiful tripe in the world. The author goes on to describe the number of flies that infested that tripe, so I was thinking to myself, “I do hope that the Secretary of State didn’t have a meal of that quality in his hometown,” although no doubt things have improved a lot.
I would like to focus on dementia this afternoon and, in a spirit of co-operation with the other side in the House, say how much I agree with the Secretary of State that this was a most appropriate debate for my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State, to have chosen.
I see the hon. Gentleman nodding his head. This is an important debate at an important time. I do not want to speak for very long, but I would like to cover some of the problems and talk about Leicestershire and some of the possible solutions, because we have heard about aspects of care, but not a lot about the solutions for people who have the condition. I therefore hope that I can add something.
I echo the earlier remarks of my hon. Friend the Member for Salisbury (Robert Key), who talked about amnesia, not dementia. The Government’s attitude to this subject has something in common with their attitude to energy, in that they appeared to suffer from amnesia in their policy on both dementia and energy for about the same length of time. For about 11 years, we did not have an energy strategy, and we certainly did not have a dementia strategy. It is amazing that the Government could have been in power for so long and then, as it were, stumbled across the issue so late in their tenure of office, which many of us suspect is almost over. The Minister of State is shaking his head, so we had better not go down that route, Mr. Deputy Speaker. Indeed, I can see you shaking your head, too. We have had various statistics—
Order. I was shaking my head about not going down that route, not about other matters.
Thank you, Mr. Deputy Speaker.
The figures show that nationally there are about 700,000 people with dementia, but the number will double and rise to about 1.5 million. In Leicestershire, the county I represent, the figures for 2008 were about 8,000, and by 2025 it is reckoned the number will be 14,000. In my constituency, the Hinckley and Bosworth figures are 1,231 for 2008, rising to 2,114. There is no doubt about the scale of the problem. It is not surprising given that we have an ageing population.
One of the key problems is the mismatch between the availability of funds and those who are required to supply the services. I hope to develop that point. Conservative-controlled Leicestershire county council has done a very good job in that respect, but it has not been provided with the funding that would have been reasonable to supply the services it wants to offer.
I shall not try to cover everything. When I first came into the House, I remember a senior Member telling me—about somebody else’s speech—that there was too much pudding in it. Three points in a speech is probably a good thing, particularly when other Members want to speak. My last point is about the negative impact of anti-psychotic drugs. The issue was also raised by the Secretary of State and commented on by the hon. Member for Broxtowe (Dr. Palmer), the hon. Member for Leeds, North-West (Greg Mulholland), who is no longer in the Chamber, and others.
Anti-psychotic drugs can cause strokes and they can cause elderly people to fall. I very much welcome Professor Sube Banerjee’s review of anti-psychotic drugs. The Minister may say something about it later on, as he was prompted to do so earlier. It is a major issue and I hope to suggest some other products that might help in such cases, although I have to be careful as I may be corrected by the doctor on the Labour Benches.
I was intending to say that not enough planning had been done. However, I was pleased to hear about the forthcoming White Paper, which I think will be helpful.
Leicestershire county council is a top-performing authority, with an established home assessment and reablement team helping older people to stay independent, living in their own homes for longer and reducing the numbers going into residential care. I speak for the county when I say that it takes great pride in that. It also has a specialist dementia team to help keep people independent with the use of various forms of assisted technology. Leicestershire county council has achieved that despite its low Government grant. As a county, we are right at the bottom of the pile.
Despite various reviews during the tenure of the Labour Government, Leicestershire’s funding is right at the bottom. We come back to the shire county versus inner city arguments. There are many different formulae but we do not get a lot of money. The grant covers only 28 per cent. of our social care budget. Nationally, there is a £6 billion shortage in social care, so it is regrettable that in general the Government have offloaded a lot of financial responsibilities to counties. No doubt, that is part of the reason why there are pressures in Nottinghamshire. I shall not go down the route of discussing the policy of privatising some of the homes there, mentioned by the hon. Member for Broxtowe. Not all privatisation is bad. Sometimes we can achieve efficiencies. In the past, we have seen private organisations develop ideas that may not have come about in the public sector.
On a point of information, Nottinghamshire accepts that it has done well from the local government settlement. The council wants to freeze council tax, which is a political issue. Incidentally, I am a doctor of mathematics so the hon. Gentleman should not ask me to operate on him.
In that case, I am not sure whether I insulted the hon. Gentleman or paid him a compliment.
The hon. Gentleman spoke about his county. My recollection is that Nottinghamshire was not always under Conservative control, although I may be wrong. Perhaps the incoming Conservative administration is trying to put right the complete shambles that existed previously. I shall give way to him if he wants to comment on that, but he seems happy to retain his seat. I am not surprised—
On the contrary, Nottinghamshire is, I believe, the only county in Britain where not only people at severe risk have personal care support, but also people at moderate risk. I may be wrong, but the council is certainly one of the very few, because of the good record of the Labour administration.
Order. I think the hon. Gentleman would do well to stick to dementia for the time being.
Perhaps amnesia got to me in that case, Mr. Deputy Speaker.
I approve of the policy of free personal care for the critical band, but where will the money come from? It has to be provided by local authorities so it is just another addition. I am happy to stand corrected, but—
I am happy to give the hon. Gentleman that figure, too. The sums are not that difficult. It does not take a doctor of mathematics to do them: £670 million minus £420 million gives £250 million. Local authorities can find that sum through efficiency savings in their delivery of care services for people in the most need, not least by reducing the numbers who have to go into residential care, because they will be supporting people living in their own homes, which is where they want to be.
Although I applaud the fact that the Government have made money available, the serious point is that there is a shortfall nevertheless. A feature of the Labour Government is that they have tended to offload central Government costs to local authorities, which has caused problems for those authorities.
Other Members mentioned the lack of memory clinics—a broken pledge. I am glad to hear that action will be taken on memory clinics. My hon. Friend the Member for Gainsborough (Mr. Leigh), the Chairman of the Public Accounts Committee, referred to some of the issues raised by officials his Committee had interrogated. He might have added that the National Audit Office has said that
“vast amounts of money have been wasted and there were doubts over whether funding would be found to improve services.”
Conservative-controlled Leicestershire county council has invested local tax payer’s money to provide services to improve social care, which has not all been matched by central Government, which is regrettable. The Leicestershire budget, raised through council tax, contributes 82 per cent. of the total cost of adult social care, even before implementation of the measures in the Personal Care at Home Bill.
We come back to the argument about delivery of service—who does it and whether it is necessary. We have heard that in Nottinghamshire some of the services are to be outsourced. I had better not go down the route of discussing the numbers in employment in Leicestershire, as I have not been briefed in this speech to make those remarks, but I take on board what the hon. Gentleman said. Leicestershire county council has provided services for older people with mental issues. Five workshops have been set up recently for carers and users.
I can confirm what other hon. Members have said about the money from the national dementia strategy that was sent to primary care trusts. It is certainly the case in Leicestershire that, because that money was not ring-fenced, it has been spent on other things. PCTs were told that the money for the strategy was not included in their baseline figure—to use the correct terminology—and that is regrettable.
I think that the hon. Member for Leeds, North-West mentioned statistics and the lack of information. These are critical issues. Solutions have been proposed in the Personal Care at Home Bill, and we have heard about plans for improvements for carers, but we have not heard a lot about what can be done to extend the period in a person’s life before dementia gets a grip, when they are not forgetful. There are certain measures that could be taken—they are not necessarily seen as mainstream medicine—and I want to focus on three of them.
The first, which has not been mentioned, is the lack of water. There is a serious problem with getting elderly people to drink enough water. I have raised this matter in the House before, over the years—[Interruption.] I am very pleased to see that the Minister has grasped the jug and is pouring himself yet another glass of water. I did not know that I had such powers of persuasion, or that I could get such an instant response from a Minister. The fact is that many elderly people do not drink enough water, although they might drink other things. This creates problems for the body. Simple strategies were applied in studies carried out in India, and it was found that people’s susceptibility to illness diminished in direct correlation to the amount of water they consumed.
The second factor is diet, and particularly the importance of antioxidants and eating fresh fruit. Some foods are specifically effective in treating these problems, one of which is blueberries. I have been making this case for years, not only for blueberries. I can see the hon. Member for Bassetlaw (John Mann) smiling, but this is true. Studies have shown that some fruits are effective in this regard. We do not have enough information, however, and I want to appeal for more information on diet and on certain foods.
Thirdly, we should also look at some of the herbs that are effective in treating this problem. I am indebted to the Alzheimer’s Society for providing me with a briefing on this subject. Many people have benefited not only from using antioxidants and improving their general nutrition but from using herbs prescribed by professional herbalists. There is a problem, however, because the Minister’s Department has still not produced its proposals for the regulation of herbal medicine and acupuncture. They have been sitting in the Department for far too long, and it would be helpful if he could give me a date when they are to be published. It would be a great tragedy if they were not published before, shall we say, early May, or even April. The Minister and his Department would really be funking it if they left this for the incoming Government. They should at least tell us what they think, and come up with some kind of policy statement.
I shall not go into details about the various plants used in herbal medicine. Related to that, however, is Chinese acupuncture, which has also been found to be very effective in this regard. I am reflecting the views of the Alzheimer’s Society on this. Whatever I happen to believe, the society believes that there is evidence of the effectiveness of acupuncture. My own knowledge of the subject suggests that it is perfectly possible to achieve results by adjusting meridians.
Studies have been carried out in Japan on the effectiveness of certain herbs. A product known as kanpo—a mixture of a Chinese herb called choto-san with other substances, including about 11 medicinal plants—has been the subject of investigation. A research study found an improvement in patients with vascular dementia who took that particular combination of herbs over 12 weeks, and decided that further research on the preparation seemed warranted. I should like to make a secondary point on the general regulation of herbs. The regulation process is considering individual herbs rather than the combinations, yet many doctors prescribe a combination of herbs. The Minister should take that into consideration.
In addition to the range of herbal medicines and products available, aromatherapy has also been helpful in treating patients using massage techniques and certain oils. Again, this should be looked at with great care. Other methods include music therapy: playing certain kinds of music can be helpful for people with this condition.
I appeal to the Minister to have an open mind on this. He should think about these alternatives, because they are effective, and they are supported by the Alzheimer’s Society. I also look forward to his announcing the date for the publication of the proposals for the regulation of acupuncture and herbal medicine, when he winds up the debate.
We have heard the policy of the Opposition Front-Bench team. The hon. Member for Bosworth (David Tredinnick) used the analogy of pudding in relation to certain speeches. The Opposition’s policy seems a bit like a jelly: it can take any shape, it can be colourless, and it can be moulded in any way they want. We can never be quite sure what is there. Having heard their attempts at policy, I think it would be helpful if they were to inform the House about what action they would take.
It is appropriate to judge political decisions on changes to systems and laws, and on priorities relating to the allocation of resources, according to experience and to what people actually do. I cite as my example the county council of Nottinghamshire. Since June, it has been Conservative-run. Not only that, but three of the county councillors wish to become Members of this House at the next election. Nottinghamshire county council therefore represents a microcosm of what Conservative policy on dementia care would be, because we can see what is happening in that county and my own constituency now, before the election.
The Conservative administration in Nottinghamshire, led by the appropriately named Councillor Cutts and backed by the non-executive cabinet members—all of whom, coincidentally, happen to be prospective parliamentary candidates for the Conservative party—have put forward policies on dementia care, and those policies involve cuts. They wish to privatise residential care. In my area, that involves James Hince Court, a specialist residential dementia care centre in Carlton in Lindrick. It is an excellent centre. It could do with a little more refurbishment, but the quality of care, the professionalism of the staff and the responsiveness to the families are all superb. It has been externally validated as being superb, and my observation and that of the families involved is that it is superb.
A second example is Westwood. It is a very new facility in my constituency, which deals not exclusively but partially with dementia care. The Tory administration wishes to sell it off to the private sector. A third example is St. Michael’s View. I was there last Friday at a meeting of residents—some suffering from the early stages of dementia and some the later stages—and they and their families are unanimous that that excellent facility should remain in the public sector. Why do they oppose the plans of that Tory administration—those would-be sitters on Conservative Benches? The reason is simple: they have experienced the private sector. Most of them moved from the private sector into the public sector. Strangely, private sector care homes have a lot of vacancies; one in my constituency has 31 vacancies. However, there are waiting lists, including of people I know, to go into the three excellent public sector centres, as there are for the other ones in Nottinghamshire. Having sampled, tried, felt, known and paid the private sector, people prefer to go into the public sector.
The second reason why people prefer public sector homes to private sector ones is that the private sector does not provide a day care facility, where people come in, have a cup of tea and use the expert provision of the staff, but do not stay overnight or pay anything significant towards the overheads. For the private sector, that does not pay. Some of our memory clinics, as they are called, are in public sector residential care centres, where properly trained, expert staff also provide specialist dementia care in a day care facility. That is why families like those centres and are adamantly against Tory privatisations, or, if they cannot be privatised, closures—that will undoubtedly follow from their spending plans.
What is the response to a major public campaign led by families against such absurd privatisations and day care cuts? Those Tories—would-be Tory MPs and others—propose in their budgets to increase significantly, by about 60 or 70 per cent., the cost of going to day care. They want to cut meals on wheels in the same way—by increasing prices. As has been outlined, they want to cut many other services relevant to dementia care, such as 20 specialist occupational therapist posts. Those are vital jobs that support the elderly and those with dementia. That is the Tories in action. That is what we will see should there be a Tory Administration nationally.
What is the Tories’ response to the public outrage? They say that they will suspend the privatisation for one year. Is it possible that that extends over the election period so that they can claim that they have listened and that it might not happen? The reality is rather different. If we read the financial pages, we see that those in the private sector, including Care UK and others, are having difficulties, and many of them are overleveraged and in big debt—some of them are featured on the front pages. They cannot make lots of profit out of dementia care. The big companies that own loads of care centres across the country cannot make them pay at the moment. I dissociate myself from any consensus that such private centres are as good in quality as public ones, because in my area and Nottinghamshire, the facts—the external ratings—prove nothing of the kind.
The state of some private centres is a scandal. Let me give an example. Abbeymoor was the nearest one to my office. About a year ago, the staff, who were badly paid and trained by comparison with the public sector, with a higher labour turnover, but who were nevertheless decent, hard-working people wanting to learn a profession and serve the community, elderly residents and those suffering from dementia, turned up for work to find the doors locked. The private owner had decided to close it down, shunt the old folk out, get rid of the staff and not even pay them the holiday pay and wages that they were owed. Thankfully, we have just won a case at an industrial tribunal, which will get the staff the money that is owed. That is not the first tribunal I have had to fight in relation to private sector care homes in Nottinghamshire, but the third—and I have not been an MP that long. Three different care homes have not paid their staff properly. I have been in some of those, and have heard what the families say—not just those who have been lucky enough to get into the council ones, but those who want to.
Many of the private care homes are a disgrace. Let me tell the House what was happening in Abbeymoor. The staff were having to go out and pay for the food themselves, because the owner was not providing sufficient money. That is a scandal. My only criticism of Government policy is that they should have a stronger inspectorate for private sector care homes, because further scandals will be unveiled. I have heard of a recent inspection of a private home in my area that has a large number of elderly people, some with dementia. The staff were there in the daytime, when the families turned up, but seemed to be missing overnight. They were not there, as though not employed by the big, top, rich company that runs a large number of care homes in the area. In another private home, I am told they stick the residents in bed at 6.30 pm—that is a good quality of life! The hon. Member for East Devon (Mr. Swire) points. Let me point the finger at the people who want to be Tory MPs who are making those decisions.
I have given the view of the families, but let me give the public view. I sampled that a week ago, when I rang 5,500 of my constituents on an official opinion poll, under market rules to ensure that it was not biased. It gave them a choice: did they agree with the privatisation of care homes? Ninety-eight per cent. were against such privatisation. That is what the Conservative party will bring if it ever gets into power. It dares to suggest that it stands for those with dementia, yet fails to condemn the Tory county council in Nottinghamshire and its disgraceful attack on elderly people, that vulnerable part of society, and their families. That is an insult to our intelligence. My community in Nottinghamshire is fighting back to put the Tories where they should be, and to beat them on those decisions.
Last year, Mr. Paul Cann, the director of policy and external relations for Help the Aged, described dementia as
“fast becoming the hidden epidemic of the 21st century”.
The more debates that we have in this place on the matter, either in Government time, or, as in the case of this afternoon, in Opposition time, the better. The subject needs to be aired and taken extremely seriously and should, on the whole, be non-partisan and non-political, difficult though that is to believe at times.
One does not need the mathematical skills that I attribute to the hon. Member for Broxtowe (Dr. Palmer) to work out that, looking at isolated demographics, the problem is set to grow rather than recede. In my constituency, 29.5 per cent. of the population is retired, against a national average for the rest of England of 17.3 per cent. In my constituency, I have the retirement destinations, as they are called, of Budleigh Salterton, Sidmouth, Exmouth and so on, so the pressures on local services are huge and set to worsen.
The Government’s national dementia strategy, which is a year old, is, of course, a good thing. I welcome it, although it is belated. It contains important elements that need to be expanded. In the limited time available to me, I shall try not to go over ground covered in this comprehensive debate, but I say, again, that early diagnosis is crucial in the treatment of dementia. The more these memory centres—or clinics, as some hon. Members have erroneously called them—can be rolled out across the country, so much the better. The savings that an early diagnosis can make, in terms of both human suffering and the economy, are huge and should not be underestimated. We have, again, touched on better training for GPs. Some GPs are crying out to be retrained or trained in spotting the early signs of dementia, and they should be assisted in that without delay.
I wish briefly to discuss research into dementia. The hon. Member for Broxtowe said that we are in a global research environment and to an extent he is right, but it is worth pausing for a moment to remember the following:
“National Institute for Health Research investment in dementia research amounted in 2007-08 to £22.2 million. The Medical Research Council (MRC) spent £10.2 million on dementia research in the same year. This total expenditure of £32.4 million amounts to some 2.5 per cent. of the combined departmental research and development and MRC expenditure for the year.”—[Official Report, 5 February 2009; Vol. 487, c. 1502W.]
Those are significant figures, but they pale into insignificance when one considers the sums that are rightly spent on research into cancer and other diseases. Although we are part of the global research family, we need to examine that. I hope that the Minister will not accuse me of ignorance in quoting those figures, because they are figures that he gave me in answer to a written parliamentary question.
I welcome the appointment of a dementia tsar. The Government’s record in appointing tsars over the years has been about as successful as the Russians’, and I hope that those tsars will not end up in the equivalent of Ekaterinburg. The appointment of Professor Alistair Burns is welcome, and I hope that he can co-ordinate the many different approaches to the treatment of dementia. My hon. Friend the Member for Tiverton and Honiton (Angela Browning), who has had to absent herself this afternoon, made an extremely good point when she said that every primary care trust should have a dementia champion who can also help to co-ordinate things on the ground.
I wish to discuss a subject that we have not spent enough time on: objective 7 of the Government’s national dementia strategy, which is on “Implementing the Carers’ Strategy”. It states:
“Family carers are the most important resource available for people with dementia. Active work is needed to ensure that the provisions of the Carers’ Strategy are available for carers of people with dementia. Carers have a right to an assessment of their needs and can be supported through an agreed plan to support the important role they play in the care of the person with dementia. This will include good-quality, personalised breaks. Action should also be taken to strengthen support for children who are in caring roles, ensuring that their particular needs as children are protected.”
The hon. Member for Bridgend (Mrs. Moon), who is not in her place, talked about the spectrum of dementia. The hon. Member for Broxtowe, in a personalised contribution, talked about the good humour that the sufferer often has. What unites the carers is that they are often the ones who suffer most in all this. An estimated 600,000 people in the UK are acting as the primary carers for people with dementia. Two thirds of people with dementia live in their own home and one third live in a care home, thus the majority of people with dementia are probably being cared for either by professional carers or by members of their own family. It is estimated that the saving to the taxpayer is about £57 billion a year, but with that often comes a cost to the carers. Evidence has been found of carers dipping into their savings that they have put aside to help care for the person with dementia, which reduces what they have to look after themselves in later life.
It has also been found that 65 per cent. of people with a caring responsibility do not identify themselves as a carer in the first year of care—such people are often referred to as the “hidden carers”. It is not just that category of people who are hidden carers. An awful lot of people who still believe in the family and look after their partner—their husband or wife—would never dream of regarding themselves as carers. Such people regard themselves as being a husband and wife and it being part of their duty to look after their lifetime partner. They also deserve our support.
Interestingly, and sadly, about one in five of the nation’s 4.4 million careers of working age have to give up their employment in order to care. Many carers of people with dementia are older people who have physical frailty and health conditions of their own. At a dementia seminar in Exmouth earlier this year, I met one lady—she was not complaining and did not necessarily want more help from the state—who has looked after her husband for 20 or 30 years, which is a life sentence. She does not regret it in any way, but she is becoming increasingly frail and in need of support. Such people are often the unsung heroes and heroines of this tragic tale.
Nearly 45 per cent. of working age carers say that they would like to work, but 38 per cent. say that they cannot work unless the right care services are in place for them. Between 40 and 50 per cent. of working carers say that a lack of flexibility and sensitivity in the delivery of services hampers them in obtaining support.
I touched on the question of child carers earlier, and it is incumbent on us to take that issue seriously. Children who end up as carers often get overlooked, but their own education and passage into adulthood gets compromised in some way. I have also alluded to Admiral nurses, who are fantastic. We need more of them, as they do a magnificent job, but I shall not dwell on that point.
I wish also to discuss respite care, which has been mentioned again today. Carers of people with dementia, probably more than any other category, need respite, if only to take some time off to go for a walk with the dog, to have their nails done or to go to the hairdresser. They just need to have a little bit of the life that they once had back, as that will, in turn, make them better carers. However, too often, we have seen day centres up and down the country close. The other day, I went round Stowford lodge in Sidmouth, in my constituency, which is used as a day care centre by people with dementia. Some of its bedrooms were being used as storerooms, but that is criminal. Surely this country should have a system in place whereby any beds in a purpose-built care centre should be available for overnight respite. It is incumbent on all political parties—this is a challenge for not only the current Government, but any future Government—to find a way to finance this properly in order to care for these extraordinarily vulnerable people.
Charges hit people with dementia hardest for four reasons: care is more expensive in care homes and two thirds of people in them have dementia; more dementia care comes from social services, and that is means-tested; people can need care for extended periods; and end-of-life care for dementia often takes place in a care home, rather than in a hospice or hospital. It is worth making the point that if somebody with cancer needs chemotherapy or surgery, or if someone with heart disease needs a heart bypass, that is provided free on the NHS, but if someone has a disease of the brain that causes dementia, their care is often provided by the local authority and is means-tested.
I do not want to revisit the case of my constituent, Mr. Mejor, on which the Minister accused me of being ignorant.
The hon. Gentleman has to be very clear. I am interested to hear what he will say about this, as he intervened earlier on other colleagues. It is quite clear that, if a couple are in their own home and one of them goes into residential care, the home is disregarded when it comes to assessing the means of that couple, because somebody is still living in the home. It is only when the second person goes into residential care —if they both have that misfortune—that the home will be assessed. A deferred payment scheme should operate, and I hope that such a scheme operates in his area, which would mean that that home would not have to be sold until neither of the couple remain alive. Those are two different points, one of which was made by my right hon. Friend the Secretary of State in response to an earlier intervention. I hope that the hon. Gentleman will accept that knowing that fact—in other words, not being ignorant of it—might help him to represent his constituent’s case.
I am most grateful to the Minister. My constituent, and everybody in East Devon, will be most interested to hear the Minister virtually make a commitment that there is no way that the Mejors can lose their home in this sorry episode. That is a magnificent thing, if that is what he is announcing this afternoon. The reality is that the case will be heard again at the beginning of February. I hope that Mr. Mejor will receive a continuing needs assessment, because he needs it, as far as I am concerned. He has at home an elderly wife and a daughter who has had to sell her home in order to care for her elderly parents. However, the truth is that if his case fails, it will be up to local social services to assess his needs, at which point charges towards the £800-a-week place in the Linksway nursing home can be re-examined and reassessed. That is, I think, the threat.
The Government are leaving this country in a sorry economic state, but I think, more than anything else, people want honesty now from their politicians. Surely, in all honesty, we need to acknowledge the problems that we have with the demographics, with the rise in people’s ages and with the problems that those changes present with mental disease. Surely, at the end of the day, whatever the cost, it is our duty as legislators to protect those who are most vulnerable in society—those who are coming to the end of their lives and those who have, so often, selflessly cared for them.
I begin by joining the tributes that have been paid to Neil Hunt, the departing chief executive of the Alzheimer’s Society. He has done a great deal, as most people involved in this issue know, to drive the subject up the political agenda to where it rightly deserves to be.
I also regret the absence from this debate of David Taylor. I know that he would have been here to contribute, as he always did on these issues. He was a well-respected and assiduous member of the all-party group that I chair, and he will be missed in this debate, as he will be in many others.
The numbers that we discuss whenever we talk about dementia are staggering. Hundreds of thousands are affected now, millions will be affected in the future and billions are being spent on the treatment and management of dementia at the moment; it is possible to become immune to those numbers and to forget the scale of the challenge that we face. However, some numbers still have the capacity to shock. The review of anti-psychotic medication undertaken by Professor Sube Banerjee recently reported to the Government and is, I think, one document that contains such figures. To know, as we stated in the all-party group’s report on this subject some time back, that there is a substantial degree of over-prescription of anti-psychotics among people with dementia is one thing, but to hear from Professor Banerjee that he thinks that some 140,000 people are wrongly on those drugs—the deleterious effects of which have already been discussed in the debate—and that, worse yet, an additional 1,800 deaths a year result from that excessive prescription, as do 1,600 or so strokes and the like, truly, in my view, puts this scandal into its proper context and underlines the need for action.
I, like others, welcome the appointment of a national clinical director in dementia. That is a positive move forward, and I hope that the Minister will confirm that one of that clinical director’s first priorities in office will be to address this serious issue. One suggestion from Professor Banerjee to deal with the trouble caused by the over-prescription of anti-psychotics is to address the fundamental issue of training. The Minister knows, not least from the other report produced by my all-party group, how strongly I feel about that subject and how central it is to the issues of dementia care in general. I shall not dwell on it now—I do not have time—but I simply repeat a request that I have made to him in the past, which is that he should keep it very much at the forefront of his mind, that we should set up substantive mechanisms to ensure that qualifications are available for those in the caring profession, that career paths should be set out in specialist dementia care and that everybody who has contact with those with dementia, which includes a large number of people across a variety of fields, has some understanding of the condition that is being dealt with.
I concede that training features as part of the national dementia strategy. I repeat my welcome for the strategy, as it is a very positive move forward and contains a great deal that needs to be done. The Secretary of State was right to say that we should not expect everything to be done by now, less than a year into a five-year strategy. I accept that it will take time to complete, and the Government have been right to say repeatedly that dementia is a priority for them. It is a national and a Government priority, but in this debate we should ask what that means. For example, does that mean that more money will be made available for researching a condition that has become a Government priority? As others have said, it is not apparent that that is what it means. The level of research has not increased at all, let alone dramatically. Greater priority should be given to dementia research; if it is not, we will not be able to address that widespread problem in a fundamental way or start to reduce the costs to the Exchequer that it incurs.
Does a Government priority on dementia mean that the Government will take action more quickly, or that they will radically change the operation of the relevant systems in the fields of health and social care? Does it mean that the Government will spend substantial amounts of new money specifically on this priority? I regret to say that I do not think that the evidence suggests that making dementia a Government priority means any of those three things, as I shall briefly explain.
First, have the Government been quick to set our their response to the challenge? Although I welcome the national dementia strategy, it was promised repeatedly—from August 2007 right up to its publication in February 2009. An implementation plan with any significant detail came only later still. I have said that the review of anti-psychotic drugs is welcome and important, but it was originally promised a long time before the strategy. The review was finally published on 12 November of last year, some seven months after the strategy was published and some two years after it was originally promised. Those delays do not have the hallmark of action that is a Government priority.
Secondly, has making dementia a Government priority initiated radical change in how this country’s health and social services are run? The context is important here. This is a Government who set considerable store by central control. They set targets that they consider important, and which those delivering services must meet.
Earlier, the Secretary of State said that the Opposition cannot have it both ways, but neither can he. If the Government believe that that is how the health service and social services should operate—with a great degree of central control exerted by means of the levers attributed to Whitehall—then they cannot simultaneously refuse to pull those levers and make something happen, saying that doing so is not their department.
Reference has been made to the NHS operating framework, the mechanism by which the Government communicate their priorities for the NHS. Due to the delays that I have described in bringing the dementia strategy forward in the first place, the Government missed the boat entirely in the operating frameworks for 2008-09 and 2009-10.
As we have discussed, those frameworks set out three tiers of priorities for the NHS—the things that all PCTs must do, national priorities for local delivery and priorities to be set locally. Dementia is not mentioned specifically or substantively in any of those tiers. Worse still, the 2009-10 framework published in December 2008—before the strategy was published, but after the substantive work that there must have been to enable the Government to know what they were seeking to achieve—stated that there would be no new national targets in the NHS until the next spending review. We are, of course, still waiting for that review. Even in the 2010-11 version of the framework that was published in 2009, there is only a brief reference to dementia, and that was about the improved outcomes and efficiencies to be gained by early diagnosis of the condition.
It is not true either that GPs, as part of the NHS, are being asked to do a great deal of specific work on dementia. The existing qualities and outcomes framework has only two criteria relating to dementia, and they are about maintaining a register and having 15-monthly reviews. I accept that those criteria are important, but they are not as fundamental as perhaps they should be. That is a good Government priority, and it is a substantial issue that should be addressed, but there is not much evidence of their doing so in the control mechanisms that they have put in place for the NHS. There is no evidence of a speedy response or of significant changes in the systems that deliver care.
What about the money? Have the Government given substantial extra resources to those who deliver care and said that those resources must be spent on the new priority of dementia care? Again, the answer is no. There is no ring-fencing, and there is no reporting requirement for PCTs to tell the Government whether, in fact, they have spent the £150 million allocated over two years across the country on dementia care. We must ask, in all common sense, how confident we can be that cash-strapped primary care trusts facing an array of different Government targets are necessarily going to spend all that money on dementia care. We have to wait for the Government’s audit to find out, but I am not immensely optimistic.
If the Government priority does not mean urgent action, if it does not mean substantially changing the systems, and if it does not mean substantially increasing the resources allocated specifically to the problem, what on earth does it mean? The danger is that the Government have set up tremendous expectations by rightly isolating dementia as a huge challenge that we must confront. If a Government priority is nothing more than a soundbite, and if a national dementia strategy is nothing more than a title, we run the risk of not only disappointing the hundreds of thousands of people with dementia now, their carers and the people who love them, but disappointing millions more in future and failing to face up to the challenge that we must face up to in the next few years. If the Government, who are running out of time, are unwilling to take on the challenge and take the necessary action, I fear that it will fall to the next Government to do so.
It is a pleasure and privilege to follow my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright).
Let us be clear about one thing. When we talk about dementia, we are effectively talking about people who have given the best years of their life to contribute to society and to make sure that the rest of us are in a better position than they were when they were living active lives. It is only right and proper that we, in turn, should look after them and treat them with the dignity and respect that they deserve. Sadly, however, that is not always the case. In fact, analysis shows that Britain is in the bottom third of European countries for diagnosis and treatment of dementia—below almost all northern and western European nations.
There are a number of reasons for that, including the stigma attached to dementia. It is not right that in the 21st century people should still be afraid to admit that they have dementia or that they have relatives with dementia. I was pleased that the Secretary of State said that there is going to be a publicity campaign to highlight the issue of dementia, and to reduce the stigma attached to it. I very much hope that it will highlight the early warning signs—for example, confusion, forgetfulness, problems with speech and so on. If someone thinks that they have those symptoms, they might take advice, and go and see a doctor.
Early diagnosis is a good way of dealing with the problem, and we have heard a great deal about the need for specialist doctors and other medical professionals to provide that. At present, as we have heard, one in three people receive formal diagnosis at any time in their illness. That statistic has simply got to change. We need to ensure that far more people experiencing the onset of dementia know that that is the case, to allow them to plan them for the future, when the illness will undoubtedly become worse. It means that families can become involved, especially in making plans for people who wish to receive care at home. It also enables people to talk to medical experts and social care services.
One of the crucial themes of the debate has been the repeated mention of support for families. May I add my appreciation of the superb work done by hundreds of thousands of family members throughout the country in supporting their loved ones who are suffering? In many cases the care is given at home, which eases the pressure on the social care services—something that is not often commented on. It also ensures that those who are suffering are able to maintain a sense of independence and dignity.
We must recognise that many family members themselves have other problems and illnesses, a point mentioned by the hon. Member for Broxtowe (Dr. Palmer). As well as the pressure of looking after somebody who is suffering, they have to endure the personal pain of seeing a loved one decline. Relatively older people are looking after even older people who are suffering. In many instances, pensioners are looking after their elderly relatives and parents.
Given the importance of the subject, it is worth while considering the Government’s record. The Government gave it priority only after receiving a couple of critical reports. In 2007 the King’s Fund reported that the scale of dementia in the UK was considerable. The National Audit Office report in July 2007 highlighted the poor diagnosis, poor quality of care, and the disjointed approach taken by health and social care services.
It was only after these reports that the Department of Health could bring itself to admit that dementia should be a priority. That was in 2007, when the Government had been in place and running the administration for 10 years. At that time Age Concern summed up the situation by stating:
“For far too long, vulnerable older people with dementia and their families have been treated as second-class citizens”.
It took a further two years for the Government to produce their national dementia strategy—10 years to recognise that the matter deserved priority, and a further two years to produce a strategy.
What is the position a year on? The report issued less than two weeks ago by the National Audit Office was anything but complimentary. It spoke of local leadership for improving dementia care still not being in place. It said that most primary care trusts and local authorities were still awaiting guidance from the Department of Health before beginning their baseline reviews of dementia needs and services. The Alzheimer’s Society has commented that a third of GPs still lack confidence in diagnosing dementia, and that nurses have so far received no information on the Government’s strategy. Indeed, dementia is not included in the nurses’ core subjects when they are training. Yet the Labour party, in its 1997 manifesto, spoke of ensuring that the views of pensioners would be heard, and said:
“Everyone is entitled to dignity in retirement.”
I conclude by adding my praise of the Alzheimer’s Society, Age Concern, Help the Aged and the many other similar charities and organisations that continue to do such sterling work.
Some 700,000 people have been diagnosed with dementia, although there may be many more undiagnosed. That figure will rise to 1.4 million in the next 30 years, and includes one in 14 people over the age of 65, rising to one in six over the age of 80, and predicted to rise further. One way or another, dementia touches the lives of half the population, with close friends or family suffering the effects.
We have heard a great deal this afternoon about the importance of early diagnosis, early treatment and intervention, and proper and effective support for the person with dementia and for those caring for people with dementia. Rehabilitation has not been mentioned much in the debate, but it is extremely important for those with dementia to be able to carry on and be as active as they can. All these aspects are vital, but what is needed is more than a strategy, although that would be welcome. Effective implementation is needed, which I do not believe the Government truly understand.
I was a bit disappointed that the Secretary of State took the debate at such an early stage into party politics—[Interruption.] No, it was he who mentioned it first. He confused priorities with targets, but we do not need targets; we need outcomes. We need implementation that will make a real difference to people’s lives—implementation that improves the outcomes for people suffering from dementia.
I was also surprised and very disappointed, actually, to hear the truly scurrilous remarks and unfounded allegations about an influence on our policy making. There is no such influence, and no conflict or possibility of conflict; everything that we do is open and fully disclosed. The hon. Member for Bassetlaw (John Mann) is no longer in his seat, but before he throws stones across the House, he should more appropriately ask his own Government about the money that independent sector treatment centres received for not doing operations.
I pay tribute to my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), who has made not only a valuable contribution today but a significant impact in raising awareness of dementia through the all-party group on dementia and his interventions in many other debates. The hon. Member for Broxtowe (Dr. Palmer) shared his very personal experiences, and his concluding remarks about a continuous spectrum of care and treatment were apt and particularly pertinent.
My hon. Friend the Member for East Devon (Mr. Swire) mentioned, in particular, the needs of carers and the hidden carers, including our child carers, who are often forgotten in the debate. My hon. Friend the Member for North-West Cambridgeshire (Mr. Vara), whose contribution was sadly cut so short, rightly spoke of the need to treat people with dignity and respect, and I pay tribute also to the hon. Member for Bridgend (Mrs. Moon), who made a number of insightful points. My hon. Friend the Member for Bosworth (David Tredinnick) raised a number of issues that are important to many of his constituents, not least his concerns about the funding shortfall for his local authority.
The National Audit Office report said that £8.2 billion has been spent inefficiently on dementia care every year. It found that although some steps had been taken and some improvements made, much more needed to be done to improve care and save literally millions of pounds. It found also that more than half of GPs surveyed had not had adequate training, and that one third remain unconfident about diagnosing dementia. Only one in five said that a senior clinician had taken the lead for improving dementia services in their hospital; and only 15 per cent. of psychiatrists said that their primary care trust had invested extra funds in the service.
Nurses, the report continued, received no information on the strategy; joined-up health and social care working is patchy; people who are admitted to hospital increasingly have longer stays and end up in residential care prematurely; only two strategic health authorities are actively working with the care home sector; there has been no improvement in GP knowledge and awareness in the past five years; dementia is not included in the core requirements for nursing degrees; it is not a priority in the 2010-11 operating framework; and it is not part of a national set of priorities against which the performance of organisations has been measured.
The fact that literally billions of pounds is spent inefficiently is truly appalling, and never has there been a greater need to ensure that all money is spent effectively and efficiently, and that above all else it is directed to and centred on the people who need the care. In the meantime, as my hon. Friend the Member for Leeds, North-West (Greg Mulholland) pointed out—
The hon. Member, perhaps I should have said. The savings made from families, friends and charities, who deliver probably the majority of care, are huge, and I pay tribute to those charities and carers—the unsung heroes in our communities—without whom the care of people with dementia would surely suffer.
We are still not clear about where all the funding will come from. In their briefing for this debate, Age Concern and Help the Aged state that the Government’s Green Paper is
“worryingly vague…leaving many frail and disabled people anxious about the future of the benefit.”
As for the carers strategy, as my hon. Friend the Member for Eddisbury (Mr. O’Brien) said, £50 million given out for respite care never reached the front line. Despite many good words in the dementia strategy, we still do not know where three quarters of the £1.9 billion is coming from. We in this House need to know, older people and their carers need to know, and the public need to know. The National Audit Office pointed out that even in the costings that we have there are still no comprehensive data on what dementia services will cost. Perhaps the Minister will tell us when the updated impact assessment will be published.
We have heard a lot about drug treatment and anti-psychotics. More than a decade ago, the Royal College of Physicians warned that too many people in care were spending their final months and years in a state of suspended consciousness, occupying a half world and waiting for death to come. It highlighted the use of the liquid cosh to keep older people with challenging behaviour easy to manage by using high doses of anti-psychotic drugs. That was unacceptable 10 years ago, and it is unacceptable today. There is clearly a need for increased training and awareness of the use of these drugs and, perhaps more appropriately, their misuse.
Malnutrition has also been mentioned, and we have recently seen the appalling scandals with people literally starving, and tube feeding being used in care homes. In 2007, the Nursing Times reported that nine in 10 of the 4,000 nurses it polled said that they were forced to take on increasing administrative work. The nurse of the year resigned in anger at the time wasted on NHS bureaucracy, talking about layer upon layer of red tape. Without a doubt, there are training needs, but there is also, never more than now, a need to allow nurses to nurse and look after the people in their care. Nurses and care staff need training, but they also need time to look after people’s nutrition.
Many older people with dementia end up spending much of their time in a combination of care settings—in acute hospitals, and in community hospitals where they still exist—being looked after by a wide variety of nursing staff and care staff, as well as in their own homes. Ferguson wrote:
“This morning I would ask you to look with me at that no-man’s land between Hospital and community. For most people Hospital care is not more than an episode, albeit an important one, in a much longer chain of events and Hospital care must be viewed, not in isolation, but as an integral and closely integrated part of health and social care.”
That was said in 1967, and those words hold good today. We need integrated health and social care delivered as part of a chain of events; no more inappropriate use of anti-psychotic drugs; time for nurses to nurse, freed from the burden of paperwork; proper training of staff at every level; proper education to end stigma; recognition of the need for the right levels of research, and how we deliver that; and a clear and unambiguous focus on outcomes. What defines us as a civil society is how we care for and look after older people in our communities.
This has, on the whole, been an excellent debate. Although at this time party politics boils to the surface, the solutions lie in a consensus and in having the right policies and strategies that deliver the very best outcomes and the very highest standards of care for some of the most vulnerable people in our society. I urge all Members in all parts of the House to cast aside party politics and support the motion.
A few months ago, I visited a new memory clinic in south London that is an outstanding example of what our dementia strategy is all about. While I was there, I spoke to a married couple. The wife had been diagnosed with dementia and the husband was looking after her. They told me how they felt relief at finally getting the diagnosis and an explanation for what was happening to them, and said that since then, they had been more active and doing more things together than they had ever done. They were playing a fuller part in their community and seeing more of their family. The picture that they painted was of a couple living well with dementia, not dying of it. They had the knowledge and support that they needed to enjoy a good quality of life—life with a zing—and they were making the most of it.
Thinking about that couple, I am pleased that Members such as my hon. Friend the Member for Broxtowe (Dr. Palmer) and my hon. Friend the Member for Bridgend (Mrs. Moon) talked eloquently about those living with dementia. They painted a picture not of inexorable decline but of people being able to live well and die well with dementia when the time comes.
To find the right response to the challenges that exist, including the demographic challenges, we must start with the right attitude. We must open our arms to an ageing society, not wring our hands. We need to be positive about how we can help older people not simply to get by, but to flourish and live full lives in times of both health and illness.
The title of the Conservative motion, with its reference to “the elderly”, sums up how far the Opposition have to go in their thinking. It is a label that conjures up a stereotype of decline and dependency. In contrast, we are optimistic about what older people can do and what we can do for older people. We see an ageing society as a challenge, but also as a massive opportunity. It comes down to four things. First, we need better general support for all older people, so that they can enjoy their lives to the full. Secondly, we need more targeted support, allowing older people to live well and to live longer in their own homes if they become frail or unwell. Thirdly, we need stronger health and care services so that older people are safe and well supported. Fourthly, we need a deeper cultural change across public services and society at large, so that people are viewed as an asset and treated with dignity and respect.
As a Government, we have made it a priority to provide additional support to every older person. Other Members have not mentioned this, but we must not forget the entitlement to a free national bus pass and free sight tests, or the winter fuel payments to help older people, particularly in the winter that we are experiencing. There is also extra help with pension tax credits. We are banning age discrimination in health and social care and building a society for all ages. We have appointed a new national clinical director not just for dementia but for older people, Professor David Oliver, a leader in older people’s health care who knows how public services work. His influence will be critical in enabling us to ensure that all older people get the services that they need as individuals.
We have debated in the House free personal care for people living at home with the greatest needs. It must be a shared view throughout the House that older people must be supported to live well and live longer in their own homes. Our work on prevention has been hugely successful, and we have seen best practice on matters such as preventing older people from falling over and getting fractures and improving access to services such as affordable foot care. There has been new guidance on intermediate care and new support for services such as audiology and telecare. Research has now proved that if we put a pound into prevention, to provide people with help in their own homes, we save £1.20 in acute care by reducing the number of people going into it.
Our Personal Care at Home Bill will provide extra help to keep older people with the highest personal care needs in their own homes, and it has been widely accepted. It went through this House without opposition on both Second and Third Reading, and it is now to be debated in the House of Lords. It means that people who have had to run down their savings to be looked after in their own homes can now look forward to having the peace of mind of not worrying about whether they can pay for their care when they are at their highest level of need.
Today, we have debated the dementia strategy—a national strategy, with an implementation plan, headed by our new national clinical director for dementia, Professor Alistair Burns. Our regional deputy directors oversee the strategy’s delivery locally, and guidance for local commissioners has also been published, as our clinical director audits the services that are being delivered, including local memory clinics, memory centres and memory services.
I am always pleased when Conservative candidates campaign for Labour policies, but I would tell voters in Chorley to get the real thing and vote Labour, which designed and will deliver the policy in the years to come.
It is a Government priority to deliver our national dementia strategy. It was interesting that when Conservative Front Benchers were challenged about their criticism of us for not giving it priority, their promise to make it a priority disappeared within almost two minutes of its being announced at the Dispatch Box. They will not make it a target or a vital sign. They will not put it in the national operating framework or mandate it locally; their words are exactly what we expected—pure fluff. They are all spin and no substance—no change there. What did they say on the airbrushed poster about support for the NHS? We have seen some airbrushing today.
The Minister is currently responsible for the dementia strategy; I hope that we will be responsible in future. For now, the question to him is why the operating framework, which was published last month, did not mention the dementia strategy in the national priorities for local delivery. It is not even mentioned in the vital signs. Even it were a matter simply of saying, “We’ve given the PCTs the money; it is a national priority to do something with it”, why did not the Minister get anything into the national priorities for local delivery?
It is good to see the hon. Gentleman taking part in the debate; we thought he had decided to leave us for a while. Of course, the strategy is in the national operating framework—it was in last year’s and it is in this year’s. Given that he aspires to be Secretary of State for Health, he should answer a couple of questions. How many meetings has he had with Nurses for Reform, which would like to privatise the NHS? We know that the Leader of the Opposition has held such meetings. Would the hon. Gentleman like to tell us whether he has done so? No, he will not stand up and reply. He has received donations—questions have been asked about that and a conflict of interest today. We have heard Conservative Members claiming that there is no conflict of interest. If that is true—[Interruption.]
On a point of order, Madam Deputy Speaker. When contributions were mentioned earlier in the debate, the Speaker was in the Chair and the Minister was in his place and listening. The Speaker specifically advised that such issues should be referred to the Parliamentary Commissioner for Standards and not brought up on the Floor of the House. Will you kindly advise me on what should be done when a Minister, who heard that, ignores the Speaker’s comments in the same debate?
Order. I shall repeat the ruling that Mr. Speaker made earlier in the debate. He said:
“I am grateful to the hon. Gentleman for his point of order. I will respond as follows, and I hope this is helpful to the House.
First, of course, responsibility for the registration of interests rests with individual Members. Secondly—I listened very carefully to what the hon. Gentleman said—if any Member has anxieties or is discontented about the conduct of another Member, the Member who is dissatisfied should complain to the Parliamentary Commissioner for Standards. At this very tense and competitive time, I should hope that Members would not air these matters on the Floor of the House when they are matters not for the Chair, but for the Registrar of Members’ Interests and the Parliamentary Commissioner for Standards.”
I repeat that for the benefit of all Members.
Thank you, Madam Deputy Speaker. Other questions were raised about points of detail. The hon. Member for Rugby and Kenilworth (Jeremy Wright) spoke of the importance of research into dementia. I can assure him that with a £1 billion forecast spend in 2010-11, assuming this Government are returned to spend that cash, I have funded a research network, and we want better bids for research funding for the benefit of research.
Madam Deputy Speaker, I was talking about dementia research when I was intervened on, but I take your guidance.
On the use of anti-psychotic drugs, I can confirm to the House that over-prescription of such drugs is unacceptable. The review of those drugs that I commissioned was comprehensive in taking things forward. I can confirm that the national clinical director for dementia will oversee matters, ensuring that every PCT sets targets for reducing the use of those anti-psychotic drugs. We must improve the way we look after people with dementia.
It is vital that we treat people with dignity and respect. I am delighted to say that we have a social movement of more than 12,000 dignity champions taking forward—from the bottom up, not just from the top down—the needs and values of, and support for, older people. As we move towards a national care and support service, we have a clear choice. On the one hand, we could retreat to the traditional views of care, and the old models and assumptions about the elderly, and to lumping older people into the same old box, not treating them as individuals, offering no alternative but to go into a care home, and making no real effort to keep people independent; or we could choose a different future, in which age is valued and not dismissed—
Question put forthwith (Standing Order No. 31(2), That the proposed words be there added.
Question agreed to.
Main Question, as amended, put and agreed to.
That this House wishes to see the quality of life improve for the 700,000 people in the UK with dementia; pays tribute to their families and carers and all those who campaign and fundraise for dementia charities; welcomes the Dementia Strategy launched in 2009 which contains a programme of work to transform services for those with dementia over five years and is backed by funding of £150 million over two years; notes that the Government will shortly publish the report of the Nutrition Action Plan Delivery Board; rejects the use of tube feeding on any grounds other than clinical need; welcomes the independent clinical review of anti-psychotic drugs which contains recommendations for the reduction in the use of these drugs for people with dementia; further welcomes the appointment of a National Clinical Director for dementia to promote better care and provide leadership for the implementation of the strategy; welcomes the creation of a Ministerial group to develop dementia research; recognises that the enactment of the Personal Care at Home Bill will help some 400,000 people with the highest need; supports the Government’s proposals to create the National Care Service, the first national, universal, entitlement-based system for care and support in England; and acknowledges that the Government’s Dignity in Care campaign is working to engage local people in a social movement and to put dignity of those in care at the heart of services.