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Dementia Strategy

Volume 507: debated on Tuesday 16 March 2010

Motion made, and Question proposed, That the sitting be now adjourned.—(Lyn Brown.)

I am grateful for this opportunity to speak about the national dementia strategy—an issue to which the House has returned on many occasions during the past few months and in which I have taken an interest over a number of years. It is now about 100 years since Alois Alzheimer first described the disease that bears his name at a medical conference in Germany. There is still no cure, and our understanding of the basic biological processes remains limited, although I will say something about current research, which is beginning to peel back some of the uncertainty and lack of knowledge.

My interest in the issue does not come from personal family experience. I have been blessed in having no direct experience of family members suffering from this terrible disease. Rather, it comes from my contact with families in my constituency who are struggling with the consequences of dementia. In particular, I am grateful to have a Princess Royal Trust for Carers centre in my constituency, at Sutton. The Sutton carers’ centre and the Alzheimer’s Society in my constituency have played an important part in educating me about the issues and exposing me to their members who live day to day with the disease.

I am a great believer in serendipity. It came as a surprise to me to learn yesterday that the Public Accounts Committee is to publish its findings today on the National Audit Office’s report on dementia services. As a member of the Committee, I found our hearings in January interesting. I have a few questions from those hearings to ask the Minister today. Both the Public Accounts Committee and the National Audit Office report areas of progress on dementia but point to what the Chairman of the Committee has described as a gulf between promise and delivery so far.

Earlier this year, I was asked to write the foreword to a report published by Oxford university and the Alzheimer’s Research Trust called “Dementia 2010”. The report revealed a number of facts that have added to our understanding of the scale and scope of the problem and the challenge that we face.

Some 820,000 people in the UK are living with dementia. The previous estimate, which is still widely quoted, was 700,000. Dementia costs the UK economy £23 billion a year; the previous estimate was £17 billion. That is twice the cost of cancer, which is £12 billion a year; three times the cost of heart disease, at £8 billion a year; and four times the cost of stroke, at £5 billion a year. The combined Government and charitable investment in dementia research—£50 million—is 12 times lower than spending on cancer research, which is £590 million a year. Heart disease receives £169 million a year and stroke research £23 million. For every £1 million in care costs resulting from dementia, £129,269 is spent on cancer research, £73,153 on heart disease research, £8,745 on stroke research and just £4,882 on dementia research.

I am sure that all that will be clear when it is on the record in Hansard, although it might not be clear now, while I am blinding colleagues with figures. What the Alzheimer’s Research Trust is trying to demonstrate in its report is the lack of ambition evident so far in the funding for dementia research. The report is saying not that less should be done elsewhere, but simply that the case for dementia research is compelling. Every dementia patient costs the economy £27,647 a year, which is more than the UK median salary of £24,700. By contrast, cancer patients cost £5,999, stroke patients £4,770 and heart disease patients £3,455. Delaying the onset of dementia by just five years would halve the number of deaths from the condition, saving 30,000 lives a year. That is a huge opportunity. The UK is undoubtedly playing a crucial role in finding a cure and leading the world in basic and clinical research, yet dementia research is woefully underfunded: the Government invest only 2 per cent. of their medical research budget in dementia, spending many times more on other health conditions.

The 2009 report on dementia by the Nuffield Council on Bioethics stated that

“the major research funding bodies within the UK do not appear to have explicit policies according to which they allocate funds between different conditions, focusing rather on research excellence and the ‘importance’ of the topic… Given the social and economic impact of dementia, we believe that a more explicit approach to research priorities would be likely to lead to significant increases in research funding for dementia. If such an increase were not to be matched by research applications of the necessary high standard, then active steps should be taken to develop and promote research capacity in the relevant areas”.

The issue was recently recognised in the United States of America, which tends to take a fairly legislative approach to pushing issues forward. An Alzheimer’s Breakthrough Bill is currently before Congress. They have lovely names for Bills in the States; our Clerks would not allow us to give a Bill a name of that sort. If the Bill is passed, it will allocate $2 billion to dementia research.

Despite that significant American commitment to dementia research, the UK must play its own role, given our international advantages in dementia and other scientific research. The UK is second only to the US in dementia research impact. British scientists are responsible for 7 per cent. of the top cited dementia papers globally, and important innovations have come from UK research, such as the discovery of most of the genes associated with dementia so far, work leading to the development of the only licensed treatment of Alzheimer’s and the neuropathology of several rarer dementias. Furthermore, the national health service gives the UK a competitive edge in trialling new dementia treatments.

Recently, after the publication of “Dementia 2010”, I was invited by the Royal Society of Chemistry to chair one of its public lectures, by Professor Chris Dobson, who is master of St. John’s college and from the department of chemistry. He lectured on some of the extraordinary work done by him and his team of young graduates on the disease mechanism behind dementia and the role of proteins in the body. It is a potential key not only to unlocking our understanding of the disease, but to identifying treatments for dementia that arrest its progression and might even cure it. The team also established a link to other neurological conditions in our understanding of dementia. That research is being done in this country. We need more such research and the ambition to fund not just a cure, but the discoveries necessary to build bridges to it.

The Minister’s taskforce on dementia research, which is intended to drive the issue forward, held its first meeting on 24 February. Will he tell us a bit about that meeting? There is clear and demonstrable public support for investment and research into dementia. One survey found that 66 per cent. of people think that the Government should spend more money on dementia research, and only 2 per cent. thought that funding should be cut.

The hon. Gentleman is making an important contribution; it is fascinating to hear him develop his argument. He has not yet addressed the question of demographics and the increase in the number of elderly and ageing people, which must have a bearing on the future. Does he agree that in our desperate need to solve the tragic problem of dementia, we must find the means to relate it to the future and the increasing number of people who will inevitably be afflicted as they grow older?

The hon. Gentleman is absolutely right to identify the demographics, which present a problem not only in the increasing number of people who present with dementia, but in our society’s ability to provide the necessary informal care. It is estimated that, over the next 20 years, this country will need an additional 15 million carers to cope with the increased burden of diseases such as dementia. That is why the research figure that 800,000 people suffer from the disease is so relevant.

I congratulate the hon. Gentleman on highlighting this subject and on the compelling case that he is making. Caring for dementia sufferers is a demanding and stressful job. Does he agree that were people not caring for their loved ones so compassionately, the burden on the state would be much higher and his figures would be different? Does he also agree that there is a stigma around mental health? Rethink is trying to tackle that problem with the “Time to Change” campaign. That is part of the context that causes dementia research and caring to be pushed into the background. We should address it head on.

The hon. Gentleman makes an important point, which I am sure the Minister and others will have heard. He is right to identify the cost of care. A substantial part of the £23 billion economic cost of dementia is the conservative estimate of £12 billion for informal care.

On research, will the Minister say what were the outcomes of the first meeting of the ministerial taskforce and when the minutes will be posted on the website? It would be good to be able to study them. What timeline do the Government envisage for increasing the funding available for dementia research? When will we hear an announcement? Could we hear one in the Budget next week?

I have taken an interest in anti-psychotic drugs for many years. I will not labour this area because of the good work done by Professor Sube Banerjee in his report that formed part of the strategy. When the Government published the action plan to reduce the use of anti-psychotics by two thirds, the report found that 150,000 people with dementia were being inappropriately prescribed and that as many as 1,800 deaths a year could result, thus suggesting that the prescription of such drugs needs to be borne down upon and reduced. The report set out a strategy to do that and stated that it could save about £55 million.

The Public Accounts Committee took evidence from David Behan, the official responsible for social care in the Department of Health, who has been widely credited for his work in this area. I asked him how soon the action plan’s strategy to reduce such prescribing by two thirds might be realised. I left the exchange with the impression that the intention was that it would be done within the next two years. On re-reading the transcript, I found that it may take two years before the baseline is established. The reduction will presumably take a further two years after that. It would be helpful if the Minister clarified whether we will see the two-thirds reduction in anti-psychotic prescribing in two years, or whether it will take two years for a baseline to be produced and a further two years for the reduction.

At the heart of my concerns is the lack of priority. The National Audit Office put its finger on that, as did the Public Accounts Committee report. In December 2007, after the first PAC examination of this matter, the Department of Health published its operating framework for 2008-09. Among the local priorities it stated:

“The Department will shortly be publishing details of the clinical and economic case for investing in services for early identification and intervention in dementia, which PCTs will want to consider when developing local services.”

That was flagged up as a local priority, not a national requirement or even a national priority.

Late last year, the NHS operating framework for 2010-11 was published. It did not identify dementia as a national priority. Only in some weak words under the title “Areas to support local prioritisation” is dementia mentioned. It states that improved efficiencies and outcomes are to be gained by

“the early and accurate diagnosis of dementia”.

In addition, the vital signs indicators to be used by primary care trusts do not mention dementia. The Department of Health has said that vital signs cannot be reopened to include anything else until the next spending review. However, given the stated priority that we have heard from the permanent secretary and Ministers time and again, surely the vital signs should be updated to include a measure on dementia, or separate guidance should be issued to ensure that dementia is a priority nationally and locally.

There is a deficit of awareness of the strategy and its implementation on the ground. Health and social care staff participating in the NAO research could not identify leaders on dementia and felt excluded from the implementation process. It is reported that care homes have received no communication about the strategy and have seen no sector leadership. Only two strategic health authorities were actively working with care homes when the NAO did its fieldwork. The research revealed that many front-line staff—in particular, general nurses—were unaware of the strategy. A lot must be done to close that gulf of understanding among professionals, let alone the public.

I congratulate my hon. Friend on securing this important debate. Unlike him, I have had the tragedy of Alzheimer’s strike people close to me. Has he read the Alzheimer’s Research Trust report that estimated that 31 per cent. of people with dementia are registered on GPs’ lists? It suggests that that is due to GPs’ lack of training and confidence in diagnosis. However, a person close to me was referred by a GP to a consultant. He actively helped her with the memory test to improve the outcome. Does my hon. Friend share my concern that the health service seems to be pursuing a strategy of ignoring the problem unless relatives fight for help, or the illness becomes so bad that it can no longer be ignored?

My hon. Friend makes some powerful points. Evidence has been gathered over the years, by the Audit Commission and others, of diagnostic denial in the NHS with regard to dementia. That is changing, which is good, but some GPs clearly still harbour the view that diagnosis is pointless because there is no cure. I disagree with that, as does the national strategy. We need early diagnosis because it allows families to plan and to come to terms with the condition.

Interestingly, the NAO found that more GPs now feel that early diagnosis is important. That is a good move forward, but some GPs still need to be convinced. In 2006, 68 per cent. of GPs agreed that it was important. In 2009, the figure was 77 per cent. Only 47 per cent. of GPs said that they had had sufficient training in dementia management, and almost two thirds were not confident in diagnosing dementia.

According to the research, there has been no improvement in GP knowledge and awareness of dementia over the past five years. There are widely held concerns among GPs about gaps in post-diagnostic support. That is why there is a question about the role played by the quality and outcomes framework. It awards GPs quality payments for keeping a register of people with dementia and for reviewing cases, but there is not much clarity on whether it is possible to enhance the emphasis on dementia. Will the Minister say what the Department’s position is on using the quality and outcomes framework as a lever to drive change in this area? It could play an important role.

When the Minister launched the strategy, he talked of the ambition of having a memory service in every town in the country. Was that just an ambition? How will it be translated into practice on the ground? How soon will that ambition be achieved?

The more I hear, the more impressed I am with the landscape being painted by the hon. Gentleman. Does he think that this debate will get any national coverage? Would he like to place a bet with me that it will almost certainly not be reported at all?

I have been an MP for 13 years, and I am used to the fact that that is sometimes the outcome of Westminster Hall debates. However, obtaining coverage is not the only reason we have such debates; we have them because they provide an opportunity to talk to a Minister directly across the floor and get a response. That is why I have chosen to initiate the debate. If any attention is paid to the matter that we are discussing, I suspect that it will be paid to the Public Accounts Committee report, rather than to this debate—but we shall see.

The next issue that I want to raise is that of local information on dementia services. Again, a commitment was made at the Public Accounts Committee meeting that, by the end of this month, each primary care trust and local authority would have a joint action plan in place to take forward plans to deliver the strategy, and that that would be part of the baseline audit of dementia. Clearly, we need to know if that will be delivered. Will the Minister tell us whether the baseline reviews are on track for delivery by the end of this month and, similarly, whether the joint action plans will be ready by the end of this month? Is the Minister confident that those things can be delivered on time?

Work force issues are at the heart of how all those measures can really transform lives. It is not just about spending more money; it is about ensuring that we have a capable and competent work force that can properly care for and look after people with dementia. It was instructive to note, during the exchanges at the Public Accounts Committee meeting, that one component of the issue of the work force is the role of the General Social Care Council. At the moment, it registers only social workers. Six years have passed since Ministers promised the House that staff who work in people’s homes would have the opportunity to be registered, and would therefore be covered by the standards set by that body and regulated by it.

We still do not have a time scale and a deadline by which those people who go into others’ homes to care for them will be registered with the General Social Care Council. That is clearly a result of the fact that the body appears to be rather dysfunctional in a number of ways, as ministerial statements have indicated. It would be useful if the Minister could say a bit more about that, and about what discussions are going on between him and his officials with organisations such as the Royal College of General Practitioners, the Royal College of Nursing and the British Medical Association about developing dementia care skills for health service staff.

There is a lot of talk at the moment about who pays for care and how we should do so. That has rightly become a much higher priority for debate and, just last week, I attended a round table with the Minister and the Opposition spokesman, the hon. Member for Eddisbury (Mr. O'Brien), in order to contribute to that discussion. I hope that such debates will continue. There is no doubt that people with dementia and their carers are among the hardest hit by the current charging system. Despite dementia being a medical condition, care is still largely provided through social care, and it is mainly means-tested, rather than being funded in other ways, as with other illnesses.

I want to mention some of the excellent work done by the Princess Royal Trust for Carers, and by Crossroads Care. Those organisations have rightly been snapping at the Minister’s heels to ensure that the undertakings given in respect of allocations of money to deliver the carers strategy bear fruit on the ground. They have just published research that has revealed some disturbing findings about the extent to which the money that Ministers said would be allocated to carers—particularly for carers’ breaks—has been siphoned off into other NHS budgets.

That research demonstrated that the money is not delivering what it was intended to deliver, and that PCTs planned to spend only 25 per cent. of the £100 million to increase services for carers—that is, from this April. That is a tiny improvement on last year’s situation, but it is still woefully less than what was promised. A significant proportion of the money that is being spent is probably being double-counted against the money allocated for other Government strategies. In my patch, the carers strategy money has been double-counted alongside money for the dementia strategy. The two strategies have been put together, so that the PCT can claim that it is achieving its spend.

The hon. Gentleman is developing a very cogent argument. I dare say that he was as shocked as I was by the bare-faced cheek of these PCTs, who have been given the money and put on notice by him, me and others that the Minister’s wish has not been delivered. The Minister’s answer has always been that MPs should chase the PCTs for a resolution to the matter, rather than getting a grip on the problem himself. However, he said last week that he would get a grip of the issue, but the future projection of the spend is hardly any better than the figures that we have already had. It looks as though the PCTs are spitting in the face of the Minister’s obvious wish.

There is a huge accountability deficit here. PCTs cannot be held to account, and sometimes getting an answer to any such questions is like getting blood out of a stone. I first asked Ministers about the matter eight months ago; I was admonished for doing so and was told that I should be asking my PCT. It took months to get an answer out of them. That answer was disappointing, and the Princess Royal Trust for Carers has had similar responses across the country. In fact, 25 per cent. of PCTs plan to reduce spending on services for carers, despite the extra resources specifically put into budgets to help with those services. A small number of PCTs continue to provide no services whatever for carers, and that picture is reinforced by the fact that, across the country, up to £1 billion that has been allocated may not be reaching its intended recipients. That is scandalous and a disgrace.

Of the £150 million committed in 2009 to 2011, 24.5 per cent. will be used to increase support for carers; the rest has gone somewhere else. The problem is that the issue is not just about the carers strategy; there is clearly a problem with the implementation of other strategies as well—the child health strategy, the end-of-life care strategy and the dementia strategy. All four strategies represent important Government announcements of nearly £1 billion in new spending. It is proving very hard for most of the charities that cover those areas to establish precisely how that £1 billion is being used.

I welcome what the Minister recently said about personally holding PCTs to account. That is very important. However, that positive announcement leads us to ask what the Minister will do to ensure that the PCTs really deliver. What does such an announcement mean in practice? Many PCTs have been advised that they would not be setting budgets until late March. PCTs have known about the extra money since June 2008, and the best committed their spending at an early opportunity. That has to happen, because many of the strategies involve working in partnership with local authorities and, moreover, with the voluntary sector in a local area. Lead times have to be considered if there is to be cost-effective delivery of new services, so why has none of that happened, and why do we not have the mechanisms to hold PCTs to account?

In the Public Accounts Committee hearings, the question of the cost of NHS continuing health care was raised. At the end of the session, I asked the Department of Health to write back to me with further information on the subject. I got the reply the other day, which stated:

“The Regulatory Impact Assessment which accompanied the National Framework for NHS Continuing Healthcare and NHS funded Nursing Care in England (2007), estimated, based on existing data about the costs of care, the overall cost of implementing the new Framework…in the first full year as £219 million.”

The cost of delivering continuing care, funded by the NHS, is £219 million. The important question is: what happens next? Where does that money come from? This is what the Department said:

“The costs of implementation will include a cost shift from Local Authority budgets”.

Some £219 million is needed to deliver the Government’s framework. How much of that £219 million will come from a cost shift from local authority budgets? We all know that social care budgets are under pressure. Social care budgets deliver most of the dementia services that make a difference to families’ lives. How on earth can we find £219 million out of local authority budgets to pay for that? Will the Minister give some reassurance about what is intended by those words? If they are to be interpreted literally, as I fear they should be, they are very scary.

I am grateful to have been given the opportunity to initiate the debate, but I want to bring my remarks to a close. There is clearly now an acknowledgement that dealing with dementia is a huge challenge and that we need to invest in services. Doing so will save money in the long run and transform lives. We need to make sure that that is a clear priority. We cannot just leave individual NHS organisations to choose whether they invest in dementia services, as if they were a luxury item. Those services are no luxury; they are essential. That is why the Government’s rhetoric on dealing with dementia as a priority must be translated into action on the ground. I hope that we will hear a positive response from the Minister on the issue of research, and some indication of a commitment to moving those matters forward. I look forward to hearing the other contributions to the debate, and I hope that the Minister will respond in detail at the end.

The hon. Member for Sutton and Cheam (Mr. Burstow) is to be congratulated on initiating this important debate.

On the point about the money that has supposedly been allocated to primary care trusts for carers, particularly for respite care, the further figures produced by the Princess Royal Trust on how the forward allocation will not be spent are disappointing. The frustrating point is that the Government all too often give the impression that something will happen—that a group such as carers will be looked after—but then in reality it does not happen. In my most recent constituency surgery I heard from a constituent who has been looking after his elderly wife, who is suffering from dementia, at home. He has been asking for respite care and some help with physiotherapy for some time now, but he has received absolutely nothing. I put the Minister on notice that I happen to be No. 1 on the list for Prime Minister’s questions tomorrow, so Mr. Speaker cannot fail to call me. I advise the Minister to give some help to No. 10 on the matter, because I may well put that point to the Prime Minister.

The fact of the matter is that men who reach the age of 65 today have an average life expectancy of 82, and for women of that age the life expectancy is 85. The advances of medical science over the past century mean that we now have longer life expectancies than at any time in the history of civilisation, so we can celebrate the fact that more people than ever before will live longer and, broadly speaking, healthier lives. The number of over-60s will therefore increase over the next two decades, both as a proportion of the total population and significantly in absolute numbers, as the post-war baby boomers move into retirement.

However, the human species is not indestructible, and although improvements in medical science mean an increase in life expectancy, the statistical fact, sadly, is that a proportion of those people living longer will succumb in due course to age-related illness. For example, the incidence of dementia rises sharply for those over 80, from around 6 per cent. for those aged 75 to 79 to 12 per cent. for those aged 80 to 85 and 21 per cent. for those aged over 85. I understand that one in three people aged over 65 will die with some form of dementia. In the Cherwell district in North Oxfordshire, in my constituency, the population aged over 65 is due to increase by 60 per cent., which is significant, over the next decade, largely because Banbury was something of a new town in the 1960s. However, nowhere do I see evidence of a 60 per cent. increase in nursing home provision in the district.

When I was first elected a Member of Parliament 27 years ago, every Christmas I would visit every nursing home in my constituency to meet the residents, who were, by and large, spry widows in their 70s, with the occasional widower. I do not think I heard the word Alzheimer’s until I had been an MP for some years. I no longer visit nursing homes at Christmas, not because I am disinterested—I frequently visit them at other times—but simply because every nursing home in my constituency, almost without exception, is filled with elderly residents suffering from increasingly severe dementia or Alzheimer’s.

I welcome the recent campaign to raise awareness about dementia, led by the Department of Health supported by the Alzheimer’s Society. It has the theme, “Dementia: the more we understand, the more we can help”. As few of us will live lives untouched either directly or indirectly by dementia, it is important that we all have the greatest understanding about it. Indeed, in my constituency I have set up an advisory group, called the successful ageing group, which consists of local people from Help the Aged, Age Concern and the local carers’ centre, because in Banbury we too are fortunate enough to have one of the first Princess Royal Trust for Carers centres, which do excellent work. The group also consists of representatives of the WRVS—formerly the Women’s Royal Voluntary Service—which does some really good work at the Cornhill centre, providing support for older residents in the community. There are representatives from Oxfordshire Links and from specific charities and organisations, such as the Alzheimer’s Society, the Multiple Sclerosis Society and Parkinson’s Disease Society. The intention is to meet reasonably regularly to try to understand what is happening locally in that landscape, because sometimes it is difficult to relate national initiatives to what is happening locally.

That takes me to the Public Accounts Committee report on improving dementia services in England, to which the hon. Member for Sutton and Cheam, who is a member of the Committee, has referred. It might be helpful if I go through the report’s conclusions. The first conclusion is:

“Although the Department said dementia would be a national priority, it has not afforded it the same status as other national priorities such as cancer and stroke.”

The Committee recommends that strategic health authorities should

“agree with each Primary Care Trust a local dementia implementation plan, comprising costed actions and a timetable, by July 2010.”

Who is leading on that? Will PCTs lead, or in an area such as mine will county council social services departments lead in trying to ensure proper services for those suffering with dementia? The reality, in my experience, is that comparatively few people suffering from dementia will stay in acute hospitals for a significant length of time. They might go into an acute hospital because they have broken a hip, for instance, which is often when their dementia is discovered, but because—understandably—their long-term needs can rarely be met in an acute general hospital, help in a care home or in the community will be sought for them fairly speedily.

One of my concerns is that I often do not think that there is a sense of grip on who is leading. If the PCTs are meant to be leading, they also need to be gripping social services departments, because all too often we have a situation in which everyone is pointing and saying that it is the other person’s responsibility. Indeed, on several occasions I have found that the only way Oxfordshire MPs can sort things out is by getting everyone involved, such as the PCT and social services, in the same room at the same time to discuss blocked beds, for instance. The PCT will say that it would like to move people out more quickly but cannot get beds in community nursing homes, while social services will say that hospitals are not getting the appraisals done quickly enough. We need to know who is leading on that.

The other element is accountability, because whoever is in charge and takes a grip needs to be accountable for what they are doing so that there is transparency and visibility. Has my hon. Friend’s successful ageing group expressed a view on where it would like the leadership to come from? There must be some kind of recognition of where it expects the lead to come from. Does it want it to be the PCTs, the local council, or indeed the Government? It would be helpful to know whether the group has expressed a view, because we could then take something forward.

My hon. Friend makes a good point. People would like to feel that they know who has a grip on the matter. There are similar concerns about who is managing the continuing care budget. Is it being managed by county council social services departments, or by the PCT? If it is being managed by the PCT, as it seems to be, what are the implications for social services if there is some tweaking in applying the budget? Someone has to be accountable, so let us know who it is. That is the important issue.

My hon. Friend raises a very interesting point. I do not want to take him too far away from his prepared remarks, but one of the biggest problems that all of us, the Minister included, contend with is that even when polling takes place to find out what the country’s priorities are, caring for our elderly population is not an item that is polled. It is subsumed in the health service or pensions and is never an item on its own. One of the problems of the demographics we face—based on what my hon. Friend has just said, I dare say that he has picked up on it—is that we find it difficult to identify precisely how people feel about putting it as a priority because it is never disaggregated as an issue of concern.

My hon. Friend makes a good point. I suggest to the House that concerns about caring for the elderly will start moving significantly up the political agenda over the next few years. I am sure I am not alone among Members of Parliament who constantly meet constituents who feel incredibly stretched. The husband and wife trying to maintain two jobs while they look after children on the one hand and aged parents on the other feel very much part of the sandwich generation. One comes across an ever-increasing number of elderly carers who are looking after a husband or wife. It is a growing trend and, as I shall say, I am not sure where we will find sufficient carers as we move forward.

In its second recommendation, the PAC states:

“Dementia is like cancer in the 1950s, still very much a hidden disease. There is a need for a massive campaign to promote openness and debate on this important and challenging issue.”

Dementia is distressing for those suffering from it and their families. Obviously, it is difficult for people suffering from dementia to interrelate socially as they once would have done. The disease tends by definition to get hidden away, and it can sometimes be frightening. The behaviour of people with dementia, Alzheimer’s in particular, can sometimes be extremely unpredictable. We all need to make every effort to explain the challenge that dementia poses, and if we are a caring society in which we have a regard to and a concern for the welfare of everyone, we will need to learn much more about dementia and ensure that those who are suffering from it are better cared for.

The PAC’s third recommendation has a familiar ring:

“The Department does not know how the first £60 million of dementia funding has been spent by Primary Care Trusts. The Department has only recently commissioned an audit of costs of dementia services which is expected to be completed in summer 2010.”

I understand that Ministers have a dilemma. On the one hand, they cannot dictate or micro-manage from Richmond house how every PCT spends every parcel of money allocated to it, but one would have thought that the very least the Department could do when it allocates money for a specific function, such as dementia services, is to ask PCTs simply to give an account of how the money is spent. It cannot be right that the Department and PCTs cannot give the PAC an explanation of how PCTs are spending the money.

Does the hon. Gentleman agree that there should not be national announcements about sums of money allocated to national strategies unless they are accompanied by a clear plan of how local organisations—NHS and PCTs—will account for how they use it? A clear audit trail has to be set up when the money is announced.

I entirely agree; otherwise, confidence in public policy and the machinery of government is very much undermined. Increasingly, people do not give credence to announcements made by Ministers. They believe that there is double accounting, window dressing or double dipping, and that nothing will materialise. When nothing happens, they understandably feel cheated, which is unfair on everyone involved. The hon. Gentleman makes a reasonable proposal: why should there not be a straightforward audit trail of money that is specifically allocated by the Department of Health for a specific purpose, whether it be for dementia or for carers, so that everyone knows where it has gone?

The PAC’s next recommendation states:

“The implementation of the Strategy is dependent on achieving”—

an eye-watering—

“£1.9 billion of efficiency savings by increasing care in the community and reducing reliance on care provided in care homes and acute hospitals.”

Let us take that apart a bit. As I understand it, the dementia strategy that the Government are introducing will require somewhere a saving of nearly £2 billion by reducing the spend on acute hospitals and care homes and by increasing care in the community.

Where does care in the community come from? “Care in the community” is shorthand for people being looked after at home by a mixture of carers and care workers, yet the Government’s attempts to give further support to carers at home, by allocating money to help them, have fallen at the first hurdle.

I am sure that when the hon. Member for Sutton and Cheam meets carers at his local carers centres and asks them about their needs, he finds—as I do—that they almost always first articulate the need for a break, or respite care. It varies from person to person: some ask for a weekly break, or a few hours off so that they can do shopping and so on. The all-party carers group, of which I am a member, had a meeting with the Prime Minister last year and all of us—officers and members—articulated that need. In fairness, the Department came forward with a chunk of money for carers. It was intended for carers’ breaks, but it is not being used for that by PCTs. What confidence can carers have that the Government will support them if they fail at the first hurdle by not ensuring that PCTs allocate carers the money that was meant to be allocated to them?

Where are the care workers to come from? I have a real concern that nursing homes on my patch seem to be manned almost entirely by good-quality nurses from the Philippines and Bulgaria. I do not mean that facetiously. The nurses are recruited and trained by UK nursing homes, but as soon as they are trained, they are often poached by the local NHS and move into it. Nursing homes are continuously having to train and retrain people. It is an ongoing experience.

I do not see a co-ordinated programme to ensure that jobs in nursing homes are seen as worth while, rewarding and valued in their own right by society. I see no evidence of local further education colleges or universities laying on courses at, for example, national vocational qualification level 4 so that we can have more qualified care workers. [Interruption.] I would be happy if the Minister told me in his summing up that I am wrong. I just do not see evidence of that in Oxfordshire. Whenever I visit nursing homes, I am told that one of their great concerns is recruitment of staff. If we are to have far more people providing care in the community, it will require a considerably larger number of qualified, caring care workers. One can introduce the policy only if such people are available.

The shorthand for that move is “personalisation of care services”, which is the jargon that is being used. May I put down a marker? If people are to be looked after more in the community, that should not be shorthand for their being isolated at home; they still need to be able to get to day centres to interact with others and to have a community life. I am concerned that pressures are being put on social services departments and county councils, on one hand to increase the amount of money that they are giving for care in the community, which is shorthand for people being looked after at home, whereas on the other hand, as a consequence, there is less money for day centres and other provision for the elderly.

The PAC states:

“This should include an immediate requirement for acute hospitals to have an older people’s mental health liaison team in place to ensure that unnecessary admissions are avoided and that discharge to appropriate care is as swift as possible.”

I can only report that I have not yet come across an older people’s mental health liaison team in the Oxford Radcliffe Hospitals NHS Trust.

The next recommendation states:

“Early diagnosis of dementia is crucial in providing timely and appropriate care and in preventing more costly hospital or residential care. The Department should work with Primary Care Trusts to ensure they urgently commission good quality and effective memory services.”

I have another suggestion that will help. Most general practitioners are stressed for time, but the condition of a large number of people who are suffering from Alzheimer’s or dementia in its early stages will have been picked up by their family or their husbands or wives much more quickly than by the GP. If we asked GPs to set up a voluntary register of people who are carers, and if carers were recognised much more in the NHS system, I suspect that there would be greater opportunity for carers to say to GPs, “I think my husband or wife is in the early stages of some difficulties with memory and perhaps dementia.” It can often be difficult for an individual to acknowledge or admit that they are in the early stages of dementia or Alzheimer’s. We need to encourage more people, as carers, to discuss candidly and frankly with their GPs the suffering of their loved one or the fact that they are in the early stages of dementia.

I am sure that all hon. Members, as friends, relatives and constituency MPs, see people who are finding life slightly difficult and who will, in a couple of months or so, start going downhill fairly fast. It is not that people are insensitive or unthinking, it is just that unless someone says to their GP, “Look, this person needs some help”, a diagnosis will not necessarily be picked up early. If we are talking about continuing professional development for GPs, one thing they need to consider much more in their surgeries is how they respond to and work with carers for those who are suffering from dementia, particularly if the Government’s policy is that ever more people should be looked after at home and not necessarily in care homes.

The PAC observes:

“There is unacceptable regional variation in access to diagnostic services for dementia and in access to dementia drugs…Local leadership is still lacking in NHS hospitals, in primary care and in the social care and care home sectors.”

That is a pretty damning conclusion. The PAC advises that every acute hospital should have a “senior clinical leader” by the end of this month, who should

“work with the new Care Homes Champion to develop dementia ‘Champions’ across the care home sector.”

That takes me back to my original point, which is that everyone wants to be confident that there are people in the system who have a grip and who provide leadership, whether in respect of an acute hospital trust, a social services department or within the care homes sector.

The PAC says:

“Most people with dementia receive their day-to-day care from domiciliary carers or care home staff, who have little understanding of dementia, which therefore puts at risk the quality of care and safety of some of the most vulnerable people in society. After six years of debate and discussion, plans to introduce registration of social care staff, many of whom are without qualifications, appears to have been abandoned. As a result these staff will remain unregulated for some time to come.”

It is not just a question of regulation; it is about staff being valued and appreciated, and about who takes the lead and who should be responsible for ensuring that we have enough domiciliary carers or care home staff who are properly and fully trained and who feel valued, just as nurses in a hospital feel valued. The work that domiciliary carers and care home staff do is crucial and invaluable in our society and deserves to be appreciated, valued and recognised. Registration should not be regarded as some sort of indictment. If there is registration, it should be regarded as a qualification that is considered worthwhile.

Lastly, like a number of previous reports, the PAC notes:

“There is inappropriate and excessive prescribing of anti-psychotic drugs for people with dementia, particularly those living in care homes, which has contributed to up to 1,800 additional deaths each year.”

That situation often comes about because care homes have to look after people with dementia with too few staff, and the only way they can manage the numbers is by putting patients on those terrible cocktails of anti-psychotic drugs.

An enormous amount of work still has to be done, and if we are to get a grip on it, there needs to be leadership from Ministers downwards. This is a growing issue—a growing challenge to us all, wherever we live in the country—and we need to ensure as a starting point that in future if the Government make pledges on dementia or other issues, those pledges are not broken.

It is a pleasure to serve under your leadership, Mr. Streeter, and to have the chance to speak in such an important debate. I congratulate my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) on securing it. Throughout this Parliament and his career, he has been a champion for older people and has led the debate on many issues regarding older people, particularly those unfortunate people suffering from the range of conditions that we term dementia, and their families and friends who also suffer.

I do not intend to make a long speech, because my hon. Friend and the hon. Member for Banbury (Tony Baldry) have already covered most of the salient points in their excellent speeches. I am sure that this will be our last chance before the election to debate the important issue of health and social care, so it is a chance to assess where we are with the national dementia strategy and what progress has been made during this Parliament. Equally—almost more importantly—all hon. Members have to call for whoever is in government after the election to make dementia a clear priority. I commit myself and the Liberal Democrats to that and to being part of it.

This is not the time for more warm words. It is time for a clear commitment to deliver and to work together to deliver: we are starting to do that more, which is positive. We have to do that because all hon. Members are committed to real breakthroughs in dementia. It is important to say that, and we all want to say it. It is about making a commitment—saying that it will happen.

I want to pick up a few points that have been made and to emphasise some of the questions that have been put to the Minister. First, there is ongoing concern about the apparent lack of prioritisation for dementia care and the fact that the recently published NHS operating framework did not refer explicitly to dementia, which was not considered to be a tier 1 priority, or even a tier 2 or 3 priority. Why is that? More importantly, will the Minister give the strongest assurance that it will be included in subsequent operating frameworks and will not suffer in the meantime from being excluded? Similarly, we have been told that the vital signs indicators have been laid out, but if there are new priorities for the nation’s well-being, why can those vital signs not be updated as we go along?

The second important area is research, about which my hon. Friend spoke strongly. I, too, have referred to it on several occasions. We have heard the figures and about the imbalance at the same time as the ticking time bomb of an ageing population and its effect on costs. It has been estimated that the cost of dementia in England will treble over the next generation from £17 billion to £50 billion. That is simply unsustainable, so clearly there must be an increase in the spending on dementia research. My question echoes that asked by my hon. Friend. Will the Minister indicate the outcome of the welcome ministerial taskforce meeting, and may we see the minutes? Crucially, what timelines do the Government envisage for increasing funding for dementia research? That is what we need to see. Will there be an announcement around the time of the Budget? I would warmly welcome that. If timelines were in place, it would be for other parties to say whether they would commit to them, and that would move the debate on in a way that we would all welcome.

I turn to some of the specific issues of the dementia strategy. My hon. Friend and the hon. Member for Banbury mentioned the NAO report, and I shall refer to a few of the concerns and criticisms. First, I recently referred on the Floor of the House to memory clinics. In the light of the apparent change in commitment, will the Minister confirm whether the vital services provided by specialist memory clinics will be available to some extent throughout the United Kingdom even if it is not possible to locate one in every town? Secondly, training remains an enormously important part of the strategy, and as hon. Members have said, we still have inadequate training on dementia care for health and social care professionals. Will the Minister give an assessment of what progress has been made, and explain what discussions he has had with the professional colleges, such as the Royal College of General Practitioners, the British Medical Association and the Royal College of Nursing, about developing the dementia care skills of health service staff?

Carers have rightly been an important part of the debate, and we have all spoken on many occasions during this Parliament about their huge importance. The hon. Member for Castle Point (Bob Spink), who is not now in his place, reminded us that if they were not caring for loved ones, friends and neighbours, there would be a huge additional burden on the social care sector and the NHS. The startling sum of £87 billion is the contribution that carers make our economy, but carers’ organisations remain deeply dissatisfied about whether the carers’ strategy is being implemented and the money that is specifically allocated goes to the key area of respite for carers.

The Princess Royal Trust for Carers estimates that only 80 per cent. of the money allocated has been used to support carers. It also pointed out the synergy with the dementia strategy and the end-of-life-care strategy in terms of the money being allocated, which is about £1 billion in total. That is simply not being spent on the purposes and important areas to which the Government allocated it. The trust made a powerful point when it said:

“There is a systemic failure in the way that Government attempts to implement or monitor the progress of national strategies.”

We all agree that national strategies are good, but if they are not being implemented and properly monitored, they will fail. None of us must allow that to happen.

Does my hon. Friend agree that a stark contrast has emerged from the National Audit Office’s work? The NAO gave a glowing report on the national stroke strategy’s progress and identified two key differences. First, the money for that strategy was clearly identified in advance and, secondly, clear national priorities were attached to it through the operating framework. Those are missing from other strategies, which his why there is systemic failure.

My hon. Friend is absolutely right, which is why there is concern that the strategies, which we all agree are important, are simply not biting or having the impact that we all agree they need to have. I note that 12 leading charities approached the Secretary of State for Health, offering to meet and to work together to share findings and to look for solutions. Unfortunately, that offer was not taken up. Will the Minister say whether that decision could be reconsidered, even at this late stage? I can commit the Liberal Democrats’ health team to working with leading charities in that way and to share findings and advocate solutions.

I pay tribute to my hon. Friend who has championed the cause against anti-psychotics. It remains a scandal that they are still used inappropriately from a health point of view and infringe the human rights of some of those for whom they are wrongly prescribed. Will the Minister update us on progress? Clearly, he and the Secretary of State take the matter seriously, so will he give us some firm timelines on when the use of such drugs will be ruled out once and for all in inappropriate cases? This is an important policy area to which we are all committed. We must look forward to the next Parliament, and I will certainly do what I can to continue to raise these issues, as will all Liberal Democrats. I hope that others will also do so. It is time to ensure that the dementia strategy delivers. Warm words are fine, but they must be turned into action and the real breakthroughs that we need.

I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this important debate, which succeeds a series of such debates in this House. I also congratulate my hon. Friend the Member for Banbury (Tony Baldry) on his predictably excellent contribution.

I welcome the opportunity to debate the dementia strategy today, and to keep up the pressure that we put on the Government in our Opposition day debate to ensure that funding for the strategy breaks free from Whitehall and primary care trust bureaucracy, and reaches patients on the front line, who live each day with the knowledge that their memory is gradually slipping away from them. Dementia is a debilitating and frightening disease, and those who suffer from it rightly want to know what action the Government are taking now to ensure that they may access appropriate care, and what research they are undertaking to discover new treatments for the disease.

It is right to pay tribute to the thousands of carers who look after loved ones, and to those charities that tirelessly campaign in the cause of those who suffer from dementia. As if a diagnosis of dementia were not enough to deal with, the last few weeks have added new cause for concern for those suffering from Alzheimer’s. In addition to the National Audit Office’s criticism of the Government’s implementation of the dementia strategy, news headlines have been filled with reports of the Government’s convoluted proposal for a death tax; the inappropriate tube-feeding of elderly and dementia patients in care homes and hospitals; and a rise in cases of malnutrition among older people in the NHS. Alongside that, there has been a political debate about how to tackle the decade-long silence from the Government on social care reform.

Against that backdrop of existing problems surrounding dementia care, we must acknowledge the scale of the challenge ahead. Of the 8.2 million people aged over 65, and the 6 million people using social care, there are currently 700,000 people diagnosed with dementia in the UK, and that figure is set to double over the next 30 years. As we consider how we might deliver better care to dementia patients, it is important to remember that without wider social care reform, the needs of dementia patients will remain unmet.

It is not only the Opposition who have concerns about the Government’s implementation of the dementia strategy. As we have heard, the NAO report published in January criticised the Government on several counts for their actions since the publication of the strategy. To my mind, the NAO’s findings raise three pivotal concerns. The first concern is the lack of accountability in place to ensure that PCTs spend the £60 million from the strategy for 2010-11 on dementia services. We need only look at the recent carers strategy to see how urgently that accountability is needed. Before Christmas, it emerged that the £50 million dispersed for emergency respite care this year hardly reached the front line, having been soaked up by local PCT bureaucracy, and we have had some exchanges on that.

Given that disturbing precedent, I hope that the Minister will tell us how the Government intend to ensure that they keep a grip on the allocation of resources that have been identified and earmarked for the dementia strategy. During the Opposition day debate, the response by the Secretary of State for Health was deeply worrying. On the dementia strategy, he said that he had

“given PCTs the freedom to determine their spending based on local needs.”—[Official Report, 27 January 2010; Vol. 504, c. 831.]

Although autonomy for PCTs should be promoted, that does not mean that the Department should lose track of local spending decisions and have no capacity to check how central funds that are assigned for specific purposes, such as dementia, have been spent.

When the Minister, the hon. Member for Sutton and Cheam and I met the Princess Royal Trust for Carers last week, I was pleased to see the Minister make a U-turn on his line that it was up to each MP to chase up their own PCT on the issue of the carers strategy funding. [Interruption.] The Minister laughs because he is embarrassed, but he said that the PCTs would now be directly accountable to him, and the hon. Member for Sutton and Cheam was there to witness that. It is important that the Minister takes the opportunity to shed some light on how PCTs will be expected to report to him, and tells us what measures he will introduce to ensure that the accountability now in place will be maintained in the long term.

I thank the hon. Gentleman for mentioning that important point. Although it is incumbent on the Minister to spell out how he will ensure that accountability, given the proximity of the general election, surely it is incumbent on us all to say how we will ensure that the money gets to the front line. Will the hon. Gentleman do that?

The hon. Gentleman is right to ask me about that. If there were time to do so, I would be more than pleased to develop that point. [Laughter.] Suffice it to say, before the Minister has complete hysterics, that the NHS board and the NHS autonomy and accountability Bill, which will be introduced in the first year of a Conservative Government, would be the chaser and enforcer of such matters. That is what is so absent from the Government’s plans—they give headline announcements but have nothing to chase them through, so the accountability fails.

I hope that the Minister will take that point seriously, rather than seek to laugh it off, and that we can move to the second concern, which is the vagueness with which the dementia strategy laid out its funding sources for the next decade. 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 £1.9 billion budget unaccounted for. The Government have yet to give a detailed indication of where the money will come from, and I hope that the Minister will provide details on that. Clearly, those savings have already been announced, and we do not need to wait for the Budget for them—that is the normal cover claimed by Ministers at the moment. There is an opportunity this morning to put those details on the record at last.

The third concern with the strategy was highlighted by my hon. Friend the Member for Banbury and also mentioned in the NAO report; it is the Government’s need to tackle the gaping hole in the skills set of all professionals who encounter dementia patients as part of their job. We sought reassurance on that matter during the Opposition day debate, and the Secretary of State said that he had commissioned Skills for Health and Skills for Care to assess training needs. However, he did not specify whether the Government were looking specifically at dementia training or at the broader work force agenda, and I hope that the Minister will take the opportunity to clarify that point.

The hon. Member for Sutton and Cheam mentioned the important issue of the evolving discussion that started with the early-hit headline announcement of memory clinics in every constituency. That was downgraded to memory services, and then to services that seem to exist already, mainly psychiatric services and centres. Perhaps the Minister will update us on where he has got to with putting a memory clinic “in every town”, to be precise with the quote. Let us see whether the strategy has been delivered on and has fulfilled the hopes that were raised by the headlines that were secured by the Government’s announcement.

Dementia research is another vital area. We must ensure that we match the commitment to research—particularly where that research has Government funding—that involves tracking the anticipated and known demography coming down the track. We have pledged to give greater priority to research on dementia and Alzheimer’s within Government research budgets, and we hold to that pledge. Hopefully, that will be matched, and I am encouraged by the Government’s more recent announcement of a new ministerial group on dementia research. It would be helpful to find out what progress has been made to date—I think that there has been a meeting—and to learn what support is on offer. We can then ensure that our research, which is world-class and in which we are leaders, can be capitalised on, so that benefits to patients can be developed and accelerated.

I come to a point that has not yet been mentioned, but which is vital. We recognise—uniquely at the moment, although we would be more than happy if other parties were prepared to match the pledge—the need to widen the remit of the National Institute for Health and Clinical Excellence. It should include not only cost and clinical effectiveness in its assessments, but the wider societal cost, which is vital. That would require primary legislation, and we have been calling for that change for four and a half years. The best example is, of course, Aricept, which can postpone, and therefore relieve, many of the early onset needs of Alzheimer’s patients, thereby postponing the time when a much greater care package needs to be found.

We have sought to look at the problem of residential care, but the fear of going into residential care needs to be addressed. Tony Blair identified that issue in 1997, but it has not been addressed for 13 years. The arguments for our home protection scheme have been well rehearsed, so I will not rehearse them again today. The scheme seeks to address that element of the care requirement, which is something that particularly affects dementia patients because so many end up going into residential care. That is why the issue is of such vital importance.

In this debate, and as we come to the end of this Parliament, there is an opportunity to hold a stocktake, and I make no apology for doing so. We have heard a lot of promises from the Government, and a considerable number of headlines have been generated. However, despite the warm words and the other utterances that secure headlines—that is the result of any ministerial announcement—it must be right to hold the Government to account, and to ask them to report on how they have delivered, rather than simply promised, not only on the dementia strategy, but on other strategies allied to it. In the 11 minutes that the Minister has in which to reply, he has the opportunity to report on the delivery of those strategies, rather than simply on the promises.

I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing the debate. We have debated social care and dementia issues on many occasions, and it is always a pleasure, as the Minister responsible for care services, to come to the House to describe the huge progress that we have been making in recent years and our ambitious plans for the future.

Dementia is a devastating disease. It is a disease of the present, which affects many people—more than 700,000. The hon. Gentleman mentioned a higher figure; either way, many people have the disease. It is also a major disease of the future, as other hon. Members noted. The number of dementia cases is set to double within a generation. However, I emphasise that it is not a disease without hope. There are many ways in which we can support people with dementia. It is possible for people to live and to live well with the disease, rather than just die from it. That is one reason why we must challenge the stigma and fear attached to it, and the awareness campaign that we launched last week is set to do that among the public and professionals alike. That is the spirit in which the dementia strategy was developed—to empower and support individuals, families and carers to live full and rewarding lives in the face of dementia. That is why I am determined to implement the national strategy quickly, effectively and in full.

Let me be clear: dementia has been, is and will continue to be a priority for the Government and for me personally. I was delighted to see that that was noted clearly by the National Audit Office report. It measured progress in terms of the fieldwork five months into our five-year strategy, and I was pleased that it said:

“We found strong direction and national leadership for the Strategy by the Director General for Social Care… Departmental leadership throughout development of the Strategy was judged as excellent by most stakeholders.”

Today’s Public Accounts Committee report describes the national and regional leadership as “strong”. Indeed, the Chairman of the Committee, the hon. Member for Gainsborough (Mr. Leigh), summed up at the end of one of the oral evidence sessions by congratulating the witnesses, particularly Mr. Behan,

“because I always like to congratulate witnesses who show drive and vigour”.

I could not agree with him more, so I would like to take this opportunity to say that, everywhere I go, I see passion, pace and drive in making change happen. The result is that we are seeing real progress and are firmly on track to deliver the strategy that I had the privilege to publish just over a year ago. The past 12 months have been about an active process to lay the foundations for a major shift—a major cultural change—as much as a change in the practice of health and social care professionals.

The considerable advances that we have made during year 1 of the strategy will put us in a strong position to transform services in years 2, 3, 4 and 5, and I want to place on the record the progress that has been made. There is strong direction and leadership of the strategy, both nationally and regionally. We have an implementation plan in place to lead the reform process. We have a strong governance structure, with a programme board, a working group and an external reference group, driving forward reform and keeping close tabs on progress. We have strong leaders in place nationally. The first ever national clinical director for dementia, Professor Alistair Burns, was appointed in January. Ian Carruthers, chief executive of the South West strategic health authority, and Martin Green, chief executive of the English Community Care Association, are national dementia champions for the NHS and the independent sector respectively. All three of those national leaders are working to inspire greater ownership and better leadership across health and social care.

We have deputy regional directors of social care working to secure local buy-in and providing advice to local organisations. There is also clear and substantial action to raise standards and improve knowledge. Forty demonstrator sites have been set up around the country to consider how dementia advisers and peer support networks can help families to obtain the support that they need. I have met many families who find those forms of support very important.

Could I ask the Minister to address the real concern, which is about the money getting to where it is needed, and given that I have asked several other questions that he probably will not have a chance to answer today, will he write to me to answer them?

I will do my best to reply to the hon. Gentleman today in the time allotted to me. Regional baseline reviews were completed in the autumn, paving the way for detailed local dementia plans. He asked whether they would be received this year. Yes, I hope so. They will be delivered as we start the new financial year. New joint commissioning guidance was published in June. That addresses the point made by the hon. Member for Banbury (Tony Baldry) about how accountability and responsibility have to be shared locally, because it is health and social care that meet the needs of people with dementia. Joint commissioning is the answer about how we ensure that local partners work together to meet the needs of patients and their families.

An online dementia portal has been established to capture and disseminate best practice with regard to the complex number of organisations involved in providing dementia services. The sector skills councils—Skills for Care and Development and Skills for Health—have embarked on a mapping exercise considering training opportunities for professionals working with people who have dementia to address the specific question that I was asked. It is also considering the gaps that may exist.

An earlier area for action is the work that we are doing with the Royal College of General Practitioners—the point about GPs was raised during the debate—to develop new training materials for GPs to raise their awareness and understanding of patients who may have early signs of dementia.

We have accepted the conclusions and recommendations of the anti-psychotics review, including the call for a two-thirds reduction in the use of anti-psychotic drugs. Professor Alistair Burns, the new national clinical director, will lead on implementing those recommendations, starting with a full audit of prescribing practices. We want that completed by this October, to answer the question from the hon. Member for Sutton and Cheam, so the two years will be to October 2012.

We are also boosting public and professional awareness through the dementia awareness campaign that we launched in partnership with the Alzheimer’s Society a few weeks ago. I hope that many people will have seen the adverts and the TV campaign, which are doing a great job.

On research, I have set up and chaired the first meeting of the new ministerial group to improve the quantity and quality of research submissions competing for the £1.7 billion of research funds available from the National Institute for Health Research and the Medical Research Council. At the first meeting, I made clear my intention to issue a research call in the future to invite new bids for dementia research covering the causes, cures and care of people suffering from this disease. I will ensure that hon. Members see a copy of the minutes of that meeting. It was a very good meeting. The charities that have been mentioned are involved as partners, and five work streams are under way.

I make no apologies for that long list. I know that others wish to describe us as not having got on with the process of delivery; I am demonstrating thoroughly just how much we are doing that.

Let me deal with one or two other points that have been made. On funding, I have said that dementia is a complex disease that spans health and social care, and we have a variety of levers involving a variety of organisations to achieve the change that we want to see locally. There is cross-party consensus that we should not make it a mandatory requirement in the national operating framework or return to ring-fenced funding. I do not think that anyone has asked for that today. I think that that is right. However, I can confirm that the operating framework of 2010-11 continues to refer to the dementia strategy, building on the recommendations in the 2009-10 operating framework that PCTs should prioritise improvements to local services for the early identification of and intervention in dementia and that PCTs should work with local authorities to consider how they improve those services.

Furthermore, the new QIPP—quality, innovation, productivity and prevention—programme will guide the NHS through the savings that it needs to make over the next five years, and that will cover dementia services. The world-class commissioning programme will continue to enable the NHS and social care to commission the right services.

Most important of all is winning the hearts and minds of people locally, which is what all the people whom I have mentioned, including those leaders in and outside the Department, and I are doing with energy, determination and success. We have given the NHS freedom and flexibility. It is right—I think that the hon. Member for Eddisbury (Mr. O’Brien) referred to this—that it has that freedom and flexibility, but it needs to be held to account for its progress. Therefore, we are conducting a full review of progress through a national audit of dementia services. That will examine the number of dementia leads in hospitals, the number of memory services established and the use of anti-psychotic drugs. We expect the first results to be available by the autumn. The audit will consider how money is spent on dementia services as a whole—not just the £150 million, but the £8.2 billion being spent on health and social care for people with dementia.

We are taking this issue forward. I am proud of the work that we have done as a Government. I look forward to being here in June to report further on the progress that the Government have made in meeting the needs of people with dementia.