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1 Apr 2009 : Column 250WH—continued
Those who have spoken mentioned early diagnosis, and I absolutely agree. I understand that the strategy was that memory clinics should be provided in each area. There is controversy, a road down which I shall not go, about whether it is to be delivered by polyclinics—the polyclinics are the controversy. The view seems to be
emerging that it is the GPs’ surgeries that should provide the memory clinics. With a high proportion of single-handed GPs coming up to retirement, I wonder precisely where the services for diagnosis and continuing general practice care will be based and how they will be funded. How are the primary care trust, the local authority and the voluntary and charitable sectors to be involved in providing the services that flow from those diagnoses?
Although I am focused on my constituency, I do not want to generalise from the particular. We have one large health facility in Beckenham, but that does not solve the problem of a potential lack of GP services for diagnosing Alzheimer’s. I hope that the Minister can give us much more detail on how the memory clinics are to work, where the Government envisage them being based, who is to run them and how they are to be funded.
Unlike other Members, I am not entirely wedded to the idea of ring-fencing, as it could work against my constituents. As I said, my constituency has a higher proportion of older people than many others. I would therefore prefer to rely on quality appointments to the PCT to achieve properly managed health services. We already have properly qualified councillors—they are elected—but we need a PCT with a clear view of how it should be spending its money and we must be aware of the potential lack of diagnosis resulting from the structure of the GP service.
Jeremy Wright: My hon. Friend will have heard me say that I do not object to the principle of local authorities and PCTs having discretion on how to spend their money. My point was that if the Government suggest to the wider dementia population that £150 million can be spent on the national dementia strategy, that is what should happen. However, it may not be the reality.
Mrs. Lait: I could not agree more with my hon. Friend. If the Government are making promises about how much money they are prepared to provide for such services, they should stick to them. Yesterday—the day before the new schools budget came into effect—I had the ghastly experience of finding that my senior schools were losing 3.2 per cent. of their sixth-form budget. That is because the Learning and Skills Council is in such a mess, although that, however, shows the state of Government finances.
I am grateful and delighted that my hon. Friend agrees that we do not want PCTs to have ring-fenced budgets. If the Minister enlightened us on how he expects the demographic problems in the GP service to be addressed so that memory clinics may be provided, I would be most grateful.
10.18 am
Tim Farron (Westmorland and Lonsdale) (LD): It is a pleasure to serve under your chairmanship, Mr. Bercow, and I echo the words of the hon. Members for North-West Leicestershire (David Taylor) and for Rugby and Kenilworth (Jeremy Wright). I congratulate the hon. Member for Rugby and Kenilworth on securing the debate and on his work on the matter in recent times as chairman of the all-party group, of which I am a vice-chair.
I endorse what has been said. I shall not repeat the arguments already made on the broader dementia strategy, but focus on a particular element of dementia. It relates
particularly to the care of people with dementia in the national health service. I shall centre my brief comments on my experience of the problem in south lakeland and the Morecambe bay health area.
The reality, as we have heard, is that the majority of people who live with dementia are cared for and supported in their own homes. Many others are supported within an institutional context only so far as they live in residential or nursing homes. Hospitals are not the right places to care for people with dementia. In recent times, health trusts across the country have been closing down dementia wards and moving that care into the community. That is laudable, up to a point.
I am worried that the baby has been thrown out with the bath water. Hospital wards have closed, but, in my area at least, commensurate care in the community has not replaced it. Ward 2 at Westmorland general hospital was closed about 18 months ago on the promise that the Cumbria mental health partnership trust would provide significantly increased support in the community for people living with dementia. That care was to be provided in collaboration with, in particular, the Alzheimer’s Society in south lakeland and the local branch of Age Concern.
A good year after the closure of ward 2, I, and the chief executives of the local branches of the Alzheimer’s Society and Age Concern, met with the chief executive of the mental health partnership and extracted the admission that the trust had not kept its promise to provide that care in the community. Essentially, it had dumped people out there without the support that they desperately needed.
It has taken so long to put this strategy in place and to deal with mental health issues in general, partly because mental health is such a taboo. It is not talked about because it is unglamorous, and we allow those who make decisions about our health service and the care of people with dementia to relegate these issues down the list of priorities. That is not acceptable. However, when ward 2 was threatened with closure and when another ward for adult mental health non-dementia sufferers was temporarily closed, 4,000 people took to the streets of Kendal to protest, so I am extremely proud of my communities, because the majority of people will not personally have been touched by mental health conditions.
There is growing awareness that mental health is not a taboo and should not be written off. We need to prioritise the care of people with such conditions, especially dementia. We must not see care in family homes as a cheap option, nor simply pass responsibility to the care home sector. As we have heard, the caring profession is held in low esteem and suffers from massive staff turnover. Care homes are run by dedicated people, supported by wonderful staff, but often they lack the necessary qualifications. The experience, therefore, of people with dementia cared for in homes can be shockingly poor—let us be perfectly honest.
We cannot overlook the reality that people with dementia will enter hospital for reasons other than their dementia. At Westmorland general hospital, one third of patients in the Langdale unit and other medical wards have dementia but are there for other reasons, whether strokes or other cardiovascular and medical
conditions. They therefore need not only treatment for their medical condition, but specialist care. That is a great problem.
Nurses on the Langdale unit—they are wonderful but are experts in other fields—have to spend all their time caring for people with dementia, so they cannot give their time to those who do not have that condition. At the same time, however, those with dementia are not receiving the necessary expert care. Next door are two mothballed wards, one of which could, and should, be opened to provide medical care for people with dementia—not to allow them to bed-block, or to allow it to become a new, institutionalised provision, but to ensure that those who have dementia but are in hospital for other reasons are properly supported.
In enacting the national dementia strategy, I call on my NHS trusts to provide that necessary support locally, and more broadly on the Government to put the care of people with dementia at the top of the agenda. They must make training and the provision of expertise paramount and ensure that the overriding focus is on the quality of the experience of people living with dementia and their families and carers.
10.25 pm
Greg Mulholland (Leeds, North-West) (LD): It is a pleasure to serve under your chairmanship, Mr. Bercow. I echo hon. Members in congratulating the hon. Member for Rugby and Kenilworth (Jeremy Wright) on securing this debate and pay tribute to him for his work and the leadership that he shows in the House through his chairmanship of the very successful all-party group on dementia. It is an example of how we can work together across all parties and have an impact in pushing an important issue further up the agenda.
I am proud to be a member of the all-party group, but I pay tribute to those who have been members for longer, including my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) and the hon. Member for North-West Leicestershire (David Taylor). They play a full part in the work being done.
The debate is important, particularly given the attempts already described to secure a debate in Government time on the Floor of the House. I echo the disappointment expressed that we did not get that debate, but it is perhaps fortuitous that we have secured this one now—the Leader of the House first said that we might have a topical debate, then that we might have a Westminster Hall debate, so goodness knows what the answer would have been if we had asked again. It is a relief, therefore, to have the debate today.
Our debate is timely because, I think, the first board meeting of the national dementia strategy programme took place yesterday. If so, I would be interested to hear from the Minister how it went. All of us here today, and other colleagues who would have liked to join us, are committed to, interested in and passionate about this area of health care—I include the hon. Member for Guildford (Anne Milton) and the Minister in that.
I, and my party, warmly welcome the national dementia strategy, which is clearly a huge step forward, as I have made clear before, and its importance to people and their families has been well put by hon. Members.
However, we—this includes the Treasury and the taxpayer—also have to take seriously the cost of dementia care, which is estimated to rise to more than £23 billion by 2018. One in three over-65s, whom we classify as “older people”, dies with dementia, and I am sure we all agree that this set of distressing conditions has not been the focus of attention that it should have been.
Of real concern—this echoes comments about the need for early diagnosis—are estimates that two thirds of people with dementia are undiagnosed, so the problem is far greater than the figures suggest.
I shall pick up on a few points that were made so well by the hon. Members for Rugby and Kenilworth and for North-West Leicestershire. It is great that we have this strategy, but the crucial questions now are about how it is implemented and its effect. Although it is right to incentivise the Department of Health, and the NHS more broadly, particularly through primary care trusts, it is important to push for local area agreements, so that we can see what the national dementia strategy means for localities.
The hon. Members for Beckenham (Mrs. Lait) and for Rugby and Kenilworth made welcome contributions on how the strategy will affect their local areas. It is important for every area to take ownership of the strategy, and I would welcome hearing the Minister’s views on the matter. Moreover, I urge him to say when we will finally get a review on anti-psychotic drugs. Concern has been expressed on that enormously important subject.
Today, the new inspection regime begins, and we all hope it will lead to a better inspection framework with a focus on care wherever it happens. At times, we have been let down by failures in the inspection regime. Such failures were highlighted last week in a debate on the situation in our care homes.
Improving awareness of the condition is, quite rightly, an important part of the strategy, but it does not yet have enough flesh on the bones. None the less, the £4.5 million investment is welcome. Will the Minister tell us how, as the strategy unfolds, such money will be used and targeted to raise awareness?
Let me turn to the important area of training for care home staff and GPs. It is worrying that GPs still say that they are not sufficiently trained to diagnose dementia or suggest pathways of care. Clearly, that must be tackled. Again, I echo the comments of other hon. Members that, although we must allow local areas to show initiative and take ownership of the strategy, we need a national framework and a truly national strategy for training, so that we can be confident that all staff who deal with dementia sufferers are properly trained.
The other issue that has been eloquently covered in the debate is funding and the £150 million that the Government have found for the strategy. Again, I echo the concern that this money, welcomed as it is by all the relevant organisations and all the parties, will not be enough to deliver the strategy for the full five years. Going back to an earlier contribution, I believe that we must ring-fence the money. I echo the comments made by the hon. Member for Beckenham that we do not want to dictate how money is spent, but that money must be spent on dementia care and services in each area. That is fundamental.
As for accountability, what will be in place to ensure that the Minister and his colleagues can come back here and tell us that the PCTs are spending the money on services? We will not tell them how to spend the money, but we need to know that they are spending it on dementia care and services. We must have that accountability and know that the money is going through to local areas and being spent on exactly what we have been promised.
My final point is negative and an issue that I raised recently with the Minister on the Floor of the House. What is in the strategy is generally excellent and a positive step forward, but the issue is what is not there, by which I mean research funding. The Government invest eight times less in dementia research than in cancer research. I am not for one minute saying that less money should be spent on cancer, but such figures mean that we spend £289 on every cancer patient in the country and only £11 on every Alzheimer sufferer. We must face up to the reality of the problem.
Professor Simon Lovestone, from the Institute of Psychiatry at King’s college London, said:
“In the next five or 10 years there is a good chance of having treatments that slow down the rate of progression of Alzheimer’s disease.”
That is excellent news, but he goes on to say:
“If it fails, we are heading for the most unmitigated disaster. We need these drugs to work”.
Rebecca Wood, chief executive of the Alzheimer’s Research Trust, has warned that if we do not have more funding now, the economic consequences will be dire. The simple reality is that the lack of funding for research means that the impact of this excellent strategy will be limited.
I hope that the summit on research funding happens soon and that the Minister can tell us when that will be. We must have a commitment to more funding now for this complex set of conditions if the strategy is to have the impact that we all want it to have. I ask him to give us some good news today. Then we will be able to feel that the strategy will have a huge impact over the next few years.
10.36 am
Anne Milton (Guildford) (Con): I congratulate my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright) on not only securing this important debate but the fantastic work that he has done with the all-party parliamentary group. Many of us come here to make a difference, and there is no doubt that he will have made a difference for dementia sufferers and their families, friends and carers.
I share my hon. Friend’s disappointment that the Government have not allowed time for such an important and significant issue. None the less, I, too, welcome the strategy. I want to pay tribute to high-profile people such as Terry Pratchett, who have a much greater impact, possibly than they ever imagined, on highlighting some of the issues related to dementia. I also pay tribute to all the families and carers around the country who save the Government, as I am sure the Minister is aware, literally millions of pounds in delivering care to people with dementia. They are unsung heroes. As has already been pointed out, they are often older themselves and have to care for sufferers in very difficult circumstances, often without support.
The hon. Member for North-West Leicestershire (David Taylor) made a very moving speech about care and caring. I pay tribute to my own branch of the Alzheimer’s Society in Guildford and all the other voluntary bodies which give support, care and money. There are more than 100 different forms of dementia, with Alzheimer’s being the most common, accounting for just over a half of all cases. A significant minority of people suffer from vascular dementia.
One person every three minutes is diagnosed with dementia. It is a life-shortening illness with an unpredictable life expectancy. The disease can progress for up to 10 years, with an average of around six years, which places a burden on families who often have no idea of the course that the disease will take. Although one in three people over 65 will die with dementia, the UK is in the bottom third of Europe for dementia care. A third will need institutional care; yet if we consider it the other way around, two-thirds of people in care homes have, or will have, some form of dementia. The hon. Member for Pudsey (Mr. Truswell) raised the issue of younger people with dementia. Although we tend to concentrate on the over-65s, it is important to note that 18,000 people under the age of 65 have dementia in the UK.
My hon. Friend mentioned anti-psychotic drugs. As the Minister is aware, that issue has been rumbling on for some time. The all-party parliamentary group produced an important report on the matter and highlighted some of the issues. Research shows that such drugs double the risk of mortality and treble the risk of stroke. It is disappointing that the Government have dropped their investigation into the use of antipsychotics, which it promised to publish alongside the national dementia strategy. I would be grateful if he clarified the situation and tell us exactly when it will be published. Spring is here—we are in British summer time—and my daffodils are out, so if he says “spring” again, I shall get very angry. What does he mean by “spring”? Are we actually talking about summer?
Up to 400 care homes for the elderly and mentally infirm have closed in the past four years, as was mentioned. There is therefore a concern not only about the provision of places for those who need them, but for the provision of places in locations where people can be visited by family and friends. The hon. Member for North-West Leicestershire mentioned the crucial issue of carers. Carers themselves need care and, often, temporary respite care can be a vital lifeline to ensure that they can continue to care.
We have not talked much about drugs, in particular for the early stages of dementia. I pay tribute to the many people who have campaigned on the issue. My party and I believe that it is only right that the National Institute for Health and Clinical Excellence reflects wider societal costs when it makes judgments about new drugs. Again, that could transform outcomes for people in those early stages.
The swan-song of the Healthcare Commission was a report into older people and mental health. Although it welcomed much of the practice in the country, the report showed that older people were often unable to access the full range of services, including out-of-hours and crisis services and psychological therapies. Those crisis services can be crucial, especially given that those caring for dementia sufferers are often older people.
The report showed that older people are often prevented from accessing care because of stretched services or a lack of age-appropriate care and talked about the fact that the number of over-65s is set to increase by 15 per cent. by 2019 and that the number of people with dementia is set to rise by more than 1 million by 2025, as has been said. It also highlighted the importance of making services for those groups accessible and robust enough to cope with those statistics.
The report is lengthy, but it highlights other important issues. It says that the integration of health and social care is very patchy. In no other area is it more important for those to be integrated, yet we still see people working in silos and being protective of their budgets, unwilling to pool them and their resources. The report states:
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