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The Minister of State, Department of Health (Lord Warner): My Lords, I congratulate my noble friend Lady Gale on securing this debate. I welcome the opportunity to debate such an important topic and the constructive and practical debate that we have had. I am not sure whether I will be able to respond to all the noble Earl's shopping list, but I will do my best.
I understand the seriousness of the condition, as my mother suffers from Parkinson's and I have seen the impact of it on her daily living and communications skills issues. I understand the practical consequences of this particular condition. I identify with the story that the noble Earl told and the other concerns that have been expressed about what happens to medication on admission to hospital. I can identify with that because I have had similar experiences in relation to my own mother. It is a very difficult issue when people go into hospital; older people in particular can go in in an emergency for something else, but what then happens to their medication on the point of admission and in terms of getting people to keep their Parkinson's medication balanced?
Last week was Parkinson's awareness week. I wish to start by recognising the importance of raising public awareness of the issues most important to those who live with the disease; not just the people who have the disease, but their carers and families too. I pay
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wholehearted tribute to the Parkinson's Disease Society for the important part it plays in providing support, advice and information to people who live with Parkinson's every day. The society is an essential part of the support and care that is now on offer in this country, and it should be proud of the work that it has done in recent years.
The background to today's debate is the transformation of care, particularly for older people. Although Parkinson's can afflict younger people, it predominately affects people over 50: both men and women. Before turning to some of the specific actions to help people with Parkinson's disease, let me say a few words on the improvements in support for older people at home, which benefits Parkinson's disease sufferers. Older citizens have been first in line to benefit from health and care reform.Homes with home care are up 52 per cent since 1998–99. The number of older people helped intensively to live at home has increased steadily from 23 per cent in that year, to 32 per cent in 2004–05, exceeding the target of 30 per cent by March 2006. People are having to spend less time in acute hospitals, which is good for them and better value for money.
Those successes are very much the result of implementation of our idea that, for most people, the best care home is their own home. We have made this possible through free nursing care in all settings including the individual's own home achieved in October 2001, paid for by the NHS. There is free community equipment and intermediate care services from social services and rapid assessments for social care services, so they begin within 48 hours and are completed within four weeks. Following assessment, the services people need should be in place within four weeks.
I turn to some of the specific measures to assist people living with Parkinson's and shall respond to some of the points made by noble Lords. First, I shall deal with the National Service Framework for Long-term Conditions. We take the needs of those living with long-term neurological conditions, such as Parkinson's disease, seriously, and have ensured support for the future through the framework. It focuses on improving services for people with neurological conditions across England. People with those conditions will get faster diagnosis, more rapid treatment and a comprehensive package of care under the NSF. In addition, all people with long-term conditions will be supported to live as full and independent lives as possible. It is an ambitious plan, and I acknowledge that we will not achieve it overnight because it is a 10-year plan.
We have commissioned NICE to produce a clinical practice guideline on Parkinson's disease for the NHS in England and Wales in consultation with stakeholders. A number of noble Lords mentioned that. I understand that the current draft deals with the issue of access to specialist nurses.
The subject of research came up a number of times during this debate. We are continually striving, together with the Parkinson's Disease Society, to find
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a cure and a treatment for those with Parkinson's disease. As the noble Baroness, Lady Finlay, said, this is a difficult area of research. At present, the medical profession has no means of curing Parkinson's disease or preventing it developing, but we hope that through research we may one day find the answers. For now, it is possible only to minimise symptoms through medication and offer comprehensive support through our health and social care services.
I shall respond to the point made by the noble Baroness, Lady Barker, about the £20 million research initiative. We established it to speed up the development of new medical treatments for dementia and neurodegenerative disease. The dementias and neurodegenerative disease research network will be led by teams from University College, London and the University of Newcastle-upon-Tyne. We are funding that work. I cannot say today how far that network extends outside the UK, but I shall look into that point, which was raised by my noble friend Lord Harrison.
My noble friend Lady Gale and other noble Lords raised a number of issues about medicines management. We agree on the need to ensure that medicines are managed properly. I accept that ensuring that patients receive their medicines at the correct time to maintain control of involuntary movements is critical for the effective management of Parkinson's disease. On average, patients take their medicines four times daily, but some patients need to take them as many as 14 times daily. Making sure that that happens in hospital is undoubtedly challenging. A new scheme is being piloted where people in hospital who have Parkinson's disease will access their medicines from their own locked cabinet and will self-medicate. The scheme was developed following feedback from 250 service users that showed that only 52 per cent of patients received their medicine at the correct time. The Healthcare Commission has made medicines management one of the three key targets of inspections this year. The inspections will include a patient satisfaction survey that will identify the extent to which patients can self-medicate from medicines under their control.
I reassure the noble Baroness, Lady Barker, that the Department of Health is providing funding to improve medicines management through the team based at the national prescribing centre, which has been helping NHS organisations improve their medicines management services since 2001. The Medicines Management Collaborative has worked with 146 PCTs throughout England and has 44 trusts currently participating in the programme. The community pharmacy framework collaborative has 28 host PCTs participating in the programme, together with a number of associate PCTs and the integrated medicines management programme currently has 25 trusts participating. That sounds very complicated, and I will confirm it in writing if noble Lords want more information, but it shows that there is a lot of activity in this area to secure improvements.
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The noble Baroness, Lady Gale, and a number of other noble Lords raised the issue of prescription charges. In 2004–05, 87 per cent of all prescription items dispensed in England were exempt from prescription charges. Over the same period, prescription charges raised £422 million for the NHS. The majority of Parkinson's disease sufferers are exempt under age exemptions in these circumstances. Since its introduction in 1968, there have been numerous calls to extend the list of medical conditions that are given prescription charge exemption to include all other medical conditions. These have never produced a consensus. Most recently the matter was looked at in 1998, but we have no plans to emulate the position in Wales.
A number of noble Lords have raised the issue of access to Parkinson's disease nurse specialists. As my noble friend Lady Morgan said, there are currently 200 Parkinson's disease nurses across the United Kingdom. We commend the work of the Parkinson's Disease Society in this area and its aim to recruit 30 to 40 new specialist nurses each year, with the eventual aim of ensuring that all those with Parkinson's disease have access to a specialist nurse. This is in addition to the initiative taken by the Government through the national service framework. I can reassure my noble friends that we support maximising the use of the specialised skills of Parkinson's disease nurse specialists. That is certainly our wish but I cannot give an absolute assurance that every PCT in the country will take notice of what the Minister says in this House.
We agree that there is a need to continue working to improve the support and services provided for carers. I am grateful for the supportive remarks of the noble Earl, Lord Howe. My noble friend Lady Morgan has mentioned the expert carers' programme, which we intend to expand. I recognise that that idea was not thought up in Whitehall but was brought to us by the Alzheimer's Society. Carers who work with patients or users of social care are working with people whom they love very much and whom they want to support in ways that best suit the person with Parkinson's and their family. However, they are often denied information about how best they can help. That is why we want to expand the expert patient programme and the expert carers' programme, to develop these kinds of networks and provide a stronger basis of support.
We have done a lot for carers and I want to underline the fact that we will continue to provide that support. In the time available, I cannot say any more about some of the issues that are in play here. We accept, however, the need to expand and develop the carers' strategy and we have committed ourselves to doing so. We do not have a firm date by which that will be published because we are continuing to work with carers themselves so that we can get it right for them.
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It is worth saying a few words about a point that has arisen now and again, which concerns improving the knowledge and understanding of health professionals in this area, including GPs. One example of the way in which care staff are supported is a project called Prodigy, which is an online, up-to-date, interactive, decision-support system. It is a source of clinical knowledge that can help healthcare professionals and patients to manage the common conditions generally seen in primary care and first-contact care. It is interesting that the section of Prodigy devoted to diagnosis, treatment and management of Parkinson's expressly recommends the Parkinson's Disease Society as a source of information and support. That is an example of how the society and its programmes are well and truly embedded in our health and social care systems.
A number of noble Lords have mentioned the White Paper Our health, our care, our say. I do not have time to go into great detail on this other than to say that it will address many of the concerns that have been expressed about the need for greater support for people with long-term conditions. The White Paper will produce a major change of emphasis and a major change in the use of resources.
I say to the noble Baroness, Lady Barker, that the new primary care trust reconfigurations will be announced shortly and will be in place by 1 October. Part of the challenges that trusts will continue to face is ensuring that practice-based commissioning not only is rolled out by the end of this year, which is our commitment, but will start to produce some real benefits. The purpose of practice-based commissioning is to bring commissioning of services closer to patients so that their family doctor, the primary care services, can respond to their needs. That should be a continuing benefit to people with long-term conditions such as Parkinson's.
The noble Earl, Lord Howe, and, I think, others mentioned pharmacists' contribution. He is exactly right; they have a big role to play, and the new pharmacists' contract will facilitate a more prominent community role for pharmacists in helping patients.
I do not have time to make more extensive remarks, so I will respond in writing to the points that I have not covered. I hope that the noble Baroness, Lady Gale, will agree with me that the Government have recognised the issues important to people living with Parkinson's and are attempting to tackle them on a co-operative and partnership basis with bodies such as the Parkinson's Disease Society. I believe that the initiatives I have described will help to make life better but I also accept that there is still a long way to go and that we need to work together at helping people to cope with this difficult disease.
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