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10.29 am
Mrs. Margaret Ewing (Moray): I shall be brief, because I realise that there are time pressures, and I am sure that the hon. Members who have sat through this debate will be interested to hear the Minister's response to the very eloquent requests that have been made. I congratulate the hon. Member for Dunfermline, West(Ms Squire) on the service she has performed for the House and for the community by initiating this debate, and on the sincerity, commitment and passion with which she opened it. These issues should be seriously examined by all hon. Members, and not solely in the course of an Adjournment debate.
Hon. Members have made personal comments in the course of this debate. I also have a parent who suffers from dementia and is in permanent nursing care. People
do not appreciate the trauma that such a situation can cause, not only for the individual but for the family and for friends and relatives. Physically, the parent is still the same person we love, who brought us up, who cared for us and who has done everything possible for our lives. But mentally, they are not the same person. To find that one of our loved ones is suffering from some form of dementia is one of the most psychologically and emotionally draining experiences a person can ever have.
It is good when families are supportive and when friends and relations are there to help one through such difficult times. Unfortunately, many people in our society do not have supportive families, and they are in the most distressing situation. I hope that we can find ways of building up care in the community services to help people who may not be as fortunate as I have been, with a supportive family to see me through particularly difficult times.
Reference has been made to community care in general. As the hon. Member for Glasgow, Springburn(Mr. Martin) said, hon. Members write off to our directors of social work and to Ministers on behalf of our constituents, but it is only when something happens to us personally that we begin to realise the complexities that are involved in ensuring that there are health visitors, home-help services and general practitioners--all the services involved in ensuring that there is community care.
One of my current worries--I refer the Minister to the excellent series of articles in The Herald this week, which is a part of Dementia Awareness Week--is that, in the local government budget for Scotland for 1996-97,£53 million has been made available directly for community care funding, which
Reference has also been made to institutions. We hate the word "institution", because it conjures up images of a Victorian era institution. I think that the hon. Member for Springburn mentioned Woodilee. That is in my former constituency, and I know exactly what he meant.
There is a stage at which residential, full-time nursing care becomes absolutely essential for many people. I was concerned about people in that situation when I read the Scottish Office's most recent "Statistical Bulletin", and saw that the private sector is growing while the state sector is shrinking. The bulletin deals with community care. I am sure that the Minister is aware of it, so I shall not rehearse all the arguments about the graph that it contains.
I should like to make two very basic points. First, dementia is an illness. It is far too easy to be dismissive and say, "The old lady or the old man is losing their marbles." It is an illness that should be diagnosed. I want fundamental research by the Government into this issue to try to ensure that people do not needlessly suffer from any form of dementia, whether it is Alzheimer's disease or some other aspect of dementia.
Mr. Alan Milburn (Darlington):
I congratulate my hon. Friend the Member for Dunfermline, West(Ms Squire) on securing this extremely timely and important debate. I also pay tribute to all hon. Members who have taken part. They have spoken with a depth of compassion and understanding that properly reflect their involvement in care issues. Finally, I pay tribute to the Alzheimer's Disease Society, which does such an important job in Scotland and across the United Kingdom in campaigning on dementia issues.
As hon. Members are aware, Alzheimer's disease and dementia are chronic and degenerative diseases. In25 years, it is estimated that approximately 1 million people in our country will suffer from dementia. As we have heard, the cost to individuals, their families and their carers is immense. The bill to society is also huge--an estimated £1 billion per annum in England. There is currently no known cause or cure for Alzheimer's disease, and it is one of the most serious medical challenges facing our society.
We live in an aging society. Increased life expectancy is certainly one of the great achievements of this century, and brings with it the potential for a richer and more fulfilling existence for each of us. But age-related illness and disability, particularly dementia, pose a serious threat to the realisation of the potential for healthy aging.
Yesterday I launched a new centre on aging, which will focus new research efforts on understanding and preventing the major causes of chronic ill health in older people. Created through a partnership between two of the north's great universities--Newcastle and Manchester--it will be a world leader in formulating new approaches to the treatment of diseases such as dementia. That such concentrated scientific and medical efforts are taking place in our public sector institutions to tackle an enormous social problem should be a great source of hope. I hope that the centre receives the support it deserves from Government.
A part of the centre's focus will be on developing more effective care delivery systems for elderly people. People with dementia are likely to be the major users of long-term care services in this country. They are also on the front line of the debate that is now taking place on the future of long-term care. That debate is long overdue. In some ways, it is very odd that the debate has not happened before now. Britain's elderly population have, after all, been around for a very long time--long enough for any competent Government to have planned for the challenge of their care.
The problem is that the Government have not done that planning. The elderly, their families and their carers are angry, and for very good reason. NHS disinvestment from
continuing care has produced a redefinition of responsibilities between health care and social care. Continuing care, free at the point of use, has been all but rationed out of our national health service. Indeed, a report on psycho-geriatric continuing care beds published by the Alzheimer's Disease Society in 1993 showed that some health authorities had disinvested to such an extent that they provided no NHS beds at all for people with dementia.
Dr. Robert Spink (Castle Point):
Will the hon. Gentleman give way?
Mr. Milburn:
I am sorry; I do not have time.
Elderly people who now have to sell their homes--there are an estimated 40,000 such cases a year--are rightly furious because they had fondly believed that the taxes they paid covered care from the cradle to the grave. Instead, as we have heard this morning, all too often those people are shunted backwards and forwards between health authorities and local authorities which are desperately trying to divest themselves of the responsibility of care.
Worse still, by passing the buck to individual health authorities to decide what services should be available to elderly people, the Government have created a lottery in long-term care provision. The ADS survey of draft health authority eligibility criteria for continuing care, which was published just a month or so ago, found incomprehensible criteria and unacceptable variations in access to services. Quite simply, under this Government, where a person lives determines the care he receives and the price he pays. Such a lottery should have no part to play in our national health service or in any civilised system of community care.
Instead of tackling the mess they have created, the Government are in effect telling the public that we have a chaotic, perverse and unfair system of long-term care: "How can we, the Government, make you, the individual, pay for it?" The Government have got the starting point wrong--they are asking the wrong question to get the wrong answer. We believe that the debate has to begin with a much more fundamental question--what services will people need in their old age? Asking that different question is likely to lead to different answers.
First, as my hon. Friend the Member for Dunfermline, West rightly pointed out, we know when and where population change will occur. The so-called demographic time bomb is not going to explode tomorrow. Its impact is being felt incrementally over several decades, so it is a change for which we can all plan. With dementia, for example, we know that there will be a steady rather than a dramatic growth in the number of people who will suffer from Alzheimer's and related conditions.
Secondly, the raw facts of change do not take into account the benefits--or the potential savings--that can flow from allowing elderly people to benefit to a much greater extent from preventive, rehabilitative and convalescent health programmes, so reducing the need for high levels of care, and delaying the onset of frailty.
Finally, I deal with a recurring theme in this debate. Providing new national mechanisms to ensure a continuum of care services among health authorities and
local authorities could end the waste of time and money that currently bedevils the delivery of long-term care for elderly people. It is those people who suffer when health authorities and local authorities tussle over resources and responsibilities. That is why we are committed to new enforced national mechanisms to speed up co-operation among health services, social services and, crucially, housing services. The latter are all too often the forgotten partner in the family of community care services.
We want a continuum of care made available for the individual. That is especially important for people with dementia. The onset of dementia is very different from its terminal stages, so care needs will change over time. It is vital that services on the ground are equal across the country, which is why we support the Health Committee's call for a national framework that specifies eligibility criteria for long-term care to define what the NHS, as a national service, is to provide.
Our aim is straightforward. We want a national health service in which access to care is a matter of right, not chance. We want a national long-term care charter so that people know what they can expect from health services, housing services and social services. We want to end the market in the NHS, to remove the perverse incentive for hospitals to discharge patients too rapidly. We have called for a moratorium on the closure of hospital beds, because the closure programme has gone too far.
The NHS has continuing bed responsibilities, but it has other responsibilities, too. That is why we will seek a new role for convalescence, where rehabilitation, recovery and respite services not only help ease the transition between hospital and community but provide more help for carers whose needs must also be met. The ADS's "Right from the Start" report identified almost half the carers looking after people with Alzheimer's as being more than 70 years old. That matter was highlighted by my hon. Friend the Member for Glasgow, Springburn (Mr. Martin). We have made a good start with the Carers (Recognition and Services) Act 1995, but it is only a start--we still need further changes.
"leaves the councils with an increase of only 0.9 per cent. over last year's base expenditure, from which they must fund any wage increases as well as restructuring costs over and above what the Government have provided for."
How does 0.9 per cent. additional funding do anything for community care in our local authorities? That issue should be addressed.
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