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Postal Services
- That the draft Postal Services Act 2000 (Consequential Modifications) Order 2003, which was laid before this House on 14th October, be approved.—[Ms Bridget Prentice.]
Science and Technology
- That Mr David Heath be discharged from the Science and Technology Committee and Dr Evan Harris be added.—[Mr. McWilliam.]
OFFICE OF THE DEPUTY PRIME MINISTER
- That Dr John Pugh be discharged from the Office of the Deputy Prime Minister: Housing, Planning, Local Government and the Regions Committee and Mr Adrian Sanders be added.—[Mr. McWilliam.]
TRANSPORT
- That Tom Brake be discharged from the Transport Committee and Mr Paul Marsden be added.—[Mr. McWilliam.]
Dementia
Motion made, and Question proposed, That this House do now adjourn.—[Ms Bridget Prentice.]
10.2 pm
Mr. Tony McWalter (Hemel Hempstead): As often happens with Adjournment debates, constituents initiated this debate—in this case, the family of a woman with dementia. However, this issue became my preferred topic for a debate not because of a constituent but because of the remarks of two Ministers, one for education and the other for local government. They made it clear that there will be continuing, welcome increases in the resources vouchsafed for education, but they also suggested that there will be a continuing squeeze on the total resources that local authorities can expect to spend. The implication of both those statements for a service that is not educational and is grossly underfunded is that it will have to persist with a resource level not very different from what it currently receives. That has certainly happened with social services.
In my area, Hertfordshire, because, ironically, improving prosperity has resulted in a boom in house and land prices, the prospect of a person with dementia getting the package of care that they need is no different from what it was when the Government took office in 1997. The closure of care homes, as well as full employment and the need for people to earn more money than would normally be paid to someone working with dementia patients, mean that it is difficult indeed to find staff to look after people in residential homes. I know that the Government's good intentions have never been in question, and there have been many initiatives designed to repair one bit of the system or another. The national service framework for older people, for instance, published in 2001 and regularly updated, shows that much new investment in health will unquestionably be directed at improving the condition of older people. However, most of the needs of someone with dementia, whether in a mild, intermediate or severe form, are categorised not as health needs but as needs for social care. The regime for social care varies throughout the country, but throughout England and Wales, while those who work in the field do so with dedication and determination, as far as sufferers and their carers are concerned, the regime is unresponsive, harsh and unyielding. One has only to contrast the stories that one hears from constituents about how wonderful the health service has been with those that one hears about the terrible problems that they have had with social services to feel that those harsh remarks are justified.
If dementia is a cruel illness, we owe those who suffer from it and those who try to care for them a high degree of consideration and kindness. What happens instead is that, sadly, we look at these matters from an entirely economic perspective. Governments begin with the thought that an adequate system would be dreadfully expensive, and then devise ways of saving money, often without any real attention to the fact that this cruel illness is made a great deal more savage because we fail to apply normal political intelligence to it.
This debate has two themes: resources and morality. I shall spend more time on resources than ethics, but I want to reflect on how those with dementia and their carers are dealt with. In a sense, it does not matter whether the Government point to 50 initiatives or 500 or whether they tell me that they have increased resources by 50 per cent. or 100 per cent. What one needs to do is focus on the lived experience of those touched by the cruelty of dementia, and the experience of those who love them and want them to have their pain, bewilderment or loss attenuated. Those who love and care for those with dementia want their own exhaustion, sense of grief and loss, fear and emotional needs to be given proper consideration, but the experience of people now facing this problem in their lives is terrible in most cases. They are categorised as having not a health need, but a need for social care and support, and that system is scandalously complex, economically punitive and shamefully unresponsive.
We know that the Government accept that the consequences of dementia could be attenuated—even the most recent communication on the national service framework for older people, dated 25 September this year, makes that point—but what comes over time and again is the need for a national strategy on dementia. To expect each local authority to cope as best it can, each with a different history and philosophy and a different resource base, is to assume that muddling through is, for the most part, the best that can be done. It is not.
I speak of these matters with some passion because I think that, in part, people with dementia are seen only as a problem and not as having a continuing contribution to make to the quality of our lives. Perhaps I can mention my own case. Shortly after I first met a lad called Jack, then aged five, we were in a home for people with dementia where he was visiting his great aunt Ruth. I was struck by how the residents responded to him as he chatted to them and played with his toys, as well as by the way in which this child dealt with each of these people as a friend. The gentleness of Jack's mother and her consideration for her aunt Ruth were striking. It was clear that she had visited the home on many occasions and that residents looked forward to her visits. Jack's mother became my wife and he became my stepson. He is now 6 ft 2 in tall and at university, and I still think that the people in that home had a strong and positive formative influence on him, as they did on me and his mum.
If that story sounds a little too personal, it is not unusual. Currently featured in "EastEnders"—so it must be a common occurrence—is a storyline in which Kat will finally realise that Alfie is the man for her because she can see in him a considerateness for his gran, who appears to have dementia, that her rich beau would never display—at least I hope that is how it will work out.
People with dementia are part of society, and the way in which we treat them in part defines who we are. The home that I mentioned was a private home with very large fees, and most people could not think of being helped there. The care that most people receive is a great deal less effective than that which was given to my adopted aunt Ruth.
In our society, we claim to have built consideration for those with dementia into the governmental system, but of course there is no single system. Central Government delegate it to local authorities, but then say that they are expected to spend a standard amount on social services. Local authorities never treat reviewing the standard spending assessment—SSA—as a priority; most who have that responsibility spend well above their SSA for social services because they are humane, but they know that the service that they provide falls pitifully short of being able to hear a cry of pain and to respond to it appropriately.
Dementia has many forms—some milder, some more pronounced and some extreme—but for many sufferers, and for all if they live long enough, the final solution is to live in a residential home, probably for the rest of their natural life. In Hertfordshire, the amount of money that the county council pays for someone who is reliant on public resources falls far short of what care home providers think appropriate. SPAIN—the Social Policy Ageing Information Network, a conjunction of various bodies that do work in this area—suggests that it is about £85 short per patient per week. The county has done its best, but last year, after hard negotiations, it had to agree a 7.9 per cent. increase in the rate that it pays for residential care, although the Government were, yet again, expecting a settlement well below that figure.
Even at that level, many operators of residential homes try hard to close them down, because the land that then becomes available is so valuable that they can secure their own economic circumstances and retirement by selling it. People from Hertfordshire are living in homes hundreds of miles away in Wales, the Isle of Wight and Liverpool—although, Mr. Speaker, I have heard no cases of them being sent to Glasgow, so we are at least that humane. Splitting families up in that way has a devastating effect on people. That is the reality behind the national service framework claim that
- "There are serious shortages of suitable care homes in some areas . . . and few local authorities have yet developed sufficient services to help people with dementia continue living at home."
Once someone is in a home, there is a continuing squeeze on money. If they are in a private home and have to subsidise it out of their own family resources, there is always the prospect that they may end up living so long that they have to move from a place that is comfortable, and where they have a more manageable existence, to a place where they know no one and their circumstances are decidedly less commodious. Caring families facing the prospect of their relatives having to make such a move, or people facing dire economic consequences for themselves if they try to hang on, are presented with an invidious choice.
What makes residents of a comfortable home insecure, and what makes it so difficult for families to find a place for their relative with dementia, is the spectre of what counts as health care and what counts as social care. For example, health care assistants count, paradoxically, as social carers. A Kafkaesque labyrinth of funding complexity is involved when they are employed. That results in lengthy delays in the appropriate resources that are eventually allocated to people with the illness.
I have a constituent whose niece is willing to help with her social care. That includes helping her to clean herself after she has excreted. What would be the health consequences if she did not have such help? Help with the preparation of food is social care, but how costly is it to cope with the health needs of someone who is malnourished? Of course, looking after elderly people with dementia is demanding and it is not surprising that many vacancies remain unfilled, given the low wages and career development prospects.
Sadly, one way in which people sometimes cope is through the prescription of neuroleptic drugs. The use of such drugs has escalated to the point where many people with the complaint no longer have the quality of life that my adopted aunt Ruth enjoyed nearly till her death.
I thank the Alzheimer's Society and Andrew Chidgey for their help in preparing for the debate. I conclude by quoting the words of the Social Policy Ageing Information Network, which is composed of many of the charities that deal with such matters. Its report concludes:
- "We urge the Government to act decisively to bring social care for older people into line with the ambitious programme for the NHS. The good intentions are there, the resources to carry them through are not.
Piecemeal measures",
- "are not enough—they merely serve to divert the pressures from one part of the system to another. What is needed is a fundamental review of funding for older people across the whole spectrum of social care. Without such a boost, neither older people's needs nor the Government's modernisation objectives for the NHS"—
- "can be met."
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