| Previous Section | Index | Home Page |
Madam Deputy Speaker: I have not been advised that the Home Secretary wishes to make a statement, but no doubt he will have heard the right hon. Gentleman.
Mr. Forth: Further to that point of order, Madam Deputy Speaker. Can you help the House and even the Government by ruling that on a future similar unfortunate occasion, should it ever occur, and I hope that the Chair will do everything to ensure that it does not, it will be in order for the Home Secretary to request to make a statement at the conclusion of business at 7 o'clock? His synthetic anger simply belies the fact that he either does not understand how the House works or he did not want to make the statement in first place.
Madam Deputy Speaker: I have ruled on that by saying that I have had no request from the Home Secretary to make a statement, but I repeat that he will have heard what the right hon. Gentleman said.
Mr. David Wilshire (Spelthorne) (Con): On a point of order, Madam Deputy Speaker.
Madam Deputy Speaker: Is it a different point of order?
Mr. Wilshire: It is a separate point of order about the business of the House.
Can you confirm, Madam Deputy Speaker, that notwithstanding all the changes to truncate debate, it is still possible, if the Government wish, for business to run beyond 7 o'clock, so it was possible for the debate to continue longer if the Home Secretary was determined to say something?
Madam Deputy Speaker:
The debate's timing was decided by the House.
27 Oct 2004 : Column 1548
Dementia Services (Norfolk)
Motion made, and Question proposed, That this House do now adjourn.—[Gillian Merron.]
7.24 pm
Norman Lamb (North Norfolk): —rose
Mr. Chope: On a point of order, Madam Deputy Speaker. This raises an issue of command and sanction. Mr. Speaker has repeatedly commanded that the Government should comply with his rulings. He now has the opportunity of exercising a sanction by requiring that the Home Secretary comes to the Dispatch Box tomorrow.
Madam Deputy Speaker: I remind the hon. Gentleman of what I said earlier. Both the Home Secretary and the Speaker will have heard what has been said. The hon. Gentleman is now taking time out of the debate for a Back Bencher.
Norman Lamb (North Norfolk): I am grateful for the opportunity provided by this debate to raise the concerns of friends and relatives of patients at Rebecca house, a specialist unit for people with dementia that was built just 10 years ago in North Walsham in my constituency. The unit faces closure as part of a review of older people's mental health services by Norfolk Mental Health Care NHS trust. The introduction of a report prepared by the trust stated:
"Older People's mental health services will change. Services, resources and staff will join existing localities to provide an age-integrated service within Primary Care Trust boundaries."
"Supported by national policies, the local Social Services strategy and carers and users workshops, mental health services for Older People will be updated to provide more community focused person centred care."
If hon. Members can interpret the jargon, that might sound like a good thing, but there is a casualty, as we will lose specialist residential units, including Rebecca house and a unit in the constituency of the hon. Member for South Norfolk (Mr. Bacon).
Dr. Ian Gibson (Norwich, North) (Lab): Have the economics been satisfactorily analysed; and, if so, do they point to closure? It would help to know, because many other services in Norfolk and other parts of the country are in the same situation.
Norman Lamb: This is all about finding the resources to improve care for people with dementia in the community, but we must consider what is lost in the process.
Rebecca house was built just 10 years ago as a specialist unit for people with dementia, but now it may be closed. It is highly regarded, and the common consensus is that it would be tragic if it were lost. The backdrop to the review is the Government's direction to strategic health authorities on the criteria for free NHS continuing care. At present, 101 beds for the elderly mentally ill are provided by the mental health trust, which has concluded that only a minority of the patients in Rebecca house and similar units qualify for continuing NHS care. Its assessment is that the whole
27 Oct 2004 : Column 1549
county needs only 28 beds for acute cases meeting the eligibility criteria. The plan is to build a new specialist intensive care unit for those patients in Norwich.
The Minister will be well aware of the report by the health service ombudsman last February about cases in which the NHS had been too restrictive in the eligibility criteria that it applied to the receipt of continuing care. As a result, strategic health authorities were asked to review their criteria, but since then there has been a great deal of criticism about their lack of progress. I should be grateful if the Minister could provide an update and explain how long it will take to complete those reviews.
Wherever the line is drawn between individuals who qualify and those who do not—many people believe that the criteria are too restrictive, and exclude too many patients from free personal care—it is inevitably arbitrary. Many people find it hard to understand why someone who needs intensive 24-hour care but does not meet the extremely restrictive criteria for NHS continuing care should be subject to means-testing, which, the Minister will know, sometimes leads to people having to sell their home to pay for personal care. People who have budgeted carefully throughout their working life are penalised for behaving responsibly.
As the Minister knows, Liberal Democrats on the Scottish Executive insisted on the introduction of free personal and nursing care as a condition of their continuing support. Does the hon. Gentleman plan to review the unfair penalty that applies in England and Wales, which is imposed on families already under enormous pressure as a result of the tragic illness affecting a loved one? What is his reaction to the fact that because of the way in which the criteria are being interpreted, patients who have qualified for NHS continuing care might subsequently be disqualified because they have become frailer and more sedate? There has been no improvement in their health, their condition has continued to decline, yet they are excluded from free personal care. Surely that must be wrong. I know that the Alzheimer's Society shares that view.
I return to the situation that we face in Norfolk. As I said, in presenting proposals the trust is essentially following Government policy. It was clear from a meeting that I attended at Rebecca house that staff have to care for a wide range of patients with very different needs, some of whom, because of their dementia, display fairly challenging behaviour, whereas others are more frail and sedate. That clearly presents difficulties, so I can see the case for a specialist intensive care unit. However, that raises the question of what happens to those who do not qualify for that unit, but whose care needs are such that they cannot easily be looked after at home. In all this we must remember the interests of those who are frequently required to care for a loved one at home. Often those people themselves are elderly and frail and find it difficult to cope on their own.
Of most immediate concern are all the existing patients of Rebecca house and the other units who do not qualify for continuing NHS care. Where will they go? If Rebecca house closes, they face the prospect of a move to a residential care home or nursing home in the private sector. Given the quality of care that they have received at Rebecca house, we can assume that there is a considerable risk that they will end up in less
27 Oct 2004 : Column 1550
appropriate surroundings, and in addition it must be borne in mind that the Alzheimer's Society says that it is best to avoid moving people with dementia. In the society's words, that should be "avoided at all cost". A move can disorient the patient and accelerate the decline in their condition.
The trust has made it clear that those who were admitted to the service before 31 March last year will continue to have their care funded by the NHS, irrespective of whether they meet the criteria for NHS continuing care, but it is also the quality of the care that concerns loved ones, not just the cost. For those admitted after 31 March last year there is no commitment to continue to cover the cost. There is also concern about the capacity of the private sector to provide the extra specialist beds that would be needed. There is already a national shortage, according to the Alzheimer's Society. At a meeting for carers held at Rebecca house, one lady described how each week it was necessary to search a local website availability list to find the odd bed that might become available that week.
It also remains unclear what will happen to those who have used Rebecca house for respite care. Four beds are set aside for that purpose. Will the respite care of those people be paid for the rest of their lives? That is incredibly important to those affected. Privately funded respite care is very expensive. When I raised the point with trust representatives, they said that no decision had been reached.
Everyone recognises how important respite care is. If more people are to be cared for at home, resources must be committed to provide an effective support infrastructure. In a rural area such as North Norfolk, people can be isolated in small village communities without public transport. If the carer has inadequate support, they can rapidly sink. The nature of dementia is such that the demands on the carer are intense and constant. Carers need a break. My fear is that the closure of the units will result in less respite care, not more. Does the Minister share my view about the importance of improving access to respite care for those cared for at home?
Rebecca house provides what is described by the trust as informal day care. The loss of that facility will hit many more people. Again, the facility is part of the infrastructure of support for people caring for loved ones at home. We have a situation in which there is a strong case for not moving existing patients, based on their needs; a lack of capacity in the private residential nursing care sector; the imperative of increasing the availability of respite care and not reducing it; and existing day care facilities that are under threat.
For me, that all points to a very strong case for trying to keep Rebecca house open. How that can be achieved given the rather unfortunate and clumsy demarcation between the mental health trust, the primary care trust and the county council social services department, I am not sure, but every effort needs to be made collectively to secure the future of this much-loved and much-valued unit.
I have an open mind about who could run Rebecca house in future, but in an area that has an ageing population and already has one of the highest age profiles in the country, it is foolhardy and reckless to contemplate the closure of Rebecca house. The same
27 Oct 2004 : Column 1551
goes for other units around the county. I note the commitment of the trust to use the resources freed up by the closure of these units—I understand that the amount will be about £1.5 million—for the improvement of mental health services in central Norfolk, but at the moment there are genuine and continuing concerns about the overall package of proposals.
My plea to the Minister is to ask him to do whatever he can, working with the local trusts, to help Rebecca house and those other units, to help ensure not only that today's patients who are in the home and need it for the rest of their lives are protected, but that there are high-quality facilities for the future.
7.37 pm
| Next Section | Index | Home Page |